bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors predicting pathological complete response in patients with localized breast cancer receiving neoadjuvant chemotherapy.
Authors: Roy Arya Mariam , Attwood Kristopher , Gandhi Shipra
Published: September 2022

165

Background: Pathological Complete Response (pCR) after Neoadjuvant Chemotherapy (NAC) is associated with improved survival outcomes in early-stage breast cancer. However, data regarding the factors predicting pCR are limited. We analyzed the clinical and pathological factors associated with the attainment of pCR after NAC. Methods: We queried National Cancer Database for non-metastatic breast cancer patients who received NAC between 2010 and 2016. All associations were compared using Kruskal-Wallis, Pearson’s Chi-Squared, and Fisher’s Exact Tests. Multivariate logistic models were used to analyze association of race, sub-type, age, clinical stage, grade, histology, insurance, comorbidity index with pCR. Odds ratios, 95% confidence intervals, and p-values for each predictor were recorded and adjusted for confounders. All analyses were conducted in RStudio v4.0.2 at a significance level of 0.05. Results: A total of 137140 female and 741 male patients were identified. Majority of the patients were Whites (n = 95909) followed by Blacks (n = 23736), and Hispanics (n = 11023). 58.4% (n = 80556) patients were > 55 years. 64% of the patients had private insurance, 31.1% (n = 42930) had government insurance (Medicare and Medicaid) and 3.6% (n = 4904) were uninsured. Majority of the patients had Charlson comorbidity index (CCI) equal to 0 (87%). Hormone-receptor positive and HER2 negative (HR+HER2-) comprised 37.9% (n = 51283), HER2+ were 35.2% (n = 47794) and triple-negative breast cancer (TNBC) were 26.9% (n = 36401). Compared to TNBC, HER2+ had higher and HR+HER2- had lower chance of attaining pCR. Blacks had lower (OR = 0.95, p < 0.001) and Hispanics had higher chance of pCR (OR = 1.1 p < 0.001) when compared to Whites in the overall population which includes all subtypes. Younger patients had lower chance of attaining pCR compared to elderly. Stage I and II patients had more chance of PCR compared to stage III. Patients with government insurance had lower odds of attaining PCR compared to those with private insurance. Patients with CCI 0 had higher chance of pCR when compared to those with CCI > = 3 (OR = 1.15, 95% CI = 1.08-1.2, p < 0.001). Conclusions: Patient and tumor factors play an important role in response to NAC in breast cancer patients. Identifying modifiable factors associated with odds of lower pCR rates such as, government insurance would help us intervene to improve the quality of care of breast cancer patients.[Table: see text]
Patient-reported outcomes in a linguistically diverse cancer population: Addressing barriers to access.
Authors: Usman Fatima , Rittberg Rebekah , Lim Howard John , Bhang Eric , Chan Brandon , Alex Deepu , Chia Stephen K.L. , Gill Karamjit , Ko Jenny J. , KoLeong Jason , Laskin Janessa J. , Loree Jonathan M. , Melosky Barbara L. , Pauls Mehrnoosh , Pollard Samantha , Wang Ying , Weymann Deirdre , Yip Stephen , Regier Dean A , Ho Cheryl
Published: September 2022

168

Background: The census metropolitan area served by BC Cancer is Vancouver which has a population of 2.4 million. Census Canada noted the mother tongue learned in childhood and still spoken was: 54% English, 17% Indo-European, 16% Chinese, 10% Indo-Iranian, 3% English+other language, 2% other. At BC Cancer, implementation of patient reported outcomes (PROs) was launched 1 year ago with consideration of preferred language. Our goal was to examine the implementation of PROs with respect to equity of access and language preferences. Methods: BC Cancer Vancouver implemented PROs including the Edmonton Symptom Assessment Scale Revised, Canadian Problem Checklist and EQ5D in April 2021 using a web-based platform. A 1-year cohort was reviewed for patients’ mother tongue and the language used for the PROs. Qualitative interviews were undertaken for non-English mother tongue patients to ask for preferred language of PROs and reasons for the choice if mother tongue was not selected. Results: 86 patients were enrolled in the PRO program. Baseline characteristics: 66% female, age 30% < 60/ 31% 60-69/ 39% >70, primary site 54% lung/ 34% colorectal/ 18% other. Ethnic origin: 53% North American and European, 40% East and Southeast Asian, 2% Latin/Central and South American, 3% South Asian, 1% Indigenous, 1% other. Mother tongue: 52% English, 48% non-English (39% English proficient, 9% low English proficiency). Patient preferred language for PROs: 81% English, 11% Chinese, 7% other. Reasons for non-English mother tongue preference for English language included comfort with written English, use of family assistance completing questionnaires for both language and familiarity with electronic devices. Conclusions: In the Vancouver linguistically diverse cancer population, the majority of patients preferred English language PROs. Reasons for this include proficiency in the written language and the use of family members to complete the questionnaires. With 39% of patients over the age of 70 in our study, the use of electronic devices for completion may have introduced an additional barrier to access. In clinic iPad questionnaires with nursing and care aide support have been introduced to help address this gap. Clinical trial information: NCT05057234.
Social determinants of health—to screen or not to screen? How, when, and what to do next are really the questions.
Authors: Angove Rebekah SM , Gallagher Kathleen D.
Published: September 2022

