bluuebunny/crossref_metadata_2025 huggingface dataset:
Characterization of the nationwide traveling oncology workforce and assessment of its influence on patient travel burden for access to cancer care: A claims-based approach.
Authors: Scodari Bruno T , Kapadia Nirav S. , O'Malley A. James , Moen Erika L.
Published: October 2023

147

Background: Oncology outreach is a common strategy for extending cancer care to rural patient populations. Several rural states consistently rely on oncology outreach arrangements and maintain specialized cancer registries to monitor physician travel. However, the nationwide characterization of the traveling oncology workforce is currently lacking, and the extent to which their outreach provides access and minimizes travel burden for rural patients remains unclear. Methods: A 100% fee-for-service sample of Medicare beneficiaries with incident breast, colorectal, and lung cancer from 2016-2018 was used in this cross-sectional study. Oncologists were linked to the patient cohort using Part B professional claims. Traveling oncologists were identified annually by observing hospital service area (HSA) transition patterns and partitioned into travel frequency bins. Encounters associated with a traveling oncologist were considered as “outreach” if they occurred outside of the oncologist’s primary HSA. Hierarchical models were used to examine the separate associations between outreach encounters and log-transformed travel time to first chemotherapy, radiotherapy, and surgery for rural patients. Results: On average, 4,333 of 30,069 oncologists engaged in annual outreach. Of this workforce, 49.5% traveled across HSA borders 1-3 times per year (low), 26.9% 4-12 times per year (medium), and 23.6% >12 times per year (high). The low travel workforce consisted of 52.3% surgeons, 34.2% medical oncologists, and 13.5% radiation oncologists, whereas the high travel workforce consisted of 15.0% surgeons, 52.0% medical oncologists, and 33.0% radiation oncologists. Collectively, traveling oncologists administered 6,677 counts of first radiotherapy, 4,681 counts of first surgery, and 1,623 counts of first chemotherapy for rural patients, of which 22.5%, 16.8%, and 15.0% were completed at outreach locations. In adjusted models, oncology outreach was associated with a 14% reduction (95% CI: 0.82-0.89) in travel time to first radiotherapy and a 13% reduction (95% CI: 0.79-0.95) in travel time to first chemotherapy for rural patients. Conclusions: Our study uses a novel claims-based approach for characterizing the nationwide traveling oncology workforce and supports oncology outreach as an effective means for improving rural access to care. These results provide conservative estimates of the influence of oncology outreach on rural access to care, as our analysis is limited to Medicare beneficiaries and does not consider patients who bypass available outreach services.
Association of area-level structural racism with racial disparities in cancer mortality.
Authors: Reeder-Hayes Katherine Elizabeth , Jackson Bradford E. , Baggett Christopher D. , Kuo Tzy-Mey , LeBlanc Matthew Roger , Wheeler Stephanie B.
Published: October 2023

172

Background: Structural racism (SR) refers to interactive systems of discrimination that perpetuate advantage for one racial group over others. Single-variable SR measures, such as residential segregation and historical red-lining, are associated with cancer disparities but do not represent all aspects of SR. We aimed to develop a composite measure of SR for cancer research and examine the association of county-level SR with disparities in cancer mortality. Methods: Adapting methods from obesity and public safety research, we developed a SR composite score (SRCS) by calculating the ratio of Black to White performance on eight county-level variables across five domains (housing, education, employment, income and healthcare) using race-stratified census data from 2006-2020. Using North Carolina as a test set, we rank-ordered counties on a min-max scale 1-100 for each domain and averaged scores across domains to create the SRCS, where higher SRCS suggests greater SR. Outcomes were county age-standardized mortality rates (per 100k) for all cancers combined, breast, prostate, colorectal and lung cancers, extracted from CDC Wonder for non-Hispanic Blacks and Whites (2000-2020). We used generalized estimating equations to regress mortality rates on SRCS, race, and their interaction. Results: County-level SRCS was positively associated with county-level racial disparities in all-cancer mortality; for each 10-unit increase in SRCS, Black-White difference in rates increased by 15.3/100k (p<0.001). For individual cancers, a 10 unit rise in county SRCS was associated with a 1.93/100k increase in the colorectal cancer mortality gap (p=0.003) and a 6.18/100k increase in the lung cancer mortality gap (p<0.001). SRCS was not associated with mortality disparities for breast and prostate cancers, although these disparities were large. For all-cancer mortality and all tumor types except breast cancer, mortality rates of Whites significantly decreased as SRCS increased, while mortality rates for Blacks remained roughly stable with rising SRCS. Adjustment for county-level measures of social deprivation, unemployment, primary care provider ratio, and severe housing problems did not attenuate the relationship of SRCS with mortality. Conclusions: A composite measure of SR is associated with racial disparities in overall cancer mortality and mortality of specific solid tumors. Continued research is needed to further understand the role of area-level social determinants, ecologic fallacy, and differences in the relationship of SRCS to mortality across cancers. Nevertheless, increased SR is associated with lower county-level cancer mortality among Whites, suggesting that SR may perpetuate cancer mortality disparities via relative advantage to White residents rather than direct disadvantage to Black residents.
Absolute neutrophil count reference intervals: Do hospital values represent the diversity of the population served?
Authors: Go Lucas T , Gunaratne Madugodaralalage , Spears Grant M , Go Lewis T , Abeykoon Jithma P.
Published: October 2023

