bluuebunny/crossref_metadata_2025 huggingface dataset:
The time toxicity efficacy-effectiveness gap: A population-based study of stage III/IV non-small cell lung cancer (NSCLC) in Ontario, Canada.
Authors: Gupta Arjun , Nguyen Paul , Wilson Brooke E , Booth Christopher M. , Hanna Timothy P.
Published: September 2024

133

Background:
While patients enrolled in clinical trials tend to have superior cancer-specific outcomes relative to those in routine practice (the ‘’efficacy-effectiveness gap’’), it is unknown if this gap extends to time toxicity. While trial protocols can impose additional contact days, trial participants also tend to be healthier, perhaps needing fewer contact days. We sought to evaluate the time toxicity efficacy-effectiveness gap among patients with stage III/IV NSCLC.
Methods:
We created a population-based, retrospective cohort with health administrative data covering the population of Ontario, Canada (15.5 million), of adults aged ≥20 years diagnosed with stage III/IV NSCLC in 2014-2017 and died in 2014-2019, receiving palliative systemic anti-cancer drug(s) as part of a trial. We matched patients 1:1 to those who received the same drug(s) in the real world (post-approval) in the same line of treatment, and received the same total lines of therapy. We calculated contact days (days with healthcare contact outside the home) from diagnosis to death and measured overall survival. We plotted, normalized, and fitted with cubic splines the weekly percentage of contact days to obtain trajectories over the disease course.
Results:
We identified and matched 55 trial participants to 55 patients in routine practice. Trial participants were younger (median age, 62 vs 66 years), had fewer co-morbidities (hypertension, 35% vs 53%), and more often had de novo metastatic disease (82% vs 67%). Median lines of therapy were 2. Systemic therapy regimens most commonly included immunotherapy (n=41, 75%). Trial participants initiated systemic therapy sooner than in routine practice (median 2.0 vs 2.4 months). Trial participants had a longer overall survival (median 13.8 vs 11.6 months) and a similar number of contact days (median 79 vs 78 days). The percentage of contact days was lower in trial participants due to longer survival (median 19% vs 22%). Trial participants had similar acute/assisted institutional care contact days (median 19 vs 18 days), but more days with laboratory tests (median 23 vs 17 days), systemic therapy (median 9 vs 6 days), and radiotherapy visits (median 15 vs 11 days). Normalized trajectories for both cohorts followed a ‘’U-shape’’; the difference between the maximal peak and trough was smaller in trial participants.
Conclusions:
We describe a novel efficacy-effectiveness gap in time toxicity, in addition to the previously established efficacy-effectiveness gap in overall survival. Encouragingly, trial participants did not experience delays in treatment, and initiated treatments sooner than in routine practice. Among trial participants, the higher number of contact days for tests, and the shallower U-shaped curve (indicating frequent visits even when relatively well) indicate potential opportunities to decrease trial-related time toxicity.
The association of disability and medical financial hardship among cancer survivors in the US.
Authors: Katana Ogongo Margaret , Zhao Jingxuan , Zheng Zhiyuan , Han Xuesong , Yabroff Robin
Published: September 2024

136

Background:
Medical financial hardship (MFH) in cancer survivors is well-documented. Little is known about how disability impacts healthcare needs and costs in cancer survivorship. We examined associations of disability and MFH among survivors in the US.
Methods:
We identified cancer survivors ≥18 years with (n=2,795) and without (n=12,263) a disability from the National Health Interview Survey 2019 to 2022. The Washington Group Short Set, a validated six-item measure intended to describe the functional status of adults (e.g. disability in seeing, hearing, or walking) was used to identify those with disabilities. MFH was categorized into three domains: 1) material (e.g. problems paying medical bills), 2) psychological (e.g. worrying about medical bills), and 3) behavioral (e.g. delaying/forgoing care due to cost). Adjusted logistic regressions were used to examine associations of disability and MFH among cancer survivors.
Results:
Cancer survivors with a disability were more likely to experience any MFH (57.2% vs. 47.0%, p<0.05) or any individual domain (Material: 26.4% vs. 13.3%, p<0.05; Psychological: 50.5% vs. 43.0%, p<0.05; Behavioral: 23.2% vs. 12.9%, p<0.05) compared with those without a disability. In addition, survivors with a disability were more likely to report experiencing multiple domains of MFH (29.1% vs. 15.9%; p<0.05).
Conclusions:
Cancer survivors with a disability face higher risks of MFH. Our findings can inform interventions alleviating MFH in this especially vulnerable population.

Association of disability with medical financial hardship among cancer survivors, National Health Interview Survey 2019-2022.

