bluuebunny/crossref_metadata_2025 huggingface dataset:
Health literacy screening in pediatric oncology and stem cell transplant caregivers: A cross-sectional cohort study.
Authors: Foti Alycia R , Beauchemin Melissa Parsons , Yao Yujing , Jin Zhezhen , Kahn Justine
Published: September 2022

155

Background: Despite advances in childhood cancer outcomes, disparities among socially vulnerable populations persist. Associations between educational attainment, English proficiency and outcomes suggest that factors impacting communication and comprehension may contribute. Health literacy (HL) is the degree to which individuals can process and act on health information. It is reported that up to 35% of adults in the U.S. have limited HL, with prevalence rising to 50% in those from low-income households. While studies from medical oncology report associations between limited HL and inferior outcomes, there remains a paucity of data on HL rates and associated outcomes in pediatric oncology and stem cell transplant (SCT) populations. We evaluated HL rates in a group of pediatric oncology and SCT parents/caregivers at a large academic medical center, and explored associations with self-reported demographics. Methods: English or Spanish-speaking parents of children (1 – 18 years) receiving chemotherapy or SCT were eligible. Self-reported sociodemographics were collected via survey, and HL was measured via bilingual interview using the Newest Vital Sign screening tool. Scores indicating likelihood of limited (0 – 1), moderate (2 – 3) and high (4 – 6) literacy were calculated and associations between HL, demographics, social determinants of health, and clinical characteristics were explored. Results: In total, 48 caregivers had evaluable HL and demographic data; 33% were Hispanic, 27% were non-Hispanic Black, and 25% were Spanish speaking only; 53% had public insurance, and 12% did not complete high school. Forty-four patients (90%) had cancer, 51% of whom had leukemia or lymphoma. Mean HL score was 3.27 (+/- 1.90). Nine caregivers (18%) had limited HL, 18 (37%) had moderate HL, and 21 (43%) had high HL. When comparing the limited/moderate HL group to the high HL group in univariate analysis, a significantly higher proportion of those in the limited/moderate group were Spanish speaking only (p = 0.035), received less than a high school education (p = 0.002), were unemployed (p = 0.038), and endorsed material hardship (e.g., food insecurity) (p = 0.001). Across all participants, 69% sought information about their child’s diagnosis from providers, and 55% sought information from the internet. Conclusions: Among this diverse population of pediatric oncology and SCT caregivers, over 50% are at risk of limited HL. Univariate models indicate that limited literacy is associated with Spanish language preference, low educational attainment, and material hardship, however larger patient numbers are needed to evaluate adjusted associations. Analyses measuring the contribution of HL to clinical outcomes are ongoing, with early results indicating that interventions addressing both material hardship and limited literacy are urgently needed.
The association of limited health literacy with frailty, health-related quality of life (HRQoL), and health care utilization among older adults with cancer: The CARE Registry.
Authors: Stephenson Coryn , Dai Chen , Harmon Christian , Fowler Mackenzie Elisha , Giri Smith , Outlaw Darryl Alan , Hollis Robert , Bhatia Smita , Williams Grant Richard
Published: September 2022

157

Background: Health literacy (HL) is a patient’s ability to obtain, process, and understand health information. Limited HL can act as a barrier to communication and access to medical treatment and lead to poor identification and management of comorbid conditions, resulting in frailty and impaired HRQoL; these issues remain unstudied in the geriatric oncology populations. We aimed to (1) describe the prevalence of limited HL; (2) examine the association between limited HL and frailty, HRQoL and healthcare utilization in older adults with cancer. Methods: The CARE registry prospectively enrolls older adults (≥60y) with cancer seen at UAB. Patients complete a patient-reported geriatric assessment. A single-item screening measure of HL (Stagliano et al. JABFM 2013) was also completed by the participants. Frailty was defined using the 44-item CARE frailty index (based on deficit accumulation). Multivariable analysis examined association of limited HL with CARE frailty index, HRQoL, and health care utilization, adjusting for age, race, sex, education, cancer type/stage and treatment phase. Results: The cohort included 475 participants with a mean age at enrollment of 69.4y; 61.9% were male; 18.9% were non-Hispanic Black. The most prevalent cancer types included colorectal (34.9%), pancreatic (17.5%) and hepatobiliary (11.4%) cancers. The prevalence of limited HL was 33.3%. Participants with limited HL were less educated (< HS: 23.4% vs. 4.7%, p= 0.01), older (71 vs. 68.5 years, p< 0.001), more likely to self-report as Black (26.6% vs. 15.1%, p= 0.009), and disabled (19.6% vs. 11.7%, p< 0.001). Patients with limited HL had a higher prevalence of frailty (57.6% vs 22.1%, p< 0.001) and hospitalizations (57.0% vs 45.4%, p= 0.036), as well as lower physical (39.5 vs. 46.4 p< 0.001) and mental (42.9 vs. 49.2 p< 0.001) HRQoL. In multivariable analysis, older patients with limited HL had 3.9 higher adjusted odds (aOR) of frailty (95% CI 2.4-6.3), worse physical (aOR 2.2, 95%CI 1.4-3.6) and mental (aOR 3.2 95%CI 2.0-5.2) HRQoL, and increased hospitalizations (aOR 1.8 95% CI 1.2-2.8), compared to those with adequate health literacy. Conclusions: Older cancer patients with limited HL had higher adjusted odds of frailty, lower physical and mental HRQoL scores, and higher odds of a recent hospitalization. Interventions to address limited HL should be explored in this vulnerable and growing cancer population.
Understanding the barriers and experiences of veterans with lung cancer.
Authors: Lopez Christopher , Murillo Ariana , Das Millie , Patel Manali I.
Published: September 2022

