bluuebunny/crossref_metadata_2025 huggingface dataset:
Associations of employment disruptions and financial hardship among individuals diagnosed with cancer in the United States.
Authors: Halpern Michael T. , De Moor Janet , Han Xuesong , Zhao Jingxuan , Zheng Zhiyuan , Yabroff K. Robin Robin
Published: September 2022

47

Background: Financial hardship is experienced by approximately half of working-age individuals diagnosed with cancer. Many working individuals diagnosed with cancer also experience disruptions with their employment. This study examines whether employment disruptions are associated with financial hardship among individuals diagnosed with cancer in the US. Methods: We utilized data from the 2016/2017 Medical Expenditure Panel Survey (MEPS) Experiences with Cancer self-administered questionnaires and identified individuals diagnosed with cancer at age >18 who worked for pay at the time of or following their cancer diagnosis. Employment disruption was defined as taking extended paid time off work; switching to a part time or less demanding job or to a flexible work schedule; and/or retiring early due to cancer, cancer treatment, or late effects. Financial hardship was defined in 3 domains: material (borrowing money, financial sacrifices, or being unable to cover medical costs); psychological (worrying about medical bills, financial stability, keeping job/income, or future earnings); and behavioral (delaying/forgoing medical care because of cost). Multivariable logistic regression analyses adjusting for the MEPS survey design were used to determine associations of employment disruption due to cancer with any financial hardship and with financial hardship intensity while controlling for patient demographic, health insurance, and clinical characteristics. Results: Among 732 individuals with a cancer history, 47.4% experienced employment disruptions and 55.9% experienced any financial hardship. Financial hardship was significantly more common among cancer survivors with employment disruption than without disruptions (68.7% vs. 44.5%; p-value of difference < 0.0001). Findings were consistent across multiple hardship measures and domains. Cancer survivors with employment disruptions were more likely to have greater (OR = 2.8; 95% CI 2.0, 3.9) financial hardship intensity. Individuals of race/ethnicity other than non-Hispanic White were also more likely to experience financial hardship while older individuals, women, and those with college education or who were married were less likely to experience financial hardship. Conclusions: Employment disruptions are common and significantly associated with multiple types of financial hardship among cancer survivors. Employer workplace accommodation and other policies to minimize disruptions among individuals diagnosed with cancer may reduce financial hardship in this vulnerable population.
Creating a proactive interdisciplinary approach to care: Embedding oncology care coordination within an oncology patient and family support program.
Authors: Low Sarah , Nakaji Ayaka , Irwin Scott A , Van der Gaag Jan-Kees
Published: September 2022

51

Background: The benefits of providing psycho-oncology services have been well documented in producing better effective team collaboration, patient outcomes, and reduced healthcare utilization. Cedars-Sinai Cancer spans five locations and serves over 11,000 patients a year. Their robust Patient and Family Support program (PFSP) includes psychiatry, palliative medicine, social work, nutrition, cancer rehabilitation, survivorship, and chaplaincy to envelop patients in multiple dimensions of support. A new oncology care coordination (CC) model embedded a social work (SW) and nurse (RN) CC within PFSP to identify and meet diverse unmet needs of patients through close interdisciplinary collaboration. Methods: Oncology CC was established within PFSP, containing an oncology SW CC and an oncology RN CC. Patients with higher acuity needs were identified through multiple avenues such as: health plan reporting and dashboards in the electronic medical record (EMR) providing alerts for patients with unmet needs. Preliminary data was captured on interdisciplinary collaboration and care coordination from a daily log kept by coordinators, as well as from the EMR. Results: Over 6 months (9/2021 to 2/2022), the PFSP CC team served 688 patients providing 1280 interventions. Of the 1280 interventions, 22% were coordination with other PFSP services; of which 54% was with SCM, 36% with Clinical SW, and 18% represented new referrals. 13% focused on outside services including medical devices, home health, and community resources. 6% comprised of post-discharge calls by the RN CC and 16% represented direct SW CC outreach. Care coordination such as appointment scheduling, assistance with prescriptions and communication with medical teams represented 9%, 1% and 11% of the interventions respectively. Conclusions: Results demonstrated for this subset of patients that the highest needs of oncology PFSP CC were SW and SCM, to address needs such as pain and symptom management, goals of care conversations and community resource linkage. Anecdotally, communication with primary oncology and other medical teams proved to be an essential role of the CC team, particularly to address inpatient to outpatient transitions of care. Discussion: CC team involvement is time-limited and appears to rely on the long-term relationship patients have with PFSP interdisciplinary team members for interventions to be long-lasting and effective. The CC team leveraged existing relationships that PFSP providers had established with primary oncology teams, allowing for timely care coordination. Future goals include: 1) developing an algorithm to better identify patients with higher acuity and unmet needs; 2) measuring impacts of CC services on care outcomes, health care utilization and reduced symptom burden; 3) expanding the CC team to serve more of the patient population.
Quality improvement project: Implementation of I-PASS, a structured patient hand-off tool to improve communication, increase patient safety, and prevent burnout among palliative care providers at a comprehensive cancer center.
Authors: Amaram-Davila Jaya Sheela , Stewart Holly A. , Aceves Monica , Tallie Kimmie , Fleckenstein Olga , Ait Aiss Mohamed , Franco-Vega Maria , Dalal Shalini , Bruera Eduardo
Published: September 2022

