bluuebunny/crossref_metadata_2025 huggingface dataset:
Palliative care usage in large cell lung carcinoma: An analysis of the National Cancer Database.
Authors: Han Emily , Wu Xinxin , Keirns Darby , Silberstein Peter T.
Published: October 2023

266

Background: The treatment approach for large cell lung carcinoma (LCLC) typically involves a multimodal treatment strategy, including chemotherapy, radiation therapies, and immunotherapy, to target both the primary tumor and any metastatic lesions. Palliative care (PC) optimizes the treatment of individuals with LCLC by relieving suffering improving quality of life for patients and their loved ones. When implemented early, PC can lengthen survival in patients with advanced non-small cell lung cancer (NSCLC) like LCLC. The association between PC utilization and race, ethnicity, insurance status, education level, income level, rural/urban geography, and facility type in the face of a LCLC diagnosis has not yet been investigated in isolation from other types of NSCLC. We will analyze these factors in this study to highlight key discrepancies in the implementation of PC when treating LCLC. Methods: A retrospective study was conducted using data collected from adults diagnosed with all subtypes of LCLC between 2004 and 2020 in the National Cancer Database to evaluate trends in PC utilization. Demographic characteristics were studied with regards to the use of PC. Multivariate with binary logistic regression was implemented to analyze the following variables: age, sex, Hispanic status, race, Charlson-Deyo comorbidity score (CDCS), education level quartile, income status quartile, facility region, geographic residence status, and primary insurance status. Exclusion criteria included missing values. Results: Among the 25362 patients diagnosed with LCLC, about 12.8% received PC (n = 3727). Patients who were more likely to receive PC had a CDCS of ≥3 (p = 0.017, CI = 1.04-1.47). Additionally, PC usage was more likely in rural (p = 0.003, CI = 1.05-1.27) and urban (p = 0.013, CI = 1.06-1.62) settings compared to metro settings. Patients who were less likely to utilize PC were Black (p = 0.018, CI = 0.77-0.98) and male (p < 0.001, CI = 0.82-0.95). Facility locations in the South (Atlantic) and West (Mountain and Pacific) regions were less likely to provide PC services. Patients paying primarily with Medicaid were the most likely to undergo PC compared to their counterparts lacking insurance or having different insurance (private, Medicare, other government). There was no statistically significant difference in PC usage among different education levels and income brackets. Conclusions: We identified patterns in PC utilization among individuals with LCLC. Variables correlated with PC usage include CDCS, race, facility location, and primary payor at diagnosis. Given that LCLC is aggressive, PC can complement curative treatments to provide comprehensive cancer care. We hope this study will serve as a foundation for reducing health disparities in the treatment of LCLC, thus advancing health equity.
A qualitative study on the role of financial toxicity on adoption of healthy lifestyle behavior after breast cancer among Black and Latina women.
Authors: Nsubayi Celeste K , Pichardo Margaret S. , Ginader Abigail S. , Peña Kryztal , Nguyen Thai Hien , Irwin Melinda , Sanft Tara B. , Fayanju Oluwadamilola Motunrayo , Molina Yamile
Published: October 2023

273

Background: This study aims to understand the role of financial toxicity on lifestyle behavior change for Black and Latina breast cancer survivors. More specifically, we sought to identify the strategies that survivors employed to overcome the effects of financial hardship on behavior change. Methods: A secondary analysis was conducted on qualitative interview data of 26 breast cancer survivors who self-identified as Black or Latina and 10 healthcare providers from an oncology setting. Transcripts were coded using deductive and inductive approaches by a team of three coders and aggregated into thematic categories using content analysis. Results: Barriers identified by survivors included the high cost of healthy food and gym memberships, challenges with unemployment during cancer treatment, and transportation. To address these barriers, survivors relied on strategies that utilized three levels of access: interpersonal, community, and institutional. At the interpersonal level, access to resources was mediated by the self, friends, and family. This strategy involved getting family members to help with bills and incorporating alternative approaches to exercise such as working out at home or going on walks with family. At the community level, access to resources was mediated by local organizations and support groups. This strategy involved receiving free food from church, free exercise programming from local organizations, and/or using government-based resources to mitigate food and housing insecurity. Finally, at the institutional level, access to resources was mediated by the multidisciplinary oncology care team to identify availability and eligibility and apply for various types of resources. This strategy involved social workers facilitating knowledge and assistance for grants to access financial resources and transportation for appointments. Conclusions: The study found that financial toxicity among Black and Latina breast cancer survivors influences their ability to afford, implement, and maintain healthy behavior changes after cancer. Participant identified strategies offer potential venues for interventions that couple financial toxicity mitigation strategies with lifestyle behavior change after breast cancer for Black and Latina women.
Patient characteristics associated with myelosuppression among patients with extensive-stage small cell lung cancer treated with chemotherapy in the community oncology setting.
Authors: Goldschmidt Jerome H. , Monnette Alisha , Shi Ping , Venkatasetty Divea , Huang Huan , Conkling Paul R.
Published: October 2023

