bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of different implant positions for two implant-retained mandibular overdenture: a retrospective 5-years radiographic evaluation of the circumferential peri-implant bone loss and posterior ridge resorptive changes
Authors: Mourad Khloud Ezzat , Emera Radwa Mohsen Kamal , Habib Ahmed
Published: September 2024

Background

Studies did not recommend which position for implant overdenture poses the lowest biomechanical risk and the least chance of peri-implant bone loss and ridge resorption for those who might need a mandibular two-implant overdenture. The study objectives were to investigate the impact of implant position, in lateral incisors or canine positions, on peri-implant bone loss and posterior ridge resorption.

Methods

Fifty patients with mandibular two-implants were recalled and divided according to the implant position into two groups (group L: implants in lateral incisor positions and group C: implants in canine positions). The circumferential peri-implant bone level and posterior ridge resorption were assessed at implant insertion (T0), one year later (T1), and five years later (T5) using the follow-up CBCT. Data were analyzed using the Statistical Package of Social Science (SPSS) program. A Mann-Whitney test was used to compare two different groups. Paired groups were compared using the Wilcoxon signed-rank test. The threshold of significance is fixed at a 5% level (p-value).

Results

Significant differences in the vertical bone loss between groups appeared at (T5 - T1) (Mann Whitney test, (P = 0.01)) and at (T5 - T0) (Mann Whitney test, (P = 0.005)), and a significant difference in horizontal bone loss between groups was found at (T1 - T0) (Mann Whitney test, (P = 0.041)) and (T5 - T1) (Mann Whitney test, (P = 0.041)). Also, there were significant differences over the evaluation period between groups at certain points along the ridge at M1 (Mann Whitney test, (P = 0.021)), M3 (Mann Whitney test, (P = 0.008)), and M4 (Mann Whitney test, (P = 0.015)).

Conclusions

According to the findings of this clinical study, the placement of implants in the lateral incisor position for two implant-retained overdentures is a viable choice. In comparison to the canine position, the lateral incisor position demonstrated superior peri-implant responses, which could potentially enhance the longevity of the implants. Furthermore, the placement of implants in the lateral incisor position can promote a more even distribution of stress and help mitigate posterior ridge resorption. Conversely, implants in the canine position may cause a seesaw effect and result in greater posterior ridge resorption.

Clinical Trial Registry Number

(NCT06055842) (13/03/2024).
Machine-learning-based models for the optimization of post-cervical spinal laminoplasty outpatient follow-up schedules
Authors: Seo Yechan , Jeong Seoi , Lee Siyoung , Kim Tae-Shin , Kim Jun-Hoe , Chung Chun Kee , Lee Chang-Hyun , Rhee John M. , Kong Hyoun-Joong , Kim Chi Heon
Published: September 2024

Background

Patients undergo regular clinical follow-up after laminoplasty for cervical myelopathy. However, those whose symptoms significantly improve and remain stable do not need to conform to a regular follow-up schedule. Based on the 1-year postoperative outcomes, we aimed to use a machine-learning (ML) algorithm to predict 2-year postoperative outcomes.

Methods

We enrolled 80 patients who underwent cervical laminoplasty for cervical myelopathy. The patients’ Japanese Orthopedic Association (JOA) scores (range: 0–17) were analyzed at the 1-, 3-, 6-, and 12-month postoperative timepoints to evaluate their ability to predict the 2-year postoperative outcomes. The patient acceptable symptom state (PASS) was defined as a JOA score ≥ 14.25 at 24 months postoperatively and, based on clinical outcomes recorded up to the 1-year postoperative timepoint, eight ML algorithms were developed to predict PASS status at the 24-month postoperative timepoint. The performance of each of these algorithms was evaluated, and its generalizability was assessed using a prospective internal test set.

Results

The long short-term memory (LSTM)-based algorithm demonstrated the best performance (area under the receiver operating characteristic curve, 0.90 ± 0.13).

Conclusions

The LSTM-based algorithm accurately predicted which group was likely to achieve PASS at the 24-month postoperative timepoint. Although this study included a small number of patients with limited available clinical data, the concept of using past outcomes to predict further outcomes presented herein may provide insights for optimizing clinical schedules and efficient medical resource utilization.

Trial registration

This study was registered as a clinical trial (Clinical Trial No. NCT02487901), and the study protocol was approved by the Seoul National University Hospital Institutional Review Board (IRB No. 1505-037-670).
What methods are currently available for incorporating implementation considerations within the economic evaluation of health technologies? A scoping review
Authors: Heggie Robert , Boyd Kathleen , Kamaruzaman Hanin , Wu Olivia
Published: September 2024

Background

When clinically effective, cost-effective health interventions are not fully implemented in clinical practice, population health suffers. Economic factors are among the most commonly cited reasons for suboptimal implementation. Despite this, implementation and economic evaluation are not routinely performed in conjunction with one another. This review sought to identify and describe what methods are available for researchers to incorporate implementation within economic evaluation, how these methods differ, when they should be used, and where gaps remain.

Methods

We conducted a scoping review using systematic methods. A pearl-growing approach was used to identify studies. References and citations were identified using Web of Science and Scopus. We included for review any study that contained terms relating to economic evaluation and a series of implementation-related terms in the title or abstract. The search was conducted and validated using two independent researchers.

