Victoria Lee Champion

Introduction: Informal caregivers (caregivers) in rural areas experience many stressors affecting their mental and physical health. This review will synthesize the current needs of cancer caregivers in rural areas to inform future research and interventions. Methods: Five databases (PsycInfo, CINAHL, EMBASE, PubMed, and Family & Society Studies Worldwide) were queried to identify studies examining mental health and quality‐of‐life outcomes in rural caregivers of cancer patients worldwide, using the Arksey and O'Malley principled analytic framework. A priori criteria included rural caregivers of adult cancer patients in peer‐reviewed studies from 2005 to 2025. Results: Database searches yielded 337 records. After title and abstract screening, 134 articles were reviewed, and of these, 35 met a priori criteria. The most frequent problems identified among rural cancer caregivers were mental health issues (depression and anxiety), loneliness or isolation, fatigue and physical issues, provider issues, and financial issues, especially related to travel, balancing duties, and cultural differences between rural populations and urban providers. Most articles were from outside the U.S.; however, results from rural caregivers in the U.S. described needs reflected in literature from other countries. Conclusions: Given increased utilization of caregivers in the U.S. and the rural burden of cancer, it is crucial to identify caregivers' unmet needs. Home‐based cancer care is increasing, necessitating additional studies to determine needs and develop effective interventions for rural caregivers. Rurally competent care from healthcare providers who interface with caregivers of their cancer patients is vital, as caregivers are well‐positioned to partner with providers to improve the well‐being of those patients.

Noninvasive stool-based colorectal cancer screening [e.g., fecal immunochemical test (FIT), guaiac fecal occult blood test (gFOBT), and multitarget stool DNA test (mt-sDNA)] reduces colorectal cancer mortality only when a positive result is followed by timely diagnostic colonoscopy. We synthesized barriers and facilitators to completing diagnostic colonoscopy after a positive stool-based screening test. Guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), we searched PubMed and MEDLINE (Ovid) for English-language, peer-reviewed studies (October 2008–June 2025) reporting barriers, facilitators, or determinants of colonoscopy completion after a positive noninvasive stool-based colorectal cancer screening test (FIT, gFOBT, or mt-sDNA). Two reviewers independently abstracted study characteristics and coded barriers/facilitators, which were categorized using a socioecologic framework (intrapersonal, interpersonal, organizational, community/environmental, and policy). Thirty-eight studies directly examined colonoscopy follow-up after a positive noninvasive test. Recurrent barriers included fear/anxiety and low perceived risk (intrapersonal), weak provider recommendation and support (interpersonal), referral and tracking failures and scheduling delays (organizational), transportation and distance (community/environmental), and cost-sharing/coverage gaps (policy). Evidence specifically assessing rural–urban differences was limited. Barriers to diagnostic colonoscopy after a positive stool-based colorectal cancer screening test are multilevel and potentially modifiable through improved communication, navigation, and closed-loop tracking. Multicomponent approaches that combine clear communication, navigation and reminder systems, transportation supports, and reduced financial barriers may improve diagnostic completion and equity.

Background/Objectives: In the United States, adult human papillomavirus (HPV) vaccination coverage remains low at 20–50%, depending on age, and cervical cancer (CC) screening rates range from 68 to 76%. Few studies have evaluated characteristics of women who are both HPV vaccinated and up to date (UTD) with screening as an integrated outcome. The purpose of the present study was to classify women into four prevention categories and examine factors associated with being double protected compared to unprotected. Methods: Data were gathered via an online survey from a sample of low-income women (household income < USD 50,000) provided by a research survey company (n = 719). Women were classified into four categories: vaccinated only, screened only, both vaccinated and screened (double protected), or neither (unprotected). Sociodemographic characteristics, healthcare access, and Health Belief Model constructs were assessed. Multivariable logistic regression compared women who were double protected with those unprotected (n = 274). Results: Most women were UTD with screening only (57.8%), while 15.5% were double protected and 22.6% were unprotected. Younger age (Odds Ratio [OR = 0.93; 95% Confidence Interval [CI]: 0.89, 0.98), having ≥1 medical visit in the past year (OR = 4.16; 95% CI: 1.74, 9.95), higher perceived CC risk (OR = 3.65; 95% CI: 1.41, 9.43), greater perceived benefits of CC screening (OR = 1.96; 95% CI: 1.45, 2.66), and higher HPV knowledge (OR = 1.09; 95% CI: 1.01, 1.17) were associated with higher odds of being double protected. Conclusions: A substantial proportion of low-income women lack comprehensive CC prevention. Integrated, bundled prevention strategies that simultaneously promote HPV vaccination and screening may be important to reduce CC disparities.