Cancer Survivors with a Disabilityn = 2,795

Cancer Survivors without a Disabilityn = 12,263

AME(95% CI)

AME(95% CI)

Any material financial hardship
26.4(24.7, 28.0)

13.3(12.5, 14.2)

Any psychological financial hardship
50.5(49.1, 52.0)

43.0(42.0, 44.0)

Any behavioral financial hardship
23.2(21.7, 24.7)

12.9(12.0, 13.7)

Any MFH
57.2(55.8, 58.6)

47.0(46.0, 48.0)

1 domain of MFH
57.2(55.8, 58.6)

47.0(46.0, 48.0)

2+ domains of MFH
29.1(27.5, 30.6)

15.0(14.1, 15.8)

Note: In adjusted analyses, covariates included age, sex, race/ethnicity, marital status, education, family income as % of Federal Poverty Level, insurance, year, and survey design; AME=Average Marginal Effect; CI = Confidence Interval.
Association between mammographic screening history and stage at diagnosis among women with screen-detected breast cancer.
Authors: Huang Sida , Westvold Sarah , Soulos Pamela R. , Winer Eric P. , Robinson Timothy J. , Dinan Michaela Ann
Published: September 2024

145

Background:
Although screening mammography is an effective means of detecting breast cancer at earlier stages, some women are still diagnosed with later stage disease despite screening mammography. We hypothesized that screening history prior to diagnosis may impact stage at diagnosis and breast cancer mortality among women with screen-detected breast cancer.
Methods:
Retrospective cohort study of women aged 70+ in the SEER-Medicare database, diagnosed with ER+/HER2- breast cancer from 2010-2017, and enrolled in fee-for service Medicare Parts A and B from 5-years prior to diagnosis through 1 year after. We used validated claims-based algorithms to identify cancers that were detected by screening mammogram. We quantified 5-year screening history by number of prior screens. Stage at diagnosis was dichotomized into very early (T1N0) vs. later stage (T2+ or N+) disease. Multivariable logistic regression was used to assess the association between screening history and stage at diagnosis and Cox proportional hazards used to examine breast cancer mortality. Models were adjusted for demographic and clinical covariates associated with later stage disease in bivariate analyses.
Results:
We included 13,029 women with screen-detected breast cancer; 3,813 (29.27%) women had later stage disease at diagnosis, and 10,095 (77.48%) had at least one prior negative screening mammogram within the past five years. During this time, 2,359 (18.11%) women had only one prior mammogram, 3,132 (24.03%) had two, and 4,604 (35.34%) had three or four. Having at least one prior mammogram was associated with 56% lower odds of being diagnosed with later stage disease (OR: 0.44, 95% CI=0.40-0.48). Sociodemographic factors associated with increased odds of later stage disease included living in an area with greater poverty (20-100% vs. 0-5% of residents, OR: 1.19, 1.00-1.40), non-Hispanic Black race (OR: 1.18, 1.00-1.38), and Medicare/Medicaid dual eligibility (OR: 1.20, 1.06-1.36). Factors associated with later stage disease included living in an area with a more people with a high-school education (30-40% vs. 0-30% of residents, OR: 0.87, 0.77-0.97). At total of 696 deaths from breast cancer were observed, including 273 deaths among 2,935 women with no prior screening (9.3%) and 423 deaths among 10,097 women who had undergone screening within the past five years (4.2%, P < 0.001). Receiving at least one negative screening prior to diagnosis was associated with decreased breast cancer-specific Mortality in adjusted analysis (HR: 0.48, 0.40-0.57).
Conclusions:
The use of prior routine screening mammography was associated with lower risk of being diagnosed with later stage disease and dying from breast cancer in elderly women with screen-detected breast cancer. Future research is warranted regarding the impact of routine vs. sporadic screening on potential morbidity and mortality in this age group.
Asian representation in the United States (US) oncology workforce.
Authors: Go Lewis , Gunaratne Madugodaralalage , Abeykoon Jithma P.
Published: September 2024

152

Background:
The American Society of Clinical Oncology (ASCO) started the Diversity in Oncology initiative in 2017. Minority representation in the US oncology physician workforce was the subject of a recent series of ASCO State of the Oncology Workforce in America snapshots (1). However, Asian minority representation was not mentioned in any of these reports. Our objective was to determine the proportion of Asian workforce in various oncology specialties inclusive of physician and non-physician practitioners as well as physician trainees.
Methods:
We searched the web for publicly available data on Asian representation among US oncology adult (A) and pediatric (P) practitioners and trainees. Major data sources included the 2020 US Census, Association of American Medical Colleges, Accreditation Council for Graduate Medical Education, and professional societies. Practitioners included hematologists/oncologists (H/O), gynecologic oncologists (GYNO), radiation oncologists (RADO), surgical oncologists (SURGO), hematopathologists (HP), oncology nurse practitioners (ONP), oncology physician assistants (OPA), and oncology nurses (ON). Trainees included fellows (F) and residents (R). For reference, we obtained similar data on US population, medical students (MS), adult internal medicine residents (AIMR), gynecology residents (GYNR), pediatric residents (PR), pathology residents (PATHR), surgery residents (SURGR), nurses (RN), nurse practitioners (NP), and physician assistants (PA). For a snapshot of the oncology workforce, data from 2020-2022 were used. Whenever available, we obtained serial data for trainees over the years.
Results:
A snapshot of the proportions of Asians based on their professions is shown (Table). While Asians comprise only 6.2% of the US population, between 14.7% to 32.1% of physician practitioners in various oncology subspecialties are Asian. Moreover, between 17.9% to 35.3% of oncology physician trainees and 26.7% of medical students are Asian and these proportions have remained stable from 2005 to 2022. Data are unavailable for HP, SURGO, and non-physician practitioners except for OPA (7.0%) and RN (7.2%).
Conclusions:
Asians comprise a large segment of the US oncology workforce. While only 1 in 20 people in the US are Asians, between 1 in 3 and 1 in 5 oncology physician practitioners and trainees are Asians. Data are limited for non-physician practitioners. Asian minority representation should be highlighted and considered as an example of success in diversity. 1.
JCO Oncol Pract
2020-2022.