Results

Our review identified 42 unique studies that included a methodology for combining implementation and economic evaluation. The methods identified could be categorized into four broad themes: (i) policy cost–effectiveness approach (11 studies), (ii) value of information and value of implementation approach (16 studies), (iii) mixed methods approach (6 studies), and (iv) costing approach (9 studies). We identified a trend over time from methods that adopted the policy cost–effectiveness approach to methods that considered the trade-off between the value of information and value of implementation. More recently, mixed methods approaches to incorporate economic evaluation and implementation have been developed, alongside methods to define, measure and cost individual components of the implementation process for use in economic evaluation.

Conclusion

Our review identified a range of methods currently available for researchers considering implementation alongside economic evaluation. There is no single method or tool that can incorporate all the relevant issues to fully incorporate implementation within an economic evaluation. Instead, there are a suite of tools available, each of which can be used to answer a specific question relating to implementation. Researchers, reimbursement agencies and national and local decision-makers need to consider how best to utilize these tools to improve implementation.
Copy number amplification-induced overexpression of lncRNA LOC101927668 facilitates colorectal cancer progression by recruiting hnRNPD to disrupt RBM47/p53/p21 signaling
Authors: Wang Zaozao , Han Haibo , Zhang Chenghai , Wu Chenxin , Di Jiabo , Xing Pu , Qiao Xiaowen , Weng Kai , Hao Hao , Yang Xinying , Hou Yifan , Jiang Beihai , Su Xiangqian
Published: September 2024

Background

Somatic copy number alterations (SCNAs) are pivotal in cancer progression and patient prognosis. Dysregulated long non-coding RNAs (lncRNAs), modulated by SCNAs, significantly impact tumorigenesis, including colorectal cancer (CRC). Nonetheless, the functional significance of lncRNAs induced by SCNAs in CRC remains largely unexplored.

Methods

The dysregulated lncRNA LOC101927668, induced by copy number amplification, was identified through comprehensive bioinformatic analyses utilizing multidimensional data. Subsequent in situ hybridization was employed to ascertain the subcellular localization of LOC101927668, and gain- and loss-of-function experiments were conducted to elucidate its role in CRC progression. The downstream targets and signaling pathway influenced by LOC101927668 were identified and validated through a comprehensive approach, encompassing RNA sequencing, RT-qPCR, Western blot analysis, dual-luciferase reporter assay, evaluation of mRNA and protein degradation, and rescue experiments. Analysis of AU-rich elements (AREs) within the mRNA 3’ untranslated region (UTR) of the downstream target, along with exploration of putative ARE-binding proteins, was conducted. RNA pull-down, mass spectrometry, RNA immunoprecipitation, and dual-luciferase reporter assays were employed to elucidate potential interacting proteins of LOC101927668 and further delineate the regulatory mechanism between LOC101927668 and its downstream target. Moreover, subcutaneous xenograft and orthotopic liver xenograft tumor models were utilized to evaluate the in vivo impact of LOC101927668 on CRC cells and investigate its correlation with downstream targets.

Results

Significantly overexpressed LOC101927668, driven by chr7p22.3-p14.3 amplification, was markedly correlated with unfavorable clinical outcomes in our CRC patient cohort, as well as in TCGA and GEO datasets. Moreover, we demonstrated that enforced expression of LOC101927668 significantly enhanced cell proliferation, migration, and invasion, while its depletion impeded these processes in a p53-dependent manner. Mechanistically, nucleus-localized LOC101927668 recruited hnRNPD and translocated to the cytoplasm, accelerating the destabilization of RBM47 mRNA, a transcription factor of p53. As a nucleocytoplasmic shuttling protein, hnRNPD mediated RBM47 destabilization by binding to the ARE motif within RBM47 3'UTR, thereby suppressing the p53 signaling pathway and facilitating CRC progression.

Conclusions

The overexpression of LOC101927668, driven by SCNAs, facilitates CRC proliferation and metastasis by recruiting hnRNPD, thus perturbing the RBM47/p53/p21 signaling pathway. These findings underscore the pivotal roles of LOC101927668 and highlight its therapeutic potential in anti-CRC interventions.
Further assessment of structural and social determinant of health effects on breast cancer care timelines: A qualitative study.
Authors: Sheni Risha , Tomer Danielle , Watnick Dana , Makower Della F. , Gupta Anjuli M , Mehta Vikas
Published: September 2024

