Metformin is an antihyperglycemic drug that is widely prescribed for type 2 diabetes mellitus and is currently being investigated for the treatment of nonalcoholic steatohepatitis (NASH). NASH is known to alter hepatic membrane transporter expression and drug disposition similarly in humans and rodent models of NASH. Metformin is almost exclusively eliminated through the kidney primarily through active secretion mediated by Oct1, Oct2, and Mate1. The purpose of this study was to determine how NASH affects kidney transporter expression and metformin pharmacokinetics. A single oral dose of [14C]metformin was administered to C57BL/6J (wild type [WT]) and diabetic ob/ob mice fed either a control diet or a methionine- and choline-deficient (MCD) diet. Metformin plasma concentrations were slightly increased in the WT/MCD and ob/control groups, whereas plasma concentrations were 4.8-fold higher in ob/MCD mice compared with WT/control. The MCD diet significantly increased plasma half-life and mean residence time and correspondingly decreased oral clearance in both genotypes. These changes in disposition were caused by ob/ob- and MCD diet–specific decreases in the kidney mRNA expression of Oct2 and Mate1, whereas Oct1 mRNA expression was only decreased in ob/MCD mice. These results indicate that the diabetic ob/ob genotype and the MCD disease model alter kidney transporter expression and alter the pharmacokinetics of metformin, potentially increasing the risk of drug toxicity.

Background: Hispanic survivors of cancer experience increased cancer burden. Lifestyle behaviors, including diet and physical activity, may reduce the cancer burden. There is limited knowledge about the posttreatment lifestyle experiences of Hispanic survivors of cancer living on the United States–Mexico border. Objective: This study aims to support the development of a stakeholder-informed, culturally relevant, evidence-based lifestyle intervention for Mexican-origin Hispanic survivors of cancer living in a border community to improve their dietary quality and physical activity. Methods: Semistructured interviews with 12 Mexican-origin Hispanic survivors of breast cancer and 7 caregivers were conducted through internet-based teleconferencing. The interviews explored the impact of cancer on lifestyle and treatment-related symptoms, perception of lifestyle as an influence on health after cancer, and intervention content and delivery preferences. Interviews were analyzed using a deductive thematic approach grounded in the Quality of Cancer Survivorship Care Framework. Results: Key survivor themes included perception of Mexican diet as unhealthy, need for reliable diet-related information, perceived benefits of physical activity after cancer treatment, family support for healthy lifestyles (physical and emotional), presence of cancer-related symptoms interfering with lifestyle, and financial barriers to living a healthy lifestyle. Among caregivers, key themes included effects of the cancer caregiving experience on caregivers’ lifestyle and cancer-preventive behaviors and gratification in providing support to the survivors. Conclusions: The interviews revealed key considerations to the adaptation, development, and implementation of a theory-informed, evidence-based, culturally relevant lifestyle program to support lifestyle behavior change among Mexican-origin Hispanic survivors of cancer living in border communities. Our qualitative findings highlight specific strategies that can be implemented in health promotion programming aimed at encouraging cancer protective behaviors to reduce the burden of cancer and comorbidities in Mexican-origin survivors of cancer living in border communities.

Background: Though telehealth has been a promising avenue for engaging cancer survivors with health care and lifestyle programming, older and rural-dwelling cancer survivors may have additional challenges in accessing digital devices and tools that have not yet been described. This study aimed to use a robust, nationally representative sample collected in 2022 to provide an updated view of digital technology use and the use of technology for health in this population. Objective: This study aimed to examine the prevalence of digital technology use for health-related activities among older cancer survivors in both rural and urban settings. The primary outcomes of interest included (1) internet access and use for health-related activities, (2) digital device ownership and use as a tool for health behaviors, (3) use of social media for health, and (4) use of telehealth. Methods: A cross-sectional analysis of the National Cancer Institute’s Health Information National Trends Survey Cycle 6 (HINTS 6) was completed to examine the prevalence of digital technology use among older cancer survivors. For analysis, the sample was restricted to cancer survivors over the age of 60 years (n=710). Unadjusted and adjusted logistic regression models were used to test the association between rurality and digital health tool use. Results: Overall, 17% (125/710) of the sample lived in a rural area of the United States and the mean sample age was 73 (SD 8.2) years. Older cancer survivors, regardless of rural-urban status, reported a high prevalence of internet usage (n=553, 79.9%), digital device ownership (n=676, 94.9%), and social media use (n=448, 66.6%). In unadjusted models, rural survivors were less likely than urban survivors to report that they had used a health or wellness application in the previous year (odds ratio [OR] 0.56, 95% CI 0.32-0.97; P=.04). In adjusted models, rural survivors were more likely to report that they had shared personal health information on social media (OR 2.64, 95% CI 1.13-6.19; P=.03). There were no differences in the proportion of rural and urban respondents who reported receiving health services through telehealth in the previous year. Conclusions: Regardless of the residential status, older cancer survivors report high internet and technology use for health-related activities. These results show promise for the feasibility of using digital technologies to implement supportive care and wellness programming with older cancer survivors.