169

Background: Social determinants of health (SDOH) have a considerable impact on the health outcomes of chronically ill patients. Although the implementation of social needs screening in clinical settings has been studied, patient perspectives of discussing SDOH with health care providers has not been thoroughly investigated. This study sought to explore the experience and perspectives of limited-resource patients with cancer regarding SDOH discussions. Methods: This cross-sectional analysis used data from a nationwide survey distributed in May 2022 by Patient Advocate Foundation (PAF). The survey was fielded via email to patients who received PAF services in 2020. Inclusion criteria included a valid email, aged >19 and a current or previous cancer treatment. Frequencies and percentages were calculated for categorical variables. Questions focused on individual experiences with SDOH screening, conversations and expectation around information use and assistance. Results: A total of 481 survey respondents with cancer completed the survey. Most respondents were female (73%), aged 56-75 (52%), household income < $48,000 (66%), and insured (98%); 38% were Black, Indigenous or Persons of Color (BIPOC). The most common cancer types were hematologic (42%) and breast (34%); 30% were diagnosed < 2 years prior and 82% received treatment in past 6 months. One quarter (26%) stopped or delayed care in past 12 months due to cost and 66% reported that social needs interfered with treatment in past 12 months. Two-thirds (64%) reported conversations about social needs in the past 12 months. Transportation (36%), food insecurity (32%) and personal safety were the most cited nonmedical needs. Conversations were most often initiated by nurse/PA (30%), social worker (30%) or doctor (29%) and patients reported being ‘extremely comfortable’ being asked these questions by the same providers; doctor (54%), nurse/PA (48%), social worker (46%). Over half (53%) reported comfort with SDOH information being part of their medical record; 61% wanted to be asked SDOH questions face-to-face. If a social need was identified, patients trusted patient advocacy groups (64%), social worker (61%) and charitable non-profit organizations (49%) to help them locate assistance. Only 21% indicated knowledge of availability of needs navigation services. Conclusions: Although patients are open to sharing social issues with providers, our data suggests that conversations may not be routinely initiated in clinical settings. There is also a need to increase awareness of resources in response to SDOH screening. Challenges in trust and privacy persist when disclosing this information. Achieving health equity requires culturally responsive strategies to embed screening and referrals into workflow to ensure cancer patients’ needs are identified and they are linked to appropriate nonmedical resources and services.
Resource needs screening and matching at an academic oncology center: RESOURCE preliminary results.
Authors: McCleary Nadine Jackson , Haakenstad Ellana K , Neville Bridget A. , Weitzner Rachel , Zhang Sunyi , Manni Michael , Cleveland Jessica , Toffler Deborah H , Wallace Julie P , Hassett Michael J.
Published: September 2022

178

Background: The social determinants of health contribute to patient (pt) health status throughout the cancer care continuum. Here we describe preliminary results of RESOURCE, a pragmatic intervention to ID and intervene on pt resource needs at an academic oncology center. RESOURCE is an EHR-integrated questionnaire (qst), given when establishing oncology care, that IDs the following needs: transportation; financial, food, & housing security; cost of care; education & employment; and caregiving burden. Pts from an HUP population or reporting resource needs on the cancer center’s intake qst are screened with RESOURCE. Those randomized to the intervention reporting a resource need receive an EHR-mediated referral to internal resource specialist and financial assistance teams. Methods: All adult cancer pts may complete the EHR-integrated intake qst. We compared historic rates of reported vulnerability from the intake qst with resource needs reported in RESOURCE. Intake qst data from 6/2015 – 4/2022 included 21,343 respondents with data on financial security, social isolation, health literacy, and health numeracy. RESOURCE data from 6/2021 – 6/2022 on the domains above included 75 respondents (125 will be accrued in total; no conditions will end accrual early). The intake qst is available for all adult cancer pts (response rate 24%; RESOURCE response rate of 87%). and The following were compared with χ2 tests: the demographic profile of each pt population; and the proportion of respondents with any one need ID'd by RESOURCE vs the intake qst. These preliminary results allow us to determine if we may prepare to scale RESOURCE upon the study’s completion. Results: The enriched pt population of RESOURCE means that there is a statistically significant difference in demographics between the general pt population responding to the intake qst and the RESOURCE pts responding to the RESOURCE by each category (p-values < 0.01). A higher proportion of pts identified a need on the intake qst (61%) than on RESOURCE (41%). RESOURCE pts most commonly reported the following needs: paying utility bills (24%), food security (20%), and cost of care (19%). Conclusions: While a larger proportion of pts reported a resource need on the intake qst, the RESOURCE qst had a far superior response rate; this discrepancy makes it difficult to determine which qst is better at determining resource needs. The RESOURCE qst allows us to see the type of need in greater detail. Collecting this data systematically allows us to quantify the resource needs of our pts so we can provide adequate support staff and resources.[Table: see text]
Innovation in recruitment and curricular design for diversity, equity, and inclusion (DEI) education for hematology-oncology (HO) trainees.
Authors: Hussaini S. M. Qasim , Rosner Samuel , Nakajima Erica C. , Messmer Marcus , Phillips Tanyanika , Naik Rakhi Prakash , Donehower Ross C. , Marrone Kristen
Published: September 2022

