PURPOSE
This scoping review explores how environmental, social, and structural factors influence cancer outcomes in Alabama. Using the Robison and Hudson (2014) survivorship framework, we examined how individual, healthcare provider, and system-level factors influence cancer vulnerability across communities in Alabama.
METHODS
Following PRISMA-ScR reporting and Joanna Briggs Institute guidelines, we identified and reviewed peer-reviewed studies published between 1995 and 2024 across five databases (PubMed, Embase, Scopus, CINAHL, and PsychINFO). Twenty-one studies met the inclusion criteria and were analyzed across six key areas: food and neighborhood environment, exposure assessment and environmental measurement methods, industrial/toxic releases as exposures, legacy/historical exposures and hematologic outcomes, socioeconomic environment and cancer incidence and racial disparities, community burden, and environmental risk.
RESULTS
Cancer disparities in Alabama are closely tied to geographic, racial, and economic factors. Communities in the Black Belt and industrial corridors face higher exposure to environmental hazards due to historical segregation and industrial development patterns. These exposures are linked to increased rates of colorectal, ovarian, and blood cancers, particularly in areas with persistent poverty and limited access to healthcare.
CONCLUSIONS
Cancer outcomes in Alabama cannot be separated from the broader social and environmental context. Understanding these connections is essential for addressing the drivers' underlying health disparities.
IMPLICATIONS FOR CANCER SURVIVORS
Improving cancer survivorship in Alabama requires a comprehensive approach that includes environmental risk assessments, enhanced provider education, and community-driven prevention. These approaches may include local screening initiatives, environmental cleanup, and targeted outreach to high-risk populations.
Anita Aboagye, Nicole Caviness-Ashe, Miriam A Miles et al.· Journal of cancer survivorsh...· 0 citations
INTRODUCTION
Social determinants of health (SDOH) are known to influence cancer outcomes. It is unknown whether SDOH effects on cancer survival differ by age at diagnosis or whether known differences in survival by race are consistent across age groups. Since the U.S. population is aging and becoming increasingly racially diverse, it is important to understand how SDOH at both neighborhood and individual levels impact survival in cancer survivors across age groups at diagnosis.
MATERIALS AND METHODS
This retrospective, population-based study utilized data from the Alabama Statewide Cancer Registry of adults (≥18 years) diagnosed with incident breast, prostate, colorectal (CRC), or lung cancers between 2010 and 2019. We included exposures of social vulnerability index (SVI), rural-urban residency, and insurance status at diagnosis. We evaluated an outcome of overall survival (OS) in months from date of diagnosis to date of death or end of follow-up. We estimated Cox proportional hazards regression models stratified by cancer type adjusting for demographics and clinical characteristics. We conducted additional models stratified by age group at diagnosis (≥65 vs. <65 years) and additionally age-race groups.
RESULTS
The sample included 26,031 incident breast, 24,567 prostate, 18,821 CRC, and 27,319 lung cancer cases. Across all cancer types, higher SVI was associated with higher risk of death with consistency across age groups. Being insured by Medicare/public insurance was associated with higher risk of death, but effects were higher among those diagnosed <65 and those identifying as White.
DISCUSSION
Higher levels of SVI and being insured by Medicare or public insurance are associated with worse survival among adults with breast, prostate, CRC, and lung cancer in Alabama with stronger effects observed among those diagnosed under <65. These results indicate that age at diagnosis is important in contextualizing and understanding differences in survival. Future efforts to improve disparities in mortality among cancer survivors should target interventions to those experiencing social vulnerability and younger at diagnosis. However, given that older adults experience differential care needs, social interventions may improve more proximal drivers of mortality in older adults with cancer such as frailty, but this needs further study.
Mackenzie E. Fowler, G. Saini, Elizabeth Baker et al.· Journal of Geriatric Oncolog...· 0 citations