160

Background: Veteran populations have higher lung cancer incidence and lower overall survival rates than non-veterans. Despite clinical advancements in lung cancer which reduce lung cancer death rates and access to care, many Veterans face barriers in receipt of such guideline-based care due to many factors including complex comorbidities, low health literacy, and significant economic and social disadvantages. In fact, the underrepresentation of Veterans in clinical trials confer even more difficulty to ensure cancer treatment and prognosis thoughtfully considers their unique challenges and needs. Few studies have evaluated Veterans’ perspectives regarding unmet needs and potential solutions to address equitable care delivery among these populations. The objective of this study was to evaluate Veterans’ perspectives regarding their lung cancer care to identify modifiable barriers that could be addressed to improve care. Methods: We conducted semi-structured interviews with fourteen Veterans diagnosed with lung cancer at the VA Palo Alto Health Care System. All interviews were recorded, transcribed and analyzed interviews using the constant comparative method of qualitative analysis. Results: All participants noted the main barrier to lung cancer care was transportation with inadequate financial coverage for gas and extensive commutes that contributed to significant anxiety and stress regarding their cancer care. Participants noted challenges in navigating the health system and suggested better understanding of the structure and function of cancer care team members to overcome these barriers. Participants noted difficulty comprehending and interpreting their cancer prognosis and were unaware of advance directives. All participants were unaware of precision medicine, namely molecular tumor testing or genomic cancer sequencing and its implications on their treatments. Conclusions: This study revealed critical gaps in lung cancer among Veterans in one VA facility. Targeted solutions should be considered to address barriers identified which include transportation access, proactive distress management, and knowledge regarding lung cancer care delivery.
The concerning disaggregation of gender disparity and racial disparity investigation at recent ASCO annual meetings.
Authors: Gardner Ulysses Grant , McClelland Shearwood
Published: September 2022

164

Background: There has been a recent emphasis in the peer-reviewed oncology literature on examining disparities by gender. Such emphasis provides an excellent opportunity to provide parallel disparities analysis. The degree to which gender disparities research has been performed concomitantly with racial disparities research at prominent oncologic societies has yet to be investigated. Methods: Abstracts presented at the American Society of Clinical Oncology (ASCO) annual meeting, the largest worldwide clinical oncology conference, were reviewed. Highly-valued abstracts selected for the elite oral abstract or clinical science symposium sessions at the 2020, 2021, and 2022 annual meetings were stratified to determine the amount of gender disparities research presented. Such research was then further assessed to determine whether racial disparities were examined simultaneously. Results: From 2020-2022, a total of 1,217 abstracts were presented at the ASCO annual meetings oral abstract or clinical science symposium sessions. Of these, seven involved gender disparities examination, of which only two (29%) concomitantly examined race. No study since 2020 concomitantly examined gender and racial disparities. Conclusions: More than 70% of elite gender disparities work presented at ASCO has been disaggregated from concomitant racial disparities examination, with complete disaggregation since 2021. Gender disparities work remains a miniscule aspect of the overall elite research landscape. Future work in examining gender disparities may be best aggregated with racial disparities in order to optimize timely solutions in both areas; such work could potentially be incentivized by stipulations of future funding mechanisms.
Racial disparities in access to prescription medications among American patients with cancer.
Authors: Midha Manav Dev , Votruba Mark Edward
Published: September 2022

173

Background: Though the associations between Black race and increased rates of financial toxicity, as well as Black race and reduced cancer survival, are well-established, further exploration of the mechanisms connecting these two phenomena is required. One channel that has not yet been explored regards access to necessary medications. Cancer may cause financial toxicity, which in turn may reduce patients’ abilities to obtain their required medications, further exacerbating the quantity and/or intensity of medical conditions. In this study, we investigate self-reported access to prescribed medications in the ten cancers with greatest incidence in the United States, regressing on Black race while controlling for covariates. Methods: From the National Health Interview Survey (NHIS) from 2000 – 2020, we extracted data on Breast, Prostate, Lung, Colon, Melanoma, Bladder, Lymphoma, Kidney, Uterine, and Pancreatic cancers. The key outcome measure of financial toxicity used was the NHIS entry “needed but couldn’t afford prescription medicines, past 12 months,” a dichotomous variable. Multivariable logistic regressions on being Black (with reference variable White), controlling for sex (except for in Prostate and Uterine cancers), age first diagnosed with the cancer of interest, having an undergraduate degree, United States citizenship, having annual income greater than $50,000, having health insurance, and year of survey, were run in RStudio (Version 2021.09.1), separately for each cancer. Alpha was set at p < 0.05. Results: In the following six cancers, Black individuals were significantly more likely to not have been able to afford a needed prescription medicine in the last 12 months: Breast (OR = 2.05, p < 0.001, n = 7328), Prostate (OR = 2.91, p < 0.001, n = 4782), Colon (OR = 2.21, p < 0.001, n = 2330), Melanoma (OR = 6.58, p < 0.001, n = 2780), Lymphoma (OR = 2.29, p = 0.004, n = 1202), and Uterine (OR = 1.66, p = 0.030, n = 1640). Conclusions: Financial toxicity-induced disparities in access to prescription medications permeate six of the ten most common cancers in the United States. Given the self-reinforcing feedback loop nature of cancer-related financial toxicity, missing needed medications, and economic standing, particularly for Black patients, there is an urgent need for public investment in programs targeted at increasing prescription medication access. Such policies could substantially reduce racial disparities in American oncology. Future research should include additional biological covariates (such as disease severity) and further address the social determinants of health.
Goals-of-care and serious illness conversations for patients with cancer with inpatient mortality.
Authors: Lee Julie Jiyun , Wheless Margaret , Domenico Henry , Martin Barbara , Bennett Marc , Green Jennifer Kiser , Agarwal Rajiv
Published: September 2022