65

Background: Communication among the health care providers plays a crucial role in team-based practices, and a standardized communication platform is essential. Our palliative care consult service (PCCS) at a university-based cancer center manages cancer-related symptoms. The handoff process among the providers takes place via encrypted emails shared among the providers. The current demand for palliative care (PC) among the cancer population led to increased patient encounters and associated handoff emails. Numerous handoff emails (sometimes up to 25-30/day) can lead to missing/overlooked information, cause burnout among the providers, and affect patient safety. Studies have shown that implementing I-PASS into clinical practices has significantly reduced medical errors without increasing documentation time. We aimed to improve communication among the PC providers, prevent burnout and increase patient safety by using a built-in I-PASS handoff tool on electronic medical records (EMR). Methods: In January 2021, we formed a team to develop a quality improvement (QI) project to implement I-PASS for our PCCS at our institution. The institutional Quality Improvement Assessment Board approved this QI project. Our team started with Plan, Do, Study, Act. After extensive brainstorming, we mapped out the Cause-and-effect diagram (Fishbone). We laid out a Process mapping through a flowchart and Feasibility impact matrix. The implementation process took place in 4 phases. Phase 1: A per-implementation survey. Phase 2: Extensive training sessions for PC clinicians, both, 1:1 and group sessions. Phase 3: October 2021 I-Pass implementation went live. Phase 4: post-implementing survey to assess provider reception. Results: Based on real-time assessment on EMR, at four months mark, we reached the 100% utilization goal for I-PASS among PC clinicians. In Pre vs. Post-implementation survey, providers perceived they could identify their patient's related information, save time, update handoff daily and locate their assignments without any efforts on I-PASS compared to email handoff (p < 0.0001). Overall, 95% of the PC providers found I-PASS helpful. Conclusions: Standardized communication tools such as I-PASS have proven safe and effective and help prevent provider burnout by improving overall workflow. Future studies need to focus on steps to continue developing tools to help modify the handoff on Smartphone EMR applications such as HAIKU.
Association of historical housing discrimination and colon cancer treatment and outcomes in the United States.
Authors: Hussaini S. M. Qasim , Fan Qinjin , Yabroff K. Robin Robin , Pollack Craig Evan , Nogueira Leticia M
Published: September 2022

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Background: In the 1930s, the federally-sponsored Home Owners’ Loan Corporation (HOLC) created maps that directed mortgage financing based largely on a neighborhood’s racial composition. American neighborhoods were subdivided into four risk-based rankings (A – best neighborhood, B – still desirable, C – in decline, and D – hazardous and mapped in red) for mortgage approvals and denials. “Redlining” resulted in racial segregation and systemic disinvestment in communities targeted for marginalization. We investigated the association between historical housing discrimination and contemporary diagnosis, treatment, and survival outcomes in colon cancer – a leading cause of cancer deaths amenable to early detection and treatment. Methods: Individuals diagnosed with colon cancer from 2007-2017 were identified from the National Cancer Database. Individuals residing within known zip code tabulation areas (ZCTA) in 196 cities with ≥10% HOLC coverage were included. Residences were assigned a HOLC grade (A, B, C, or D) based on the majority HOLC area represented. Multivariable logistic regression models (adjusted for age and sex) were used to investigate the association of housing discrimination and late stage (stages III/IV) diagnosis, time to chemotherapy initiation, and non-guideline-concordant care (no chemotherapy, surgery, or < 12 lymph node dissection). Multivariable Cox proportional hazard models with age as time scale were used to investigate the association of housing discrimination and overall survival. Results: There were 98,335 patients with new diagnoses of colon cancer with median age 68 years. Individuals residing in HOLC D were more likely to be non-Hispanic White (59%), have public insurance (46%), and income < $40,000/year. Compared to people living in majority HOLC A ZCTAs, living in majority HOLC D had higher odds of a late-stage diagnosis, and living in majority HOLC B, C, or D had higher odds of non-guideline concordant colon cancer care with longer time to chemotherapy initiation. For people living in majority HOLC C and D, overall survival for all stages and late stage was worse when compared to HOLC A ZCTAs. Findings were consistent in sensitivity analysis. Conclusions: Historical housing discrimination is adversely associated with contemporary colon cancer care and outcomes. Findings underscore the importance of state-and federal-level practices on mortgage lending regulation and fair housing practices in determining equitable cancer risk, access to care, and outcomes.[Table: see text]
Changes in cancer mortality rates after Medicaid expansion under the Affordable Care Act and the role of changes in stage at diagnosis.
Authors: Barnes Justin Michael , Johnson Kimberly J. , Osazuwa-Peters Nosayaba , Chino Fumiko
Published: September 2022

