Diabetes Cancer: Racial Disparities Gaole Song, DrPH

Diabetes Cancer: Racial Disparities In Prevention An Epidemiological Perspective By Gaole Song

By Gaole Song, DrPH From the City of Hope

 

So far, for my research, I’m very interested in cancer prevention, cancer promotion, and also diabetes prevention from an epidemiological perspective. Cancer and diabetes are both serious public health issues in California State and Los Angeles County.

Cancer is a leading cause of death in Los Angeles, and diabetes ranks sixth. These two diseases are very important, and both have obesity as an important cancer risk factors. Minority patients have a higher risk of developing cancer and diabetes based on previous research results. However, they also have limited access to healthcare and other medical services. Our City of Hope catchment area has a highly diverse population, so we want to determine if patients with both cancer and diabetes face significant barriers in accessing healthcare services.

What is the Reason for Conducting this Research in Diabetes Cancer treatments?

This is the most important reason for conducting my research. It is a secondary analysis study, and I use the national representative Behavioral Risk Factors Surveillance System (BRFSS) from 2017 to 2021 as my dataset. The BRFSS survey is a powerful tool for targeting and developing health promotion activities. It is also nationally representative and has a very large sample size.

 

I chose this dataset because it covers most of my areas of interest and has comprehensive question settings for cancer and diabetes patients. I use this dataset at the beginning stages to gain a national perspective on healthcare service utilization among patients with both diabetes and cancer.

 

My findings show that racial and ethnic minority patients have lower service utilization. The American Diabetes Association has recommendations for patients with diabetes regarding their clinical service use. They recommend that patients who have been diagnosed with diabetes receive annual clinical diabetes care services, including at least two HbA1C tests, at least one eye examination, and at least one foot examination by healthcare providers.

 

From my findings, I discovered that ethnicity is significantly associated with the combination of these three recommended clinical care service activities. Particularly, Hispanic and Latino patients with diabetes and cancer, as well as Pacific Islander patients, have significantly lower rates of achieving all three clinical healthcare activities.

 

And also, I found patients who have healthcare insurance. regular physical checkup and healthcare providers have a significantly higher oath for achieving all clinical healthcare activities for demographic factors such as age, educational levels. They also have some influence on the complications.

 

I mean, on the Swiss care use, being older and also well-educated, and also having better annual household incomes, and also being physically active. Physical activity as a house behavior. Those patients are associated with annual clinical care service use, which means they are positively inclined to finish all of the recommendations from ADA clinical care service use and also for another house behavior, which is consumption. I found that heavy drinkers are not very positive in finishing all of the clinical healthcare service use. And these findings are a good supplement for previous studies.

 

What was found in previous studies and research on Diabetes Cancer treatments?

Basically, I found that the previous studies and research only focused on one disease like cancer patients and also for diabetes patients. And my research focuses on patients who already have cancer and diabetes for both of the diseases. So I think my research findings can be can, can go to be for, for, for the as a supplement to the existing research.

 

Because for patients who have two or more current chronic diseases, their medical needs are more complicated and should be taken into account for their medical needs, such as and also for example, if a patient has cancer, their cancer treatment may have different influences on their diabetes treatment and the.

 

And also, for patients who have diabetes, their diabetes medications and the treatment can influence their cancer treatment. So providers should be more careful when they have some patients with both diseases.

 

What demographic factors come into this research?

As I mentioned, demographic factors, healthcare insurance data, health behaviors, and and if they have and if they have the awareness of their diabetes and cancers can be key factors to contribute to their racial, and I think that’s very I think the most important factor is healthcare insurance because, based on my research, patients who have healthcare insurance coverage could be more confident to complete to achieve their healthcare insurance I mean healthcare service use because they may have the confidence they will be paid for some part.

 

I mean, part of their payment. However, if the patient doesn’t have any kind of insurance coverage, no matter the public coverage or the private insurance coverage, they may feel fear. They may be afraid to go to the hospital and ask their providers to complete their examinations. So I think insurance coverage is one of the most important factors, and also even though I didn’t include it in this research, I can see that language and cultural barriers are also important factors for minority patients.