289

Background: Myelosuppression, usually manifested as neutropenia, anemia, and/or thrombocytopenia, is a common complication of chemotherapy for extensive-stage small cell lung cancer (ES-SCLC). Myelosuppression has a substantial impact on both the patients and the healthcare system. Despite the published literature on risk factors associated with neutropenia among cancer patients, there is very limited research on whether there are risk factors associated with myelosuppression among ES-SCLC. This study examined the association between patient attributes and the risk of myelosuppression in ES-SCLC, utilizing real-world data from US community oncology practices. Methods: A retrospective observational study analyzed US Oncology Network iKnowMed electronic health records data from 1/1/2015 to 12/31/2020. The study identified adult ES-SCLC patients who began chemotherapy between 1/1/2015 and 12/31/2019 and followed them until 12/31/2020, the date of their last visit or death, whichever occurred earliest. Myelosuppression events were identified based on Common Terminology Criteria for Adverse Events v5.0 definitions for anemia, neutropenia, and thrombocytopenia. Multivariate regression analyses were performed to examine the association between patient characteristics and the risk of experiencing grade ≥3 myelosuppression in any lineages. Sensitivity analyses were conducted on risk of grade ≥3 myelosuppression in each lineage. Results: A total of 1,574 adult patients with ES-SCLC receiving chemotherapy were included (mean age 68 years, 82.2% White, 47.6% male, and 55.5% with an ECOG score ≤1). During follow-up (mean 8.9 months), 56.6% of patients had grade ≥3 myelosuppression. Patient demographics (age, sex, and race) were not identified as factors associated with having grade ≥3 myelosuppression in any lineages. Prophylactic G-CSF use was associated with lower risk of grade ≥3 myelosuppression (OR=0.61, p<0.0001). Receiving a higher dose of chemotherapy was associated with increased risk for grade ≥3 myelosuppressive events (OR=1.14 for 1 mg of increase in dose of carboplatin, p=0.03 and OR=1.01 for 1 mg increase in cisplatin, p=0.003). Having an index treatment hold was associated with higher risk for grade ≥3 myelosuppressive events (OR=2.16, p<0.001). Lastly, having an index treatment delay was associated with higher risk for grade ≥3 myelosuppressive events (OR=1.68, p<0.001). The area under the ROC curve was 0.64 for the main model and ranged 0.60-0.70 in the sensitivity analyses. Conclusions: Patient characteristics were not significant risk factors for myelosuppressive events in ES-SCLC, while chemotherapy intensity and treatment patterns played a more prominent role. The study suggests that prophylactic management may help reduce the risk of myelosuppression in ES-SCLC patients.
Implementation of financial toxicity screening and a novel financial navigation program.
Authors: Noor Chelsea Nadiha , Reyes Maria Fatima , Hsieh Tina Yi Jin , Hacker Michele R. , Garrett Leslie A. , Esselen Katharine
Published: October 2023

290

Background: “Financial Toxicity” is the financial burden and stress imposed on a patient due to a disease and its associated treatment. About 50% of patients with gynecologic cancer experience financial toxicity. The aim of the study is to evaluate implementation of financial toxicity screening and a novel financial navigation program for patients with gynecologic oncology. Methods: Patients presenting for initial consultation with a gynecologic oncology provider from July 2022 to January 2023 were included. A new financial navigation program began in July 2022. On October 17, 2022, a financial toxicity screening question was added to new patient intake forms. We quantified patient referrals to the navigator before and after screening implementation, along with needs identified, action taken by the navigator and institutional support services utilized. Results: We included 458 new patients, 49% before and 51% after introduction of screening. The majority were white (61%) and had private insurance (59%) followed by Medicare (31%); median age was 59 (IQR 47-69). Following screening, a higher proportion of patients were referred to the financial navigator (15%) than before screening (4%, p<0.001). Additionally, referrals to other hospital social support services decreased from 9% before screening to 3% after (p<0.001). Uterine and cervical cancers were more prevalent in the 29 patients (12%) who screened positive (31% and 14% respectively) compared to those who screened negative (17% and 1%) or did not respond (24% and 4%). Referrals to the navigator included 59% of those who screened positive, 8% who screened negative and 10% who did not respond. Over six months, 62 patients (new and follow-up) were referred to the navigator. The most common need was transportation (21%) followed by financial assistance (16%) and emotional support (16%). The navigator assisted 11% of patients with transportation and referred 13% to financial counseling/billing and 27% to other resources. Conclusions: Implementing a financial toxicity screening question on intake forms was feasible, and increased identification of patients with financial toxicity and referrals to our financial navigator. Further investigation is needed to understand screening barriers and evaluate the program.
Impact and value of olanzapine as part of a 4-drug regimen in patients receiving high emetic risk chemotherapy.
Authors: Bowen Ashley , Hassett Kristen P. , DeVries Kelly , Mackler Emily R. , Thompson Michael P. , Griggs Jennifer J.
Published: October 2023