191

Background: ANC is used to determine the dosing of chemotherapy and eligibility in clinical trials. Duffy-null phenotype is associated with a lower ANC and present in 2/3 of the Black population. Therefore, ANC reference intervals from hospitals serving a larger percentage (%) of Black population are expected to be lower. Ideally, reference intervals should represent the normal values of the population served. The objective of this study is to determine if the ANC reference intervals of hospitals in the US are representative of the population served based on racial diversity. Methods: We obtained hospital ANC reference intervals from the Mayo Clinic EPIC electronic medical records Care Everywhere health information exchange. Reference intervals from 2020-2023 were included. For each hospital, we determined the city where it is located. For each city, the % of Black population was obtained from the 2020 US Census. We studied the correlation (Pearson) between reference ANC values and % of Black population. To determine the expected ANC reference intervals, we obtained ANC data from the 2021-2022 National Health and Nutrition Examination Survey (NHANES) and performed a reference interval simulation study. Individuals with cancer and cirrhosis were excluded. Random samples of 120 individuals were selected, consisting of n samples from Black individuals and 120-n samples from non-Black individuals. This was performed for n from 0 to 120, and repeated 1000 times per n. Results: We collected data from 107 hospitals across 40 states and 81 cities. Fifty-three (49.5%) hospitals were academic. The % of Black populations in the cities served by the hospitals was a mean of 23.4% (range, 0.7%-82.8%). There was no correlation between ANC upper (r = -0.17, p=0.07) and lower (r = 0.01, p=0.88) limits based on the % Black population. This finding was similar in both academic and non-academic hospitals. Assessment of the ANC distribution in the US population based on race by using the NHANES database showed a clear association with race at the 2.5th (p<0.001) and 97.5th (p=0.009) percentiles with an overall estimated mid-95% reference range of 2.0-8.3 for non-Black individuals and 1.3-7.7 for Black individuals. Conclusions: Hospitals serving a higher % of Black population have similar upper and lower ANC reference intervals compared to those serving a lower % of Black population. This contrasts with the findings from NHANES data which showed significant variations in the normal ANC values between Black and non-Black individuals. Therefore, current hospital ANC reference intervals may not represent the diversity of the population served. Potential clinical implications include misdiagnosis of neutropenia, delay or underdosing of chemotherapy, and inappropriate exclusion in clinical trials, especially in areas with a high % of Black population.
The PaCES Study: Cost effectiveness of an early palliative care intervention in patients with advanced colorectal cancer.
Authors: Sinnarajah Aynharan , Akude Philip , Zarrabi Mahmood , Earp Madalene , Biondo Patricia , Fong Andrew , Blacklaws Kelly , Pakseresht Mohammadreza , Kaposhi Bethany , Shack Lorraine , Watanabe Sharon , Tang Patricia A. , Kerba Marc , Simon Jessica
Published: October 2023

20

Background: An early palliative care (PC) pragmatic trial conducted in outpatient cancer clinics for patients living with advanced colorectal cancer (CRC), led to a 17% increase in early referrals (more than 3 months before death). This study evaluates the cost effectiveness of this trial. A lack of timely palliative care is associated with poorer quality of life, poorer symptom control and fewer days spent at home. Improving on this time toxicity is an important part of early palliative care. Methods: This pragmatic controlled before-and-after study was performed in 18 outpatient cancer clinics in two tertiary cancer centers in neighboring metropolitan cities. Baseline phase was from April 2017 to December 2018 with intervention phase only occurring in 1 of the cities, from April 2019 to December 2020. Intervention consisted of systematically screening patients for unmet PC needs, adding a community-based PC nurse specialist and templated ‘shared care’ letters sent from oncologists to primary care providers. Effectiveness was defined as the number of days spent at home in the last 90 days of life, by subtracting days in hospital, residential hospice, emergency department and clinic. A healthcare system perspective was used to calculate total costs in all sectors including hospital, cancer care, home care, palliative care and physician visits. Healthcare outcomes and costs were analysed using a difference-in-differences (DID) method, while accounting for geographic variations and other covariates. Results: A total of 695 decedents were included. There was a 15% decrease in hospital stay and 18% decrease in chemotherapy days in last 90 days of life. The intervention was cost dominant with an overall DID increase of 2.3 community days with an average cost reduction of C$1,942.17 per patient day in the community. Adjusted analysis showed that this difference was not statistically significant. A non-parametric random resampling of the population with 1,000 reiterations (bootstrapping) showed that the likelihood of the program remaining dominant was 69%. The biggest cost contributors were inpatient acute care (53.6%) and residential hospice (33.6%). Conclusions: Integrating early palliative care services into the care of CRC patients’ shows potential for cost savings and more days spent in the community in the last 90 days of life. Measuring time toxicity is a potentially important outcome in early palliative care trials while examining impact on cost.
Introducing the SEER-Medicare-Housing and Urban Development data linkage: A novel resource for examining the association of housing assistance and cancer care and outcomes.
Authors: Yabroff Robin , Pollack Craig Evan , Helms Veronica E. , Banks Robert , Howe William , Johnson Taylor , Blackford Amanda L. , Enewold Lindsey
Published: October 2023