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Background: Medicaid expansion is associated with earlier cancer diagnoses and improved cancer survival. However, it is unclear if the expansion-associated survival benefits are driven primarily by early detection leading to improved prognosis and/or increased access to appropriate cancer care. A nationwide analysis was performed to determine the degree to which expansion-associated changes in cancer mortality rates can be explained by changes in stage at diagnosis. Methods: State-level cancer incidence and mortality data from 2001-2019 for individuals ages 20-64 years were obtained from the combined Surveillance, Epidemiology, and End Results and National Program of Cancer Registries databases (incidence) and the National Center for Health Statistics (mortality), which cover the 50 US States and Washington DC. Difference-in-differences analyses were conducted to compare changes in localized and distant stage cancer incidence rates and cancer mortality rates from pre- vs. post-2014 in expansion vs. non-expansion states. We utilized generalized estimating equations to account for autocorrelation within states and adjusted for age, race, sex, year, state, early Medicaid expansion effects, and state-level covariates (unemployment, education, poverty, race/ethnicity, and insurance). Analyses were conducted overall and by cancer site subtype. Mediation analyses were utilized to assess whether local and/or distant stage diagnosis rates were mediators of the changes in cancer mortality rates. Results: The data consisted of 16,470 state-year observations stratified by age, sex and race. In our adjusted analyses with all cancer sites combined, there were decreases in the distant stage cancer incidence rate (OR: 0.966, 95% CI = 0.942 - 0.991, P=.009) and cancer mortality rate (OR: 0.974, 95% CI = 0.950 - 0.999, P=.041) after Medicaid expansion in expansion relative to non-expansion states. There were no expansion-associated changes in localized cancer incidence rates (OR: 0.989, P=.45). Changes in distant stage cancer incidence mediated 26% of the expansion-associated change in cancer mortality ( P=.013). By cancer site, there were Medicaid expansion-associated decreases in cancer mortality rates for breast (OR: 0.954, P<.001), cervical (OR: 0.934, P=.020), and colorectal (OR: 0.945, P=.045) cancers, though local or distant stage incidence rates were not found to be statistically significant mediators. Conclusions: Medicaid expansion was associated with decreased metastatic stage cancer incidence and decreased overall cancer mortality. Approximately 25% of the improvements in cancer mortality can be attributed to decreases in metastatic diagnoses suggesting increased rates of curative-intent treatment, amongst other factors. Remaining survival benefits may reflect access to timely, quality cancer care not captured in this analysis.
Factors influencing “no treatment” decisions in advanced stage cancers.
Authors: Akpoviroro Ogheneyoma , Akpoviroro Oghenetejiro Princess , Uwandu Queeneth , Yossef Kristena , Suastegui Steven , Castagne Myriam , Rodrigues Elga , Bolden Brian , Mirza Wasique
Published: September 2022

77

Background: Several studies have attempted to explore treatment refusal in patients with cancer (CA). We performed a study that focused on patients with advanced CAs, characterizing those in this group that refused therapy. Based on this study, we sought to determine if some variables significantly correlated with ‘no treatment’ decisions, compared with a group of similar patients who accepted therapy. Methods: Our inclusion criteria were patients aged 18-75 years, diagnosed with stage IV CAs (per the American Joint Committee on Cancer staging) between 1/1/2010 and 12/31/2015 and refused therapy (Cohort 1). A randomly selected group of patients with stage IV CAs who accepted treatment in the same timeframe were used for comparison (Cohort 2). We used Proc SurveySelect and a simple random sampling method to create Cohort 2. Geisinger Health System’s data was used. Results: We found 508 patients for cohort 1, and 100 patients for cohort 2. The significance level was < 0.05. Female sex was associated with treatment acceptance (51/100, 51.0%) compared with refusal (201/508, 39.6%); p = 0.03. There was no association between treatment decision and race, marital status, BMI, tobacco use, previous CA history, or family CA history. Government-funded insurance was associated with therapy refusal (337/508, 66.3%) than acceptance (35/100, 35.0%); p < 0.0001. Cohort 1 had an older population compared with cohort 2 (p < 0.0001). The mean age of cohort 1 was 63.1 years (standard deviation (σ) 8.1), and 59.2 (σ 9.9) in cohort 2. The most common malignancy site in both cohorts was the respiratory system but this was not related to treatment decisions. Patients with pancreatic CA tended to refuse treatment (p = 0.0009). Only 19.1% (97/508) in cohort 1 were referred to palliative medicine, with 18% (18/100) in cohort 2; p = 0.8. There was an insignificant trend for patients who accepted treatment to have more comorbidities per the Charleston Comorbidity Index (CCI) (p = 0.08). The mean CCI in cohort 1 was 6.5 (σ 3.7), and 8.0 (σ 3.9) in cohort 2. Treatment of psychiatric disorders after CA diagnosis was inversely associated with treatment refusal (p < 0.0001). Conclusions: Male sex, older age, government-funded health insurance, and pancreatic CAs were associated with treatment refusal in advanced CA patients. Those who refused treatment were not increasingly referred to palliative medicine. Treatment of psychiatric disorders after CA diagnosis was associated with treatment acceptance.[Table: see text]
Underrepresented minority clinical trial participation: Perspectives of the research care team and patients.
Authors: Warner Erica T. , Revette Anna C. , Lormil Brenda , Booz Natalie A , Vora Kruti Bhagirath , Haas Jennifer , Moy Beverly
Published: September 2022