121

Background:
Time to treatment (TTI) delays result in increased morbidity and mortality for cancer patients. These treatment delays disproportionately occur within marginalized communities due to structural challenges with social determinants of health (SDoH), disengagement with the healthcare system and limited or low health literacy that impacts their ability to obtain timely, appropriate care. We conducted semi-structured interviews with patients treated for breast cancer about their care treatment trajectories to further understand barriers and facilitators for timely treatment from the patient perspective.
Methods:
We conducted semi-structured interviews with 30 patients in 2023 who received curative intent breast cancer treatment at Montefiore Medical Center from 2019 to 2023. Interviews addressed barriers and facilitators of timely TTI, perceived timeliness and salience of timeliness, emotional well-being, and perceptions of the healthcare team and communication. We analyzed interviews using framework analysis.
Results:
A total of 30 patients were interviewed (mean age 58.9 year ± 10.6, 75% Non-Hispanic Black, 25% Non-Hispanic White). The median TTI was 52.5 days (49, 62 IQR). First treatment modality included surgery (75%) and chemotherapy (25%). Many participants found significant emotional and logistical support through family, social networks, religion, and connecting with survivors. Several patients faced transportation issues hindered their ability to adhere to schedules, childcare challenges, and difficulty managing numerous appointments, with some wishing transportation services had been offered at diagnosis. Some participants experienced unique cancer presentation, required clearances, involvement of non-oncologic providers and consultants, and time for decision-making about treatment options that may have contributed to delays. Some patients faced financial burdens including personal expenses, family support needs, and difficulties accessing third-party assistance (i.e., short-term disability, Supplemental Security Income). Some patients valued mental health counseling and other resources like group therapy and social workers, though some wished for earlier, more specialized support, indicating gaps in the support timeline. A few patients expressed preference for longer TTI that afforded them time to make important decisions and seek opinions.
Conclusions:
The study revealed that many patients faced logistical, emotional, and informational challenges while awaiting treatment and highlighted a need for more tailored assistance and timely interventions. Findings from our work highlight the need for further study on how healthcare systems can better equip and engage patients early in the care timeline to avoid delayed TTI.
Disparities in cancer mortality outcomes among adult immigrants in the United States.
Authors: Santos Patricia Mae Garcia , Boe Lillian A. , Barnes Justin Michael , Cervantes Lilia , Yabroff Robin , Chino Fumiko
Published: September 2024

134

Background:
The “immigrant health paradox” posits that immigrants are generally healthier than US natives of similar demographic and socioeconomic background. However, immigrant noncitizens with cancer face unique barriers to care, including limited access to routine screening and continuous healthcare coverage, which may portend worse outcomes.
Methods:
The 2011-2018 National Health Interview Survey Linked Mortality Files were used to identify all adult (age ≥18 years) US natives, foreign-born citizens, and noncitizens with a cancer history. Differences by group were assessed using the chi-squared test with Rao & Scott’s second-order correction. Cox-proportional hazards models tested associations between nativity/citizenship status and cancer-specific (CSM) and all-cause mortality (ACM), adjusted by age, gender, and survey year. Sequential models separately tested the added effects of individual patient-level covariates selected
a priori
—including race/ethnicity, smoking status, region, educational attainment, employment, insurance status, and having a usual source of care.
Results:
A total of 23,603,743 US natives, 1,647,188 foreign-born citizens and 477,861 noncitizens met criteria for inclusion. Compared to US natives, immigrants had significantly greater distribution of gastroesophageal (2.3%, noncitizens vs 2.3%, foreign-born citizens vs 1.0%, US natives,
p
<0.001), head & neck (8.4% vs 6.2% vs 4.4%,
p
=0.003), and lung cancers (3.1% vs 4.2% vs 2.8%,
p
=0.03). Of the1,302,0771 US natives, 105,258 foreign-born citizens, and 21,937 noncitizens who died during the study period, cancer was the primary cause of death for 52% of noncitizens and 62% of foreign-born citizens (vs 44%,
p
<0.001). Lung cancer was the most common diagnosis in this group, accounting for 40% of cancer deaths among non-citizens (vs 19% vs 13%;
p
=0.03). Relative to US natives, foreign-born citizens had a significantly lower risk of all-cause (adjusted HR [95%CI], 0.67 [0.54-0.83]) but not cancer-specific mortality (0.94 [0.71-1.23]); no differences in mortality risk among noncitizens were observed. On subset analysis limited to adults with lung cancer, noncitizens had over twice the hazard of cancer death (2.72 [1.22-6.09]) as well as death from any cause (2.14 [1.01-4.55]). While the association with ACM was no longer significant in sequential models, the association remained significant for CSM. Importantly, insurance status attenuated but did not eliminate the risk of lung cancer death for noncitizens (2.63 [1.16-5.96]).
Conclusions:
Although immigrant noncitizens did not have a significantly greater risk of cancer death overall, those with lung cancer were more than twice as likely to die from their disease, even after adjustment for patient-level variables, including insurance status and having a usual source of care. Future research is warranted to identify root causes and potential points for intervention.
Geographic residence of patients with medication-related osteonecrosis of the jaw.
Authors: Knapp Mary-Peyton , Levine Beverly J. , McKay John T. , Rush Benjamin Woodress , Douglas Emily H.
Published: September 2024