179

Background: Alongside persistent disparities in healthcare outcomes in HO, there is an inability to adequately recruit, maintain and promote a diverse and inclusive work force nationwide. To our knowledge, a structured approach to DEI education/recruitment in HO training is lacking. We sought to establish a longitudinal curriculum aimed at educating HO trainees in structural barriers impacting cancer equity and developing tools to enhance Underrepresented in Medicine (URiM) recruitment. Methods: Trainee-led DEI framework was presented to program leadership and officially adopted into the curriculum for the 2021-22 academic year. This consisted of initiatives across 4 domains: 1. Curricular Development (emphasis on disparities during trainee orientation, didactic lectures on cancer disparities, financial toxicity, workforce diversity, pandemic impact on cancer inequities) ; 2. Recruitment & Retention (implicit bias training, targeted recruitment from HBCUs, trainee-led discussions on enhancing recruitment); 3. Engagement & Mentorship (local community mentorship within institution, external mentorship through ASCO URM MSR program); 4. Disparities Research (career guidance sessions with invited faculty, development of registry-based studies to evaluate disparities). Impact of new curriculum was measured through anonymous surveys, at 1, 7, and 12 months during the academic year. A 5-point Likert scale (strongly disagree to strongly agree) was utilized. Results: At baseline, surveyed trainees were predominantly PGY5 (33%), ages 31-40 (66%), and self-identified as White or Caucasian (47%). Over the academic year, trainee recognition of structural barriers that prevented oncologic care delivery increased. More trainees felt departmental/fellowship-wide DEI efforts were transparent and impactful leading to quantifiable changes, and creation of new mentorship opportunities. Trainees rated the following as most helpful to address biases in the workplace: opportunities to mentor minority high school/college-level students, implicit bias training, and formal lectures. Anonymous qualitative feedback from fellows favored small group discussions and encouraged a top-down approach to promoting diversity in leadership. One trainee-mentored URiM medical student presented work at the ASCO annual conference on cancer disparities, while program leadership efforts led to incoming trainee class comprised of 25% URiM. Conclusions: We demonstrate feasibility of a longitudinal DEI curriculum in HO trainee education and recruitment that raises awareness and creates opportunity for URiM. Future efforts will build on this curriculum utilizing trainee feedback and departmental buy-in with the goal of building an oncologic workforce that better reflects the patients we care for.
Discordance between patient with cancer and caregiving partner self-reported financial toxicity.
Authors: Rivers Zachary , Shankaran Veena , Porter Laura S , Langer Shelby
Published: September 2022

182

Background: While financial toxicity (FT) is a well-documented problem facing cancer patients, few studies have simultaneously investigated the financial experiences of patients and their caregiving partners. Here, we report concordance and discordance in experiences of FT between cancer patients and their caregiving partners. Methods: Patients aged ≥18 with stage II-IV breast, lung, or colorectal cancer who had received treatment within the past two years and were married or in a committed, cohabitating relationship were enrolled along with their partners. Patient and caregiver responses to the FACIT-COST (lower scores indicating higher FT; score ≤ 26 meeting FT threshold) were calculated, and dyads were categorized as concordant or discordant in their experience of FT. Logistic regression models were used to explore patient and caregiver predictors of FT. Results: A total of 327 dyads (median patient age 53, 45% stage IV, 36% breast, 44% colorectal, 19% lung) were included in the analysis. Numeric COST scores were lower in patients (27, IQR: 19, 25) than in caregivers (30, IQR: 23,37) and more patients than caregivers met the threshold for FT (45% vs. 34%, p = 0.002). Both members of the dyad had similar FT experiences in 74% of cases (26% and 48% reported FT and no FT respectively) while 26% diverged in their experience of FT (8% of partners reported FT while the patient did not; 18% of patients reported FT while the caregiver did not.) Higher patient age was associated with a reduced odds of patient-reported FT (OR for each year: 0.92, 95% CI 0.86-0.98) while higher odds of FT was seen with increased patient comorbidities (OR: 1.56, 95% CI: 1.26-1.96 for each comorbidity) and patient race (Black OR: 1.41 - > 10 compared to White). Similarly, caregiver comorbidity, caregiver race, and female sex increased the odds of caregiver-reported FT. In addition, the odds of caregiver-reported FT were higher with lower annual household income ($60,000-$120,000: OR: 0.26, 95% CI: 0.09-0.73, > $120,000: OR 0.15, 95% CI 0.04-0.51 compared to less than $60,000), and the presence of children in the home (OR: 4.15, 95% CI: 1.88-9.67). Conclusions: More than a quarter of patients and caregivers had discordant experiences of FT. Assessing both members of a patient-caregiver dyad for FT is therefore critical to understanding the household financial impact of cancer diagnosis and treatment.
Time of clinic appointment and advance care planning discussions in oncology.
Authors: Kolla Likhitha , Chen Jinbo , Parikh Ravi Bharat
Published: September 2022