293

Background: The Michigan Oncology Quality Consortium, MOQC, has increased the use of olanzapine as part of a 4-drug antiemetic regimen for high emetic risk chemotherapy in many of its 50 practices across Michigan. The purpose of this project was to estimate the impact of olanzapine prescribing on health care utilization and subsequent savings in healthcare utilization payments in patients with breast cancer on (neo)adjuvant doxorubicin and cyclophosphamide (AC) for breast cancer. Methods: Multipayer claims data were used from the Michigan Value Collaborative (MVC), a collaborative quality initiative of over 100 hospitals and 40 physician organizations with the goal of improving healthcare value. We identified a cohort of female patients with a 90-day episode of care for breast cancer resection between 2016-2021 who received chemotherapy with AC as (neo)adjuvant chemotherapy. Patients were covered by Blue Cross Blue Shield of Michigan insurance plans or Medicare. Each patient was attributed to one practice using National Provider Identifiers on professional claims. Facility claims were used to identify inpatient admissions and emergency department (ED) visits across the patient’s course of chemotherapy, up to 21 days following final chemotherapy. Practice-level use of olanzapine abstracted by MOQC as part of ASCO’s Quality Oncology Practice Initiative (QOPI™) data collection was used to determine whether each patient's chemotherapy treatment began when the practice had “high” (≥25%) or “low” (<25%) rates of olanzapine use for high emetic risk chemotherapy. We compared healthcare utilization among patients treated by high- vs. low-prescriber practices and calculated the estimated differences in price-standardized payments attributed to olanzapine use. Results: We identified 1,891 total patients attributed to 45 MOQC practices; 922 patients were attributed to 15 practices that eventually became high prescribers. Patients treated by a high olanzapine prescribing practice had significantly lower hospitalization rates (10%) during chemotherapy compared to patients treated when their attributed practice was a low olanzapine prescriber (15%, p=0.02). There was no difference in the proportion of patients visiting the ED. The mean per-patient price-standardized insurance payment for inpatient hospitalization for this cohort was $12,007. Increased use of olanzapine led to an estimated payment savings of $334,095 in prevented hospitalizations among 525 patients treated when their attributed practice had a high olanzapine prescribing rate. Conclusions: In this patient sample, practice use of olanzapine in ≥ 25% of patients on high emetic risk chemotherapy was associated with significant reductions in the risk of hospitalization. As the proportion of patients receiving olanzapine increases, we expect even greater reductions in the risk of hospitalization and greater cost savings.
The National Comprehensive Cancer Network (NCCN) Distress Thermometer and Problem List as a screening tool for sexual problems in adults with cancer.
Authors: Jahan Nusrat , Caston Nicole E. , Williams Courtney , Henderson Nicole , Ingram Stacey A. , Wilson Christina , Rocque Gabrielle Betty
Published: October 2023

295

Background: Cancer diagnosis and treatment adversely affect sexuality, which often remains unaddressed. Few clinic-based, easily administrable tools exist to identify sexual problems in patients with cancer. The National Comprehensive Cancer Network (NCCN) Distress Thermometer and Problem List (NDT) is frequently used to measure distress in oncology clinics. This study explored the prevalence and associative factors for sexual problems and their overlap with reported distress in cancer patients using NDT screening data. Methods: This retrospective cohort study included adults with cancer receiving oncology care at the University of Alabama at Birmingham from March 2017 through April 2023. Participants completed a lay navigator-administered NDT around their first visit. Participants reported their distress levels in a score of 0 (no distress) and 10 (extreme distress) and checked their problems from a 42-item Problem List, sexual problems being one of them. Distress was categorized as mild (0-3), moderate (4-7), and severe (8-10) distress. Patient age, sex, race, tumor type, and stage were captured. Frequencies of reported sexual problems were calculated and compared by patient characteristics and reported distress using Cohen’s d (0.2 small, 0.5 medium, 0.8 large effect) or Cramer’s V (0.1 small, 0.3 medium, 0.5 large effect) effect sizes. Results: Of patients completing an NDT survey (N=2821), 62% were female, 22% were Black, and 30% had a diagnosis of breast cancer. A total of 4% (n=99) expressed sexual problems. Compared to those reporting no sexual concerns, patients who reported sexual concerns were younger (median age 56 [interquartile range, IQR: 48-66] vs. 64 [IQR: 57-72], d=0.6) and more often had a breast cancer diagnosis (45% vs. 29%, V: 0.10), (V=0.2). Participants reporting sexual problems more often reported moderate to severe distress than those who did not (64% vs. 34%, V=0.1). Conclusions: Though the percentage of participants reporting sexual problems was low compared to historical data on sexual dysfunction in patients with cancer, the NCCN Distress Thermometer and Problem List could be a helpful screening tool for identifying sexual problems in adults with cancer. Sexual problems reported by patients with cancer differed by age, cancer types, and distress levels. More research is needed to understand best practices for capturing and responding to sexual concerns in patients with cancer during clinical encounters.
Annual cost and implementation of remote oncology pharmacist order review within a network of community oncology practices.
Authors: Koselke Elizabeth , Carroll Melissa , Cho Judy , Conkling Hilary , Greisl Natalie , Hale Brittney , Keisler Meredith , Kendzierski Daniel , Roman Andrea , Howell Josh , Hough Shannon
Published: October 2023