135

Background:
Bone-modifying agents (BMAs) are utilized to reduce the risk of skeletal-related events in patients with bone metastases. Medication-related osteonecrosis of the jaw (MRONJ) is a rare but difficult to treat adverse event of BMAs. There are known patient and treatment related risk factors for development of ONJ, however, little is known on social and geographic risks. In patients with bone metastases and concurrent MRONJ, we seek to describe differences in patient's geographic residence (rural versus urban) with other social factors as secondary outcomes.
Methods:
We conducted a retrospective chart review of Atrium Health Wake Forest Baptist Comprehensive Cancer Center patients in the date range of 01/01/2013 to 11/01/2023. Included were patients with metastatic breast cancer, metastatic prostate cancer or multiple myeloma who had a diagnosis of MRONJ. We recorded Rural-Urban Commuting Area (RUCA) codes, the Area Deprivation Index (ADI), age, race, ethnicity, smoking status, alcohol use, body mass index, insurance status, type of cancer, type of BMA, and cumulative dosing of BMAs. Patients were defined as rural or urban based on criteria from the health resources and services administration website. Relative socioeconomic advantage versus disadvantage was determined by the patients’ ADIs with a decile rank from 1-10 for state ADIs and a percentile rank of 1-100 for national ADIs. SAS software (version 9.4) was used for data analysis (2023, SAS Institute Inc, Cary, NC).
Results:
A total of 88 patients met inclusion criteria. 64% of patients lived in urban areas and 36% in rural. Demographic features of the identified patients are listed in table 1. MRONJ patients from both urban and rural areas had an above average national and state ADI, with a trend toward higher ADIs in rural locations compared to urban locations; mean of 6.7 vs 5.3 state ADI and mean 70.6 vs 62.0 national ADI, for rural and urban patients respectively. There were no statistically significant differences between rural and urban patients in any of the demographic or health-related characteristics we examined.
Conclusions:
Patients with bone metastases and MRONJ in our cohort demonstrate relative socioeconomic disadvantage in comparison to national and state averages. In comparing the rural with urban patients, however, we observed relatively similar profiles.

Patient characteristics by rural/urban status.

Rural (n=32)
Urban (n=56)

Age in years (mean, sd)

64 (11.3)
65 (10.9)

Sex, N (%)
Male
19 (59)
29 (52)

Female
13 (41)
27 (48)

Race, N (%)
Non-Hispanic White
30 (93.8)
40 (71.4)

Non-Hispanic Black
1 (3.1)
11 (19.6)

Hispanic
1 (3.1)
3 (5.4)

Non-Hispanic Asian
0 (0.0)
1 (1.8)

Other
0 (0.0)
1 (1.8)

State ADI (mean, sd)

6.7 (2.4)
5.5 (2.7)

National ADI (mean, sd)

70.6 (16.9)
62.0 (23.8)

Former/current smoker, N (%)

18 (56.3)
25 (44.6)

Medicaid/Medicare, N (%)

16 (50.0)
16 (28.6)

Months on BMA (mean, sd)

37.2 (35.5)
40.3 (38.2)
Disparities in neighborhood deprivation and patient reported quality of life relating to post-operative sequelae after radical cystectomy.
Authors: Dadabhoy Anosh , Doshi Chirag , Moghaddam Farshad Sheybaee , Mehta Sejal V. , Sobhani Sina , Tobar Mariann , Wood Erika L. , Xia Leilei , Schuckman Anne K. , Daneshmand Siamak
Published: September 2024

141

Background:
Readmissions following radical cystectomy(RC) remain high despite prehabilitation and enhanced recovery after surgery (ERAS) care. Recently, studies have shown the correlation between socioeconomic neighborhood deprivation (ND) and post-operative quality of life (QoL) in oncologic surgeries. We sought to examine the impact of preoperative QoL and ND with postoperative sequela following RC.
Methods:
This was a prospective IRB approved study of patients undergoing RC for bladder cancer from 2021 to 2023. QoL was assessed with the FACT-Bl-Cys survey. Clinicopathologic, complication, and readmission data were collected up to 90 days, as well as distance from the hospital and 4 zip-code based Indices (1-100 index scores representing socioeconomic deprivation). FACT-BL-Cys and indices scores were correlated with outcomes of interest. Pairwise Spearman correlation was done between indices and QoL Instruments. A multivariable analysis (MVA) identified the factors that influence complications and readmissions.
Results:
The cohort consisted of 56 patients, mostly men (n=40, 71%). Median age was 69, most had organ-confined disease (≤(y)pT2N0M0, n =45, 80%) and underwent neoadjuvant chemotherapy (n=32, 57%). 75% underwent a continent diversion (neobladder n=38, 68% or continent cutaneous diversion n=4, 7%). Median follow-up time was 10.1 months (range 3.7 - 16.7 months). No correlation was observed between 30/90-day complications or readmissions with FACT-BL-Cys. Healthy Places Index (HPI) correlated with overall QoL and subscores. On MVA, correlation was seen between Social Deprivation Index (SDI) and 90-day readmissions (p=0.03, OR=0.97, 95%CI= 0.94-0.99).
Conclusions:
Patient-reported QoL aligns with diverse socioeconomic strata, as per deprivation indices, which in turn correlate with readmissions. Further studies are needed to understand the relationship between patient reported QoL and ND with postoperative outcomes.

Correlation between zip code-based deprivation indexes and quality of life scores.