185

Background: Early advance care planning (ACP) in oncology increases goal-concordant care. However, time pressures during a busy clinic day may prevent clinicians from engaging in necessary conversations. Given prior evidence of suboptimal clinician decision-making in non-oncology settings in latter parts of a clinic day, we investigated the association between appointment time and likelihood of ACP conversations. Methods: We used electronic health record data to identify medical oncology encounters. We ascertained the presence of ACP from either (1) a specific ACP note type in the EHR, or (2) an ACP smart phrase in clinical progress notes. ACP documentation was used as a surrogate for ACP discussions, as ACP documentation is a quality metric used by organizations including the ASCO’s Quality Oncology Practice Initiative. Appointment times between 8am and 4pm were separated by the hour. Oncology clinicians usually practiced in a morning (8am to 11am) or afternoon (12pm to 4pm) session. Time was indicated by grouping appointment times in the order they occur in a session. We used generalized estimating equations, clustering by clinician, to estimate the probability of ACP documentation. Session hour (1-5) was included as a categorical and continuous variable. We adjusted for patient clinical and demographic features. We also performed a sensitivity analysis using a restricted sample that excluded encounters from 12pm. Results: Adjusted odds ratios (ORs) for ACP documentation rates were significantly lower for all hours of a session after the earliest hour (Table), with consistent results in the sensitivity analysis. Conclusions: Oncology clinicians’ likelihood of having advance care planning conversations decreases as a clinic session progresses. Decision fatigue and falling behind schedule could be contributing reasons for this effect. Lower rates of discussions about goals of care later in a session could result in more aggressive end-of-life treatments. Proactive scheduling of high-risk patients earlier in a clinic session or scheduling separate visits for advance care planning could facilitate necessary conversations and should be further studied.[Table: see text]
Advance directives among patients with advanced cancer in Mexico.
Authors: Chavarri Guerra Yanin , Ramos-Lopez Wendy Alicia , Sánchez-Román Sofía , Quiroz Paulina , Covarrubias-Gómez Alfredo , Alcocer Natasha , Morales Alfaro Andrea , Jiménez Sotomayor María Reneé , Gonzalez Salazar Roberto , Carrillo Bedoya Araceli , Jimenez Cruz Ariana Michael , Carrillo Monica , Garcia Dominguez Karen Eloisa , Madariaga Cobos Aimee Cristina , Amaya Caballero Montserrat , Soto Pérez de Celis Enrique
Published: September 2022

186

Background: Completion of advance directives can help to ensure consistency with people´s preferences at the end of life. However, disparities in access to advance care planning is common among Hispanic population and little is known about their end-of life wishes. Although in Mexico, advance directives were legalized in 2008, only 21% of people know about it. Objective: To describe end-of-life wishes among patients with advanced cancer planning in a third level hospital in Mexico City. Methods: We conducted a cross-sectional analysis of advance directives planning from patients with advanced cancer included in a multidisciplinary patient navigator-led supportive care program in Mexico City (Te Acompañamos). Patients with a life expectancy of 6 months or less were invited to complete advance directives (AD). Life expectancy was calculated using the palliative performance scale (PPS). Descriptive statistics were used for this analysis. Results: From September 2017 to November 2021, a total of 238 patients were invited to complete AD and 55 (23.1%) completed it, 14.5% in 2017, 29% in 2018, 34.5% in 2019, 9% in 2020 and 12.7% in 2021. The mean age among those who completed AD was 65.8 years (range 38-91), 52.7% were women and 61.8% had gastrointestinal cancer. Forty-three (78.1%) patients stated their wish to die at home, 18.1% to have cardiopulmonary reanimation, 9% invasive mechanical ventilation, 24.4% tube feeding, 90.9% pain medications, 10.9% organ donation, 40% cremation, 38.1% a funeral and 50.9% a death ritual. At median follow up of 5 months (0-39), 43 (78.1%) patients have died, and their endo-of-life wishes were respected in 77.5 % of them concerning the place of death and in 96.7% regarding cardiopulmonary reanimation and invasive mechanical ventilation. Conclusions: In our patient navigator-led supportive program approximately a quarter of patients with advanced cancer and a life expectancy of 6 month or less completed AD and end-of-life wishes were respected in a significant proportion of them. Telemedicine methods used to invite patients during COVID-19 pandemic decreased the proportion of AD completion. Although, advanced care planning is associated with improved in quality of care at the end of life, several barriers and disparities exist among Hispanics and strategies to improve their completion are needed.
Acute care utilization at the end of life: Does race/ethnicity matter?
Authors: Rodriguez Gladys M. , G. Rosas Lisa , Patel Manali I.
Published: September 2022

189

Background: Lung cancer is the leading cause of US cancer deaths. Providing high quality care near end-of-life (EOL) is critical. Hispanic and Black patients with cancer receive less palliative and hospice care referrals and have less knowledge of advance directives compared to non-Hispanic Whites. While it is posited that such inequities can result in disparities in acute care use and goal-discordant care at the EOL among racial/ethnic minority populations, few studies have evaluated whether acute care utilization at the EOL for patients with lung cancer differs by race/ethnicity. Methods: Adult patients with a lung cancer diagnosis who died between 2005-2019 were identified in the California Cancer Registry database linked to a hospital discharge abstracts from the Office of Statewide Health Planning and Development. ICD9/10 codes were used to identify aggressive EOL care defined as: hospital/ED visit, death, intubation, CPR, and dialysis within 14-days of death. Logistic regression models estimated the odds of such care by race and ethnicity. Models were adjusted in apriori considerations of age, income, socioeconomic status, insurance, geography, histology, stage, comorbidities, and care receipt at NCI-designated hospitals. Results: Among 207,429 patients included, mean age was 74 years, 51% were male, 83.6% lived in urban areas, 28% had income 200% below Federal Poverty Level, 48.8% had Medicare, 91.8% received care in a non-NCI designated cancer center and 48.3% had stage IV disease. Black, Hispanic and Asian/Pacific Islander patients compared to Non-Hispanic Whites had increased odds of aggressive EOL care (See Table). Conclusions: This study demonstrates disparities in acute care use and aggressive care delivery among racial and ethnic minorities with lung cancer at the EOL. Solutions are urgently needed to reduce such disparities in care.[Table: see text]
Oncologist-reported frequency of managing specific long-term and late effects in breast cancer survivors.
Authors: Brauer Eden , Petersen Laura , Ganz Patricia A.
Published: September 2022