184

Background: Goals-of-care (GOC) and serious illness conversations are an integral part of personalized cancer care, particularly toward the end of life (EOL). Eliciting patients (pts)’ preferences and values facilitates informed decision-making throughout the disease course and enables oncologists to provide patient-centered care. Many aspects of GOC discussions and advance care planning (ACP) are inadequately understood, particularly during transitions of care when pts are hospitalized. Methods: We administered surveys to inpatient and outpatient medical oncologists of pts who died while hospitalized from 5/1/2020 to 5/31/2021. Survey items included oncologists’ knowledge of inpatient death, anticipation of pt death within six months of admission, recollection of GOC discussions taking place, and perceived barriers to GOC discussions. To better characterize EOL planning for these pts, retrospective data was collected to identify documentation of GOC discussions, advance directives, and hospice consideration in pts’ electronic health records. Results: For 75 cancer pts who died while hospitalized, 158 surveys were electronically administered with 104 responses (response rate: 66%). Pts characteristics: median age 62 (range 25-89); 63% men; 79% white; median length of hospital stay 7 days (range 1-45). Primary cancer disease type varied: 26.7% gastrointestinal, 18.7% non-small cell lung, 14.7% hematologic, 10.7% sarcoma, 9.3% genitourinary, and 19.9% other cancers. Of 104 completed surveys, responses were received from 40 inpatient and 64 outpatient oncologists. 81 oncologists (77.9%) were aware of the pt’s death prior to survey communication, 68 (65.4%) anticipated the pt’s death within six months of admission, and 67 (64.4%) recalled having a GOC discussion prior to or during the terminal hospitalization. Only 21.3% of pts had documented GOC discussions prior to admission, 33.3% had advance directives, and 22.7% had prior documentation of hospice consideration. Oncologist-reported barriers to GOC discussions included unrealistic expectations from pts or family (25%) and inability for pts to participate due to their clinical condition (15%). Oncologists commented on lack of time, lack of communication between inpatient and outpatient teams, and discordance among multiple inpatient providers as additional barriers. Conclusions: Most oncologists recalled having GOC discussions and anticipated six-month mortality for cancer pts who died while hospitalized. However, documentation of ACP and serious illness communication remained sub-optimal. Ongoing analyses are examining potential associations between patient, provider, and patient-provider relationship factors and oncologists’ survey responses. Addressing barriers to serious illness conversations across different healthcare settings is crucial to providing high-quality EOL care for cancer pts.
Patients' perceptions of treatment benefits and correlation with end-of-life quality markers in advanced malignancy.
Authors: Garg Neha , Patell Rushad , Dodge Laura E. , Miller Eric James , Halleck Jennifer , Einstein David Johnson , Buss Mary K.
Published: September 2022

188

Background: High-quality end-of-life (EOL) care is a recognized goal for modern cancer care delivery. Illness perception is often inaccurate among patients with cancer and may be associated with the quality of EOL care. We surveyed patients receiving palliative cancer-directed therapies to assess associations between accuracy of perceived likelihood of treatment response and recognized EOL quality measures in a cohort of patients with advanced solid malignancies. Methods: Patients and their oncologists were surveyed regarding perceived benefits of palliative cancer-directed therapies. Accuracy of perception was calculated as patient-assessed minus physician-assessed likelihood of benefit, expressed as a score from -100 to 100, with positive scores indicating that the patient was more optimistic than the oncologist with regards to treatment response. For deceased patients, data on quality of EOL measures, including timing of recent chemotherapy, emergency room (ER) visits, hospitalizations, and intensive care unit (ICU) admissions, hospice enrollment, and location of death were collected. The primary outcome consisted of a composite of ER visit, hospitalization, or ICU admission within 30 days, and/or chemotherapy within 14 days of death. We tested for associations between the unadjusted mean and 95% confidence interval perception of treatment response and EOL metrics. Results: Of 69 patients, median age was 67 years (interquartile range: 61-75), and 50% were male. Cancers included lung (32%), gastrointestinal (22%), genitourinary (16%) and gynecological (16%). Treatments at time of enrollment included cytotoxic chemotherapy (65%), immunotherapy (23%) and oral targeted therapy (12%). Most patients (67%) enrolled in hospice > 7 days prior to death, and 59%, 19%, and 46% were hospitalized, had ICU admission, or an ER visit within 30 days of death, respectively. 12% received cancer-directed systemic therapy in the last 14 days of life. Patients’ accuracy of estimated treatment response was lower for patients with the composite quality outcome, suggesting poorer EOL quality, though this was not statistically significant (20.5, 95% CI: 12.4–28.7 vs. 28.5, 95% CI: 18.0–38.9, p = 0.24). Patients enrolled in hospice > 7 days before death had less accurate perception of treatment benefit (28.1, 95% CI: 20.5–35.8 vs. 13.5, 95% CI: 2.5–24.4, p = 0.03). There was no significant difference for other individual EOL quality measures (all p≥0.17). Conclusions: In this cohort of patients with advanced solid cancer, higher EOL quality measures did not correlate with accuracy of perception of treatment responses. Patients who were more optimistic compared to their treating oncologists were more likely to be enrolled in hospice for > 7 days before death. Improving EOL care for patients with advanced cancer requires more than ensuring accurate patient understanding of treatment goals.
Methylene blue for the treatment of oral mucositis related to radiation therapy of head and neck cancers: An uncontrolled cohort.
Authors: Roldan Carlos , Koyyalagunta Lakshmi , Rosenthal David Ira , Warner Keith , Feng Lei
Published: September 2022