 

Why is the trust between minorities and their healthcare providers so low?

Sometimes, they have the feeling that minority patients may not trust their providers if the providers are from a different background. Additionally, language barriers can hinder their understanding of healthcare services. Take the HBC test, for example.

 

Patients from another country or culture may be unfamiliar with the test-taking process. In such cases, providers who share a similar cultural and language background can play a crucial role. By explaining from the patient’s perspective, they can enhance their awareness of the test. However, if patients only have caregivers from a different culture and language background, they may feel confused, even if they possess some basic knowledge.

 

Culture and language barriers are significant obstacles for minority patients when it comes to accessing healthcare services. In my opinion, the most crucial aspect is improving healthcare insurance coverage, especially for minority patients. The Affordable Care Act (ACA) serves as an example. When the ACA was implemented, newly insured Hispanic and non-Hispanic Black patients were reported to have better disease control compared to newly insured non-Hispanic White patients. This suggests that with insurance coverage, minority patients can feel more confident seeking essential healthcare services from their providers.

 

Another example is the California Cancer Care Equality Act, which City of Hope and other hospitals and cancer centers have collaborated on to encourage the government to pass. This bill aims to expand access to specialized cancer care for medically complex patients with cancer diagnoses. These examples highlight the significance of addressing the comprehensive medical needs of patients. Therefore, policymakers should prioritize improving insurance coverage and access for minority patients.

 

And also, future public health providers can focus more on improving the quality of Whole Person Care. Whole Person Care is a new approach that is patient-centered and aims to improve health outcomes and well-being. It covers different aspects, including physical, behavioral, emotional, and social services, through the optimal use of various resources.

 

From this perspective, I believe that vulnerable patients, including minority patients, can have more comprehensive healthcare services and greater access to Whole Person Care, which would be beneficial for their future health outcomes.

 

Another suggestion for providers is to build trust among their patients. Sometimes, if they have the opportunity to learn another language and become familiar with different cultural backgrounds, it can be helpful, especially for providers working in minority communities. I think this would not only strengthen their relationship with patients but also encourage them to seek and complete more healthcare services.

 

For cancer patients and diabetes patients, patient education and self-management are crucial. While there are self-management recommendations from organizations like the ADA, I believe more needs to be done to involve patients in clinical service utilization.

 

What steps should be taken to improve this in Diabetes Cancer treatments?

The first step should be to raise awareness about the importance of self-management. Additionally, implementing stewardship care plans for diagnosed cancer and diabetes patients, where they work together with their providers to review the care plans, can provide valuable insights about the next steps after diagnosis.

 

Having patient navigators can also be beneficial. Sometimes, patients feel more comfortable communicating with patient navigators instead of providers, as navigators or fellow patients can discuss the plan in a less stressful manner. Improving patient awareness of self-management, educating them about their disease and care, and explaining the next steps after diagnosis are all important aspects.

I think makers should have the opportunity to get some feedback from providers because, in the real world, providers are the people who are communicating with patients and giving them healthcare service. Sometimes if the policy is not helpful, sometimes if the policy is too high level, they may face challenges for providers to take advantage of the policy.

 

So I think feedback from providers is very important, and patient navigators are very important as well. Also another thing is, as I mentioned, since language and cultural background are very important, I think policymakers should develop some policies to encourage minority students to be interested in being healthcare providers.

 

So in that case, there will be more bilingual, bicultural providers in the future to help patients with their healthcare service. Additionally, I think providers should also be familiar with the new policies and how to take advantage of them to help patients take, for example, the policy 9, 8, 7. This is a very new policy for California providers. Sometimes they have questions about this policy, like how to encourage patients with cancer to get their specialist medical care needs. So I think for both providers and policymakers, they should be open to each other and also have some feedback and suggestions from each other’s studies.