93

Background: Clinical trials (CT) are important treatment options for patients with cancer, yet enrollment rates among underrepresented minority (URM) patients remain suboptimal. Oncology care teams need to assess barriers and facilitators of CT participation and identify practices and resources to better support patients. As part of a larger mixed-methods project, we elicited perspectives on improving URM CT enrollment from oncology research care teams and patients. Methods: We conducted four 60-minute focus groups with 12 oncology physicians, 12 research nurses, and nine clinical research coordinators, and semi-structured interviews with nine URM CT patients at a large academic medical center between January and December 2021. Results: Thematic analysis of the focus groups and interviews identified multiple barriers and potential resources and supports at the patient, healthcare team, institutional, and trial design levels. Barriers included difficulty ensuring patient understanding and informed consent, especially among patients with low health literacy and limited-English proficiency, complex logistical and financial demands of CT participation for patients, and the lack of multidisciplinary oncology care team collaboration. Collectively, these barriers undermined communication, trust, and the quality of patients’ relationships with the care team, all affecting CT participation. Suggested resources and practices included proactive needs assessments for all patients with early engagement of social workers, providing a liaison or navigator for each patient, services and support to reduce patient out of pocket costs, expansion of non-English materials availability and increased used of interpreters, increased training and diversity for all care team roles, and simplifying CT requirements by streamlining informed consent documents, eliminating unnecessary CT-related appointments, and broadening eligibility criteria. Conclusions: Findings suggest that changes in clinical trial design, care team coordination, and early assessment and monitoring of patients’ needs and experiences may help reduce access barriers and increase enrollment of URM patients into cancer CTs.
Decentralized and hybrid trials in oncology: Results of a global survey of clinical research executives.
Authors: Beg Shaalan Shaalan , Bustos Drew
Published: September 2022

102

Background: Decentralized (DCT) and hybrid (Agile) clinical trials have the potential to deliver significant enhancements to trial operations by improving access to patients and providers. We conducted a survey of research executives at sponsor sites and contract research organizations (CRO) to understand trends in oncology clinical trials. Methods: The survey took place in March and April 2022 via online questionnaires. Only complete responses from senior executives who are either involved in sponsoring or managing clinical research within oncology, or who are planning to execute oncology clinical trials in future, were included. Response data were analyzed by an independent market research service and tested for significance at the 95% confidence level. Results: The questionnaires generated a “qualified” respondent sample of 85 responses. Most (60%) respondents were from biopharmaceutical sponsors, with around one-third from organizations with more than US$20 billion in revenue. The most frequent perceived challenges for oncology clinical trials execution were patient recruitment (72% of execs ranked this in their top 3); study start-up (55%); and study delays (54%). Three in four executives (73%) are planning to run either a DCT or hybrid trial for oncology in the next 12 months, up significantly from 49% in the prior 12 months. Most common cancer indications for DCT in the next 12 months are lung cancer (40%), leukemia/blood cancers (37%), and breast cancer (30%). More than half of respondents reported that they plan to include ePRO/eCOA tools (57%) and telemedicine (54%) in their oncology clinical trial designs over the next 12 months. A further 48% expect to deploy Mobile Nurses, with the same number planning to incorporate eConsent. The top three perceived benefits of using DCT tools identified in oncology trials are increased patient retention (67%); greater patient diversity (54%); and faster patient recruitment (50%). Conclusions: The survey of oncology research executives highlights the most common perceived challenges in executing clinical trials. Many of these challenges can be addressed using decentralized tools. Researchers are planning to significantly increase the adoption of DCT in the coming year. DCT adoption in oncology clinical trials Prev 12 mos Next 12 mos Traditional, Site-Based Trial 88% 65% Agile Trial (Hybrid) 43% 58% Fully Decentralized Trial 19% 40% Agile Trial OR Fully Decentralized Trial 49% 73%.
Barriers to cancer prevention among women experiencing homelessness who receive onsite mammography, patient navigation, and education (HOPE).
Authors: Hurwitz Heather McKee , Anderson NaSheema , McCaffrey Kate , Combs Pamela , Jackson Raymond D. , Kilic Sarah S , Mariner Markayla , Onger Tiffany , Sanders Kimberly , Stimpert Tyler , Suwarna Jeremy , Weleff Jeremy , Shah Chirag S.
Published: September 2022

111

Background: While incidence rates of cancer are lower among women experiencing homelessness (WEH), cancer mortality remains higher. Barriers to screening include economic, transportation, housing, childcare and other barriers. This study evaluates barriers to mammographic screening as part of a prospective program that provides onsite mammography services to WEH. Methods: Cleveland Clinic partnered with shelters to provide breast health education, patient navigation, and mobile mammograms onsite at shelters. Also, participants received a meal, a bra, and hygiene items. 75 women and persons of other genders completed a mammogram. 55 WEH participated in the study by completing a survey for a response rate of 73.3%. The survey included questions about barriers and demographics. We conducted a preliminary analysis to improve study quality and plan for a follow up study. Results: Participants were 40-75 years old and identified as American Indian/Alaska Native (5.5%), Black/African American (60%), and White (40%). 16% of participants received their first ever mammogram. 34% noted a family history of breast cancer and 22% had previously been advised to return for additional imaging. One participant was a breast cancer survivor. On average, participants’ last mammogram was four years prior with the greatest screening lapse being 18 years prior. A majority (n = 39, 70.9%) disagreed or strongly disagreed with the statement, “I’m afraid the mammogram will be painful.” Likewise, a majority (n = 46, 83.7%) disagreed or strongly disagreed with the statement, “I’m embarrassed about having a mammogram.” A majority (n = 44, 80.0%) also disagreed or strongly disagreed with the statement, “I’m busy and do not have time.” Almost all participants (n = 51, 96.2%) responded “yes” to the statement, “I believe in preventative care screenings.” However, participants’ responses to the statement, “I’m afraid of finding breast cancer” varied widely from strongly disagree (n = 7, 13.0%) and disagree (n = 10, 18.5%), to neutral (n = 15, 27.8%), to agree (n = 12, 22.2%) and strongly agree (n = 10, 18.5%). Conclusions: Our preliminary data shows that most participants believe in preventative screening, showing that novel services such as onsite mammography may address the lack of screening in this population. 40.7% of participants stated they are afraid of finding breast cancer, indicating this is a barrier to screening in the WEH population. Future research should explore reasons for fear (financial burden, mortality, lack of access to care, etc.) and why this may result in a lack of screening.
Cancer treatment delays among patients with cancer living with HIV during the COVID-19 pandemic in the United States.
Authors: Khouri Ashley , Islam Jessica Yasmine , Van Bibber Nathan , Coghill Anna , Suneja Gita
Published: September 2022