194

Background: Oral mucositis is a feared complication of radiation therapy of head and neck cancers, causing severe pain that affects oral functioning, nutrition, and quality of life, as well as therapy non-adherence or failure. Growing reports suggested that methylene blue (MB) oral-rinse was an effective and safe treatment for this oral pain. Methods: In order to evaluate the efficacy and safety of MB oral-rinse for the treatment of oral pain from mucositis in patients treated with radiation therapy of head/neck, we retrospectively evaluated patients who experienced refractory pain despite conventional therapy. Results: We identified 58 patients who received MB oral-rinse. Most were receiving treatment for squamous cell carcinoma of the tongue (n = 26, 44.83%) and squamous cell carcinoma of the tonsil (n = 14, 24.1%). The most common cancer therapy used was chemotherapy plus radiation (n = 23, 39.66%). The median duration of symptoms was 14 days. The mean NRS pain score before MB oral-rinse therapy was 7.59 (±1.68 standard deviation [SD]; median 8), and after therapy, 2.05 (±2.20 SD; median 2) ( P< 0.0001). The mean oral function scores (ability to talk, chew, and swallow) before MB oral-rinse therapy was 3.55 (±1.33 standard deviation [SD]; median 3.5), and after therapy, 0.52 (±0.86 SD; median 0) (P < 0.0001). Among 58 patients, n = 11; 18.92% had percutaneous feeding tubes placed before using MB oral rinse. Of those, four (36%) were soon removed after pain was controlled using MB. A few patients had PEG tubes inserted despite using MB oral rinse (n = 2; 3.44%), one for malnourishment and another for dehydration. Few adverse events were reported (n = 9, 15.48%) Three patients experienced oral burning sensation during the first-time use. One patient discontinued MB oral-rinse use due to cost of pharmacy compounding charge. Other discontinued it for unknown reason. Conclusions: MB oral-rinse is an effective and safe treatment for refractory pain from oral mucositis related to radiation therapy.
The PaCES (Palliative Care Early and Systematic) Project: Impact of individual components of a multi-faceted intervention on early referral to specialist palliative care.
Authors: Sinnarajah Aynharan , Earp Madalene , Biondo Patricia , Piquette Camille , Vandale Janet , Tang Patricia A. , Kerba Marc , Watanabe Sharon , Tan Amy , Simon Jessica
Published: September 2022

199

Background: Early referral to specialist palliative care can improve, or maintain, symptom and quality of life outcomes that matter most to patients facing life-limiting illnesses. We tested a multifaceted oncologist-facing intervention (Palliative Care Early and Systematic) in the real-world setting of a busy outpatient cancer clinic for its ability to increase the proportion of patients who receive early specialist palliative care (defined as ≥ 90 days before death). Herein, we describe how each component of the multi-faceted intervention, intended to bridge cancer, primary, and palliative care, impacted early use of specialist palliative care among advanced colorectal cancer patients. Methods: Two intervention components were implemented in Calgary, Alberta, Canada’s tertiary cancer centre from January 2019 to June 2020: 1) Adult colorectal cancer patients were referred to a community-based Clinical Nurse Specialist if they failed, or could not receive, first-line chemotherapy, or had high symptom burden (indicated by an Edmonton Symptom Assessment System Revised score ≥ 7); 2) Medical oncologists sent templated ‘Shared Care’ letters to patients’ primary care providers to improve communication, collaboration and role clarity. Results: N = 209 eligible patients died during the intervention period, of whom 57% experienced early referral to specialist palliative care. The median days from referral to death was 130 (IQR: 53-359). Of the 209, 28 (13%) saw the Clinical Nurse Specialist and received Shared Care letters, and all (100%) had early specialist palliative care referral (median 240 days, IQR: 161-359). 21/209 (10%) saw the Clinical Nurse Specialist but had no Shared Care letter. Of these 21, 76% had early specialist palliative care referral (median 197 days, IQR: 96-251). 43/209 (21%) had a Shared Care letter but no interaction with the Clinical Nurse Specialist. Of these 43, 53% had early specialist palliative care referral (median 102 days, IQR: 53-257). 117/209 (56%) did not interact with the Clinical Nurse Specialist or have a Shared Care letter. Of these 117, 45% had early specialist palliative care referral (median 86 days, IQR: 40-204). Conclusions: The Clinical Nurse Specialist was associated with the greatest increase in early specialist palliative care referral; however, the Clinical Nurse Specialist and Shared Care letters combined were associated with even greater (100%) early specialist palliative care use.
Health-related quality of life among metastatic prostate cancer survivors: Comparisons to survivors originally diagnosed with localized disease and men without a cancer history in the United States.
Authors: Zheng Zhiyuan , Shi Kewei , Yabroff K. Robin Robin
Published: September 2022