30

Background: The US Oncology Network’s ClinReview program employs a team of centralized clinical pharmacists providing remote services to community oncology practices. Literature demonstrating the clinical impact of the oncology pharmacist has been well established. However, comprehensive data supporting the financial value compensating these clinical services continues to prove challenging. The aim of this study is to evaluate the annual cost-avoidance realized by the ClinReview program through clinical and quality interventions. Methods: A team of 6 oncology clinical pharmacists electronically reviewed chemotherapy orders within 9 community oncology practices. The pharmacist identified opportunities to optimize oncology regimens by performing clinical treatment plan reviews, identifying orders requiring dose modifications, symptom management recommendations, clinical consultations, regimen entry, or drug interaction reviews. Recommendations were discussed with the treating provider or modified if permitted by approved practice policies. A retrospective, observational study was performed utilizing clinical intervention data entered by ClinReview pharmacists from October 2022 through March 2023. Interventions were allocated to specific cost-avoidance values based on previously validated studies and extrapolated to an annualized value. Results: During the 6-month study period, a total of 10,195 interventions were documented and categorized as treatment plan management (2,434, 24%), medication regimen/dosing change (6,365, 62%), symptom management (1,145, 11%), drug information consultation (103, 1%), regimen entry, (69, 1%), and drug interaction management (90, 1%). Based on previously validated cost-savings estimates, annualized cost avoidance realized from the ClinReview program was $2,247,818. Taking into account the cost of pharmacist time, the 6-month intervention data demonstrated an annualized net cost-avoidance of $1,896,164. Conclusions: The integration of the ClinReview program into community oncology practices delivers significant quality, safety, and financial benefits, with approximately $1.9 million in annual net cost-savings benefit. [Table: see text]
Nationwide analysis of legal barriers impacting patients with cancer and caregivers.
Authors: Hussaini S. M. Qasim , Chen Krista Y. , Blackford Amanda L. , Bryant Monica , Morales Joanna
Published: October 2023

300

Background: The extent of legal barriers requiring appropriate navigation in patients following cancer diagnosis is unknown. We performed a nationwide analysis of a patient navigation program to investigate prevalence of such barriers. Methods: This retrospective analysis used the Triage Cancer Legal & Financial Navigation Program’s de-identified electronic database. Triage Cancer is a national, nonprofit organization that provides free education on legal issues that impact individuals diagnosed with cancer. Sociodemographic, financial, disease-site, and medical-legal navigation information were obtained for descriptive analysis. The main study outcome was the primary legal issue prompting a call to Triage Cancer for assistance. Associations between variables and the primary legal issue were explored with multinomial logistic regression analysis. Results: We investigated 2613 callers (1679 patients, 463 caregivers, 373 providers) between 2021-2023 in reference to patients who were 61% female, 57% aged 40-64y, 48% White, 37% employed, 32% on employer-sponsored insurance, and 45% with income <$50k. Breast (27%), hematologic (18%), and GI (10%) cancers were most common, and 39% of all patients were on treatment at time of call. Majority called for assistance with 1 (51%) or 2 (32%) legal barriers. Most common primary issue was health insurance (29% - insurance options, navigation, and appeals), followed by financial (20% - financial assistance or life insurance), disability (18% - applications and appeals), employment (17% - taking time off, working through treatment, returning to work, laid off, new job search, and unemployment benefits), and other (16% - housing, estate planning). Compared to health insurance, navigation for disability-related barriers was significantly higher among Black (OR 2.1) patients, and those with GI (OR 3.1) and lung cancer (OR 2.9) (Table). Employment barriers were higher among Black (OR 2.5) and Hispanic (OR 2.5) patients, and financial barriers among Black (OR 2.9), Hispanic (OR 2.4), and those on Medicaid (OR 2.9). Conclusions: This study highlights the prevalence of legal barriers impacting patients with cancer and their caregivers. It underscores an urgent need for accessible legal navigation programs, and potential for federal policy-level efforts in building legal safeguards to improve care.[Table: see text]
Who is participating in goals of care conversations? A review of a pilot quality initiative to improve documented goals of care conversation in an integrated healthcare system.
Authors: Wei Jenny , Aller Ashley , Shirazi Aida , Liu Raymond
Published: October 2023