Well Being Scores
Distance to Hospital
HPI
DCI
SDI

Physical

0.35
(p=0.01)

0.28
(p=0.05)

-0.22 (p=0.11)
-0.15 (p=0.27)

Social
0.00 (p= 0.97)
0.10 (p=0.46)
-0.11 (p=0.40)
-0.10 (p=0.49)

Emotional
-0.07 (p=0.62)
-0.18 (p=0.21)
0.19 (p=0.15)
0.22 (p=0.11)

Functional

0.28
(p=0.04)

0.36
(p=0.01
)

-0.26
(p=0.05)

-0.16 (p=0.24)

BL-CYS
0.13 (p=0.36)
0.23 (p=0.10)
-0.11 (p=0.42)
-0.04 (p=0.79)

TOI (PWB+FWB+BL-CYS)
0.26 (p=0.06)

0.34
(p=0.01)

-0.22 (p=0.10)
-0.13 (p=0.33)

FACT-BL-CYS Total Score
0.19 (p=0.16)

0.31
(p=0.03)

-0.20 (p=0.13)
-0.11 (p=0.42)

HPI: Healthy Places Index, DCI: Distressed Communities Index, SDI: Social Deprivation Index, ADI: Area Deprivation Index.
Digitizing community resources and closed-loop referral system to identify top sought health-related social needs (HRSN) in a community cancer center.
Authors: Traul Abigail
Published: September 2024

154

Background:
Prior to implementation of a digital closed-loop referral system, community resources were not centralized, and knowledge of resources varied between clinic staff within a community cancer center treating patients throughout the Willamette Valley of Oregon. Referrals to community-based organizations (CBO) were found in the electronic health record as unstructured data and were difficult to track manually. As an organization, the medical care team needed to identify top sought HRSNs to better understand health equity needs in our community.
Methods:
2023 Q1: Partnered with Findhelp, a social needs closed-loop referral platform. 2023 Q2-4: Attended Findhelp train-the-trainer education and began building a customized oncology database of local, regional, and national resources. Developed a process to log community-based referrals, update the referral status, and close the referral loop within Findhelp for individual patients. Educated and trained support services staff. 2024 Q1: Utilized Findhelp data analytics to review and evaluate closed-loop referral system and top sought HRSNs.
Results:
We describe our results to date (Table).
Conclusions:
Digitizing community resources and establishing a closed-loop referral process between the community cancer center and CBOs allowed accurate data tracking and increased access to data to ensure patients’ needs were met. After eight months, financial toxicity, housing insecurity, and food insecurity were identified as the top three sought HRSNs. In the future, increased data will help evaluate gaps in resources and leverage stronger relationships with CBOs to meet patients’ HRSNs in a community cancer center.

Month
% Closing the Referral Loop (patients with closed-loop referrals/total patient referrals)
Top Sought HRSN Needs

July 2023
74% (50/68)
Help pay for healthcare

August 2023
68% (51/75)
Help pay for healthcare

September 2023
80% (59/74)
Housing

October 2023
67% (66/98)
Help pay for healthcare

November 2023
78% (51/65)
Food

December 2023
86% (55/64)
Support/Counseling

January 2024
83% (52/63)
Help pay for healthcare

February 2024
65% (56/86)
Food
Journey towards equity: Unveiling the relationship between patient travel distance and social vulnerability among patients with cancer.
Authors: Deepak Divya , Indurlal Puneeth , Hakimian David , Shah Niki , Mirza Irfan Ahmed , Manjunath Rajini , Malhotra Rajat
Published: September 2024

158

Background:
Patient travel distance is a significant barrier to accessing high-quality cancer care, impacting patient outcomes. Factors such as geographic location, transportation infrastructure, and socio-economic status contribute to variations in patient travel distance. The relationship between patient travel distance and the area deprivation index (ADI), a measure of socioeconomic disadvantage (based on income, education, employment, and housing quality) and social vulnerability of neighborhoods developed by the Health Resources & Services Administration (HRSA), remains largely unexplored. This abstract seeks to unveil the intricate relationship between patient travel distance and ADI, shedding light on the impact of social vulnerability on cancer care access.
Methods:
Using patient ZIP code data and practice location data from April 2023 to March 2024, we calculated the straight-line, one-way, patient-clinic travel distance (travel distance). We then derived the ADI for patient ZIP codes using geospatial mapping techniques and compared travel distances by area deprivation vulnerability categories.
Results:
While analyzing geographic data for 20,000 patients at 5 locations, we observed that 89% of patients traveled 15 miles or less one-way to reach the practice location, with a median travel distance of 5 miles. Median travel distance in miles for patients within 15 miles of each practice location by ADI vulnerability category is provided (Table). Median travel distances between ADI categories were statistically significant (Kruskal Wallis H-test, p <0.001). Patients from the most disadvantaged neighborhoods generally travel longer distances to access cancer care.
Conclusions:
Patients in socially vulnerable locales generally travel longer distances to access cancer care. By considering the ADI alongside patient travel distance, healthcare providers and policymakers can understand barriers faced by disadvantaged populations and allocate resources to reduce disparities in access to care. Targeted interventions and policies, like improving transportation services/infrastructure, empowering community-based care locations, and expanding telehealth, are necessary to address travel distance disparities for vulnerable populations. The effects of increased travel distance on timely access to care, treatment adherence, health outcomes, finances, caregivers, and patient satisfaction warrant further investigation.