205

Background: Maximizing health-related quality of life (HRQOL) is an important therapeutic goal for metastatic prostate cancer patients. Moreover, HRQOL measures can inform clinicians about treatment sequelae and aide decision-making. To date, few studies have comprehensively compared HRQOL between metastatic prostate cancer survivors and survivors with localized diseases and men without a cancer history. Methods: The SEER-Medicare Health Outcomes Survey (MHOS) data linkage was used to identify prostate cancer survivors and individuals without a cancer history enrolled in Medicare Advantage plans. Prostate cancer survivors (diagnosed 1988-2017) who completed the MHOS baseline survey (1998-2019) after diagnosis but < 10 years post diagnosis were included, as were men without a cancer history who completed the MHOS in the same years. Survey records were clustered at person-level. 27,829 prostate cancer survivors with 42,277 survey records (metastatic n = 752 with 1040 records) and 784,305 Medicare Advantage enrollees in SEER regions without a cancer history with 1.15 million survey records were identified. Multilevel linear regressions were used to compare HRQOL outcomes, i.e. The Veterans RAND 12 Item Health Survey (VR-12 scores), between metastatic survivors and other survivors, and men without a cancer history. The VR-12 includes 8 health domains: general health, physical functioning, role limitations due to physical and emotional problems, bodily pain, energy-fatigue, social functioning and mental health. All analyses adjusted for age at survey, stage, comorbid conditions, body mass index, race/ethnicity, marital status, socioeconomic status, SEER region, and survey era. Results: Compared to men without a cancer history, prostate cancer survivors were older, had fewer comorbid conditions, were more likely to racial/ethnic minorities, married, and higher socioeconomic status. Compared to men without a cancer history, metastatic prostate cancer survivors were most likely to report worse general health (T-score difference: -6.26, 95% confidence internal [95CI]: -7.14 to -5.38; p <.001), and physical (T-score difference: -4.33, 95CI: -5.18 to -3.48; p <.001) and mental component summary (T-score difference: -2.64, 95CI: -3.40 to -1.88; p <.001), followed by survivors with early stage diseases in adjusted analyses. Results were similar for other HRQOL VR-12 measures. Conclusions: Metastatic prostate cancer survivors experience significantly worse HRQOL than men diagnosed with early-stage disease and men without a cancer history across all domains. Our findings suggest a need for better symptom management and palliative care for men diagnosed with metastatic prostate cancer.
Provider-led advance care planning in community oncology: A successful multidisciplinary quality improvement intervention.
Authors: Mudumbi Sandhya , Owens Leah , Schneider Christy L , Frailley Susan A , Arrowsmith John , Waddell Pam , Vanatta Kim , Bilbrey Larry Edward , Murphy Kathleen L , Blakely L. Johnetta , Schleicher Stephen Matthew , Dickson Natalie R.
Published: September 2022

209

Background: Advanced care planning (ACP) is an important aspect of shared decision making in cancer treatment. Due to its importance, in 2016, Medicare expanded coverage and reimbursement for advance care planning (ACP) services (CPT codes 99497 and 99498). Despite this, ACP has been underutilized in practice. Methods: Tennessee Oncology aimed to increase knowledge and utilization of this service by medical oncologists and advance practice providers and corresponding CPT codes through an educational and quality improvement project. We formed a multidisciplinary team with individuals representing medical oncology providers, palliative care team, billing and accounting, information technology and informatics, nursing, navigation team, and operations. This team created an educational video, incorporating the “PAUSE” framework for addressing advance care planning and its role in community oncology, and details of documentation and billing. We also built in documentation templates into the medical oncology note and created a process to automate the charge capture to avoid additional steps for oncology providers. Results: Prior to this initiative, there was no baseline method to measure ACP and corresponding documentation. After two months of launching our educational video and new documentation templates, 120 documented ACP discussions were completed. ACP documentation was performed by 61 total providers practicing across 16 clinics. Providers completing documentation included both medical oncology (n = 53, 86%) and palliative care (n = 8). Of medical oncology providers, 39 (73%) were physicians and 14 (27%) were advanced practice providers. The three most common cancer diagnoses in ACP encounters were lung (20%), breast (13%), and prostate (8%). Conclusions: This combination of education and automation with multidisciplinary team input helped establish a baseline for ACP measurement that will help identify gaps and improve ACP discussions and documentation in our practice going forward.
Association of pain catastrophizing longitudinally with pain severity and interference in patients with chronic pain and cancer: A CHOIR study.
Authors: Azizoddin Desiree Rachel , Wilson Jenna , Mackey Sean , Flowers Kelsey Mikayla , Darnall Beth , Edwards Robert , Schreiber Kristin L.
Published: September 2022