308

Background: Goals of care (GOC) conversations are essential in identifying and implementing goal-concordant care for advanced cancer patients. However, there is limited understanding of the context of GOC discussions in clinical practice. As part of the ASCO Quality Training Program, Kaiser Permanente San Francisco Cancer Center (KPSFCC) piloted the initiative I-DO GOC electronic medical record template, increasing GOC documentation by oncology providers from 0% to 47%. Here, we aimed to identify patient, situational and provider characteristics associated with documented GOC for advanced cancer patients. Methods: We identified all adult advanced cancer patients treated at KPSFCC with at least one documented GOC conversation using the I-DO GOC template from January 2022 to May 2022. The conversations’ content and context were compared with clinical, patient and provider characteristics. Results: 178 advanced cancer patients had I-DO GOC documented by 8 oncology attendings and 6 fellows. 51.7% patients were female, 46.1% were Non-Hispanic White and median age was 71 years. The leading cancer types were breast (n=34) and lower gastrointestinal (n=29). Comparison of patient and provider characteristics with clinical context are outlined in Table 1. The most common clinical situations prompting GOC conversations were prognosis discussions (n=102) and changes in condition (n=39). Attendings, when compared to fellows, documented GOC conversations more frequently, were more likely to conduct GOC during brief telephone encounters and were more likely to have GOC with patients alone. While attendings initiated GOC conversations in a variety of clinical contexts, fellows conducted GOC conversations mostly during prognosis discussions. Conclusions: Provider training level and clinical situation were associated with differences in GOC documentation. The higher frequency of GOC documentation among oncology attendings compared to fellows suggests differences in comfort level and experience with GOC discussions. This effort supports further investigation of factors influencing GOC conversations which may improve provider initiation and documentation of these key discussions.[Table: see text]
Assessing the role of the quality and quantity of caregiver clinical participation on patient activation in the metastatic breast cancer setting.
Authors: Henderson Nicole , Bourne Garrett , Hendrix Emma , Thigpen Haley , Williams Courtney , Ingram Stacey A. , Odom James Nicholas , Triebel Kristen , Rocque Gabrielle Betty
Published: October 2023

312

Background: Caregivers maximize health and quality of life of individuals undergoing treatment for cancer by assisting with daily activities, managing complex care, navigating health care systems, and communicating with health care professionals. In metastatic breast cancer (MBC), caregiver roles may be more extensive due to treatment trajectories. Little is known about how caregivers participate in clinical encounters and how their roles in treatment decision-making impact patient engagement. Methods: This mixed-methods analysis explored the effect of the quantity and quality of caregiver participation at clinical encounters in women with MBC. Participation quantity was measured by calculating proportion speaking time (seconds spoken/total appointment time) for oncologists, patients, and caregivers. A summative thematic content analysis using a constant comparative method was utilized to inductively identify caregiver roles during recorded appointments. Caregiver participation quality was then operationalized as the summed number of roles displayed (0-12). Patient participation quality was assessed using the Patient Activation Measure (PAM; scored 0-100 with higher scores indicating more activation) and compared to caregiver quantity and quality of participation using Spearman’s correlations. Results: Fifty-three clinical encounters with verbal caregiver participation were recorded. Patients had a mean age of 58 (SD 10) and were predominately white (72%); demographics of caregivers were not collected. On average, encounters lasted for 30 minutes (SD 12) during which oncologists spoke for 76%, patients for 20%, and caregivers for 4% of the encounter. Identified caregiver roles included: General Support; Management of Treatment or Medication; Treatment History; Decision-Making; Insurance or Money; Pharmacy; Scheduling; Travel Concerns; General Cancer Understanding; Patient Specific Cancer Understanding; Caregiver-Initiated or Emphasis on Symptom Severity; and Caregiver Back-Up of Patient Symptom Description. Caregiver quality scores averaged 5 roles (SD 3) and patients were highly activated (M=65, SD 16). Quality [r(53) = 0.349, p=0.010] and not the quantity [r(53) = 0.213, p=0.126] of caregiver contributions were associated with higher levels of patient activation. Conclusions: Although caregiver time speaking did not impact patient activation, the more ways that the caregiver productively participated in the clinical encounter, the more activated the patient was in their care. Greater integration of the caregiver into treatment decision-making appointments could help to encourage patient engagement when developing a treatment plan for MBC.
National service is free, not cancer disease: Financial toxicity in a public universal coverage healthcare system.
Authors: Russo Paola , Del Duca Francesca , Vitiello Grazia , Celentano Roberto , Martinelli Giuseppe , Musella Domenica , Parascandolo Ileana , Maddalena Antonio
Published: October 2023