Snapshot of Asian representation among oncology trainees and practitioners in the US.

Trainees
2022
A-H/O-F
35.3%
AIMR
35.9%

2022
P-H/O-F
20.0%
PR
22.0%

2022
RADO-R
26.4%
MS
26.7%

2022
GYNO-F
17.9%
GYNR
14.9%

2022
HP-F
20.0%
PATHR
26.6%

2022
SURGO-F
21.2%
SURGR
19.2%

Practitioners
2021
A-H/O
32.1%
OPA
7.0%

2021
P-H/O
20.4%
RN
7.2%

2021
RADO
25.9%
HP/SURGO/ONP/ON
NA

2020
GYNO
14.7%
US Census
6.2%
The relationship between radiation oncology department NIH funding and institutional community inclusion/investment.
Authors: Awobayiku Oluwatomiwa , Sun Yilun , McClelland Shearwood
Published: September 2024

153

Background:
Disparities in healthcare access and funding allocation persist among racial minorities and low-income populations. Radiation Oncology departments play a crucial role in cancer treatment, yet the extent to which these departments serve historically underrepresented communities following receipt of National Institutes of Health (NIH) funding remains unclear. This study accessed the relationship between radiation oncology departments that are awarded National Institute of Health (NIH) funding and Lown Institute Hospitals Index rankings for community benefit and inclusivity.
Methods:
Radiation oncology departments awarded funding from the NIH from 2019-2021 were retrospectively studied. The 2023 Lown Institute Hospital Index rankings for community benefit and inclusivity were examined. The community benefit metric measures financial assistance spending, community investment spending, and Medicaid as a portion of patient revenue. The inclusivity metric measures the similarities of income, race, and education level between the hospital patient population and the surrounding community. Kendall’s correlation coefficient (tau value) and linear regression were used to evaluate the relationship between measures of community benefit and inclusivity and NIH radiation oncology department research funding.
Results:
Twenty-two radiation oncology departments that received NIH funding (median = $ 419,555.00) were included. A statistically significant positive correlation was observed between the amount of radiation oncology NIH research funding received and institutional rankings for overall community benefit (tau = 0.378; P < 0.034), with a trend towards significance for institutional rankings for community investment spending (tau = 0.497; P < 0.053). No significant correlation was observed between the amount of radiation oncology department funding and institutional rankings for charity care spending (P = 0.430), Medicaid as a portion of patient revenue (P = 0.837), and service of patients from racial and or ethnic minorities (P = 0.505), with low income (P = 0.612), or with lower levels of education (P = 0.700).
Conclusions:
Our study highlights the relationship between recent NIH funding received by Radiation Oncology departments and their commitment to community health and inclusivity. Our findings indicate a significantly positive correlation between NIH funding received by radiation oncology departments and overall community benefit. This suggests that departments receiving NIH funding may be incentivized to allocate resources towards initiatives to improve community health outcomes beyond direct patient care. This study prompts further exploration into the mechanisms through which NIH-funded radiation oncology departments allocate resources and engage with their surrounding communities.
Practices and barriers to cancer care among oncologists for patients with serious mental illness.
Authors: Gupta Bhawna , Moffett Nicholas , Bone Robert , Jeune-Smith Yolaine , Feinberg Bruce A.
Published: September 2024

171

Background:
Serious mental illness (SMI), defined as a mental, behavioral, or emotional disorder resulting in serious functional impairment, that substantially interferes with or limits one or more major life activities, includes schizophrenia, bipolar disorder, and major depression. Patients with SMI and cancer have poor survival rates attributed to inequities in cancer care. Such patients are often diagnosed at an advanced stage and are more likely to have their cancer care interrupted. This study surveyed the general practices oncologists apply to integrate mental health and cancer care in their clinical practice. The study also surveyed perspectives on personalized collaborative care intervention to improve cancer outcomes in patients with SMI while identifying the barriers to adapting such intervention in clinical settings.
Methods:
In February and March 2024, US-based hematologists/oncologists convened at live meetings to discuss abstracts presented at the 2023 ASCO Quality Care Symposium. An online premeeting survey was used to collect participants’ demographics. Participants’ approach to mental health care for patients with cancer were captured via an audience response system during the live meetings. Responses were aggregated and analyzed using descriptive statistics.
Results:
Among 125 participants, 77% were community providers. The majority of participants (60%) reported frequently discussing mental health with their patients with cancer. Respondents support the mental health needs of their patients with cancer by utilizing in-house social workers (52%) or in-house counseling services (31%), or by referring to in-house clinical psychologist (40%) or an external psychiatrist (41%). They identified challenges to integrating mental health care into cancer treatment: lack of dedicated staff (54%), high patient volume (44%), and lack of available psychosocial tools (40%). Additionally, a subset of participants was asked about their perspectives on collaborative care intervention for cancer care of patients with SMI, and while most participants were encouraged, they also reported that mental health services should be coordinated primarily through either a psychiatrist (25%) or a social worker (25%). Interestingly, limited access to psychiatric care (78%) and lack of resources to screen patients for SMI (56%) were the primary barriers to adapting a personalized and collaborative care approach in the real-world setting.
Conclusions:
Participants were inclined to incorporate personalized mental health assessments into routine clinical care for their patients with cancer, however they face several barriers to implementation. Further research is needed to address those modifiable barriers and assess the impact of a personalized and collaborative care approach on timely diagnosis and mitigating inequities in cancer care to improve cancer outcomes in patients with SMI.
Insights into missing populations: Exploring characteristics of unscreened patients with cancer in psychosocial distress and social drivers of health screening in an ambulatory setting.
Authors: Aryeh Brittany , Liu Mark , Snow Alison , Sheng Tianxiang , Mazor Melissa , Jones Tessa , Bhardwaj Aarti Sonia , Besculides Melanie , Smith Cardinale B.
Published: September 2024