In the Spring of 2021, the COVID-19 vaccination was authorized for emergency use by the Food and Drug Administration. Healthcare workers (HCWs) are one of the most trusted sources of information for vaccination choices. However, HCWs at this time appeared to continue to have lower rates of COVID-19 vaccination uptake than expected in Arizona. The objective of this study was to examine factors that play a role in the vaccination decision-making process among Arizona HCWs. Between January and April 2021, 18 semi-structured interviews were conducted among physicians, emergency medical technicians and long-term care nurses in Pima County. The informed consent process was completed for each participant. The interview guide was informed by the Increasing Vaccination model to collect information on vaccination decision-making. A codebook was developed using an inductive approach. Coding and analysis was conducted using the software MAXQDA. Participants were primarily male (11/18, 61%) and white (11/18, 61%). Three participants identified as Hispanic. Initial themes that emerged included: mixed opinions concerning the innovations in COVID-19 vaccine development, access-related barriers, issues related to distribution inequities, concerns about misinformation and conspiracy theories, and dialogue concerning the benefits of requiring mandatory vaccination. The results gathered from this study indicate that there continues to be hesitancy among some healthcare professionals in Pima County. These results will be used to help Arizonan Health Departments promote rollout of novel vaccines more effectively through targeting relevant vaccination decision-making factors among HCWs.

Assessing and managing symptoms has a survival benefit for patients with advanced cancer. However, rural cancer patients have difficulty accessing services to address symptoms. Technology may offer one solution; however, little work has been done to specifically leverage technology-based solutions to deliver high quality supportive care in rural settings. Nurse AMIE (Addressing Malignancies in Individuals Everyday) is a 2-year, Phase III randomized controlled efficacy trial to investigate the use of a tablet-based symptom management and supportive care intervention to improve overall survival among 344 advanced cancer patients living in rural areas. Participants are randomized on a 1:1 basis to the Nurse AMIE intervention or a usual care group that receives a binder with written supportive care materials. Intervention participants are asked to access the Nurse AMIE application daily using the study-provided tablet to answer symptom questionnaires regarding their level of pain, fatigue, sleep, and distress. After receiving an empathic response from Nurse AMIE, participants are offered a guideline concordant self-care intervention to address their symptoms. The trial is powered to detect a 19 % difference in overall survival between groups at 2 years. Secondary outcomes include symptom severity, function, quality of life, patient-reported outcomes, and cost-effectiveness. Nurse AMIE is the first trial to apply and rigorously assess the effect of ongoing symptom assessment and management on overall survival among rural, advanced cancer patients. Results from the Nurse AMIE trial will provide evidence of the efficacy of delivering a high-quality, technology-based supportive care program among underserved rural populations. gov registration number NCT05221606.

Cancer survivor-caregiver dyads from underrepresented racial and ethnic groups and those with lower socioeconomic status are less likely to participate in clinical research. Sociocultural and socioeconomic barriers perpetuate health inequity and increase disparities in cancer care. We describe our systematic approach to recruiting and retaining diverse survivor-caregiver dyads in supportive cancer care studies. Matsuda's research recruitment guidelines of evaluate, engage, reflect, and carefully match (“EERC”) were adapted and applied through a framework of six guiding principles. A systematic approach to recruitment of underrepresented dyads in cancer support research includes 1) Developing a bilingual, bicultural study team with shared language and culture of the study population, 2) Ensuring team members share a passion for cancer health equity and are trained with a community-centric approach, 3) Designing accessible interventions, study materials, and shared data collection tools across similar studies with community and stakeholder input, 4) Engaging local and regional stakeholders with expertise of health disparities among the catchment area, 5) Partnering with Community Health Workers (CHWs) and gatekeepers to enhance community presence, and 6) Ensuring careful application of matching study team members and participants beyond race and ethnicity to prioritize the cultural values and social factors that impact cancer survivors and caregivers. Applying a systematic approach to recruiting and retaining underrepresented dyads in cancer research can potentially reduce sociocultural and socioeconomic barriers to cancer health equity.