Community outreach and engagement (COE) is an integral component of NCI-Designated Cancer Centers’ efforts to affect the cancer burden in their catchment areas. We describe examples of community-informed research and bidirectional engagement strategies undertaken by cancer center COE teams across the Big Ten Cancer Research Consortium. Guided by the Continuum of Community Engagement Framework, examples of community engagement were described by COE teams from 11 centers. Four examples were selected to illustrate varying levels of bidirectional community engagement across cancer center programs. The most common strategies included disseminating information about research studies to community partners and the public, assisting community research partners in developing surveys, conducting community needs surveys to inform scientific focus, and facilitating scientists’ communication with the community to assess the relevance of their research. Key challenges include garnering financial resources, motivating scientists to develop community partnerships, and creating ways to reimburse community members for their time. Although shared leadership is the highest level of engagement, it is not always practical or appropriate. Researchers should strive for bidirectional community engagement to inform research questions, foster research relevant to the community, and facilitate the translation of findings to reduce the cancer burden.

Background/Objectives: Low-income compared to high-income women have a higher incidence of and mortality from cervical cancer (CC) due to lower screening rates (under/never-screened). Home-based screening for CC via mailed “self-collection” for human papillomavirus (HPV) testing is an alternative to traditional, provider-collected screening that may be more acceptable to low-income women. Theoretically, adoption of a recent technology, in this case, mailed return of self-collection, is related to the Diffusion of Innovations concepts of advantages and complexity. The purpose of this study was to develop and psychometrically test scales to measure advantages and complexity of self-collection in a low-income, under/never-screened population. Methods: Low-income women (n = 168) were recruited in person from food pantries and online using Facebook in the Midwest U.S. After a baseline survey, women were mailed a self-collection kit. We assessed reliability with item analysis and Cronbach’s α and evaluated validity with exploratory factor analysis and t-tests, using mailed kit return as the independent variable. Results: Two scales were developed: (1) advantages (Cronbach’s α = 0.84), item–total correlation = 0.51 to 0.69, and (2) complexity (Cronbach’s α = 0.82), item–total correlation = 0.45 to 0.64. Exploratory factor analysis supported items factoring on their respective scales, and t-tests supported a relationship between each scale and mailed return of kits. Conclusions: Both the advantages and complexity scales demonstrated reliability and validity among low-income women. Future studies should evaluate these scales in a larger, more diverse population. Nurses could use these scales to assess preferences and difficulties associated with self-collection and aid patients with CC screening decision-making.

Estimated association of metastasis and other factors with the pre–post proportional increases in medical service charges and OOP expenses. Estimated relative ratio of proportional increase in pre– and post–colorectal cancer (CRC) medical charges and OOP expenses associated with each factor, with 95% CIs, two-sided P value, and illustrative plots. Ref, reference. *, P < 0.05; **, P < 0.01; ***, P < 0.001.

Estimated association of metastasis and other factors with the pre–post proportional increases in outpatient prescription charges and OOP expenses. Estimated relative ratio of proportional increase in pre– and post–colorectal cancer (CRC) prescription charges and OOP expenses associated with each factor, with 95% CIs, two-sided P value, and illustrative plots. Ref, reference. *, P < 0.05; **, P < 0.01; ***, P < 0.001.

Estimated differences in pharmacy prescription costs before and after CRC diagnosis for non-mCRC versus mCRC patients, stratified by treatment modality in the first year