Tracking Social Outcomes of Hypertension in Women with Breast Cancer – LaQuita Cooper, PhD, MPH, MHSA
LaQuita Cooper, Ph.D., MPH, MHSA
University of Mississippi Medical Center
The problem of hypertension control is particularly urgent for women in Mississippi. Predicted prevalence estimates show women in Mississippi have the highest prevalence of hypertension (42.6%) among women in the US. Substantial clinical and social comorbidities complicate the management of hypertension in Mississippi, requiring new strategies to provide tailored, accessible care that addresses hypertension, comorbidities and social concerns of women in the state. The UMMC Cancer Center Research Institute will collaborate with UMMC National Telehealth Center for Excellence and UMMC Myrlie Evers Williams Institute for the Elimination of Health Disparities to implement a study that will provide hypertension telemonitoring and food resources to support health promotion for UMMC breast cancer patients across the state of Mississippi. This study will advance health equity through interventions that link community and healthcare resource. However, neither of these resources (telemonitoring, food provision) has been examined as part of a feasibility study to examine the potential to improve in the care for women with hypertension and breast cancer, either as separate or joint interventions.
Recruitment of forty adult females age 18 and older will be implemented for a six month study. These forty-women will be UMMC Cancer Treatment Center breast cancer patients who are diagnosed with hypertension exceeding 2017 ACC/AHA guidelines of ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg. Specifically, metrics related to implementation planning and evaluation (Reach, Effectiveness, Adoption, Implementation, Maintenance, “RE-AIM”), and feasibility (recruitment, adherence, fidelity, acceptability, integration) for either home telemonitoring for hypertension or community partnership for food provision, have not been evaluated in hypertensive women with breast cancer in Mississippi or nationally.
Additionally, food insecurity has been extensively documented as a modifiable social concern that affects care delivery for both hypertension control and breast cancer. Mississippi has consistently ranked as having the highest prevalence of food insecurity in the US, recently estimated in Mississippi as 15% to 17.6%. Though the prevalence of food insecurity among breast cancer patients in Mississippi is not known, studies in similarly vulnerable populations estimated food insecurity as high as 26-56% among cancer patients. The reasons for food insecurity included costs related to “transportation to appointments (84%), job loss due to frequent appointments (81%), and the need for a more expensive diet while undergoing treatment (59%).” To manage the joint clinical problems of hypertension and cancer, expert recommendations suggest home blood pressure monitoring (telemonitoring) may be successfully used in cancer patients as a preferred strategy to manage hypertension due to its effectiveness, “reproducibility and tolerability” for chronic blood pressure management. Unfortunately, there are limited data to suggest strategies for addressing food insecurity as a social contributor to inequity in hypertension control for patients with breast cancer. Our study fills this gap in the literature by evaluating the feasibility and implementation of joint blood pressure and food insecurity management as an equity strategy to meet social and clinical needs in women at risk for cardiovascular disease mortality.
