br Variable Adjuvant Neoadjuvant Chemoradiation Surgery
Variable Adjuvant Neoadjuvant Chemoradiation Surgery Only P-Valuea
Distance from Incisors to Proximal Edge r> Tumor Size b
Grade Differentiation b
AJCC TNM Staging b
Adjusted Survival Rates
b Pathologic data, if unknown: clinical data. Abbreviations: AJCC, American Joint Committee on Cancer; not applicable, N/A.
Figure 1: CONSORT flow diagram depicting inclusion and exclusion into the study.
Figure 2: Unadjusted Kaplan-Meier (A) and adjusted (B) survival curves for all patients stratified by treatment group. P value for unadjusted comparison AWD 131-138 provided on the plot and there was no p value for the adjusted comparison.
Figure 3: Unadjusted Kaplan-Meier (A) and adjusted (B) survival curves for all patients stratified by annual surgical volume. P value for unadjusted comparison is provided on the plot and there was no p value for the adjusted comparison.
Figure 4: Adjusted survival curves stratified by annual surgical volume and treatment group: adjuvant (A), neoadjuvant (B), surgery alone (C), and definitive chemoradiation (D). Note: Maximum follow up in the adjuvant therapy group was 8 years in facilities performing 20 or more esophagectomies per year and limited the survival analysis at 8 years.
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Patient Education and Counseling
Analyzing paths from online health information seeking to colorectal cancer screening using health literacy skills frame and cognitive mediation model
Seok Won Jina,*, Yeonggeul Leeb, David A. Diac
b Department of Social Welfare, University of Seoul, 163 Seoulsiripdaero, Dongdaemun-gu, Seoul 02504, South Korea
Colorectal cancer screening Health literacy
Online health information seeking
Health literacy skills frame
Cognitive mediation model
Objective: To test the hypothesized paths for Online Health Information Seeking (OHIS) behaviors in developing health literacy, leading to colorectal cancer (CRC) screening among Korean Americans (KAs) using Health Literacy Skills Frameworks (HLSF) and Cognitive Mediation Model (CMM). Methods: A total of 433 KAs aged 50 through 75 in a metropolitan area in the Southeastern U.S. completed a cross-sectional survey regarding sociodemographics, OHIS behaviors, information overload, health literacy, decisional balance, and CRC screening history. Path analyses were implemented to assess the hypothesized causal models by examining the relationships among these variables.
Results: OHIS was positively associated with information overload and health literacy; information overload was negatively associated with health literacy. Health literacy was positively associated with decisional balance; decisional balance was positively associated with uptake of sigmoidoscopy and colonoscopy.
Conclusion: The findings supported both theoretical frameworks, HLSF and CMM, for OHIS to develop health literacy, leading to CRC screening. These findings highlight the significant roles of information overload and attitudes and beliefs about screening in enhancing health literacy and CRC screening among KAs.
Practice Implications: Practice efforts for facilitating CRC screening among medically underserved older KAs should target improving access to and use of OHIS and culturally-tailored health information delivery.
Cancer is the leading cause of death in the U.S., while the cancer-related death rate has steadily declined over the last two decades . The American Cancer Society estimates that the average lifetime risk of developing cancer is nearly one in two (40.8%) for American men and more than one in three (37.5%) for American women . In response to this, researchers have underscored the need for cancer screening, which can reduce the risk by identifying precancerous cells or detecting cancers in their early stages, thereby saving lives . Cancer institutes also firmly recommend routine cancer screening for people at average risk [4,5].
Despite the risk of cancer and the benefits of screening, cancer screening rates remain low for the general U.S. population. For
* Corresponding author.
E-mail addresses: [email protected] (S.W. Jin), [email protected]
example, the commonly recommended guideline for colorectal cancer (CRC) screening includes having a fecal occult blood test (FOBT) annually, sigmoidoscopy every five years, or colonoscopy every ten years for those aged 50–75 [6,7]. However, a nationally representative household survey recently reported that 62.4% of men and women were up to date with the guideline , which falls short of the national goal (i.e., 70.5%) set by Healthy People 2020 . Further, division of subgroups in the U.S. population by race/ ethnicity revealed a disparity in CRC screening, especially for underrepresented populations [10,11]. In particular, a systematic review study on CRC screening demonstrated that only 25–50% of Korean Americans had ever had any of these tests, while only 10– 40% reported having undergone a screening within the past five or ten years .