200

Background: Lack of stable and affordable housing is an important social determinant of health. Federal housing assistance—through housing choice vouchers, public housing, and other programs—may buffer against housing vulnerabilities among low-income households, but research examining the association of housing assistance and cancer care has been limited. We introduce a new linkage of SEER-Medicare and Housing and Urban Development (HUD) administrative data that can be used to examine housing assistance and cancer care and patient outcomes to inform efforts to reduce inequities. Methods: Individuals enrolled in HUD programs 2006-2021 were linked with cancer diagnoses 2006-2019 identified in the SEER-Medicare data from 16 states using Match*Pro probabilistic linkage software. HUD administrative data include timing and type of housing assistance and verified household income. Medicare administrative data are available through 2020. We describe the cohort aged ≥66 years with continuous Medicare fee-for-service Parts A/B coverage surrounding diagnosis who had episodes of housing assistance: 1) at diagnosis or 2) starting within 3 years after diagnosis. Because supply of housing assistance is limited, eligible, low-income families are frequently wait-listed; individuals who receive housing assistance after diagnosis can serve as controls for individuals with housing assistance at diagnosis. Results: Among 42,197 individuals aged ≥66 years diagnosed with cancer and with housing assistance, the most common diagnoses were female breast (n=8,108), lung (n=5,400), colorectal (n=5,197), and prostate (4,548) cancers. Sociodemographic characteristics were similar among the 35,873 individuals with HUD assistance at diagnosis and 6,334 who received it later (Table). Both groups were majority female and non-Hispanic white and with median household income <$14,000. Private multifamily housing programs were the most common form of assistance, followed by housing choice vouchers, and public housing. Conclusions: This novel data linkage will be available through the National Cancer Institute and can be used to explore the ways in which housing assistance is associated with cancer diagnosis and outcomes, including the role of housing assistance in potentially reducing or contributing to inequities across racialized and ethnic groups.[Table: see text]
The cancer caregiver lived experience: Supporting and advocating for patients with cancer throughout the care continuum.
Authors: Raymond Martha , Simonetta Margaret-Ann
Published: October 2023

222

Background: Data from the National Cancer Institute’s Surveillance, Epidemiology & End Results Program (SEER 2022) estimates there are currently over 18.1 million cancer survivors in the United States who rely on family and friends to provide caregiver support. Family and volunteer caregivers fulfill a vital and essential role for cancer patients throughout the care continuum and are at the forefront of advocating and navigating the health care system for the patients under their care. Recognizing the caregiver’s lived experience and the demands and obstacles caregivers endure has a direct impact on understanding the challenges cancer patients face daily. Methods: November 2022 – April 2023 the Raymond Foundation hosted nationwide cancer caregiver focus groups, personal interviews, advisory boards, and online surveys. Primary goals included reaching a diverse range of caregivers in medically underserved communities, rural, urban and community oncology settings. In addition, researchers were interested to learn how the cancer caregiver experience and burden had evolved since our nationwide cancer caregiver published studies in 2018 and 2020. Results: 1214 caregivers (48% identified as male; 52% identified as female) participated during the six-month research period. 96% stated they provide direct patient care, such as: overseeing and ensuring adherence of oral chemotherapy or immunotherapy; communicating with clinicians to coordinate medications for adverse effects; surgical and treatment-related wound and drain care; colostomy, ileostomy, urostomy, and percutaneous endoscopic gastrostomy (PEG or G) support; 94% of caregivers reported they are included in all medical and treatment decisions; 91% reported they felt ill-equipped to navigate complex medical terminology including precision medicine information, biomarker, genetic and hereditary testing and navigating clinical trial options; 87% reported respite care, additional support and educational services would enable them to become a more empowered caregiver and patient advocate; 78% reported their overall quality of life had diminished since becoming a caregiver with feelings of depression, anxiety, financial insecurity, burn-out, loneliness and fear. Conclusions: Cancer caregivers experience significant challenges as they care for their loved one facing a cancer diagnosis. Caregivers are trusted partners in treatment decision making, but too often caregivers do not receive the tools they need to help make informed decisions. Additional caregiver education and support services are essential, so caregivers can provide the best possible support for patients throughout the care continuum.
The influence of religion/spirituality (R/S) on end of life (EOL) outcomes among patients of Dharmic religions with cancer: A mixed methods study.
Authors: Patel Rushil Virendra , Bowden Jill M , Boselli Danielle , Strahley Ashley Elizabeth , Gibbs Sydney-Evelyn L. , Kotecha Ritesh R , Murali Komal P , Patel Viraj R , Nelson Judith Eve
Published: October 2023