174

Background:
Psychosocial distress is common among patients with cancer and distress screening is required for American College of Surgeons Commission on Cancer accreditation. Screenings proactively identify needs, connect patients to services, reduce distress and improve cancer outcomes. We implemented a dynamic 17-question electronic screening tool that includes: assessment for psychosocial distress, social drivers of health (SDH) and spiritual care, and evaluated differences in patient characteristics among those who did and did not complete the survey.
Methods:
The survey was developed through an interdisciplinary review of evidence-based questions to proactively address supportive care needs for patients. It is available in English and Spanish and sent to patients via the patient portal 7 days before the second oncology appointment with a reminder 3 days before the appointment. It was implemented across 5 Mount Sinai Health System ambulatory facilities, spanning 3 New York City boroughs between June 2022 and February 2024. We used descriptive statistics to compare demographic and clinical characteristics of patients who did and did not complete the survey.
Results:
A total of 11,199 patients were assigned surveys; (42%) did not complete it. Patients who did not complete the survey were more likely to be Asian and Hispanic, older age, to speak a language other than English, reside in Queens or Brooklyn, and were less likely to have Commercial insurance compared to those who completed the survey (p<0.001 for all). There was no difference in sex (p=0.93) among the groups.
Conclusions:
There are significant disparities in the completion rates of electronic psychosocial distress and SDH screenings among patients with cancer, revealing that certain groups are less likely to engage with the tool. Targeted strategies are needed to increase screening completion rates among these populations. Future efforts should focus on addressing language barriers, enhancing technological accessibility, and developing culturally sensitive approaches to ensure all patients benefit from these screenings so we can better identify and address the supportive care needs of all cancer patients.

Characteristics of patients who did and did not complete the survey.

Characteristic
Did Not Complete4654 (42%)
Completed6545 (58%)
p-value

Race

<0.001

Black
978 (21)
1538 (23)

Asian
642 (14)
698 (11)

Unknown
225 (5)
258 (4)

Other/Patient Declined
1298 (28)
1461 (22)

White
1511 (32)
2590 (40)

Age (mean (SD))
64 (14)
61 (15)
<0.001

Non English Language
1167 (25)
956 (15)
<0.001
Improving verbal communication for oncology patients who self-identify as having low/marginal health literacy.
Authors: Coletti Erika , Bandanza Lane , Nowak Jessica , Shenoy Indira , Eng Kelly , Donohue Caitlin C
Published: September 2024

177

Background:
Within our academic oncology institute, patient’s health-related social needs (HRSN) are identified through the new patient intake questionnaire (NPIQ). 28% (n=2787) of patients who completed the NPIQ (n=9836) reported low/marginal health literacy (HL). While reviewing the HRSN data, it was discovered that there was no formal process to support patients who reported having low/marginal HL. While printed and online health materials use standard reading levels, verbal communications are not individualized to patients’ literacy needs. As an integral member of the interdisciplinary team, Oncology Nurse Navigators (ONNs) communicate vital and complex health information with patients throughout the cancer continuum. This quality improvement project explored the impact ONNs could have with patients who self-identify as having low/marginal HL.
Methods:
To assess ONN HL knowledge and communication strategies for patients with low/marginal HL, a survey was conducted in March 2024. Findings revealed a HL knowledge gap across all disease programs. For project manageability, our team piloted HL interventions to the sarcoma disease group where 33% of patients (n=223) responded to the NPIQ as having low/marginal HL. Two-part intervention included: 1) creation of a HL training and tools for ONNs (e.g., teach-back method; scripting; reference materials) and 2) development of Epic Smartphrase acknowledging training and tools were utilized.
Results:
To understand ONNs knowledge of where to find patient HL score in Epic, we conducted a survey (n=69; response rate=43%). 94% of ONNs reported not knowing where to access HL information. The first intervention was training-based. ONN trainings (n=2) were held from 3/12/2024 to 5/14/2024. At baseline, 0% of ONNs (n=4) used HL tools, as they were not in existence. At first reassessment, 75% of ONNs reported using the HL tools to communicate with patients. Part two of the intervention (in-progress) is the creation of a Smartphrase to document when ONNs altered patient communication. Data on Smartphrase usage are forthcoming.
Conclusions:
Providing HL training and tools to ONNs equips them to 1) identify patients who have low/marginal HL, and 2) conduct conversations with patients at an appropriate literacy level.
Ensuring precision medicine for veterans with lung cancer: A randomized clinical trial.
Authors: Thomas Mikalah , Banks Lakedia Charman , Das Millie , Das Millie , Patel Manali I.
Published: September 2024