 

There are still a lot of questions remaining. Actually, for my next step in this research, I would focus more on local patients. As I mentioned, I only used national-level data for this study. But this is a good start for me to gain some essential insights about the overall healthcare services among patients who have both cancer and diabetes.

However, for the next step, I will try to collect data from our catchment area and focus more on local patients to understand their medical needs and what their status of healthcare service use is. Also some limitations of this research are that the asked questionnaire didn’t include a question like which disease was diagnosed first.

 

That means if a patient with cancer was diagnosed with diabetes after, or if a diabetes patient was diagnosed with cancer after. So that is also a question for future studies because sometimes which disease is diagnosed first is also very important for the healthcare process.

 

They may have different treatments and different medical decisions based on their diseases. Mm. Another question that remains is, I think it’s hard to also relate to healthcare access because sometimes if a patient lives in a more rural area, they have limited access to providers and healthcare services.

 

That is also a possibility for a lower rate of healthcare service use. But in this research, we didn’t we didn’t cover this question. So in the future, I will also collect zip code information to see if I can do some geographic analysis to detect if the zip code, if the area is also a factor for this low rate of clinical healthcare services.

 

What insights can be given?

My research should give some insights among policymakers and providers to encourage them to focus more on patients with complex medical needs. My research focuses on patients with diabetes and cancers, but they may also have other chronic diseases. So for the patients who have more than one disease, their medical needs are more complicated, and they should be taken into account in terms of how to improve their awareness and also improve their quality of life after their diagnosis.

 

I think the most important outcome is to protect their health and improve their health outcomes. So I will continue my research to focus more on local patients. And hopefully, we can get some new policies based on our research.

 

10 Key Takeaways from the Racial Disparities Abstract

1. Race/ethnicity is a significant risk factor for cancer and diabetes.

2. Many minority patients with cancer also have diabetes, but lack proper diabetes care and sufficient use.

3. A study using the Behavioral Risk Factor Surveillance System 2017-2021 found racial and ethnic disparities in diabetes-related clinical care service use among cancer patients.

4. The cohort included 66,991 cancer patients with co-occurring diabetes, with the majority being non-Hispanic White.

5. Race/ethnicity was significantly associated with the completion of three recommended clinical care activities.

6. Hispanic/Latinx and Pacific Islander patients had significantly lower odds of achieving all clinical health care activities compared to non-Hispanic White patients.

7. Patients who had health care insurance, routine check-ups, and health care providers had significantly higher odds for full completions.

8. Patients who used insulin and who had eyes affected by diabetes were more likely to complete annual clinical tests fully.

9. Heavy drinkers were less likely to achieve all clinical care activities.

10. Tailored clinical care services targeted to minority patients with low socioeconomic status are needed to address the lower rates of completing ADA recommendations of diabetes-related clinical care use among minority patients.

 Gaole Song, DrPH, MS – About The Author, Credentials, and Affiliations

Gaole Song, DrPH, MS, is a health care expert with extensive experience in public health research and data analysis. She is presently a biostatistician II at City of Hope, California’s premier cancer treatment and research facility.

 

The University of California, Los Angeles (UCLA) awarded Dr. Song a Doctor of Public Health (DrPH) and a Master of Science (MS) in Biostatistics. Her educational background and professional experience have equipped him to design and implement research studies, conduct statistical analyses, and interpret data.

 

Prior to joining City of Hope, Dr. Song was a data analyst at the Los Angeles County Department of Public Health, where she analyzed data pertaining to chronic disease prevention and health equity. She has also worked as a teaching assistant and research assistant at UCLA, where she contributed to numerous research initiatives on topics including cancer screening and health disparities.

 

Dr. Song has published numerous articles in prominent public health journals, such as the American Journal of Public Health and Cancer Epidemiology, Biomarkers & Prevention. She is dedicated to advancing public health research and utilizing data to inform interventions that promote health equity and enhance health outcomes for all populations.