213

Background: Understanding how psychosocial factors change during cancer and affect chronic pain outcomes may help identify potential interventional targets. This longitudinal cohort study of cancer patients investigated the relationship between changes in psychosocial factors and worsened pain severity and interference over time using the Collaborative Health Outcomes Information Registry (CHOIR) dataset. Methods: Data from patients with cancer and chronic pain (n = 316) treated at a tertiary pain clinic were prospectively collected. At their initial visit (baseline; Time 1), patients provided demographic and clinical information, and completed validated psychosocial and pain assessments. Psychosocial and pain assessments were repeated at Time 2, on average 4.9 months later. Change scores (Time 2-Time 1) were computed for psychosocial and pain variables. Multivariable hierarchical linear regressions assessed the associations between changes in psychosocial factors with changes in pain outcomes over time. Results: Participants had an average age of 59, were 61% female, and 69% White. Overall, a decrease in pain severity ( p≤.001), but not pain interference, was observed among the group from T1 to T2. Increased pain catastrophizing was significantly associated with increased pain severity over time (b= 0.24, p≤.001). Similarly, increased pain catastrophizing (b= 0.21, p≤.001) and increased depression (b= 0.20, p≤.003) were significantly associated with increased pain interference over time. Demographic and clinical characteristics were not significantly related to changes in pain outcomes. Conclusions: Increased catastrophizing was uniquely associated with increased chronic pain severity and interference. Future interventional studies investigating the utility of nonpharmacological approaches that address psychological processes, like catastrophizing, for patients with cancer and chronic pain are needed.
A pilot intervention to improve health insurance literacy and financial toxicity among recently diagnosed adolescents and young adults with cancer.
Authors: Kirchhoff Anne C. , Mann Karely , Waters Austin R. , Kaddas Heydon K. , Perez Giselle K. , Warner Echo L. , Vaca Lopez Perla L. , Ray Nicole , Chevrier Amy , Allen Karlie , Fair Douglas Beaty , Tsukamoto Tomoko , Lewis Mark Andrew , Haaland Ben , Park Elyse R.
Published: September 2022

218

Background: Adolescents and young adults (AYAs; ages 18-39) with cancer report worries about costs and feeling uninformed about their insurance, which may impair their ability to navigate the health care system, use their insurance, and manage costs. We conducted a pilot randomized controlled trial (RCT) to assess a virtually delivered health insurance navigation intervention (“CHAT”) to improve health insurance literacy (HIL) and knowledge, increase awareness of insurance protections in the Affordable Care Act (ACA), and reduce financial toxicity and stress. Methods: CHAT is a 4-session program delivered by a patient navigator. Session content included learning about insurance, navigating your plan, insurance-related laws, & managing care costs. Eligible participants had access to a wireless device, were within their first year of cancer diagnosis, and were treated at oncology sites from the University of Utah Healthcare and Intermountain Healthcare systems. We assessed feasibility and preliminary efficacy of CHAT compared to usual navigation care, including HIL (9 items on confidence using insurance), insurance knowledge (13 items on terms such as deductible & copay), ACA protections (8 items), Perceived Stress Scale (PSS; 4 items), and COmprehensive Score for financial Toxicity (COST; 11 items) using t-tests. Results: From November 2020 to January 2022, 86 AYAs enrolled (46.2% approached consented); 68.6% were female, 72.1% white, 18.6% Hispanic, 34.9% age 18-25, 65.1% age 26-39, 83.7% had private insurance, and 10.5% public. Mean baseline HIL scores were 22.6 (range = 9-33, SD = 5.5). At baseline, 65.1% of participants were unaware of the ACA provision allowing appeals for coverage denials. 64.4% of intervention participants completed all 4 sessions; 86.0% completed the 5-month follow-up survey with data collection ongoing (74/86). At follow-up, compared to usual navigation care, CHAT participants had improvements in HIL, knowledge of insurance, and knowledge of ACA provisions (Table). While PSS improved more for CHAT than usual care, COST did not differ. Conclusions: Results support the feasibility and preliminary efficacy of CHAT with related improvements in HIL and knowledge of the ACA. Clinical trial information: NCT04448678. [Table: see text]
Impact of the Cancer and Aging Research Group (CARG) chemotherapy toxicity (tox) risk score on the benefit of a geriatric assessment–driven intervention (GAIN) among older adults with cancer.
Authors: Crook Christiana , Sun Can-Lan , Kim Heeyoung , Soto Pérez de Celis Enrique , Chung Vincent , Koczywas Marianna , Fakih Marwan , Chao Joseph , Cabrera Chien Leana , Charles Kemeberly , Katheria Vani , Trent Monica , Roberts Elsa , Jayani Reena , Moreno Jeanine , Sedrak Mina S. , Dale William , Li Daneng
Published: September 2022