131

Background: The COVID-19 pandemic led to care disruptions across the cancer continuum. It is unknown if immunosuppressed patients with cancer who may be at high risk for SARS-CoV-2 infection were disproportionately impacted. Our objective was to compare delays in cancer treatment initiation between people living with HIV (PLWH) and cancer, the general cancer population (GCP), and patients with cancer and a history of solid organ transplant (SOT), another immunosuppressed patient population. Methods: We used data from Flatiron Health electronic health record-derived de-identified database (2018-2021) comprised of US patients with cancer from 800 sites of care across the country. We included patients with lymphomas, myeloma, and melanoma, as well as cancers of the breast, lung, prostate, head & neck, and gynecologic or gastrointestinal systems. We calculated time to cancer treatment initiation (TTI) as the difference between the date of cancer diagnosis and the earliest date that one of the following treatments was recorded: cell based treatment, other local treatment, radiotherapy, surgery, systemic therapy, or transplant. 16.4%, 19.9%, and 13.3% of the GCP, PLWH, and SOT groups, respectively, did not have treatment information in the database. This may have been due to no receipt of treatment or lack of data in the medical record. All analyses reported were conducted among patients with available treatment data. PLWH and those with a history of SOT were selected using ICD 9/10 codes. After adjusting for age, sex, and metastatic disease (yes/no), we used a difference-in-difference analysis to compute TTI for each study group both prior to and during the COVID-19 pandemic. We then determined whether study group differences in cancer patient TTI (e.g., HIV-associated treatment delays) changed during the pandemic. Results: The sample included 181 PLWH, 65073 GCP patients, and 195 patients with a history of SOT. Overall, no significant delay in TTI was seen between the three groups pre-COVID. However, during the pandemic, the TTI was statistically significantly delayed for PLWH compared to the HIV-uninfected GCP (median TTI 41 days vs. 27 days, p = 0.0017). No significant difference was observed overall between the GCP and the SOT group (median TTI 27 days vs. 20 days, p = 0.376), evidence that COVID-related treatment delays were specific to PLWH. Difference in difference analysis revealed that, when compared to the GCP, there was a significant increase in TTI among PLWH over time, with delays increasing by almost one month during COVID [DID: 32.6 days (8.9-56.3); p = 0.007]. The increase in TTI for PLWH was consistent across treatment modalities, including surgery (DID: 55.1, 95% CI: 28.8-81.3, p < 0.001) and systemic therapy (DID: 30.4; 95% CI: 4.6-56.3, p = 0.021). Conclusions: PLWH and cancer experienced significant delays in cancer treatment initiation after diagnosis during the COVID-19 pandemic.
Trends in the improvement in survival among patients with diffuse large B-cell lymphoma (DLBCL).
Authors: MacDougall Kira , Day Silas , Nipp Ryan David , Hall Spencer , Zhao Yan D. , Al-Juhaishi Taha
Published: September 2022