178

Background:
National guidelines recommend molecular testing for patients with non-small cell lung cancer, yet this is not routinely completed in practice. In prior work, we identified barriers to testing in the Veterans Affairs. First, physicians are unaware if and when testing has occurred. Second, patients are unaware of testing and the implications on treatment and clinical outcomes. In response, in collaboration with a Veteran and Caregiver Advisory Board, we created a multilevel intervention led by a peer volunteer who: 1) provides tailored education of molecular testing for 1 month for Veterans newly diagnosed with lung cancer and, 2) alerts clinicians via secure messaging if tumor samples have not been tested. We conducted this randomized clinical trial to assess whether the intervention improves patient knowledge of molecular testing and patient activation and increases receipt of molecular genomic testing compared with usual care.
Methods:
All veterans >18 years old with a new diagnosis of any stage non-small cell lung cancer were eligible. Exclusions included inability to consent. All participants completed baseline assessments at randomization and at 1-month follow-up comprised of a 3-question validated precision medicine knowledge questionnaire and a 13-question validated patient activation measure. Genomic testing was assessed by chart review at 6-months follow-up. We used regression models to assess differences in mean knowledge and activation scores over time between groups and compared rates of genomic testing.
Results:
75 Veterans were screened with 46 eligible. All 46 consented to participate, with 23 in each group. All were male (100%), had mean age of 76.3+/-5.54 years; 31 (67.4%) were Latinx; 2 (4.4%) Asian; 11 (23.9%) Black; 1 (2.2%) Native Hawaiian; 32 (69.6%) White; 32 (69.6%) had Stage 4 disease. At 1 month follow-up mean knowledge scores increased over time in the intervention group and remained stable in the control group (mean score 2.30 +/- 0.97 versus 1.16 +/- 1.15, p=0.014). At 1-month follow-up, patient activation increased for the intervention group more than the control group (46.7 +/- 11.3 versus 37.6 +/- 9.26, p=0.002). There were no significant differences in tumor testing between groups (intervention: 95.6% versus control: 86.9%, p=0.62) or time to first treatment course from biopsy (intervention: 28.2 days versus control 36.2 days).
Conclusions:
A volunteer led effort improved patient education regarding precision medicine and patient activation among Veterans as compared with usual care alone. Interventions that include volunteers and other support can enhance care and clinical outcomes among veterans with lung cancer.

Clinical trial information:
NCT05795959

.
Enabling patients with health-related social needs.
Authors: Osborne Evan , Wilfong Lalan S. , Genetti Marsie , Christman Amanda
Published: September 2024

183

Background:
Addressing health-related social needs (HRSNs) is essential to help ensure patients surviving cancer achieve optimal outcomes. Socioeconomic and environmental insecurities can make it challenging for patients to successfully complete their treatments. The US Oncology Network (The Network), has partnered with Findhelp, a resource facilitation tool enabling anyone with internet access to connect with community-based organizations providing discounted or free social services to meet resource needs. This alliance enables an enhanced level of assistance for patients in need, supporting optimal outcomes for those disadvantaged by various circumstances, such as HRSNs impacted by social drivers of health (SDoH).
Methods:
Beginning April 25
th
, 2024, patients utilizing Navigating Cancer’s patient portal, across 302 community-based oncology clinics serving nearly 500,000 patients annually, could access information through a Findhelp website unique to practices in The Network. The investigators are collecting engagement data based on click rates to the Findhelp website link via the patient portal, the number of unique visitors to The Network’s Findhelp application, and the county, city, and zip code of users accessing the application. Data from the Findhelp website will be assessed to determine which insecurity categories (i.e. food, housing, goods, transit, health, money, care, education, work, legal) and areas across the nationwide network of practices receive the highest engagement, and if there is variability based on subgroup analyses. The subgroup analyses will be performed based on patient demographics and include age, gender, race, and geographic location.
Results:
Initial retrospective results from this prospective study reveals the average number of searches by patients prior to go-live was 106/day. Post go-live averages have been 4,369/day, a 4,037% uplift in engagement. Top searched needs have been health (26.5%), food (22.3%), and housing (21.1%). Additional data elements are being derived from aggregated, de-identified patient engagement and search activity by geographic location categorized by resource insecurity.
Conclusions:
Conclusions are being drawn based on outcome measures and cross walking with search and referral activities. The goal of the collaboration is to increase awareness of technologies and local organizations within communities bridging the resource gap by way of facilitating services through the Findhelp platform; ultimately empowering patients to overcome health-related social needs and barriers to care leading to improved access.
Early palliative care involvement in gastrointestinal malignancies: A community cancer center perspective.
Authors: Hwang Min Woo , Curtis-Romonchuk Shairna , Dvergsten Erik , Pierattini Chiara , Karovic Sanja , Wadlow Raymond Couric
Published: September 2024