235

Background: The CARG tox score can predict risk of chemotherapy-related tox in older adults with cancer. GAIN can reduce tox vs standard of care (SOC) among these patients (pts); GAIN’s impact across CARG risk groups is unknown. Methods: A secondary analysis of the GAIN randomized clinical trial (NCT02517034) of pts aged ≥65 (solid tumor diagnosis, starting a new chemotherapy) was performed. Pts were randomized 2:1 to receive GAIN vs SOC and were categorized into low (0-5), medium (6-9), and high (10-20) risk groups according to CARG score. The primary outcome was incidence of grade 3-5 tox. Chi-square/Fisher’s exact tests were used to compare outcomes (GAIN vs SOC, stratified by risk groups). Log-rank tests were used to compare 1-year survival across risk groups. Results: This analysis included 600 pts: 26.5% low risk, 45.2% medium risk, 28.3% high risk. Table shows pt/treatment characteristics. For pts with low/medium risk scores, GAIN demonstrated a 14.0% (95% CI 4.1%-23.9%) reduction in tox vs SOC (p = 0.006). No significant reduction in tox was observed among pts with high risk scores (p = 0.86). One-year survival (GAIN vs SOC) for each risk group was 73.6% vs 67.4% (low risk), 68.5% vs 64.5% (medium risk), and 57.3% vs 61.7% (high risk), respectively (log-rank p = 0.10). Conclusions: Older adults with low/medium, but not high, CARG risk scores benefit from GAIN. Additional strategies may be needed to improve outcomes for pts with high CARG risk scores. Clinical trial information: NCT02517034. [Table: see text]
Bone mineral density testing and the risk of fractures in men initiating androgen-deprivation therapy: Population-based study.
Authors: Hu Jason , Aprikian Armen G. , Dragomir Alice
Published: September 2022

238

Background: Androgen deprivation therapy (ADT) is a staple of advanced prostate cancer (PCa) treatment, however several side-effects are associated with its long-term use. Notably, loss of bone mineral density (BMD) is accelerated which increases fracture risk. Although guidelines recommend BMD testing when initiating ADT to properly assess baseline fracture risk, there is limited data to support this recommendation in the PCa patient population. The objective was to examine the association between baseline BMD testing (bBMDT) and the risk of fractures in men initiating ADT for PCa. Methods: A retrospective observational cohort study using data from Quebec public healthcare insurance administrative databases was conducted. The cohort included PCa patients who initiated ADT from 2004-2015 and who received at least one year of ADT treatment. Baseline BMD testing was defined as a BMD test performed from 6 months prior to ADT initiation and up to 3 months after. Patients were categorized as either having received bBMDT or not received bBMDT when initiating ADT. The primary study outcomes were incidence of any fracture and incidence of fractures resulting in hospitalization. Inverse probability of treatment weighting was used to adjust for measured baseline characteristics which included patient demographic variables, comorbidities, risk factors for fractures, and use of other medications affecting bone density. Results: We identified 13,532 patients who initiated ADT, of which 2,070 (15.3%) underwent bBMDT. The unadjusted 5-year incidence of any fracture was 15.1% for patients not receiving bBMDT and 14.0% for patients receiving bBMDT. In adjusted analyses, bBMDT (hazard ratio [HR] 0.92, 95% confidence interval [CI] 0.76-1.12) was not associated with the risk of any fracture. For fractures requiring hospitalization, bBMDT was associated with a lower risk (HR 0.71, 95%CI 0.52-0.98). Furthermore, bBMDT was associated with increased odds of bisphosphonate use within 1 year of ADT initiation among patients who were bisphosphonate-naïve at baseline (odds ratio [OR] 2.03, 95%CI 1.74-2.36). Conclusions: In our study population, bBMDT was associated with a lower risk of fractures resulting in hospitalization. Given the low uptake of bBMDT, additional efforts emphasizing the importance of BMD testing in guidelines may be needed.
Investigating keratinocyte growth factor hair serum for the prevention of chemotherapy-induced alopecia.
Authors: Potluri Preethika , Paul Emma Elizabeth , Segar Jennifer Margaret , Ehsani Sima , Jiralerspong Sao , Roe Denise , Chalasani Pavani
Published: September 2022

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Background: Chemotherapy induced alopecia (CIA) is known to have a significant psychological and quality of life impact, mainly in women. While cold caps have been shown to decrease CIA, expense, availability, and extension of treatment durations are barriers for routine clinical use. Keratinocyte Growth Factor (KGF) has been shown to have cytoprotective effects on human keratinocytes in vitro and reduce apoptosis in human hair follicles. Based on this data, we hypothesized that KGF-Hair serum (KGF-HS) will prevent CIA in women undergoing chemotherapy as treatment for breast cancer. Methods: We designed a Simon 2-stage prospective study to test our hypothesis. Study was approved by our institutional review board and registered on clinicaltrials.gov (NCT04554732). In part 1 we planned to enroll 20 patients into a single arm. If ≥ 4 responses are noted, we proposed to initiate part 2: randomized double-blind placebo-controlled study. Patients with early-stage breast cancer (ESBC) who were scheduled to get at least 4 cycles of anthracycline or taxane based chemotherapy were included. Patients with inflammatory scalp conditions, hair loss disorder, scalp disorders were excluded. The primary endpoint was successful hair preservation using the Common Terminology Criteria for Adverse Events 4.0 scale at the end of 4 cycles of chemotherapy. Secondary end points included wig use and scores on the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire–Core 30, Hospital Anxiety and Depression Scale, and a summary scale of the Body Image Scale. Results: Twenty patients completed part 1 of the study and were evaluable for primary endpoint. Mean age was 60 years and 70% were treated with taxane based chemotherapy. Successful hair preservation was noted in 0 of 20 women. Mean duration of treatment with KGF-HS was 4.6wks (range 2-10 weeks) before women came off study due to grade 2 hair loss. There were no statistically significant differences in changes in any of the scales of quality of life from baseline to end of treatment. There were only 2 grade 1 events (1 rash and 1 itching) reported which resolved after coming off the KGF-HS. There were no serious adverse device events. Conclusions: Among women with early-stage breast cancer receiving chemotherapy with a taxane, anthracycline, or both, using KGF-HS did not prevent CIA. Further research is needed to investigated other novel topical options to prevent CIA. Clinical trial information: NCT04554732.
Severe symptom reporting in medical oncology patients at community cancer centers assessed through eSyM.
Authors: Bian Jessica J , Cronin Christine , Tramontano Angela , Schrag Deborah , Osarogiagbon Raymond U. , Dizon Don S. , Wong Sandra L. , Hazard-Jenkins Hannah W. , Hassett Michael J.
Published: September 2022