230

Background: Spiritual support of cancer patients has been associated with improved EOL outcomes; however, little is known about EOL experiences among cancer patients who identify with a Dharmic religion (DR; Hinduism, Buddhism, Sikhism, Jainism). This study used mixed methods to evaluate utilization and EOL care preferences among DR cancer patients. Methods: We conducted a secondary analysis of data from a separate retrospective study of utilization of chaplaincy services by patients hospitalized at a specialty cancer center in New York City between 2015 and 2019. This database included information about patients' religious identification and about accepted measures of EOL care utilization: hospice enrollment in the last 3 days; chemotherapy use in the last 14 days; urgent care center (UCC) visits or ICU admissions within the last 30 days; and inpatient deaths. Bivariate analyses examined associations between religious identification and EOL care metrics. In 2020, we prospectively conducted semi-structured qualitative interviews to explore EOL care preferences among DR patients with cancer at this hospital. Data were coded and analyzed independently and iteratively by two investigators, and themes were identified. Results: Among 28711 patients (99% NDR), DR patients had significantly higher rates of EOL care utilization on every measure (Table). Only 41% of DR patients had ≥ 1 chaplaincy visit. Twenty-two patients (91% Hindu, 9% Sikh) and 11 NDR chaplains were interviewed. Few patients felt religion influenced their preferences for CPR and intubation. Some patients felt uncomfortable discussing EOL practices with their care team, and several chaplains acknowledged lacking knowledge in EOL practices. To improve EOL care for DR patients, chaplains suggested improving chaplaincy training and developing relationships with community-based leaders and volunteers. Conclusions: While DR patients had higher EOL care utilization, most did not report religion influenced their EOL care preferences. Chaplains’ unfamiliarity with DR-specific EOL practices was identified as a barrier. Future work to optimize EOL care for DR patients should improve chaplaincy training and access to faith-concordant spiritual care providers.[Table: see text]
Feasibility of exercise during oxaliplatin infusions to reduce neuropathy in patients with gastrointestinal cancer.
Authors: Dhawan Natasha , MacKenzie Todd , Brooks Gabriel A.
Published: October 2023

244

Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of oxaliplatin, often leading to discontinuation of therapy and persistent functional impairment. Limited evidence suggests that exercise may reduce risk and severity of CIPN. This pilot study assessed feasibility and acceptability of an exercise intervention during oxaliplatin infusions over a 3-month period. Methods: Patients (≥18 years) with gastrointestinal malignancies receiving oxaliplatin participated in this prospective, single-arm study. Patients exercised for 30 minutes during 6 infusions, using hand and foot pedal machines for upper and lower extremity exercise. Feasibility and acceptability were evaluated by patient report, using Weiner’s Feasibility and Acceptability of Intervention Measures (FIM and AIM, scored 1-5). We defined feasibility and acceptability as a composite score of ≥4 on the FIM and AIM for ≥60% of subjects, respectively. We evaluated CIPN severity (via EORTC-CIPN20) and quality of life (via PROMIS-29) at baseline, 8 weeks (wks), and 14 wks. We calculated descriptive statistics and tested for changes over time using a mixed effects model. Results: Ten patients (median age 64 years, 50% men) enrolled, comprising all patients approached. Nine of 10 patients completed all planned exercise sessions. Nine of 10 patients found the intervention feasible (median FIM score = 4, IQR 4-4.75) and 6 of 10 found it acceptable (median AIM = 4, IQR 3.56-4.19). Patients reported decreasing anxiety (p=0.02) and increasing fatigue (p=0.02) over the 3-month period. In an exit survey, 3 of 9 patients agreed with the statement “I found myself wanting to exercise more over the past several weeks”. In free-text, 6/9 patients stated that they enjoyed the intervention. Conclusions: The intervention of upper and lower extremity exercise during oxaliplatin infusions over a 3-month period met the pre-defined study objectives of patient-reported feasibility and acceptability. Most patients indicated that they enjoyed the exercise intervention and that participating in this study encouraged them to exercise more on their own time. Further study is needed to evaluate the effectiveness of the intervention for reducing CIPN. Clinical trial information: NCT05916118 .[Table: see text]
Effect of immunotherapy on health-related quality of life outcomes in patients with advanced gastro-esophageal cancers: A meta-analysis.
Authors: Gupta Kush , Roy Arya Mariam , Attwood Kristopher , Nipp Ryan David , Mukherjee Sarbajit
Published: October 2023

