Division of Hematology, Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC.
Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC.
J Clin Oncol. 2024 May 1;42(13):1563-1574. doi: 10.1200/JCO.23.01290. Epub 2024 Feb 21.
Cancer health disparities result from complex interactions among socioeconomic, behavioral, and biological factors, disproportionately affecting marginalized racial and ethnic groups. The objective of this review is to synthesize existing evidence on interventions addressing racial or ethnic disparities in cancer-related health care access and clinical outcomes.
A comprehensive search of Cochrane Library, Google Scholar, Ovid MEDLINE, Ovid Embase, PubMed, Scopus, and Web of Science Core Collection was conducted from database inception to February 23, 2023. Controlled vocabulary and keywords helped to identify studies on cancer-related disparities and interventions in adults age 18 years or older. Two reviewers followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis reporting guidelines. Study quality was assessed using the Joanna Briggs Institute Critical Appraisal Tool.
Of 7,526 screened studies, 34 met the inclusion criteria involving 24,134 participants. Most studies focused on breast cancer (n = 17) and Hispanic/Latino populations (n = 10) and enrolled participants primarily from community-based sites (n = 19). Twenty-one studies examined patient-centered outcomes, such as health-related quality of life and psychological well-being, while 15 studies assessed process-of-care outcomes, such as timeliness of care. Most studies followed a community-based participatory research framework. Five patient-centered outcome studies reported a positive intervention effect, often combining cancer education with psychological well-being interventions. Among the 15 process-of-care outcome studies, nine reported positive effects, with the majority (n = 8) being navigation-based interventions.
This systematic review emphasizes the vital role of community partnerships in addressing racial and ethnic disparities in oncology care and highlights the need for standardized approaches in intervention research because of the heterogeneity of studied interventions. Furthermore, the prevailing emphasis on breast cancer and Hispanic populations indicates the need for future investigations into other priority demographic groups.
癌症健康差异是由社会经济、行为和生物学因素之间的复杂相互作用导致的，这些因素不成比例地影响到边缘化的种族和族裔群体。本研究的目的是综合现有的证据，以了解针对癌症相关医疗保健获取和临床结局方面的种族或族裔差异的干预措施。
从数据库建立到 2023 年 2 月 23 日，我们对 Cochrane 图书馆、Google Scholar、Ovid MEDLINE、Ovid Embase、PubMed、Scopus 和 Web of Science 核心合集进行了全面检索。使用受控词汇和关键词来识别有关癌症相关差异和 18 岁或以上成年人干预措施的研究。两位评审员遵循系统评价和荟萃分析报告的首选报告项目。使用 Joanna Briggs 研究所的批判性评估工具评估研究质量。
在筛选出的 7526 项研究中，有 34 项符合纳入标准，涉及 24134 名参与者。大多数研究集中在乳腺癌（n=17）和西班牙裔/拉丁裔人群（n=10），并主要从社区为基础的地点招募参与者（n=19）。21 项研究评估了患者为中心的结果，如健康相关生活质量和心理健康，而 15 项研究评估了护理过程的结果，如护理的及时性。大多数研究遵循基于社区的参与性研究框架。5 项患者为中心的结果研究报告了积极的干预效果，通常将癌症教育与心理健康干预相结合。在 15 项护理过程结果研究中，有 9 项报告了积极的效果，其中大多数（n=8）是基于导航的干预措施。
本系统评价强调了社区伙伴关系在解决肿瘤学护理中的种族和族裔差异方面的重要作用，并强调了在干预研究中需要标准化方法的必要性，因为所研究的干预措施具有异质性。此外，对乳腺癌和西班牙裔人群的关注表明，需要对其他重点人群进行未来的调查。