242

Background: Among cancer patients (pts) treated with chemotherapy, electronic patient reported outcome (ePRO)-based symptom management programs at quaternary cancer care institutions have improved outcomes. Uptake of ePRO programs in the real-world setting, where less is known about severe symptom reporting, is often complicated by perceptions of increased workload and erroneous severe symptom reporting. The SIMPRO study group, which includes 6 diverse health systems, are implementing an integrated electronic symptom management (eSyM) program to address these challenges. Methods: SIMPRO sites deployed the Epic-embedded eSyM program for thoracic (THOR), gastrointestinal (GI), and gynecologic (GYN) medical oncology (MO) pts, who received PRO-CTCAE-based questionnaires via the patient portal twice weekly for 6 months after starting a new chemotherapy regimen. Symptoms were scored 0 (none), 1 (mild), 2 (moderate), and 3 (severe) and automatically transmitted to care teams within Epic. The distribution and predictors of severe symptom reporting were assessed using descriptive statistics and logistic regression modeling. Results: From September 2019 – March 2022, 47% of eligible pts (2679/5716) submitted 27,062 questionnaires (median age of 67 years, 55% female, 78% white, 53% married, and 49% retired). 17% of eSyM questionnaires included at least 1 severe symptom (15% for GI, 14% for GYN, and 18% for THOR). Table displays the frequencies of all symptoms reported with fatigue, general pain, and constipation being most common. Among respondents, older, black, and employed pts reported significantly fewer severe symptoms (p < 0.03); cancer type was not associated with a greater likelihood of severe symptom reporting. Conclusions: Only approximately 1 of every 6 eSyM responses included a severe symptom, suggesting that routine monitoring in the real-world could help identify patients experiencing bothersome symptoms with minimal disruption to clinical workload. The mix of symptoms commonly reported as severe are challenging to treat with medications alone, arguing that symptom management strategies should provide multidisciplinary supportive care. Interventions that aide both patients and care teams and are embedded within eSyM or Epic could help address these symptoms without overburdening care teams. Clinical trial information: NCT03850912. [Table: see text]
“It sounds very negative”: Patient perspectives on de-escalation of treatment concept and language.
Authors: Andrews Courtney J. , Lawhon Valerie , Wolff Antonio C. , Wallner Lauren P. , Smith Mary Lou , Rocque Gabrielle Betty
Published: September 2022

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Background: As the combination of systemic and targeted chemotherapies is associated with severe adverse side effects and long-term health complications, there is interest in reducing treatment intensity for patients with early-stage breast cancer (EBC). Currently, this approach is being described as “de-escalation,” though there is some concern that this language and framing are not well understood or preferred by patients. Methods: We collected qualitative interview data from twenty-four patients with Stage II-III breast cancer and sixteen patient advocates. Interviews explored interest in participation in clinical trials testing reduced amounts of chemotherapy, reactions to the word “de-escalation,” and preferred ways to describe this approach and its anticipated benefits. Interviews were audio-recorded and transcribed, and researchers used qualitative content analysis to code for dominant themes. Results: Twenty-three participants (57.5%) expressed interest in participating in a trial of reduced chemotherapy. However, 60% of participants had a negative response to the word “de-escalation,” including 78% of respondents that said they were interested in the concept. To describe this approach, respondents tend to prefer words like “personalization,” “optimization,” or “reduced chemotherapy.” Participants also expressed the importance of provider-patient communication, clear and simple language, sharing the decision-making process, and continued support throughout and after treatment in their consideration of trials testing lower amounts of chemotherapy. Conclusions: Among individuals with EBC, there is significant interest in alleviating treatment-related toxicity by reducing chemotherapeutic intensity. Patients are more apt to feel comfortable participating in trials testing this approach if they are framed in terms of customizing treatment to the individual patient and added benefit—reduced toxicities, higher quality of life during treatment and lower risk of long-term complications—rather than in terms of taking treatments away or doing less than the standard of care. “De-escalation” is not an ideal word to describe these trials as many associate this word with giving up in the war against cancer. Instead, participants prefer positive, patient-centered language. This information will be useful to providers in considering how best to describe de-escalation clinical trials to eligible patients in ways that avoid therapeutic misconception and facilitate the shared decision-making process regarding treatment.