32

Background: Italian National Health Service provide regional control on clinical pathways to be cost-free. ASL Napoli 1 centralized model of Palliative Care Unit ensure free multidisciplinary medical and nursing assistance, beyond aids and devices. Since healthcare costs are rising and private spending is becoming necessary, our aim is screening financial toxicity in the most densely populated area in Europe. Methods: From January to April 2023 we performed simple random sampling to select 27 home care patients. From the richest neighborhoods to poorest ones, patients answered the COST-FACIT questionnaire. We collected information about medical history, sociodemographic characteristics (employment status or retired, family composition, if benefiting from state allowances) and, above all, out-of-pocket costs. Results: Data highlight that wealthiest and middle-class patients are afraid about out of control medical expenses and their satisfaction about economic status is declining. Patients from a lower socioeconomic background are deeply concerned about not being able to work and not being of financial support to often single income families. Score analysis reveals significant variation among the different items, and the average score is 12.4. Highest scores count 28 and 29, respectively, suggesting that these patients are more able to manage the costs of treatment or access financial resources to cope with medical expenses. Three scores of 0 suggest higher financial toxicity in the realm of palliative oncology care. These patients face greater difficulty in handling treatment costs, encounter barriers in accessing financial resources, or experience high expenses. Patients have highlighted that purchase of non-reimbursable drugs is the most onerous out-of-pocket cost in home care setting. Conclusions: Our centralized Palliative Care Unit organizational model coordinates by adapting purchasing and providing holistic sanitary approach beyond patients' economic abilities. Our centralized Palliative Care Unit provides health services to endure equity across all the city. However, score analysis suggests a range financial suffering for home care patients. Low average score 12.4 suggests how much financial suffering in palliative care impacts, even in a model of centralization of health care with global coverage. So, screening for financial toxicity plays a key role in directing health policies on pharmaceutical expenditure.
A survey-based assessment of internet and social media use by oncology patients and their caregivers for health-related education.
Authors: Burkenroad Aaron , Zektser Yuliya , Cohen Melissa J. , Ashouri Shay , Kaul Anita , Slomowitz Samuel , Anand Sidharth
Published: October 2023

321

Background: Oncology patients are increasingly utilizing the internet and social media (SM) as sources of health-related information. Contemporary information on oncology patient use patterns for health-related education is not well understood. To address this gap, we surveyed adult oncology patients on active treatment seen in a community-based oncology clinic about their use of the internet and SM around cancer-specific content. Methods: We conducted a qualitative, cross-sectional anonymous survey to understand the range of values, perspectives, and behaviors that patients and caregivers have around their use of internet and SM resources. We also assessed patient beliefs regarding the quality of education provided by their oncologists and how this may relate their patterns of use of these resources. Results: Of the 40 patients surveyed: 55% were male, 64% identified as Caucasian, 22% Latino, 14% were of other races, and 81% spoke English as their primary language. The group represented a diverse age range and education level and a variety of solid and hematologic malignancies. Most participants (89%) reported receiving written educational materials by their oncologist and 58% reported receiving links to electronic/internet resources for disease education.The vast majority of patients (95%) had a positive opinion of in-person education provided by their oncologist and 75% were satisfied with the quality of written or online resources provided. The majority of patients (85%) reported using the internet to learn about their diagnosis and treatment. A smaller proportion (43%) of patients used SM platforms. Of internet information sources used, the patient’s own health system website was the most popular choice (41.7%). Interestingly, 87% found resources without specific guidance from their oncologist. Notably, 11% of patients were instructed by their oncologist to avoid researching their diagnosis online. Conclusions: Our research shows that internet and SM use among patients with cancer is ubiquitous, and independent of the educational interventions provided by their oncologists. Importantly, 66% of participants felt that online research helped them feel more prepared for discussions with their oncologists. A quarter (25%) of patients agreed that they only use online resources recommended by their oncologist’s office, suggesting that the majority of patients will pursue their own research in a self-guided fashion. Encouragingly, the majority of patients (86%) reported that they feel comfortable discussing information they find online with their care provider. Improved understanding in this area will help oncologists better guide their patients to reliable resources and engage more directly in the patient or caregiver’s process of seeking cancer-specific information from outside sources.
Projected population mortality reduction from liquid biopsy screening approaches: High sensitivity screening for focused cancer types and populations—High specificity screening for broad cancer types and populations.
Authors: Bach Peter Brian
Published: October 2023