245

Background: Immune checkpoint inhibitors (ICIs) have revolutionized cancer care, with increasing data demonstrating improved survival outcomes using ICIs among patients with advanced gastroesophageal cancer (aGEC). ICIs are also associated with a lower incidence of grade ≥3 adverse effects (AEs) compared to chemotherapy (CT), suggesting that ICIs may have favorable effects on health-related quality of life (HRQoL). This meta-analysis sought to evaluate the effects of ICIs on the HRQoL of patients with aGEC. Methods: An online bibliographic search was conducted on Medline via PubMed using MeSH-based terms to retrieve randomized controlled trials (RCTs) that evaluated the effects of ICIs on HRQoL in patients with aGEC. We included RCTs that incorporated ICIs as part of the intervention arm either as monotherapy (second-line) or as a combination therapy (first-line) with another ICI or CT. We combined the HRQoL measures into a meta-analysis using standard random effects models, from which estimates of the average mean difference (MD) were obtained with 95% confidence intervals. We assessed heterogeneity of the study outcomes using the Q and I2 statistics. Results: 11 phase-3 RCTs were included, with a mean enrollment of 820 patients. Most (n=X) of the RCTs had ICI plus CT combination in the intervention arm, three had ICIs as monotherapy, and one had doublet ICI therapy in the intervention arm. All RCTs had CT for the control arm. Collectively, trials reported 37 HRQoL measures using 5 different HRQoL tools. The pooled analysis favored the intervention over the control arm in terms of Functional Assessment of Cancer Therapy-Esophageal (FACT-E) scores [MD 2.7 (95% CI 0.1 to 5.3), p<0.05]. In a subgroup analysis of 8 RCTs comparing combination therapy with ICIs plus CT versus CT alone, the effect estimates favored the ICI arm regarding the FACT-E [MD 2.7 (95% CI 0.1 to 5.3), p<0.05] and the EORTC QLQ-OES18 pain scale [MD -2.2 (95% CI -4.3 to -0.2), p<0.05]. We found no statistically significant differences in HRQoL scales in subgroup analysis of ICI monotherapy versus CT. Conclusions: In this meta-analysis, we found that the inclusion of ICIs as first-line treatment for aGECs yielded better HRQoL outcomes than CT. Further research on the impact of ICIs on HRQoL is needed, yet with increasing evidence that ICIs improve survival outcomes in patients with aGEC, these corresponding benefits with HRQoL are encouraging.[Table: see text]
Examining oncologist involvement in a nurse-led primary palliative care intervention.
Authors: Booth Georgeann , Wong Risa Liang , Althouse Andrew , DeBlasio Richelle , Rosenzweig Margaret Q. , Schenker Yael
Published: October 2023

264

Background: Patients with advanced cancer are recommended to receive palliative care (PC) early, but a limited PC specialty workforce limits feasibility. Primary PC, administered by providers outside the PC specialty, has been proposed as a way to increase access to PC. However, prior studies of primary PC have not demonstrated benefit, possibly due to lack of collaboration within the care team. We examine oncologist involvement in the largest primary PC study to date, where primary PC was delivered by oncology nurses. Methods: CONNECT (NCT02712229) was a cluster-randomized controlled trial of a primary PC intervention conducted at 17 community oncology clinics in Western Pennsylvania from 2016-2020. Selected clinic nurses (N=23) were trained to deliver up to 3 monthly primary PC visits, formulating a care plan after each visit. Nurses were asked to update the patient’s oncologist after each visit and to document this communication. We use descriptive statistics to examine level of oncologist involvement in these primary PC visits, based on nurse documentation. Results: Of 336 patients randomized to receive the primary PC intervention, 266 completed at least one study visit, and 233 (87.6%) had at least one visit where the nurse reported updating the oncologist afterwards. Of 674 total study visits, nurses reported updating the oncologist in 553 (82.0%) of them, most commonly in person (77.0%), followed by email (13.4%) and phone (9.6%). For in person or phone exchanges, mean length of interaction was 8.3 (SD 5.7) minutes, with a median of 5.0 minutes. For visits where communication occurred between the nurse and oncologist, the nurse reported presenting their specific care plan only 29.5% of the time (163/553 visits). In 96.9% (158/163) of cases, the oncologist was reported as receptive to the presented care plan, with no further details given in the 5 instances where the oncologist was reported as not receptive. When the oncologist was receptive to the care plan, it was reported that no changes were made by the oncologist in 94.3% (149/158) of cases. In the handful of cases where changes were made, changes involved ordering additional tests (3), changes to non-oncologic medications or therapeutics (2), involving other providers (1), changing oncologic treatment (1), and modifying the patient’s visit schedule (1). Conclusions: In a large trial of oncology nurse-led primary PC, oncologist involvement in care plans was not robust. More extensive team collaboration may be required in future primary PC interventions to increase the efficacy of primary PC. Clinical trial information: NCT02712229 .
Financial hardship experienced in adults with metastatic breast cancer (MBC) from diverse racial, ethnic, and socio-economic backgrounds.
Authors: Rosenberg Shoshana M. , Zeng Caroline , An Anjile , Lombardo Gina , Stein Taylor , Ssebyala Shakirah , Taiwo Evelyn , Elreda Lauren , Walker Desiree , Mercurio Anne Marie , Hershman Dawn L. , Pinheiro Laura C
Published: October 2023