Location
Site Category
Within 15 miles of the practice location

% of patients
Median travel distance (in miles) by overall ADI vulnerability

Highest (8, 9, 10 ADI Rank)
Mid High (5, 6, 7 ADI Rank)
Low (1, 2, 3, 4 ADI Rank)

A
Suburban Metro
89.8%
13.5
2.2
4.7

B
Suburban Small Town
86.7%
12.5
13.03
8.5

C
Suburban Metro
85.1%
14.9
9.4
5.9

D
Suburban Metro
90.9%
12.9
9.6
4.7

E
Urban Metro
93.6%
12.9
4.8
2.7

ALL

89%
12.5
6.3
5.0
Services to address food shortage concerns among people undergoing cancer treatment in the US.
Authors: Marrero Gonzalez Alejandro Roberto , Crawford Anna , Incudine Andrea , Tardif Carla , Graboyes Evan Michael
Published: September 2024

161

Background:
In line with recommendations from cancer research and advocacy organizations, including ASCO, there has been an increased interest in addressing food insecurity (FI) among people with cancer, and recent clinical trials have evaluated the effectiveness of food-specific services (e.g., food delivery programs, food vouchers) on FI and clinical outcomes in this population. However, non-food-specific services (e.g., education, financial assistance) may be used by community-based organizations to promote food security and address the underlying financial strain. To date, little is known about the nature and distribution of services to address FI from community-based organizations for people with cancer undergoing treatment.
Methods:
This cross-sectional study included adults undergoing cancer treatment from 2020-2023 who had food shortage concerns and received services from Family Reach, a national cancer support organization that provides support to people with cancer undergoing treatment. The primary outcome was supportive service to address food shortage concerns, which were categorized as either food-specific (i.e., food pantry, food delivery) or non-food-specific (i.e. financial assistance, resource navigation). Multivariable logistic regression was performed to evaluate factors associated with receiving food-specific services.
Results:
Among 4166 adults with cancer undergoing treatment who had food shortage concerns, the median (IQR) age was 45 (18) years; 41.4% identified as non-Hispanic white, and 68.2% were female. The most common cancer types were breast (32.3%) and hematologic (23.0%). Overall, 100% with food shortage concerns received non-food-specific services and 24.2% received both non-food specific services and additional food-specific services. The most common food-specific services were referrals to food pantries (16.9%; 704/4166) and food delivery programs (14.1%; 585/4166). The most common non-food-specific services were a stipend for financial assistance (43.2%) and resource navigation with tailored referrals for patients’ needs (37.9%). On multivariable analysis, People living in a dual unemployment household (aOR 0.50, 95% CI 0.34-0.74) and people whose preferred language was Spanish (aOR 0.68, 95% CI 0.48-0.96) were less likely to receive food-specific services to address their food shortage concerns, while people with Medicaid health insurance were more likely to receive food-specific services than those with private insurance (aOR 1.33, 95% CI 1.07-1.66).
Conclusions:
In a large nationwide financial support organization serving people with cancer, food shortage concerns are managed with a combination of food-specific and non-food-specific services. Additional research is needed to identify the package of financial supportive care services that are most beneficial for each person’s social and clinical situation.
Assessment and improvement of goals of care discussion by internal medicine residents.
Authors: Shah Zunairah , Baloch Ali Shahbaz
Published: September 2024

191

Background:
End-of-life goals and quality of life are intrinsically connected, focusing on providing care that maximizes comfort, dignity, and personal satisfaction during the final stages of life. Residents are primarily involved in Goals of care (GOC) discussion in hospitalized patients it is an integral component in Internal Medicine (IM) resident education. Literature has shown improved outcomes in delivering bad news by residents and oncology fellows after workshops, lectures, and courses. We aimed to improve Residents' competency in effective GOC discussion.
Methods:
We devised a questionnaire with the help of palliative care specialists and distributed it via a Google survey to the IM residents. After the survey, a palliative care specialist lectured about understanding the POLST form and components of Code Status Discussions. The same questionnaire was sent again. Five survey questions were used as post-lecture improvement parameters, and residents were stratified among three different classes: Interns, Year 2, and Year 3.
Results:
Before the lecture, residents were asked about their comfort level on a scale from 1-10, with 10 being the most comfortable conducting GOC discussions with the patient or the patient's family. As per the combined survey of all three classes, 50% of residents scored seven or above. Post lecture, 69.3% of intern year residents and 100% of 2nd and 3rd-year residents scored seven and above, which showed significant improvement in residents' comfort level while conducting GOC discussions. The parameters analyzed were the ability to explain SPIKES protocol for 'Breaking Bad News. Initially, 58.3% of the residents were comfortable explaining it, while 41.7 % answered negatively. After the survey, 84.6% from the intern year, 92.3% in 2nd year, and 77.8% of 3rd-year residents stated being comfortable with explaining SPIKES protocol. Another evaluated paradigm was the residents' ability to determine the patient's prognosis using any given scale/score (like the UCSF prognosis calculator). 33.3 % of the residents said 'yes' while 30.6% answered 'maybe.' Post-intervention, 100% of 3rd-year residents and 61.5% of 2nd-year residents, while 30.8% of intern-year residents said 'yes.' The cumulative mean of all three combined classes was 64.1%, which showed significant improvement compared to pre-intervention 33.3%.
Conclusions:
The results show that residents' comfort level of conducting GOC discussions improved with a single lecture on the topic. Further interventions and mentorship are needed. Intern-year residents were found to have a lower level of subjective comfort in conducting these discussions, which can be explained by their being relatively new to the work environment. A more integrated approach at the beginning of the residency training regarding GOC discussion training can improve interns' confidence and comfort for ensuing such discussions.
Urgent palliative care: An effective intervention to improve end-of-life experience and outcomes for patients with advanced cancer.
Authors: Bowden Kasey , Maurer Grace , Treem Jonathan
Published: September 2024