33

Background: There are two distinct ‘liquid biopsy’ cancer screening approaches. Focused testing for selected cancers where screening is recommended but not being received, in which test sensitivity can be prioritized as false positives reflex to standard of care screening. Broad testing for many cancers where false-positives necessitate high test specificity, typically at the expense of sensitivity. The public health impact and testing burden of these approaches has not been explored. Methods: Projected cancer deaths averted and annual number of tests performed based on published performance and target populations for liquid biopsy tests with published data. Focused screening modeled for patients who are not receiving guideline-recommended screening for lung, liver and colorectal cancer. Broad screening modeled for all individuals aged 50-80 and assumed to detect all cancer types. Averted deaths determined by combining the mortality reduction associated with screening (published literature, 20% if no literature); adjusted for reported prospective test sensitivities: focused (85%), broad (28%). Only individuals not receiving a particular cancer screening could have liquid biopsy avert a death for that cancer. Results: Focused and broad screening strategies each prevented approximately 20,000 cancer deaths annually. Focused screening required testing one-fifth as many people annually as the broad testing approach (30MM vs.150MM). All of the projected reduction in mortality associated with focused testing was based on randomized studies; for the broad strategy the equivalent statistic was 53%. Conclusions: Cancer deaths can be reduced equivalently through focused cancer screening at high sensitivity and broad cancer screening at high specificity at one-fifth the testing burden. The impact of false positives in the focused testing approach and false reassurance in the broad testing approach might alter these findings, which could also be affected by the cost of testing and follow-up. [Table: see text]
Patient-centered collaborative research: Exploring perspectives on clinical meaningfulness in metastatic breast cancer with clinicians, patients, and caregivers.
Authors: Graff Stephanie L. , Freeman Emily C. , Roach Meaghan , Wilson Rozanne , Stemland Jeanne , Chan Rebecca J. , Wochal Paulina , Katz Julie , May Suepattra G.
Published: October 2023

338

Background: In metastatic breast cancer (mBC), treatment decision-making is informed by many factors including patient values, preferences, and care goals. Important to treatment decision-making is clinical meaningfulness, or the degree to which a treatment for mBC results in a meaningful change in the patient’s daily life, and clinically meaningful outcomes that are relevant to patients (e.g., survival, quality of life). However, patient and clinician perspectives and alignment on these concepts have not been well elucidated. Engaging patients and other key stakeholders as research collaborators is vital to guiding the delivery of high-quality cancer care focused on outcomes that patients considered meaningful. The aim of this work is to describe the implementation of an innovative multi-collaborator engagement with patient advocates and professional oncology societies to support a study examining perspectives on clinical meaningfulness in mBC treatment among clinicians, patients, and caregivers in the United States. Methods: This mixed-methods study utilizes qualitative semi-structured in-person and virtual focus groups to inform the development of collaborator-specific surveys on clinical meaningfulness in mBC. A multi-collaborator engagement approach was selected to support the conception, implementation, and completion of this study. Specifically, we have convened a collaboration with patient advocacy groups and professional membership organizations to engage researchers, patients, caregivers, and clinicians. The collaboration is designed to: i) facilitate the development of study protocols and key data collection documents; ii) review and reflect on findings and salience for relevant populations; and iii) participate in dissemination activities whereby collaborators co-create, co-present and discuss findings and their impact on clinical practice. Results: To date, we have partnered with four breast cancer patient advocacy groups representing sociodemographic diverse constituencies throughout the US and three oncology professional membership organizations. By describing how to implement these partnerships, we seek to present a collaboration roadmap that can be replicated and adapted to similar studies in oncology care delivery. Such a comprehensive and rigorous approach aims to enhance the quality of data collection and interpretation, generating evidence that will optimally improve patient-centered mBC care delivery and meaningful patient outcomes. Conclusions: Engaging patients and other key collaborators in research is important to generate clinically meaningful evidence to those involved in mBC treatment decision-making. This study offers a robust methodological approach for gaining insights into the delivery of patient-centered cancer care.
Health insurance literacy among patients receiving outpatient cancer treatment.
Authors: Zhao Jingxuan , Zhang Nan , Hilal Talal , Griffin Joan M. , Yabroff Robin , Khera Nandita
Published: October 2023

339

Background: Limited health insurance literacy (HIL) has been linked to problems paying medical bills or delaying care among patients with cancer. In this study, we describe the prevalence and correlates of HIL in a cohort of cancer patients measured using a ten-question HIL quiz developed by the Kaiser Family Foundation. Methods: We examined HIL in 393 adult patients (aged >18 years) receiving cancer treatment in two ambulatory infusion centers, Mayo Clinic in Phoenix, Arizona (12/2019 to 2/2020 and 8/2020 to 10/2020) and University of Mississippi Medical Center in Jackson, Mississippi (9/2020 to 1/2021). HIL was categorized as low, moderate, or high based on the total number of correct answers: 0-4 (low), 5-6 (moderate), and 7-10 (high). Descriptive statistics characterized the sample and chi-square statistics compared HIL by sociodemographic factors. Results: Most patients understood basic insurance terms, such as premiums and deductibles (Table). However, fewer patients answered questions correctly about provider networks (46.1%), formularies (48.6%), and calculating out-of-pocket (OOP) spending (16.8%). 53 (13.5%), 69 (17.6%), and 271 (69.0%) patients had low, moderate, and high HIL scores, respectively. Lower HIL was more common among patients of younger age (<65 years: 17.8%, 65+ years: 8.7%), lower educational attainment (less than college: 23.2%; college or higher: 4.4%), and lower household income (<$4999: 21.1%, $5000+: 6.1%) (all p-values<0.05). Conclusions: Although HIL in our cohort of cancer patients was relatively high - 69% answered at least 7 questions correctly - there were gaps in understanding of provider networks, formularies, and calculation of OOP spending. Efforts to improve HIL and help with navigation of health insurance plans may be required, especially for socioeconomically vulnerable patients.[Table: see text]
Frequency of standardized patient-reported outcome measures in routine clinical care of patients with cancer.
Authors: Bone Robert , Jeune-Smith Yolaine , Feinberg Bruce A.
Published: October 2023