276

Background: MBC profoundly impacts physical, psychosocial, and financial well-being. With treatment advances, patients often manage ongoing treatment for extended durations, which has employment and financial implications (e.g., missed work for appointments). As part of a study evaluating the “collateral damage” of MBC, we sought to describe employment and financial challenges, with a focus on Black and Hispanic adults living with MBC. Methods: From 5/22-5/23, English or Spanish speaking adults with MBC (de novo stage IV or recurrent) treated at 4 New York Presbyterian (NYP) sites (Weill Cornell Medicine-Manhattan, NYP-Brooklyn Methodist, NYP-Queens, and NYP-Columbia) were invited to complete a survey that included a measure of collateral damage (SHINE-financial and employment concerns) and social determinants of health. Fisher’s Exact tests were used to assess differences by race and ethnicity. Results: Of 87 respondents, 14% identified as Hispanic, 28% non-Hispanic Black (NHB), 41% non-Hispanic White (NHW), 7% Asian American Pacific Islander (AAPI), and 10% other/multiracial; 41% did not have a college degree, 32% were employed, 19% unemployed, 9% homemakers, 27% retired, and 13% disabled. Employment concerns were prevalent across racial and ethnic groups; Black, Hispanic, and AAPI participants were more likely to report financial concerns (Table). While 100% of Hispanic, NHW, and AAPI participants reported having stable housing, 29% of NHB participants were worried about losing housing (p=.002). 42% of Hispanic and 45% of NHB participants (vs. 8%, NHW and 0%, AAPI, p=.007) were food insecure; 18% of Hispanic and 17% of NHB adults indicated lack of reliable transportation in the last year (vs. 0%, NHW/AAPI, p=.041). Conclusions: NHB and Hispanic MBC patients report higher levels of financial concern and are more likely to experience food and transportation insecurity, compared to NHW patients. Evaluating the role of screening to systematically connect patients with resources to address unmet social and financial needs should be prioritized in an effort to identify feasible approaches to support economically vulnerable patients following an MBC diagnosis.[Table: see text]
Risk for anxiety and depression among men with prostate cancer.
Authors: Morris Victoria G. , Rogers Kimberly Papay , Doughtie Kara , Popalis Madyson , Miller Melissa F.
Published: October 2023

280

Background: Men with prostate cancer (PC) commonly experience symptoms of anxiety, depression, and suicidality; yet, identifying men in need of mental health support can be difficult, particularly as gender role socialization may deter men from seeking care. We aimed to identify sociodemographic, clinical, and social factors associated with risk for clinically significant anxiety and depression among men with PC. Methods: 118 men with PC completed the Cancer Experience Registry, provided sociodemographic and clinical information, degree of symptom and side effect (SSE) burden in the prior month (16 items), completed the CancerSupportSource Risk for Anxiety and Risk for Depression 2-item subscales , and PROMIS Emotional Support and Instrumental Support 4-item subscales. Bivariate analysis was used to identify significant variables associated with risk for anxiety or depression to be included in subsequent models. Multivariable logistic regression was used to determine which factors significantly predicted risk (1=At risk; 0=Not) for 1) anxiety and 2) depression Independent variables included sociodemographic (age, race/ethnicity, employment, income, marital status), and clinical factors (time since diagnosis, staging, treatment status, history of recurrence, radical prostatectomy, chemotherapy, hormone or radiation therapy, total SSE burden), and social support (caregiver (Y/N), emotional and instrumental support). Results: The sample was 84% Non-Hispanic (NH) White, 9% NH Black. Mean age was 66 years ( SD=9.8). 42% NED, 23% localized, 26% metastatic disease. 53% were retired, 35% employed, and 10% unemployed due to disability (UDTD). 31% were at risk for clinical levels of anxiety; 25% were at risk for clinical levels of depression. In multivariable logistic regression analysis: significant predictors of risk for anxiety ( p<.001) included age (OR =0.88, p<.01), not having a caregiver (OR =5.02, p=.02), and emotional support (OR =0.81, p=.04). Risk for depression ( p<.001) was significantly predicted by instrumental support (OR=0.67, p=.01) and higher among those with active, localized disease compared to NED (OR =10.84, p=.02), and among those UDTD compared to employed (OR =11.09, p=.03). Significant correlates of risk for anxiety and depression in bivariate but not multivariate analysis: marital status, time since diagnosis, and total SSE burden. Conclusions: Younger age, UDTD, localized cancer status, social support, and not having a caregiver were significant predictors of risk for clinical levels of anxiety or depression. Routine risk assessment for anxiety and depression, coupled with multidimensional distress screening can help triage patients to tailored care. Further, those with greater social support and those with a caregiver had lower odds of being at risk for anxiety or depression, emphasizing the need for connecting men with cancer to emotional and instrumental supportive services in their community.
“Bad memories and a big debt—not a legacy I want to leave.” Patient perspectives on cancer treatment choices, cost of care, and legacy goals.
Authors: Figueroa Gray Marlaine , Banegas Matthew P. , Henrikson Nora B.
Published: October 2023