198

Background:
Early involvement of palliative care (PC) specialists enhances quality of life for patients with advanced gastrointestinal (GI) cancer.
Methods:
This retrospective study evaluated patients with newly diagnosed stage III and IV GI cancer seen at a large community cancer center between 10/1/22 and 9/30/23. We compared patients seen by a PC provider in clinic at least once to those without an outpatient PC visit within the one-year study period.
Results:
283 patients with stage III/IV colorectal (42%), gastroesophageal (23%), pancreatic (16%), hepatobiliary (12%), and other GI cancers (8%) received care within the study period (Table). Of these, 49 (17%) had at least one PC clinic visit, and 234 (83%) had no PC visits. Patients with pancreatic (35% vs 12%) and hepatobiliary cancer (20% vs 10%) were over-represented in the group receiving PC vs those without PC, while patients with colorectal cancer were under-represented (20% vs 47%). Greater percentages of patients in the group receiving PC completed advanced care planning (ACP) documents (63% vs 24%) and died during the study period (65% vs 15%).
Conclusions:
A minority of patients with GI malignancies at a large community cancer center are seen by an outpatient PC provider during the first year after diagnosis. These patients are more likely to have tumor types associated with worse prognosis, to complete ACPs, and to die within one year. Broader delivery of early PC will require expanded services in community cancer centers and continued development of tools for identifying patients most likely to benefit.

The distribution of gastrointestinal cancer between outpatient palliative care visit and no outpatient palliative care visit.

Primary cancer
PC
No PC
Total

Colorectal
10 (20% | 8%)
110 (47% | 92%)
120 (42% | 100%)

Gastroesophageal
10 (20% | 16%)
54 (23% | 84%)
64 (23% | 100%)

Pancreatic
17 (35% | 39%)
27 (12% | 61%)
44 (16% | 100%)

Hepatobiliary
10 (20% | 30%)
23 (10% | 70%)
33 (12% | 100%)

Other GI
2 (4% | 9%)
20 (9% | 91%)
22 (8% | 100%)

Total
49 (100% | 17%)
234 (100% | 83%)
283 (100% | 100%)

PC: Palliative care.
Prescribing comfort: Understanding pain medication prescribing patterns in cancer care.
Authors: Fernandez Jennifer , Neeb Jessica louise , Wilfong Lalan S. , Indurlal Puneeth
Published: September 2024

22

Background:
Pain management in cancer patients is a crucial aspect of their overall care, aiming to alleviate suffering and enhance their quality of life. However, the involvement of multiple care providers during cancer treatment can lead to complex and varied approaches to pain medication prescribing. This abstract provides a review of pain medication (PM) prescribing patterns for cancer patients.
Methods:
Using prescription, drug administration, and episode data from 2016 to 2022 for 15 physician group practices in The US Oncology Network participating in the Oncology Care Model (OCM), we evaluated the narcotic PM prescribing patterns.
Results:
Of 304,951 episodes for 127,296 unique cancer patients, 38.6% of episodes and 55% of patients had PM prescribed. 35.3% of PM were prescribed by oncology providers, 7.5% by pain management providers. 30.7% of episodes had PM prescribed by an oncology provider only, and 4.8% by a pain management provider only. 41.5% of episodes had PM prescribed by more than 1 provider, and 41.5% episodes had more than 1 PM prescribed. Some prescription patterns are provided (Table). 7 drugs accounted for about 87.5% of the PM prescriptions. However, individual drug choices were considerably different among providers.
Conclusions:
Overall, this review sheds light on the complex landscape of PM prescribing patterns for cancer patients. Oncology providers, by virtue of providing the preponderance of care for cancer patients, also prescribe PM to their patients. Concurrent PM prescribing by multiple providers for cancer patients opens the door for unintended adversities. Despite the complexity of managing cancer related pain, pain management specialists are seldom engaged in managing cancer pain. Different prescribing providers make distinct drug choices and follow different prescription patterns. Evaluating guideline concordance and the knowledge of appropriate pain management strategies among oncology providers is an area for further exploration.

% of PM prescriptions.

Prescription Type

Days’ Supply

Oncology Providers

Pain Management Providers

All Other Providers

All PM Prescriptions

Oral or Topical
1–10 days
26.1%
5.1%
29.4%
26.5%

11–30 days
62.8%
91.4%
45.7%
55.2%

All Other
1.2%
0.8%
1.4%
1.3%

Injectable
9.8%
2.7%
23.5%
17.1%

Drug Name

Hydrocodone + Acetaminophen
27.5%
33.4%
22.3%
25.0%

Fentanyl
15.6%
10.8%
17.4%
16.3%

Tramadol
9.5%
7.7%
16.7%
13.5%

Oxycodone
13.8%
15.8%
9.0%
11.2%

Morphine
11.2%
9.1%
9.7%
10.2%

Oxycodone + Acetaminophen
6.0%
10.0%
5.8%
6.2%

Hydromorphone
5.0%
3.4%
6.0%
5.4%
Baseline characteristics of parents enrolled in ACCL20N1CD: Financial distress during treatment for pediatric acute lymphoblastic leukemia (ALL) in the US.
Authors: Santacroce Sheila Judge , Beauchemin Melissa P. , Ponce Olivia Christine , Ji Lingyun , Ramakrishnan Subhash , Bona Kira , Muñeton-Castaño Yudy , Robles Joanna M. , Allen Kamala , Sung Lillian , Parsons Susan K.
Published: September 2024