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Background: Advances in treatment for patients with DLBCL have led to improved patient outcomes, but whether disparities exist with regards to improved survival outcomes remains understudied. We sought to describe changes in DLBCL survival rates over time and explore potential differential survival patterns by patients’ race and age. Methods: We utilized the Surveillance, Epidemiology, and End Results (SEER) database to identify patients diagnosed with DLBCL from 1980-2009 and determined 5-year survival rates for all patients, categorizing patients by year of diagnosis. We used descriptive statistics and logistic regression, adjusting for stage and year of diagnosis, to describe changes in 5-year survival rates over time by race/ethnicity and age. Results: We identified 43,564 patients with DLBCL eligible for this study (median age 67 years [ages: 18-64 = 44.2%, 65-79 = 37.1%, 80+ = 18.7%], 53% male, 40% stage III/IV). Most were White race (81.4%), followed by race/ethnic groups of Asian/Pacific Islander (API) (6.3%), Black (6.3%), Hispanic (5.4%), and American Indian/Alaska Native (AIAN) (0.05%). Overall, the 5-year survival rate improved from 35.1% in 1980 to 52.4% in 2009 across all patients (odds ratio (OR) for 5-year survival with increasing year of diagnosis = 1.05, p <.001). Patients in race/ethnic minority groups (API: OR = 0.86, p <.0001; Black: OR = 0.57, p <.0001; AIAN: OR = 0.51, p =.008) and older adults (ages 65-79: OR = 0.43, p <.0001; ages 80+: OR = 0.13, p <.0001) had worse 5-year survival rates adjusting for race, age, stage, and diagnosis year. We found consistent improvement in the odds of 5-year survival for year of diagnosis across all race and ethnicity groups (White: OR = 1.05, p <.001; API: OR = 1.04, p <.001; Black: OR = 1.06, p <.001; Hispanic: OR = 1.05, p <.005; AIAN: OR = 1.05, p <.001) and age groups (ages 18-64: OR = 1.06, p <.001; ages 65-79: OR = 1.04, p <.001; ages 80+: OR = 1.04, p <.001). Conclusions: In this analysis of SEER data, we found that patients with DLBCL experienced improvements in 5-year survival rates from 1980 to 2009, despite ongoing disparities demonstrating worse survival among patients in race/ethnic minority groups and older adults. Notably, we did not find differential improvement in the odds of 5-year survival within subgroups of race and age, underscoring the need for ongoing investigations to address disparities in cancer care delivery and outcomes.
Disparities in place of death from prostate cancer revealed by disaggregation of Asian race.
Authors: Noveihed Alexandra , Lall Naveena , Hussaini S. M. Qasim , Kuo Pei-Lun , Blackford Amanda L. , Gupta Arjun , Sedhom Ramy
Published: September 2022

187

Background: Place of death (PoD) is a surrogate determinant of health care inequity in patients with cancer. Aggregation of Asian Americans, a diverse group, may mask significant health disparities in end-of-life care. Methods: De-identified death certificate data were obtained via the National Center for Health Statistics. All adult (> 18 years of age) prostate cancer deaths from 2018 to 2019 were included. Multinomial logistic regression was used to test for differences in place of death associated with sociodemographic variables. Results: From 2018 through 2019, 81,292 adults died from prostate cancer. Overall, most Asians were less likely to die at home (p < 0.05) or nursing facility (p < 0.05) compared to White patients. Significant differences in nursing facility use was noted in disaggregated analysis, with Samoan patients 12.44 times more likely to die in a hospice facility compared to hospital (CI 2.89, 53.6; p < 0.001) and Chinese patients 100 times less likely to die in a hospice facility (CI 0.01, 0.02; p < 0.001) to give two notable examples. Chinese (OR 0.26), Guamanian (OR 0.2), and Vietnamese race (OR 0.05) had the lowest likelihood of dying at home, with odds ratio lower than Black race (OR 0.3) (Table). Conclusions: Increased attention to PoD over recent years has highlighted issues around equity in end-of-life care. Overall, our data underscore important differences among Asian subpopulations and possible barriers to quality end of life care that would otherwise be masked with data aggregation. It is well known that resources are needed to allow death at home or at a nursing facility. Further qualitative work is planned to investigate culture differences contributing to PoD differences for patients with cancer through the lens of the social determinants of health.
Palliative care utilization and mortality in patients who received inpatient chemotherapy.
Authors: Anderson Justine , Handa Shivani , Petrone Giulia , Chowdhury Nobel , Kwon Deukwoo , Bhardwaj Aarti Sonia , Jain Priya , Smith Cardinale B. , Berger Natalie S
Published: September 2022

198

Background: Early integration of palliative care (PC) into advanced cancer care has been shown to improve quality of life and prognostic understanding. However, there is a paucity of data on utilization of inpatient PC consultation and survival outcomes in patients (pts) receiving inpatient chemotherapy (IC). Methods: A retrospective review was performed at a single academic center of pts receiving IC between Jan 2016 and Dec 2017. We evaluated utilization of PC services, reasons for consult, code status, disposition, and 60-day mortality. Descriptive statistics and odds ratios (OR) were estimated from logistic regression models with mixed-effect, taking into account correlations from multiple admissions per patient. Cumulative incidence plot and Cox proportional hazard regression models were used to assess the association between mortality and study covariates. Results: Of 880 admissions, 733 (83%) were hematologic malignancies (HM) and 147 (17%) were solid tumors (ST). PC consults were more likely in ST than HM (OR 3.19, 95% CI 1.85 - 5.50) and for KPS ≤50% (OR 22.20, 95% CI 11.51- 42.79). Of 159 PC consults, 91 (57%) were for pain and 25 (16%) for goals of care. 66 pts (10%) who received IC died within 60 days of admission, 44 (67%) HM and 22 (33%) ST (p = 0.002). In pts who died within 60 days, 63% had PC consult. Median time from admission to PC consult was 2 days for ST and 9 for HM. Of those with PC consult, 40% had a change from full code to DNR/DNI and were more likely to have a health care proxy (HCP) assigned (OR 7.31, p = 0.001). PC consults were also associated with significantly higher odds of discharge to hospice (OR 10.52, 95% CI: 4.3-25.6; p = < 0.0001; Table). Mortality risk was higher in those admitted for symptoms/complications related to their disease or with progression (HR 3.24, 95% CI (2.50-4.19), p < 0.001) and in those with advanced stage disease: Stage 3 (p = 0.033); Stage 4 (p = 0.0003). Of the pts who died within 60 days, 33 (50%) died during the admission and 24 (36%) in hospice. Conclusions: Significant 60-day mortality after receiving IC is consistent with aggressive end-of- life care. Pts with ST and those with poor performance status more frequently utilized inpatient PC services; however, there is opportunity to increase utilization amongst pts with HM and introduce PC earlier in the inpatient clinical course. PC consultations improve advanced care planning with appropriate transitions in code status, HCP assignments and discharge to hospice.[Table: see text]
Palliative radiation therapy pathway for patients on hospice in a statewide quality improvement collaborative.
Authors: Simon Natalia , Boike Thomas Pence , Devisetty Kiran , Beusterien Sam , DeVries Kelly , Griggs Jennifer J.
Published: September 2022