342

Background: Patient-reported outcomes (PROs) assess a patient’s self-reported health status, including disease symptoms, treatment experience, functional outcomes, and quality of life. Incorporation of PROs has been linked to improved patient symptom control and increased shared decision making. Standardized PRO measures (PROMs) are becoming more frequent as an endpoint for clinical trials, however their use is less frequent in routine care for patients with cancer. The goal of this study was to assess the utilization of PROMs and identify barriers to their use. Methods: US-licensed oncologists/hematologists convened at one of three live meetings in 2023 to review recent clinical updates. Respondent demographics were collected ahead via an online survey. During the meetings, participants responded to queries on their use and perceptions of PROs and PROMs. Responses were captured via audience response system technology; not all participants answered every question. Pooled data were summarized using descriptive statistics. Results: Of the 146 respondents, 77.4% self-identified as community-setting providers, spent 84.3% of their time seeing patients, saw an average of 19.8 patients/day, and averaged 17.7 years of experience. Respondents found PROs to be most useful in early detection/management of treatment toxicities and symptoms (63.8%) and tailoring of clinical/supportive care (56%). The majority of PROs are typically recorded through informal verbal inquiries, while 18.1% and 10.9% of respondents use validated and non-validated PROMs, respectively. Few respondents (11.3%) administer PROMs to every patient at every visit, while over one-third (38.3%) never administer PROMs. Within the practice, medical assistants and nurses are most likely to be the provider administering PROMs. PROMs are most commonly administered when the patient is in the office and are infrequently administered through other means. Lack of time to administer or review PRO surveys (45.1%), and lack of reimbursement (38.9%) and EMR integration (38.9%) were the most common reported barriers to using PROMs in the respondents’ practices. Conclusions: Despite the majority of respondents finding PROs useful in practice, a minority use formal measures to record PROs. Further, usage is infrequent across patient visits. Lack of time, lack of reimbursement, and logistic barriers are the most common reasons for not using PROMs in routine care. These barriers may be overcome by efforts or guideline changes from regulatory agencies, payors, or clinical guideline organizations. Future work will assess how physicians are using PROMs in treatment selection for their patients with cancer.
Assessing the validity and feasibility of using a best-worst scaling measure for values elicitation among older adults with newly-diagnosed blood cancers to inform treatment decisions.
Authors: Richardson Daniel R. , Mhina Carl J , Washko Matthew F. , Deal Allison Mary , Cole Amy C. , Kwong Elizabeth C , Adapa Karthik , Crossnohere Norah L , Bridges John F.P. , Wheeler Stephanie B. , LeBlanc Thomas William , Bennett Antonia V.
Published: October 2023

344

Background: Multiple stakeholders have called for the development of tools to facilitate values elicitation with patients to inform treatment decision making about chemotherapy. We previously developed a best-worst scaling (BWS) measure, a theory-driven values elicitation tool, for older adults (≥ 60 years) with blood cancers through patient and expert engagement. We sought to evaluate the feasibility and validity of using this measure to inform initial treatment decisions for newly-diagnosed patients. Methods: We completed a convergent mixed-methods study to test feasibility and validity of remote delivery of the measure following guidance for choice experiments (Janssen, Exp Rev Pharm Out Res, 2017). Convergent validity was evaluated by comparing preferences with a ranking exercise. Content validity was tested in cognitive interviews. Results: 178 patients at a public safety net hospital were eligible, 157 (88%) were approached, and 48 (31%) consented (48% lymphoma, 40% leukemia/myelodysplastic syndrome, 12% other). Mean age was 73.9 years (range 60 - 95). 59% were male; 96% were white; 67% had a bachelor’s degree or higher. 52% completed the BWS measure prior to their initial treatment visit. Patients agreed or strongly agreed that the instrument was understandable (96%), relevant to them (58%), and showed their real preferences (75%). 50% felt it was easy to answer. 54% of responses from the BWS measure were concordant with ranking on their top priority. Cognitive interviews (n=7) demonstrated content validity: all patients were able to accurately describe the instructions of the BWS instrument and correctly define each included outcome; most patients reported that the BWS instrument helped solidify their preferences; all patients reported it was beneficial; no patients reported missing domains of outcomes; all reported that the time and emotional burden to complete the measure were appropriate. Conclusions: Using this BWS measure to inform treatment decisions of older adults with newly-diagnosed blood cancers is feasible and appears valid for clinical use. Future work is needed to optimize implementation and validate the measure in different settings and with a larger and more diverse population.