193

Background: Breast cancer survivors may experience a broad range of physical and psychosocial long-term and late effects. Although disease-specific guidelines for breast cancer survivorship care are available, systematic approaches remain a challenge in clinical practice. The purpose of this study was to describe variations in how medical oncologists assess and manage specific long-term and late effects in breast cancer survivors. Methods: This study is a secondary analysis of data from a survey of medical oncologists about breast cancer survivorship care in the United States. Using a study-specific list, oncologists were asked to report the “most common” and “most distressing” concerns of breast cancer survivors in their clinical practice, as well as the frequency at which they assess and manage 16 specific long-term and late effects in routine survivorship care. Data was analyzed using descriptive statistics to rank perceived patient concerns and compare practice variations across specific post-treatment issues. Results: Data from 215 surveys were included. Oncologists perceived anxiety, fatigue, neuropathy, and menopausal symptoms as top-ranking common and distressing concerns in breast cancer patients. When asked how often they assess and manage specific long-term and late effects in routine survivorship visits, oncologists reported the highest frequency for neuropathy (55%), bone health (54%), and pain (52%), and the lowest frequency for cognitive impairment (19%), sexual dysfunction (15%), and body image concerns (13%). Cognitive impairment and body image were perceived as the fourth and fifth most distressing issues that breast cancer survivors face, yet oncologists reported routine assessment and management less than 20 percent of the time. Conclusions: Findings from this analysis indicate that oncologists routinely assess and manage certain long-term and late effects, while others remain neglected. Important disconnects between perceived patient concerns and the issues that are routinely addressed in clinical practice were also identified. Standardized approaches that incorporate brief patient-reported assessments across multidimensional issues may facilitate comprehensive, guideline-concordant survivorship care.[Table: see text]
Palliative care usage in metastatic thyroid cancer: An analysis of the National Cancer Database.
Authors: Swedek Michelle , Wu Xinxin , Malouff Timothy Dean , Silberstein Peter T.
Published: September 2022

196

Background: Metastatic thyroid cancer portends a poor prognosis, especially in patients over the age of 55 or in more aggressive histologies, such as anaplastic. Palliative care (PC), which focuses on improving the quality of life in patients with severe disease, may be beneficial to these patients. To our knowledge, there has yet to be a study describing the demographic and usage factors associated with PC in metastatic thyroid cancer. Methods: We conducted a retrospective analysis of the National Cancer Database (NCDB) from 2004-2017 for subjects with metastatic thyroid cancer (n = 5,229) of all histologies. Analysis was completed between patients who utilized PC (n = 826) and patients who did not use PC (n = 4,403). The NCDB defines palliative care as care provided to alleviate or palliate symptoms, including radiation therapy, surgery, pain management, and/or systemic therapy. PC usage and survival were compared between cancer subtypes. Demographic factors were analyzed using Pearson chi-squared tests and t-tests, while survival was estimated using Kaplan-Meier curves. Results: Of the subjects with metastatic thyroid cancer, 50.6% had papillary, 25.2% had anaplastic, 15.9% had follicular, and 8.3% had medullary thyroid cancer. Anaplastic, medullary, follicular, and papillary metastatic cancers had median survivals of 2.4, 19.9, 49.5, and 55.3 months, respectively (p < 0.001). PC usage increased between 2004 (3.4%) and 2017 (11.4%) across all subtypes. The mean age at diagnosis of PC patients was 69.2 years old compared to 66.9 years old for non-PC patients (p < 0.001). Anaplastic thyroid cancer made up the greatest proportion of PC usage (42.5%) compared to other histologies (p < 0.001). Subjects of Spanish/Hispanic origin received PC at lower proportions (p < 0.001). In addition, Asian patients made up a smaller fraction of the PC cohort (4.2%) compared to the non-PC cohort (6.7%) (p = 0.028). Patients with private insurance made up a smaller proportion of PC users (26.5%) compared to non-PC users (35.6%), while subjects with government insurance or no insurance made up a greater proportion of PC usage (p < 0.001). Less PC usage was seen by patients who lived in an area where greater than 17.6% of individuals did not attain a high school degree; these patients made up 25.3% and 19.9% of the non-PC and PC cohorts, respectively (p = 0.006). Patients who received PC tended to live closer to the reporting hospital (p = 0.007). No statistically significant difference was seen between PC and non-PC cohorts for income and facility type. Conclusions: In this study, we highlighted several disparities in PC usage across common types of thyroid cancer. We also compared usage between categories and noted a greater proportion of PC usage in recent years. Our study is a valuable baseline as PC continues to be integrated in cancer care.
Expansion of an advance care planning initiative in patients with metastatic cancer: Successes and challenges.
Authors: Oppenheim Steven , Figlin Robert A. , Castroll Rica R , Irwin Scott A , Isserman Sean Louis , Hallum Andrew David , Zorina Nadejda
Published: September 2022