203

Background:
Early integration of palliative care services for advanced oncology patients has a well-documented benefit on quality-of-life measures including symptom management, quality-of-death measures, cost-effectiveness, care-giver burden, and patient satisfaction metrics. However many barriers exist, including delayed referrals and negative perceptions of hospice/palliative care by patients and families. Furthermore, wait times from referral to visit can vary from weeks to months. For patients with late-stage disease, rapidly advancing disease or symptoms, this delay can lead to unnecessary acute care utilization, impoverished quality-of-life, and discordant end-of-life care.
Methods:
The CU Cancer Center CARE clinic provides advanced symptom management and urgent care services to oncology patients, often seeing patients with high symptom burden and advanced disease. A recent unpublished case-based analysis demonstrated that patients seen in CARE clinic 4 times or more in a month have a high risk of inpatient mortality within 3 months. In response, the CARE clinic created an urgent palliative care program wherein patients have the ability to see a palliative care provider within 1 week of referral who could provide ongoing advanced symptom management/medication titration and facilitate conversations around goal-concordant care in late-stage illness. A 1-year feasibility pilot took place from 2022-2023. Referrals required patients to meet the following criteria: 1) Not already being seen by an ambulatory palliative care professional; and 2) any of the following: prognosis of weeks without an end-of-life care plan; symptoms likely to require hospitalization if not addressed within a week; or seen in CARE clinic 4 or more times in the last month From 09/2022-08/2023, 55 patients were seen. Outcomes were followed for 3 months following final CARE clinic visit and were compared to patients who had received palliative care referrals from the CARE clinic in the preceding year (9/2021-9/2022).
Results:
In-hospital deaths, hospital days in the last 30 days of life, and palliative care/hospice involvement were all positively affected in our initial pilot. Notably, in-hospital deaths were reduced by 50%. There was also a 14% increase in deaths with hospice care in the pilot group compared to the control group.
Conclusions:
Data from this feasibility pilot suggest that urgent palliative care can improve key metrics in oncology quality-of-care, and improve cost effectiveness. Further delineation of the outcomes compared in a rigorously controlled population will further define the relative clinical benefit and fiscal implications of such interventions.

Urgent palliative care outcomes.

Historical Control (2021-2022)
Pilot (2022-2023)

N
44
55

Hospitalizations
101
52

Deaths
30 (68%)
40 (72%)

Deaths in the Hospital
8 (18%)
5 (9%)

Deaths With Hospice Care
21 (47%)
34 (61%)
“Tell me I’m okay”: A cross-sectional quality-of-life assessment of patients in a breast cancer survivorship program.
Authors: AlKhaifi Muna , Zhang Elwyn , Sadeghi Sarina
Published: September 2024

213

Background:
The number of breast cancer survivors is increasing due to improvements in care and an aging population, leading to an increased need for care that addresses the physical and psychological needs of patients after completion of active treatment. The Sunnybrook Breast Cancer Survivorship Program was established to provide comprehensive evidence-based survivorship care and facilitate the transition to family doctors. Despite rising interest in dedicated survivorship care, there is little consensus regarding which individuals are likely to suffer the most long-term impacts of breast cancer treatment. Factors as varied as age, ethnicity, socioeconomic status, and treatment type can influence Quality-of-Life (QoL) outcomes. This cross-sectional assessment uses mixed methods to evaluate QoL trends in the patient cohort.
Methods:
Current patients of the Sunnybrook Breast Cancer Survivorship Program were asked to complete a baseline information form, as well as the EORTC QLQ-30 and BR-45, two validated measures of QoL for breast cancer patients and survivors. QoL, functional, and symptom domains were calculated from these responses accordingly and analyzed statistically. Patients reported their most bothersome QoL concerns through an open-ended questionnaire, which was analyzed and organized thematically. 99 patients have been recruited to date, of a planned 200.
Results:
We find that sexual health is of importance for this population, with 50 (50.5%) participants reporting sexual activity. Patients under 50 have poorer sexual functioning scores (p<0.01) as well as more issues with body image (p<0.05) than older survivors. Both married and under-50 patients are significantly more likely to have poorer outlooks on the future (p<0.05; p<0.01). Younger patients also tended to have worse role functioning, cognitive functioning, emotional functioning, and social functioning scores, though these differences were not statistically significant. Thematic analysis of qualitative data showed that patients’ chief concerns were the impact that ongoing side effects had on their daily functioning, impact of treatment on body image, disruptions to work and personal relationships, and strong anxiety about potential recurrence.
Conclusions:
While it is understood that younger BC survivors face unique challenges, our findings indicate that these obstacles persist into older age groups. In addition to physical side effects, such concerns as body image issues, social strain, and emotional functioning can drive QoL scores for these patients. Notably, many patients endorsed strong anxiety regarding potential recurrence that affected QoL, and identified dedicated survivorship follow-up as an ameliorating factor. Further research should be conducted into the unique needs of under-50 survivors, as well as the role of recurrence anxiety in impacting QoL.
Barriers to serious illness conversations in patients with advanced cancer: A mixed methods study.
Authors: Hanley Samantha , Cotner Cody , Fenton Anny , Wright Alexi A. , Manz Christopher
Published: September 2024