283

Background: Legacy—how one hopes to be remembered and how one impacts others after death—is an unexplored and important dimension of care decision-making for people facing serious illness. This study examined 1) how people with cancer facing serious illness conceive of legacy, 2) the types of treatment choices people make with legacy in mind and 3) if and how patients want to discuss their legacy goals with their care team. Methods: We conducted a scoping literature review to characterize the legacy construct and identify legacy-related treatment choices. We conducted semi-structured telephone interviews with cancer patients at an integrated health system who had received at least 1 palliative care consult in the past year. Interview topics included patient definitions of legacy, the importance of legacy over time, and what mattered most as they made treatment choices. We used Atlas.ti to thematically analyze interview transcripts. Results: In the scoping review, we identified three major intersecting legacy goals that influence patients’ care choices: being remembered as an individual, being remembered for one’s social role, and impacting others' well-being. Financial legacy—the material artifacts related to one’s estate—cut across all three legacy domains and emerged as a substantial factor at the intersection of care decision-making and legacy planning. In qualitative interviews, many people worried that the cost of care and necessary medications would negatively impact the legacy they were able to leave behind. Examples included choosing less expensive or forgoing treatment to preserve their financial legacy (e.g. not wanting to lose their house because of medical costs); feeling shame at experiencing financial hardship due to cancer care costs (“I don’t want to be remembered begging people for gas money to get to my appointments”); and death planning with cost in mind (“I don’t want to leave a horrible mess behind.”). Few people had discussed their legacy goals with their health care team, but many wanted support to do so, especially as these goals were threatened by high out of pocket costs. Conclusions: People with cancer consider their legacy goals, and in particular their financial legacy, as they make treatment choices. Further work is needed to identify how and for whom legacy goals should be addressed as part of patient-centered care, including for whom legacy and financial legacy is most important.
Sociodemographic and clinical characteristics associated with utilization of rehabilitation services in breast cancer survivors.
Authors: Gorzelitz Jessica Susan , Brick Rachelle Sophia , Deng Luqin , Mollica Michelle , Stout Nicole Lynn , Stoller Stefanie , Williams Courtney
Published: October 2023

286

Background: Breast cancer treatment is increasingly efficacious, but commonly results in functional morbidity and decreased quality of life for survivors.Rehabilitation services, including physical and occupational therapy, are recommended by clinical practice guidelines to counteract these impairments, yet these supportive services may be underutilized. Little is known about how use of rehabilitation services may vary by patient-level characteristics. Methods: Data from the Surveillance, Epidemiology and End Results (SEER)-Medicare linked database was used to identify women aged ≥66 years diagnosed with stage 0-III breast cancer between 2011-2016. Rehabilitation services (evaluation/treatment by a physical and/or occupational therapist) delivered in the initial phase of care (0-11 months post-diagnosis) were identified via outpatient or physician visit claims. Descriptive statistics compared rehabilitation usage by patient sociodemographics and clinical characteristics (age, race, dual eligibility status, rural/urban residence, cancer stage, subtype, treatment type). Associations between patient characteristics and rehabilitation services were calculated using modified Poisson models estimating relative risk (RR) and corresponding 95% confidence intervals (CIs). Results: Of 55,539 breast cancer survivors, 33% (n=18,244) had received any type of rehabilitative services. Survivors were a mean age of 75 years (SD 6.7), 88% White, 86% urban-dwelling, 21% Medicare/Medicaid dually enrolled, and 82% had HR+ breast cancer. Clinically, 88% of survivors had received chemotherapy, 69% lumpectomy, and 27% mastectomy. In adjusted models, patients aged >75 vs. ≤75 and dual-eligible beneficiaries vs. those with other insurance were 6% (RR 0.94, 95% CI 0.92-0.96) and 4% (0.96, CI 0.93-0.99) less likely to have received rehabilitative services, respectively. Patients with at least a high school education vs. less than high school, White vs. non-White, or living in a rural vs. urban area were 26% (1.26, CI 1.22-1.30), 6% (1.06, CI 1.02-1.11), and 6% (1.06, CI 1.02-1.10) more likely to have received rehabilitative services, respectively. Patients with invasive vs. in situ cancer and those who received surgical treatment vs. none were 13% (1.13, CI 1.06-1.21) and 15% (1.15, CI 1.02-1.32) more likely to have received rehabilitative services, respectively. Conclusions: Rehabilitation services use differed by patient sociodemographic and clinical characteristics, with the largest differences seen for survivors of differing educational and treatment statuses. Further research is needed on barriers for, access to, and delivery of rehabilitation services, specifically for women with breast cancer who are less educated, older-aged, non-White, or Medicare/Medicaid dual eligible.
Financial toxicity in patients with newly diagnosed pancreatic cancer: A prospective cohort study.
Authors: Tehranchi Kian , Halbert Brian , Hsieh Tina Yi Jin , Garita Esteban , Sucre Santiago , Hacker Michele R. , Bullock Andrea J.
Published: October 2023