197

Background: Advance Care Planning (ACP) activities including dialogs about care preferences, patient goals, and advance directives are an important component of cancer care. A pilot ACP initiative has been expanded to include additional sites of cancer care within the Cedars-Sinai Cancer Health System. Methods: The pilot study including two cancer care sites (started July 2017) was expanded to include two additional sites. The prior results were presented to 86 oncologists at all four cancer care sites to promote increased ACP activities for patients with metastatic cancer and/or refer those patients to palliative medicine (PM). ACP activities were defined as one of the following within the last year: 1) an advance directive (AD) or physicians order for life sustaining therapy (POLST), 2) an ACP note and/or 3) a PM referral. Patients with metastatic cancer were identified by an EMR M1 designation by the oncologist from July 2021 to March 2022. Oncologists received monthly lists of patients with metastatic disease lacking ACP activities and quarterly scorecards with their ACP completion rate compared to their peers. Results: An average of 1302 unique patients with metastatic cancer were identified each month combined from all four sites. System wide ACP activities were unchanged from a baseline 51% in July 2021 to 53% in March 2022. One site representing, an average of 101 patients/month, increased ACP activities from 16% to 65%. Conclusions: This initiative increased ACP activities since July 2021 for patients with metastatic cancer at one of four sites. The remaining three sites, two of which were part of the pilot from 2017, showed a plateauing of ACP activities despite embedded PM providers, ACP education and monthly feedback to the providers. This may have been from a higher baseline and longer PM presence at those sites. The site showing improvement was given economic incentives to meet Cedars-Sinai priorities for ACP activities and started at a lower baseline, both of which may have contributed to the increase. Further improvement in ACP activities may occur with involvement of clinic reception, nursing and social work along with more broad economic incentive for ACP activities. This increase was primarily from ACP note completion of 53% (PM 18% and AD completion 10%).[Table: see text]
Associations between patient-perceived cancer curability and advance directive completion based on race and ethnicity and cancer type.
Authors: Pywell Cameron , Caston Nicole E. , Ye Star , Rocque Gabrielle Betty
Published: September 2022

200

Background: Despite Advance Care Planning (ACP) recommendations for patients with cancer for over 20 years, uptake remains low, and many such patients lack Advance Directives (AD). Our previous data showed a lack of association between patient-perceived cancer incurability and AD completion, however less is known about whether this relationship remains for key subgroups where perceptions may differ, such as BIPOC (Black, Indigenous, or People of Color) patients and patients with incurable hematologic malignancies. Methods: This cross-sectional study used Patient Reported Outcomes (PRO) from surveys administered during routine outpatient care at the University of Alabama at Birmingham from 12/2016 to 08/2021. Patients self-reported AD completion and perception of curability. Demographics consisting of age, sex, race and ethnicity, and marital status, and clinical characteristics, namely cancer type, cancer stage (stage 0-III grouped as early vs. IV/progression/recurrence as late) and phase of care (initial being the first 12 months, survivorship starting after this, and end of life being the last 6 months of life) were abstracted from the electronic medical record. Descriptive statistics were calculated using frequencies and percentages for categorical variables and median and interquartile ranges (IQR) for continuous variables. Likelihood ratios (LR) and 95% confidence intervals (CI) were estimated using a modified Poisson regression with robust error variance to evaluate the relationships between patient-perceived incurability and AD completion. Models were subset for White patients (n = 879), BIPOC patients (n = 330), and patients with solid organ malignancies (n = 987). Models were adjusted for demographics and clinical characteristics. Results: Of 1209 patients, 73% were White, and 82% had solid organ malignancies, most commonly gynecologic (32%), breast (17%), and gastrointestinal (13%). The sample was predominantly female (70%) with early-stage disease (60%) and a median age of 66 (IQR 58-72). AD completion was 46%, 32%, and 41% for patients who were White, BIPOC, or had solid organ malignancies, respectively. In adjusted analyses, patient-perceived incurability was not associated with AD completion for any of the patient subgroups (White LR 1.06, 95% CI 0.89-1.35; BIPOC LR 0.93, 95% CI 0.60-1.44; solid organ LR 1.10, 95% CI 0.88-1.36). Conclusions: Patient-perception of incurability does not appear to be associated with AD completion even in subgroup analyses based on race and ethnicity or cancer type.
Development of a patient-reported outcome measure (PROM) screening strategy for early palliative care needs in outpatients with advanced cancer.
Authors: Kaufmann Tara L. , Rocque Gabrielle Betty , Kvale Elizabeth Ann , Kamal Arif , Pignone Michael , Bennett Antonia Vickery , Saxton John , Hernandez Rabecca-Kimberly , Stover Angela M.
Published: September 2022