228

Background:
Serious illness conversations (SICs) are discussions between oncology clinicians and patients with cancer about illness understanding and care preferences. SICs are associated with less intensive and more goal-concordant care near the end of life, but many patients die without an SIC.
Methods:
PATH-SIC is an ongoing, single-center randomized trial (NCT05629065) that enrolls adults without a documented SIC starting a treatment for breast, gastrointestinal, genitourinary, gynecologic, or lung cancers with an expected prognosis of less than one year. The trial examines the effects of clinician- and patient-nudges on SIC documentation within 60 days of patient’s randomization to one of four arms (no nudge, clinician nudge, patient nudge, or both). This embedded mixed methods study recruited patients who still did not have an SIC 60 days from randomization, their caregivers (if present at time of consent) and oncologists. Interviews explored patients’ and caregivers’ 1) experiences with SICs, 2) perceptions about why SICs may not occur, and 3) suggestions to empower others to initiate SICs. Participating oncologists were surveyed by email. We used qualitative content analysis and descriptive statistics to identify themes.
Results:
The study included 44 participants: 19 patients, 10 caregivers and 15 oncologists. Patients had a median age of 63 years, were 63% female and 58% White and 68% had gastrointestinal cancers. Though no patient had a documented SIC, patients and their oncologists often disagreed about whether an undocumented SIC had occurred previously (Table). Patients’ and caregivers’ reported barriers to SICs included patient factors (lack of readiness, desire to maintain hope, focus on the present), clinician factors (perceived discomfort with prognostic disclosure and SICs), and prognostic uncertainty (current disease control, unpredictable prognosis). Patients’ and caregivers’ reported facilitators to SICs included patient- (self-advocacy, SIC readiness), clinician- (comfortable rapport), disease- (progression, worsening symptoms), and family-related facilitators (advocates for the patient to engage in SICs). To increase SICs, patients and caregivers reported greater acceptance of interventions involving a personal touch (e.g. phone call) over automated processes. Oncologist survey responses were brief. They reported SICs were most frequently triggered by disease progression or treatment intolerance, and recommended longer appointment times and written materials to facilitate SIC.
Conclusions:
Patient, caregiver and oncologist feedback on barriers and facilitators to SICs provided useful insights to improve interventions to encourage SICs.

Patient/oncologist dyad (n=16) concordance of prior SICs.

# of dyads

Agreed SIC occurred
7

Agreed SIC did not occur
2

Only oncologist reported SIC
6

Only patient reported SIC
1

Total patient/oncologist dyads
16
Time toxicity faced by patients with advanced cancer across primary cancer sites.
Authors: Duffens Ali , Zhu Shiyun , Shirazi Aida , Liu Raymond
Published: September 2024

268

Background:
Time toxicity, defined as the burden of time for patients interacting with the health care systems, is particularly important for patients with limited life expectancy. Little is known about the relative impact of time toxicity among different cancer types at the end of life. This study examines median contact days for inpatient, outpatient, and home health services among different primary cancer types for patients with advanced cancer with limited prognosis.
Methods:
A retrospective cohort analysis was performed on patients with advanced (stage 4) cancer who died within one year of diagnosis at Kaiser Permanente Northern California between January 1, 2015, and June 30, 2023. Time toxicity was defined as comprehensive contact days with healthcare system over the course of patients’ survival period between cancer diagnosis and death (i.e., contact days divided by survival or contact %). Types of contact included institutional stay (emergency department visit, hospitalization, skilled nursing facility, rehabilitation); outpatient visits (ambulatory care, labs, imaging); and in-home care (home-health, home hospice, telephone and virtual visit). The study quantified overall median contact % and contact % by specific care settings, stratified by cancer primary site.
Results:
The study included 10102 patients. The median age at diagnosis was 74 years with 47% female. Patients were predominantly white (65%), followed by Asian (12%), Hispanic (12%), and black (8%). The median Elixhauser comorbidity score was 4. With the exception of head and neck cancers, most cancers had higher contact % near diagnosis and at end of life (U-shaped curve). Head and neck cancers had the highest percent of patients undergoing surgery (36%) and radiation (52%), which may explain its sinuosity-like curve with a rapid increase of weekly contact % after diagnosis (a small peak), followed by rapid decrease and another increase by the end of their life. Survival days were comparatively long for head and neck cancers (158 days, IQR: 84-265) and short for thoracic (80 days, IQR: 35-166) and upper gastrointestinal cancers (80 days, IQR: 38-173). Malignant hematology patients had notably higher comprehensive contact % (74%, IQR: 47-100) which was driven primarily by emergency room department visits and hospital stays (p<0.001 for all contact types).
Conclusions:
The study highlights the high burden of time toxicity in patients with advanced cancer with limited prognosis. The significant variations in time toxicity among different cancer types, especially in malignant hematology and head and neck patients, emphasize the need to tailor goals of care discussions for patients with cancer at the end of life. By focusing on reducing unwanted time toxicity, healthcare providers can enhance the quality of life for patients with cancer, ensuring more efficient and patient-centered care delivery.