201

Background: Patients on hospice receive care directed at alleviating symptoms with the goal of reducing burdensome and unnecessary healthcare. Single-fraction radiation therapy is an effective palliative treatment for cancer‐related bleeding. Hospice physicians and radiation oncologists are driven by the same goals of relieving symptoms and decreasing the burden of treatment. In general, hospices are not able to support the costs of providing palliative radiation in eligible patients. The inability to receive radiation therapy may pose a barrier to hospice enrollment. Methods: The Michigan Oncology Quality Consortium (MOQC), a collaborative of nearly 90% of oncologists in Michigan, partnered with radiation oncologists, hospice directors, and patients and caregivers to create a pathway for the referral and treatment of patients with cancer-related bleeding. Through regular meetings, the collaboration created a pathway for patients on hospice or eligible for hospice who were candidates for palliative radiation therapy for bleeding. In patients with cancer-related bleeding, the hospice clinician collaborates with a participating radiation oncologist to confirm eligibility. This decreases the hospice costs of treatment, increases access to palliative radiation, and alleviates the financial and emotional burdens on the patient and family. Results: In Michigan radiation oncology practices and hospices with statewide representation approved the pathway. Radiation oncologists in 19 practices across the state agreed to high value radiation treatment (focused level 3 consultation, complex isodose planning, single fraction treatment). Eligible patients may be seen via virtual consultation and then treated within 1 to 2 days with a single fraction of 8 Gy. A second fraction can be given in patients who continue to have bleeding. MOQC established direct connection to members of the collaborative whose contact information is available on MOQC website. In addition to this treatment pathway, the previously adopted palliative radiation pathway for oncology patients with bone metastases may be found on MOQC website. Conclusions: The radiation therapy pathway for patients with bleeding ensures a unified approach to providing a patient-focused care in patients with limited life expectancy. Challenges to the implementation of the pathway include dissemination of the document across over 100 Michigan hospices and the upfront effort required to screen patients.[Table: see text]
Can we talk about sex? Feasibility of universal sexual health screening for BRCA1/2 patients.
Authors: Kulkarni Amita , Bhoj Seema , Nchako Corbyn Mbock , Ahsan Muhammad Danyal , Frey Melissa Kristen
Published: September 2022

211

Background: Patients with BRCA1/2 pathogenic variants have an elevated risk for several malignancies including breast and ovarian cancer. Recommended risk-reducing treatments and surgeries can cause sexual dysfunction. Yet, sexual health is often under-addressed among this population. The goal of this initiative was to assess the feasibility and acceptability of implementing universal sexual health screening among BRCA1/2 patients in the outpatient setting. Methods: From 1/2022-6/2022, all patients with BRCA1/2 pathogenic variants in an outpatient Gynecologic Oncology clinic were asked to complete a sexual health symptom questionnaire at their visit. The self-administered screener was distributed by a medical assistant in the waiting room and included a validated single-item screener to assess for sexual dysfunction and questions regarding prior provider discussions about sexual health and how patients wanted to receive information on the topic. The screener was positive if a patient reported at least one symptom related to sexual dysfunction. Results: Thirty-six patients were given the sexual health screening and 100% completed it. The median age was 41 years (range 27-72) and 28 (78%) identified as White and 32 (89%) as non-Hispanic. Fourteen (39%) patients screened positive for sexual dysfunction and 25 (69%) reported never having previously discussed the topic of sexual health with a provider. Among the 14 patients that screened positive for sexual dysfunction, 6 (43%) preferred written educational resources about sexual health and 5 (36%) wanted a follow-up in-person visit. Vaginal dryness, lack of interest, and difficulty with orgasm were the most common patient concerns. Conclusions: Implementing a universal sexual dysfunction screening tool for patients with BRCA1/2 pathogenic variants in the outpatient setting is feasible and acceptable, with 100% participation. Further, over one third of patients screened positive for sexual dysfunction, the majority of whom had never discussed their symptoms with a provider. Future efforts are needed to evaluate scalable strategies to assess and improve sexual health among patients with hereditary cancer syndromes.
Implementation of a scalable integrative oncology (IO) program in a large community oncology network.
Authors: Darden Mary , Dudley B. Stephens , Reviere Anne Laura , Schleicher Stephen Matthew , Blakely L. Johnetta , Bilbrey Larry Edward , Dickson Natalie R.
Published: September 2022