203

Background: There is a critical need to develop standardized and feasible methods to monitor patients for unmet palliative needs and direct timely referral to specialty palliative care. We developed a patient reported outcome measure (PROM) measurement strategy to screen patients for multidimensional palliative care needs. Methods: Guided by evidence-based frameworks for early palliative care in oncology, we identified 8 key domains for PROM monitoring that are meaningful and actionable in clinical care and appropriate for direct patient report. We conducted a systematic search for PROMs assessing these key domains using the Palliative Care Research Cooperative (PCRC) Measurement Core resources and the Grid-Enabled Measures Database. PROMs for each domain were compared for content coverage, psychometric properties, proprietary availability, Spanish translation, and attributes (response options, length, literacy demand). Results: We selected 13 PRO items for weekly monitoring (Symptom PROs) and 11 PRO items for monthly monitoring (Palliative PROs) (Table). We did not identify any validated PROMs to assess caregiver burden from the patient perspective. Validated PROMs in short formats for spiritual/existential needs are limited. Conclusions: Existing PROMs are limited in capturing the multi-dimensionality of palliative care needs for patients with cancer, particularly for spiritual needs and patient-reported caregiver burden. Future work will focus on piloting identified PROMs to monitor patients for early palliative care needs and determining thresholds to trigger referrals to specialty palliative care.[Table: see text]
Efficacy of a brief telemedicine-based cognitive behavioral treatment (BRIGHT) versus attention control for head and neck cancer survivors with body image distress: A randomized trial.
Authors: Graboyes Evan Michael , Maurer Stacey N , Balliet Wendy , Li Hong , Williams Amy M. , Osazuwa-Peters Nosayaba , Padgett Lynne , Yan Flora , Gordis Tamar , Rush Angie , Ruggiero Kenneth J. , Sterba Katherine R.
Published: September 2022

212

Background: Nearly 1 in 3 head and neck cancer (HNC) survivors suffer from body image distress (BID), a source of devastating psychosocial morbidity that impairs quality of life. Evidence-based strategies to manage BID among HNC survivors are lacking. This trial evaluates the preliminary efficacy of BRIGHT (Building a Renewed ImaGe after Head & neck cancer Treatment), a brief tele-cognitive behavioral intervention, relative to attention control (AC), at reducing BID among HNC survivors. Methods: HNC survivors with clinically significant BID were randomized to BRIGHT (n = 20) or AC (n = 24). BRIGHT was delivered by a psychologist in 5 weekly video tele-medicine sessions. AC consisted of dose- and delivery-matched survivorship education. Changes in HNC-related BID and cancer-related BID were assessed using the IMAGE-HN and Body Image Scale (BIS), respectively. The effect of BRIGHT vs AC was analyzed using generalized linear models. Clinical response (proportion of patients with a clinically meaningful change in IMAGE-HN and BIS scores) for BRIGHT vs AC was analyzed with logistic regression. Results: The median age was 63 years (range 41-80) and 61% had stage III/IV HNC. BRIGHT decreased HNC-related BID from baseline to 1- and 3-months post-intervention relative to AC (Table). At 3-months post intervention, the response rate of BRIGHT on HNC-related BID was 6.6-fold higher than AC (OR = 6.6; 90% CI 2.0 to 21.8). BRIGHT decreased cancer-related BID from baseline to 3-months post-intervention vs AC (Table). The improvement in HNC-related BID and cancer-related BID for BRIGHT vs AC at 3-months was clinically significant and the effect size was large (Cohen’s d = -0.9, 90% CI -1.4 to -0.4 for each). Conclusions: In this pilot RCT, BRIGHT results in clinically meaningful improvements in BID among HNC survivors. These promising preliminary data support conducting a large efficacy trial to establish BRIGHT as the first evidence-based treatment for HNC survivors with BID. Clinical trial information: NCT03831100. [Table: see text]
Defining the needs of lung cancer survivors: Physical, social, emotional, and medical needs.
Authors: Guo Matthew , Miller Mattea , Olson Sarah , Eaton Cyd , Boulanger Mary , Turner Michelle , Hsu Melinda Laine , Feliciano Josephine Louella
Published: September 2022

225

Background: Lung cancer survivors (LCS) are a rapidly growing population. Cancer survivors benefit from dedicated survivorship care, but the physical, psychosocial, and medical needs of LCS are poorly defined. Methods: Non-small cell LCS (defined as alive ≥1 years from diagnosis) of any stage treated at Johns Hopkins were invited to complete an IRB-approved cross-sectional survey of needs of 4 subscales (physical, social, emotional, and medical needs) rated on a 5-point Likert scale (1 = no need, 5 = highest need). Demographic and clinical information were collected by chart review and patient reported questionnaire. Multiple regression models identified factors that were significantly associated with greater total number of needs on each subscale. Results: 235 surveys were completed. We excluded surveys with < 80% completion. Non-Caucasian race was associated with a significantly lower rate of survey completion (p = 0.002). Median age of LCS who completed the survey was 69, most were female (62%), Caucasian (74%), married (71%), or had stage III/IV cancer (60%). More than half of respondents reported emotional needs of fear of recurrence (79%) and living with uncertainty (74%). Common physical needs included fatigue (70%), sleep disturbance (60%), memory and concentration (57%), and weakness (54%). Multivariate analysis identified factors associated with higher needs in physical, social, and emotional needs (Table). We did not identify any factors associated with differences in medical needs. NS – non-significant value. Conclusions: We identified physical, emotional, social, and medical needs that burden survivors of NSCLC. Emotional needs are prevalent. Clinical and demographic factors are independently associated with higher needs in physical, social, and emotional domains. These results are critical in identifying high-impact gaps in providing survivorship care for lung cancer survivors. Future work to identify interventions to address needs is crucial.[Table: see text]
Shift in survivorship care delivery.
Authors: McGrath Elizabeth Boutin , Willyard Jennifer , Langa Maya , Walsh Sarah K. , Buccellato Andrea B
Published: September 2022