220

Background:
Personal costs of childhood cancer can contribute to disparities in health outcomes. The purpose of ACCL20N1CD is to examine trajectories of parental costs and the associated financial distress, cost coping behaviors, and household material hardships (HMH) during treatment for pediatric ALL. Objective is to report baseline characteristics of the parents and their households.
Methods:
The study used a prospective cohort design with repeated measures. Setting was Children’s Oncology Group (COG) practices at National Cancer Institute Community Oncology Research Program (NCORP) institutions. Parents who use English or Spanish, and have children newly diagnosed with ALL treated at COG NCORP practices were eligible. Parents were asked to complete surveys at 3 time points, including baseline (T1; during induction and <7 days after planned induction remission evaluation). Surveys included items about (a) parent socio‐economic status, financial distress measured by 8-item Personal Wellness Scale (PFWS), and cost coping behaviors, and (b) HMH. Factors related to high PFWS scores were evaluated by logistic regression.
Results:
Of 104 evaluable parents, most were female (83.7%), white (65.4%), non-Hispanic (48.1%), partnered (79.8%), > high school diploma (93.3%), used English (84.6%), worked full (48.1%) or part (5.8%) time, and paid for their child’s care with public insurance (57.7%). Median household income=$50,000 (Inter-Quartile Range/IQR 20,000-100,000) for 4 (IQR 4-5) people. Not including wages lost due to caregiving, out of pocket payments for medical care + other ALL-related costs in the prior month >15% of monthly income for 51.9% of households, which is considered financially catastrophic. 24.0% of households lacked food stability; 21% had housing insecurity.
Conclusions:
At baseline, sizeable proportions of parents exhibit high out of pocket costs, high financial distress level, and multiple cost coping behaviors with implications for future health and individual and household quality of life.
Oncologists’ management of non-cancer conditions: An observational study.
Authors: Shah Kanan , Gallagher Grace B. , Chakraborty Nirjhar , Mitchell Aaron Philip
Published: September 2024

23

Background:
Cancer diagnoses introduce layers of complexity for care coordination. Oncologists often find themselves independently managing coincident, non-cancer illnesses. How often oncologists engage in direct management of non-cancer conditions, rather than coordinating with patients' other providers, is not well understood. We examined how often oncologists prescribe medications to manage non-oncologic conditions, as a proxy for assuming primary-care responsibilities.
Methods:
The cohort included all US physicians with a specialty of Hematology-Oncology or Medical Oncology from 2016-2020, available in the Centers for Medicare & Medicaid Services Part D Prescribers dataset. Prescription drugs were categorized as “cancer-directed”, “cancer-related” (eg., opioid pain medications), or “non-cancer” (eg., antihypertensives). Primary outcomes included prescription of cancer-directed, non-cancer, and cancer-related medications. Multivariate logistic regression assessed the association between non-cancer medication prescriptions and provider location, medical school graduation year, gender, and practice affiliation during 2020.
Results:
A mean of 8.3% (median 5.3%, IQR 0% – 12.5%) of oncologists’ prescriptions were for non-cancer medications; this decreased during the study period, falling from 9.5% in 2016 to 7.4% in 2020 (p<0.001 on Kruskal Wallis test for non-parametric data). Providers practicing in the Midwest (aOR 1.3, 95%CI [1.2-1.5]), Southeast (1.5 [1.3-1.7]), and Southwest (1.6 [1.4-1.9]) were more to prescribe non-cancer medications, as were providers who graduated >10 years prior to the end of the study period, most notable in providers graduating 1990–1991 (2.2 [1.9-2.6]). Those at academic institutions (0.7 [0.6-0.8]) were less likely to prescribe non-cancer medications.
Conclusions:
A small but substantive portion of oncologists’ prescriptions are for medications unrelated to cancer care. The downtrend in non-cancer prescriptions may reflect that coordinated co-management of patients with cancer is increasing. The rise in telemedicine and digital health represents an opportunity to establish stronger multidisciplinary care for patients with cancer through hybrid cross-collaboration between primary care physicians and oncologists. This is especially advantageous in regions where in-person integration of physician groups may not be possible. Additionally virtual continuing medical education sessions may aid primary care physicians in managing non-cancer medications for the cancer population.

Trends in oncologists’ prescribing patterns from 2016–2020: Mean per-provider proportion of non-cancer medication prescription (%).

Medication Class
2016
2017
2018
2019
2020

Cancer-Directed
30.4
31.1
32.2
32.7
33.9

Non-Cancer
9.5
8.9
8.2
7.6
7.4
Impact of early onset colorectal cancer on mental and physical health: A comparative analysis of self-reported mental and physical health outcomes using the PROMIS framework in the NIH All of Us Research Program.
Authors: Olusoji Rahman Adesoji , Eun Yong , Osei Noah , Omore Ibrahim , Ahluwalia Meena
Published: September 2024