215

Background: Integrative Oncology (IO) has become a specialized area of cancer care because of patient desire for holistic approach to care and in response to unmet symptom burden. Until now most IO programs have been limited to large academic medical centers. At Tennessee Oncology (TO), a large community oncology program spanning over 30 clinical sites of care throughout Tennessee and Georgia, an IO program was developed and implemented to bring IO to patients in the community. Methods: In June 2021, the IO program was launched with a physician and a nurse practitioner, both trained in Integrative Oncology. The program started at 8 clinics with visits primarily performed through telemedicine to allow access to each clinic. Providers were educated via email communication and a short video describing the program. Patient education was provided through our website and flyers placed in clinics. A referral order was created within the electronic health record. Results: Within one year, the IO program grew from seeing less than 20 patients per month to seeing over 100 patients per month. To date we have provided approximately 1,050 IO visits for 432 unique patients. Of these patients, 362 (83%) were female and 70 were male. The average age was 59 years old. The top three associated malignancies for patients were breast (n = 182), colorectal (n = 30), and gynecologic oncology (n = 29). Our IO program has expanded from eight to 16 clinics during this time frame. 75% of visits were provided through telemedicine. The most common reasons for IO referral were nutrition and symptom management (fatigue, neuropathy, etc). Conclusions: Implementation of an IO program is possible and scalable in a large community oncology setting. Future directions include studying the impact of our program on patient experience and overall health and wellness.
Implementing suicide risk screening as a part of routine cancer care.
Authors: Donato Umberto , Nguyen Oliver , McCormick Rachael , Hume Emma , Alishahi Amir , Islam Jessica Yasmine , Hallanger-Johnson Julie E. , Gilbert Scott Michael , Turner Kea
Published: September 2022

216

Background: Head and neck cancer (HNC) patients are at increased risk for suicide. Few studies have tested approaches to preventing suicide in this population, such as routine suicide risk screening. To address this issue, the current study pilots and assesses the feasibility and implementation of a suicide risk screening program for HNC patients at a National Cancer Institute (NCI)-designated Comprehensive Cancer Center. Methods: Routine screening was implemented at all in-person visits in the HNC clinic from February 1, 2021 – January 31, 2022 using the PHQ-9. Patients with passive suicidal ideation were consequently screened by social work for active suicidal ideation. Results: Most (92.6% or 1519/1641) HNC patients with a scheduled in-person visit completed at least one suicide risk screening; 9,968 screenings were completed (mean: 3.7; SD: 3.8 per patient) in total. Among patients who were screened, 3% (49/1519) of HNC patients reported passive suicidal ideation and 0.3% (5/1519) were identified as having active suicidal ideation. Patients with five or more visits were more likely to participate in screening compared with patients who only had one visit during the study period (100% vs. 82.7%; P <.0001). Other patient factors, such as race/ethnicity and socioeconomic status, were not associated with screening participation. Conclusions: Findings suggest suicide screening was feasible and effective at identifying patients at an increased risk for suicide. Longitudinal studies are needed to evaluate the impact of suicide screening on suicide prevention and further research is required to scale up suicide screening to reach additional cancer patients.
Depression screening and use of supportive care services in prostate cancer.
Authors: Wong Risa Liang , Cheng Heather H. , Fann Jesse R. , Hnida James , Chakoian Marty , Jannat Samia , Schenker Yael , Yu Evan Y. , Gore John L.
Published: September 2022

219

Background: Patients with prostate cancer (PC) have high rates of depression (15-20%), which is associated with worse oncologic outcomes. The PHQ-9 is commonly used in depression screening, but men with depression may present differently than women, and male-specific screening tools such as the Gotland Male Depression Scale (GMDS) have also been developed and validated. The use of supportive care services in men with PC and depression is not well-described. Methods: Men with ≥1 Urology or Medical Oncology clinic visit for PC in the prior 6 months were emailed the PHQ-9 and GMDS every 60 days. Men who screened positive (score ≥10 on PHQ-9 or ≥13 on GMDS, consistent with moderate to severe depression) were contacted by phone to discuss the positive screen; during that conversation patients were offered a referral to an oncology social worker for a formal needs assessment and connection to supportive care services. Patient characteristics and use of supportive care services (palliative care, psychiatry, counseling, support groups, or spiritual health) at baseline and as a result of study screening were collected by survey and chart review. Results: Between 6/2021-12/2021, 201 men enrolled (Table). 184 completed ≥2 screens with mean follow-up 6.5 months (SD 1.3). 31 men (15.4%) had ≥1 positive PHQ-9 screen and 11 (5.5%) had ≥1 positive GMDS screen, 9 of whom also screened positive on the PHQ-9. Of the 33 men offered clinical social work referrals based on PHQ-9 or GMDS screening, 12 (36%) initially accepted and 7 (21%) ultimately met with social work. Of these 7 men, two ultimately received ongoing supportive counseling from social work, two were referred to support groups or peers in the community, and one was referred to financial services; the remaining two men were not followed longitudinally or referred to any services by the social worker, but were given the option to re-contact the social worker as needed. For the two patients who screened positive on the GMDS but not the PHQ-9, one declined social work referral, and one initially accepted but never scheduled an appointment. Conclusions: Use of supportive care services in men with PC was low, including when services were actively offered as a result of depression screening. Beyond the PHQ-9, the GMDS did not identify any men who engaged in supportive care services. More work is needed to optimally identify men with PC who may benefit from supportive care services and barriers to use.[Table: see text]