230

Background: Survivorship care often occurs within a single visit at the end of treatment to discuss a treatment summary and/or survivorship care plan with a patient. With increased understanding of both immediate and long-term effects of cancer and cancer treatment we need to consider support for the patient from the time of diagnosis through the end of the patient’s life. In this quality improvement (QI) initiative, a team of survivorship stakeholders utilized survey and focus group methodology to develop a set of recommendations to support a large, academic medical center in a rural setting to move toward this holistic notion of survivorship care. Methods: Surveys regarding experience with survivorship care were deployed to oncology providers, allied health providers, and patients and care partners. Surveys were deployed via a web-based survey tool using email groups and lists developed by the oncology department, as well as printed handouts with the survey URL and a QR code available to patients during clinic visits. A focus group was conducted with oncology APPs to discuss findings and to develop recommendations to support survivorship care delivery. Results: Responses received from 59 patients, 20 care partners, 24 allied health providers, and 19 providers. Over half (52.6%) of patients and care partners indicated that survivorship services were “very important” to their care, with less than 10 respondents (11.5%) indicating that they were “not at all important.” Providers indicated that they do discuss and/or provide survivorship support to their patients (84.2% of respondents), but almost 80% indicated that they were only somewhat knowledgeable (36.8%) or not knowledgeable at all (42.1%) about survivorship services available to patients and care partners. Both allied health and providers indicated that documenting survivorship care was complex. Only 12.5% of providers indicated that patients had a formal survivorship visit; instead, providers indicated that survivorship care is incorporated into routine follow-up visits (75%) and/or active treatment visits (50%). Both allied health (60.0%) and providers (69.2%) indicated that documentation, if done at all, was entered through a free text note. Many acknowledged that this made data tracking, whether for continuity of care or program analysis purposes, labor-intensive. Conclusions: This QI initiative revealed the need for two supportive mechanisms to facilitate the shift from survivorship care that’s limited to a dedicated visit type or tied to a specific document to survivorship care that is woven into all aspects of a patient’s treatment and life beyond treatment. The first mechanism is a robust set of informational resources to ensure providers are knowledgeable about the services that are available to their patients and the referral mechanisms for those services. The second is a mechanism within the EHR to allow survivorship notes to be entered into any visit type and be extracted easily from the system.
Developing a standardized approach to prevention and outpatient management of febrile neutropenia.
Authors: Crespo Andrea , Gallo-Hershberg Daniela , Enright Katherine , Forbes Leta Marie , Vu Kathy
Published: September 2022

234

Background: Optimal prevention and safe management of febrile neutropenia (FN) in the outpatient setting, when clinically appropriate, can help to keep vulnerable patients from experiencing severe complications requiring hospitalization. Variation in the prevention and outpatient management of FN was identified as a quality and safety gap by Ontario clinicians. This initiative aimed to facilitate a standardized approach to prevention and outpatient management of FN through the development of practical, evidence-based health-care provider and patient resources. Methods: A clinical practice guideline was developed by a 15-member multidisciplinary Working Group (WG) consisting of physicians, pharmacists, nurses, and administrators who are knowledgeable in the areas of prevention and management of FN. The WG reviewed current relevant international guidelines and available literature on primary and secondary FN prophylaxis and FN management, with an emphasis on the optimal use of granulocyte colony-stimulating factor (G-CSF) and appropriate FN management in the outpatient setting. The 2016 Cancer Care Ontario recommendations on the use of G-CSF were used as a foundation for the prevention of FN content. Key clinical questions were identified by the WG, and content was approached with an Ontario-specific lens. Recommendations were developed using an iterative consensus-building process over six WG meetings. The guideline report was reviewed by external clinical experts who validated final content. Accompanying patient information was informed by health literacy best practices, existing symptom management resources, and input from patient education experts, patients, and caregivers. Results: A user-friendly clinical practice guideline was created. Definitions, risk factors, FN prophylaxis strategies based on risk/treatment intent, and appropriate outpatient management of FN are described. Key clinical questions are reviewed and a total of 25 evidence-informed consensus-based recommendations are presented. The guideline includes FN risk assessment and outpatient FN management algorithms, as well as summaries of available literature and WG discussion. The accompanying patient information explains what neutropenia and neutropenic fever are, lists potential symptoms, and describes management strategies in patient-friendly language. All resources are publicly available on the Ontario Health-Cancer Care Ontario website and have been disseminated broadly to relevant stakeholders via email, social media, and webinars. Conclusions: Review of current evidence and expertise from oncology and infectious disease clinicians resulted in an evidence-informed, consensus-based guideline. This clinical practice guideline and accompanying patient information resource can help to facilitate safe, standardized prevention and appropriate outpatient management of FN.