241

Background:
Patients with early-onset colorectal cancer (EOCRC) have complex psycho-social needs that can impact their overall health and well-being. With the increasing incidence of EOCRC, it is essential to investigate the effects of this diagnosis on patients' mental and physical health. This study uses the Patient-Reported Outcomes Measurement Information System (PROMIS) framework to compare patients' self-reported mental and physical health perceptions with EOCRC and those with late-onset colorectal cancer (LOCRC).
Methods:
We utilized the National Institutes of Health's (NIH) All of Us database Registered Tier Dataset v7, which includes 266,520 participants who agreed to share their EHR information, for analysis. Participants completed PROMIS surveys for physical health (PROMIS-PH) and mental health (PROMIS-MH). We categorized patients with colorectal cancer into EOCRC (age at diagnosis <50) and LOCRC (age at diagnosis >=50) using ICD 9/10 codes. We calculated the raw summed scores for PROMIS-PH and PROMIS-MH for each group. We transformed the raw summed score into a T-score. The study compared scores in EOCRC and LOCRC using the Mann-Whitney U test with a significance level of P<0.05. We used the R programming language in the web-based Jupyter Notebook platform for data analysis.
Results:
Our study revealed 1764 colorectal cancer patients, with 408 cases of EOCRC (mean age of onset: 42.13 years, SD: 7.0) and 1356 cases of LOCRC (mean age: 63.72 years, SD: 8.35). Analysis of PROMIS Global scores showed that EOCRC patients had a mean PROMIS-MH score of 13.90 (SD: 3.42, T-score: 45.8, 95% CI: 38.74-52.86) and mean PROMIS-PH score of 13.95 (SD: 3.38, T-score: 42.3, 95% CI: 34.07-50.53). In contrast, LOCRC patients had mean PROMIS-MH and PROMIS-PH scores of 14.47 (SD: 3.37, T-score: 48.3, 95% CI: 41.05-55.55) and 14.24 (SD: 3.35, T-score: 44.9, 95% CI: 36.47-53.33), respectively. The PROMIS-MH scores were significantly higher in LOCRC than in EOCRC (p-value <0.001). However, there was no significant difference between the PROMIS-PH scores in both groups (p-value= 0.191).
Conclusions:
The study suggests that patients with EOCRC have a lower level of perceived mental health compared to LOCRC. Also, the EOCRC had a lower level of perceived physical health, although not statistically significant. These findings emphasize the significance of age-specific approaches in cancer research and underscore the importance of focused interventions to meet the unique mental and physical health needs of patients with EOCRC.
Association between malnutrition risk and healthcare utilization in a culturally diverse sample of ambulatory patients with cancer.
Authors: Lopez-Pentecost Melissa , Natori Akina , Sookdeo Vandana Devika , MacIntyre Jessica , Calfa Carmen Julia , Schlumbrecht Matthew , Penedo Frank J. , Crane Tracy E.
Published: September 2024

254

Background:
Malnutrition is prevalent among cancer patients placing them at an increased risk for treatment-related complications and poor clinical outcomes. This study investigated the relationship between malnutrition risk and healthcare utilization in a diverse sample of adult ambulatory cancer patients from the Sylvester Comprehensive Cancer Center.
Methods:
A retrospective analysis was conducted with data collected through the
My Wellness Check
(MWC), an electronic health record (EHR)-based assessment. Malnutrition was assessed through the NUTRISCORE, an integrated and validated nutritional screening tool within
MWC
that evaluates self-reported weight loss, appetite, cancer type, and treatment modality to assess risk of malnutrition. A NUTRISCORE greater or equal to 5 is considered malnutrition risk. Time to an emergency room (ER) visit and hospitalization were calculated in days from the first
MWC
questionnaire assignment and the first event, respectively. All ER visits and hospitalizations in the University of Miami Health System, self-reported patient demographics, and clinical characteristics were captured from the EHR. Uni- and multi-variate logistic regression models were used to examine factors associated with malnutrition risk. For survival analyses, the Kaplan-Meier method was used to calculate the cumulative incidence function of events and the cox proportional hazards regression models adjusting for patient demographics and clinical characteristics.
Results:
A total of5,984 ambulatory patients completed the
MWC
assessment between October 2019, and August 2023, with 31.2% (n=1,868) identified at malnutrition risk (NUTRISCORE ≥5). Patients were predominately White (n=5,092, 85.2%), and Hispanic (n=2,341, 39.1%). Hematologic cancer was the most common diagnosis (n=1284, 21.5%) followed by malignancies in digestive system (n=903, 15.1%) and male genitourinary (n=892, 14.9%). After adjusting for covariates, patients at malnutrition risk were at significantly higher risk for both ER visits (HR 1.57, 95% CI; 1.29 - 1.91, p<0.0001) and hospitalizations (17.4% vs. 7.4% at 100 days, p<0.0001) compared to those with low malnutrition risk. Factors associated with malnutrition risk included Hispanic ethnicity (aOR 1.17, 95% CI; 1.01-1.35), fatigue (aOR 1.62, 95%CI; 1.07-2.45), declined physical function (aOR 1.75, 95% CI;1.37 - 2.24), physical inactivity (aOR 1.20, 95%CI;1.04 - 1.38) and low HRQOL (aOR 2.48, 95%CI; 1.93-3.19).
Conclusions:
Malnutrition was associated with higher healthcare utilization in a diverse sample of ambulatory cancer patients. Hispanic ethnicity and worse PROs are factors associated with higher risk for malnutrition. Results from this work underscore the need of early nutritional interventions to prevent malnutrition and improve clinical outcomes.