29

Background: Financial toxicity (FT) refers to the financial strain and distress experienced by patients due to the costs associated with cancer care. Patients with pancreatic ductal adenocarcinoma (PDA) experience unique challenges including limited treatment options, aggressive disease progression, complex multidisciplinary care needs and an overall limited prognosis. The aim of this preliminary analysis was to measure FT in patients newly diagnosed with PDA and determine factors associated FT. Methods: In this prospective cohort study, patients with newly diagnosed PDA prior to treatment initiation were enrolled through a pancreatic multi-disciplinary clinic at a single institution. The Comprehensive Score for Financial Toxicity (COST), a validated instrument for measuring FT, was used to measure participant’s baseline FT upon initial clinic visit and at two-month intervals via online survey. Mean baseline COST scores were compared using a two-sided t test for binary variables and an ANOVA test for categorical variables with >2 categories. Demographic information including age, race, educational experience, income and insurance status was also collected by questionnaire. Results: Between July 2021 and March 2023, 63 patients were enrolled of which 45 participants completed the baseline surveys (71% response rate). Patients with higher stage disease experienced higher baseline financial toxicity, with mean COST score 38.0 for resectable disease, 26.9 for borderline resectable disease, 22.1 for unresectable disease and 17.5 for metastatic disease (p = 0.03). Participants enrolled in Medicaid experienced the highest FT (mean COST 16.0), while those enrolled in Medicare reported the lowest FT (mean COST 31.8). Participants having private insurance fell in-between with a mean COST score 22.1. Baseline FT also varied inversely with household income with participants with annual household incomes <$50,000 experiencing the most FT (mean COST = 12.7) and participants with annual household incomes >$200,000 experiencing the least FT (mean COST = 34.6). Conclusions: Patients with more advanced pancreatic cancer not only face a worse prognosis but also experience heightened financial strain even before initiation of therapy, emphasizing the early vulnerability of these individuals both medically and financially. Future analyses will measure FT longitudinally after treatment initiation and measure the association between FT, response to therapy and mortality. [Table: see text]
Factors associated with the decision to continue adjuvant endocrine therapy for five more years in a diverse sample of breast cancer survivors.
Authors: Hawley Sarah T. , Kurian Allison W. , Furgal Allison Kate Cullen , Katz Steven , Ward Kevin C , Hamilton Ann S. , Wallner Lauren P.
Published: October 2023

319

Background: Guidelines suggest that breast cancer survivors consider taking adjuvant endocrine therapy for 10 years post diagnosis to maximize recurrence prevention. Little is known about how patients decide to continue endocrine therapy beyond 5 years. Methods: iCanCare is a longitudinal study of women diagnosed with breast cancer in 2014-15 and reported to the Los Angeles County and Georgia Surveillance, Epidemiology and End Results (SEER) registries. Women were surveyed during initial treatment and again 6 years later (2021-22) (Expected final N=1430, 60% current response rate). The proportion of respondents who completed 5 years of endocrine therapy was determined from SEER and patient report (N=793). This group was queried regarding their decision to continue for an additional 5 years (yes/no/undecided). Patients were asked about the importance of personal values in making this decision (all categorized into very/quite/somewhat important vs. a little/not important), and perceived benefit of continuing (none, small/moderate, large/huge). They were also asked to report on how the decision was made (decision style, involvement of oncologist and primary care physician, PCP). We conducted bivariate analyses to assess associations between the decision to continue (yes vs. no/undecided) and decision-making factors. Results: In the sample of 793 women who completed 5 years of endocrine therapy, 40% decided to take it for more than 5 years, 54% decided not to, and 5% were undecided. Overall, 44% reported that it was a shared decision between them and their physician(s). The values survivors reported as most important in their decision to continue were doing what their oncologist wanted them to do (77%) and worry about recurrence (61%). Medication costs (11%) was the least important factor. Among survivors who chose to continue, most important were doing what their oncologist wanted them to do, worry about recurrence, and desiring the most extensive treatment possible (all p <0.001). A greater proportion of those who perceived a large/huge benefit (vs. less benefit) of continued therapy chose to continue (87% vs. 13%, P<0.001). Having received a strong oncologist recommendation was strongly associated with the decision to continue, as was PCP involvement in the decision (both p<0.001). Conclusions: In this population-based sample of breast cancer survivors who completed 5 years of adjuvant endocrine therapy, less than half decided to extend therapy for 5 more years. Personal values and role of physicians weighed heavily into the decision to continue. Further work to understand how to incorporate and address patient values in endocrine therapy decision making is needed.
Reducing 30% of waiting time in the administration of antineoplastic oral drugs in patients with urological cancer.
Authors: Diaz De Cerio Amaya , Marfil Peña Carmen , Rodriguez Montani Hernan Alberto , Alonso de Pablo Virginia , Marron Maria Cruz
Published: October 2023

325

Background: In order to reduce waiting time in the administration of oral antineoplastics we participated in ASCO/ECO QTP. We propose the creation of an oncology nursing office, trained to evaluate and administer oral antineoplastic medication. Methods: The waiting times of patients diagnosed with urological cancer and receiving treatment with oral antineoplastic drugs are collected, between their arrival at the hospital and the drug’s dispensation. Waiting times are calculated using a prospective qualitative analysis and we represent the data using SPC graphs such as R-Charts, process maps, Pareto and cause-effect diagram, objectifying, the longest waiting time between the oncology consultation appointment and the entrance to consultation. An oncology nursing consultation, with protocols based on checklists (where the most frequent adverse effects are collected, blood pressure is measured and the corresponding analytical parameters are assessed) is created to facilitate the job and train nursing for the administration of drugs. Subsequently, the waiting times are analyzed again, after the implementation of the nursing consultation and a month after it. Results: Along a period of 6 months (time from when we started the ASCO/ECO QTP course, until we implemented the medical oncology consultation), we have reduced the median time between the patient's appointment to the drug dispensation, from 35 minutes to 5 minutes, approximately a reduction higher than the 80%. One month after the implementation of the nursing consultation, waiting times are analyzed again, and the improvement is maintained. Conclusions: The creation of a specific nursing consultation has made possible to reduce waiting times in the administration of oral antineoplastic drugs, reducing the waiting list and managing to quote 3 more patients each day in medical oncology consultation.