Browsing by Author "Raveendran, Yadurshini"

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    Racial and ethnic disparities in genomic testing among lung cancer patients: a systematic review.
    (Journal of the National Cancer Institute, 2024-06) Meernik, Clare; Raveendran, Yadurshini; Kolarova, Michaela; Rahman, Fariha; Olunuga, Ebunoluwa; Hammond, Emmery; Shivaramakrishnan, Akhilesh; Hendren, Steph; Bosworth, Hayden B; Check, Devon K; Green, Michelle; Strickler, John H; Akinyemiju, Tomi

    Background

    Racial and ethnic disparities in genomic testing could exacerbate disparities in access to precision cancer therapies and survival-particularly in the context of lung cancer where genomic testing has been recommended for the past decade. However, prior studies assessing disparities in genomic testing have yielded mixed results.

    Methods

    We conducted a systemic review to examine racial and ethnic disparities in the use of genomic testing among lung cancer patients in the United States. Two comprehensive searches in PubMed, Embase, and Scopus were conducted (September 2022, May 2023). Original studies that assessed rates of genomic testing by race or ethnicity were included. Findings were narratively synthesized by outcome.

    Results

    The search yielded 2739 unique records, resulting in 18 included studies. All but 1 study were limited to patients diagnosed with non-small cell lung cancer. Diagnosis years ranged from 2007 to 2022. Of the 18 studies, 11 found statistically significant differences in the likelihood of genomic testing by race or ethnicity; in 7 of these studies, testing was lower among Black patients compared with White or Asian patients. However, many studies lacked adjustment for key covariates and included patients with unclear eligibility for testing.

    Conclusions

    A majority of studies, though not all, observed racial and ethnic disparities in the use of genomic testing among patients with lung cancer. Heterogeneity of study results throughout a period of changing clinical guidelines suggests that minoritized populations-Black patients in particular-have faced additional barriers to genomic testing, even if not universally observed at all institutions.
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    The Barriers and Facilitators to Achieving Optimal Nutrition for Pediatric Oncology Patients in Tanzania: A Mixed Methods Analysis
    (2020) Raveendran, Yadurshini

    Background: Each year, approximately 400,000 children are diagnosed with cancer with over 85% of new cases occurring in low- and middle-income countries (LMIC). Survival rates in LMIC are 25% compared to 85% in high-income countries (HIC). Undernutrition is a key factor contributing to this disparity. Children diagnosed with cancer are at a higher risk for undernutrition, especially in low resource settings, but nutritional status remains largely unrecognized and unmonitored in many pediatric oncology hospitals in LMICs. Study aims: This study aims to first, determine the prevalence and severity of undernutrition at diagnosis, and second, evaluate existing barriers and facilitators to optimal nutrition among children with cancer at a large specialty referral hospital in Mwanza, Tanzania.

    Methods: A mixed methods approach was used including quantitative surveys, and semi structured interviews that were distributed to caregivers and medical providers for children with cancer treated at Bugando Medical Centre (BMC) from May to December 2019. Results: Quantitative surveys were completed by caregivers(n=65), with a sub group completing a second KAP survey (n=51). Both caregivers (n=10) and stakeholders (n=14) also completed in-depth qualitative interviews. Using Tanzanian nutrition guidelines, the majority of pediatric cancer patients (60%) were classified as undernourished and 78.4% of caregivers reported being food insecure. Key factors perceived to contribute to poor nutrition included 1) food insecurity; 2) lack of education; and 3) community support was reported as facilitator towards achieving optimal nutrition. Additionally, parents expressed interest in being involved in nutritional education and supplementation programs during treatment. Conclusions: The study addresses a major gap in understanding factors contributing to undernutrition among children with cancer in LMIC and provides strategy targets for future interventions and policies to promote nutrition for pediatric oncology patients in Tanzania.