bluuebunny/crossref_metadata_2025 huggingface dataset:
Social vulnerability and cancer-related mortality among U.S. counties, 2013 to 2019.
Authors: Hussaini S. M. Qasim , Chen Krista Y. , Blackford Amanda L. , Quick Harrison , Sedhom Ramy , Gupta Arjun , Laheru Dan
Published: September 2022

162

Background: Substantial differences exist among US counties with regards to cancer-related mortality. Social determinants of health (SDOH) can predispose underserved communities to poor cancer outcomes. We investigated the impact of county-level social vulnerability on age-adjusted cancer mortality rates (AAMRs). Methods: We linked cancer-related deaths across US counties from 2013 to 2019 in the CDC WONDER database to county-level Social Vulnerability Index (SVI) data from the CDC/ATSDR. Scores for overall SVI and its 4 subcomponents (socioeconomic status; household composition and disability; minority status and language; housing type and transportation) were calculated using 15 SDOH attributes. These were presented as percentile rankings by county and classified into quartiles based on their distribution among US counties (1st [least vulnerable] = 0 - 0.25; 4th [most vulnerable = 0.75 - 1.00]). AAMRs per 100,000 individuals across US counties were compared between 1st and 4th SVI quartiles using robust linear regression models with a log scale. Results: There were 4,107,273 deaths with overall AAMR 173 per 100,000 individuals. Highest AAMRs were noted among older adults > 65 years, men, non-Hispanic Black, and rural counties. AAMRs increased proportionally when moving from least to most vulnerable counties. Counties in 4th SVI quartile had 20% higher AAMRs compared to 1st SVI quartile (rate ratio; RR 1.08, 95% CI [1.08, 1.09], p < 0.001). This was pronounced for ages 45-65 (42% increase; RR 1.21, 95% CI [1.12 – 1.24]), Hispanic race (26% increase; RR 1.11, 95% CI [1.06, 1.16]), and rural counties (21% increase; RR 1.17, 95% CI [1.15, 1.19]). Increase in AAMR between 1st and 4th SVI quartile from vulnerable socioeconomic status was most pronounced in rural counties (RR 1.17; 95% CI [1.15, 1.2]), women (RR 1.17; 95% CI [1.15, 1.2]) and ages 45-65 (RR 1.15; 95% CI [1.09, 1.14]). Vulnerable household composition/disability was most pronounced for rural residents (RR 1.12; 95% CI [1.09, 1.14]), and housing/transportation barriers for Hispanic individuals (RR 1.15; 95% CI [1.09, 1.21]). Conclusions: This study highlights the most socially vulnerable US counties have higher cancer mortality rates than the least vulnerable US counties. Furthermore, non-Hispanic blacks, older adults, and rural counties face highest risks of health inequities. Our findings inform ongoing congressional deliberations on transportation, telehealth, and rural infrastructure to achieve geographic parity.[Table: see text]
Racial/ethnic disparities in HPV-associated anogenital cancers among males in the United States (2005-2016): A population-based retrospective cohort study.
Authors: Villalona Seiichi , Sukhdeo Simone , Reinoso Daisy , Stroup Antoinette , Ferrante Jeanne
Published: September 2022

163

Background: Among the HPV-associated cancers, research has primarily focused on understanding prevention and outcomes among females with cervical cancer. Limited data is available on health outcomes of male HPV-associated anogenital cancers, particularly among racial/ethnic minority groups. Methods: This population-based retrospective cohort study included 39,601 males diagnosed with HPV-associated invasive penile and anorectal cancers between 2005-2016 in the North American Association of Central Cancer Registries. Outcomes included: age-adjusted incidence, late-stage diagnosis, survival, and cancer-specific mortality. We evaluated association of race/ethnicity with outcomes using multivariable logistic regression, adjusted survival curves, and Cox proportional hazard modeling, adjusting for age, insurance, residential characteristics (metropolitan/non-metropolitan, area poverty, and geographic region), stage, and treatment. Results: Hispanic and Non-Hispanic (NH) Black males had the highest age-adjusted incidence of penile and anorectal cancer, respectively. Higher odds of late-stage penile cancer were observed among NH Black (adjusted odds ratios [aOR] 1.22, 95% CI 1.07-1.39) and Hispanic males (aOR 1.17, 95% CI 1.04-1.31). Higher odds of late-stage anorectal cancer were observed among NH Black (aOR 1.25, 95% CI 1.14-1.36) and NH Other males (aOR 1.29, 95% CI 1.01-1.66). Compared to all other groups, NH Black males had the lowest cumulative and mean survival of both cancers and higher cancer-specific mortality (penile adjusted hazards ratios [aHR] 1.23, 95% CI 1.01-1.49; anorectal aHR 1.25, 95% CI 1.10-1.42). Adjusting for treatment attenuated associations but did not eliminate the observed cancer-specific mortality. Conclusions: Hispanic males had the highest incidence of penile cancer and were diagnosed at later stages than non-Hispanic (NH) White counterparts. NH Black males had the highest incidence of anorectal cancers, and regardless of anatomic site, they had the highest rates of late-stage diagnosis and mortality even when controlling for all other covariates, including treatment. The findings highlight the necessity of interventions to increase HPV vaccination rates, early detection, and treatment of anogenital cancers in males, particularly among men of color.
Differences in patient and caregiving partner responses to individual items on the FACIT-COST questionnaire.
Authors: Rivers Zachary , Shankaran Veena , Porter Laura S , Langer Shelby
Published: September 2022

183

Background: The financial impacts of cancer diagnosis and treatment extend beyond patients to affect intimate partners. Understanding how both members of the dyad experience financial toxicity (FT) can help inform dyadic interventions to address FT. We compare patient and partner responses to items on the Functional Assessment of Chronic Illness Therapy (FACIT)-COST, a patient-reported outcome measure of cancer-related financial distress. Methods: Adult patients with stage II-IV breast, lung, or colorectal cancer and their spouse/ cohabiting partner independently completed the 11-item FACIT-COST. Correlations between responses by both members were calculated using Pearson’s correlation coefficient. Results: There were 336 dyads (median patient age 53, 45% stage IV, 84% white) included in the analysis. Both members of the dyad had similar FT experiences in 74% of cases (26% and 48% reported FT and no FT respectively) while 26% diverged in their experience of FT. Responses to items 3, 6, 7, 10, and 11 (Table) were highly correlated (r > 0.6) while responses to questions 4 (I feel I have no choice about the amount of money we spend on care) and 5 (I am frustrated that I cannot work or contribute as much as I usually do) were weakly correlated (0.3 > r > 0), with patients generally reporting worse scores than partners on these items. Conclusions: Within-couple correlation between FACIT-COST items varies, with multiple responses weakly correlated. Future research should assess the impact of this variation on psychosocial functioning and explore approaches to facilitate dyadic communication around this important issue.[Table: see text]
Oncologists’ attitudes and practices regarding fertility preservation at a tertiary academic center.
Authors: Ragavan Meera Vimala , Kennedy Vanessa Elaine , Banerjee Rahul , Lin Amy M. , Velazquez Manana Ana I.
Published: September 2022

190

Background: Infertility is a significant long-term consequence of cancer treatment and can negatively impact health related quality of life. As the incidence of cancer rises in younger populations and an increasing number of patients are prescribed systemic therapy in the neoadjuvant and adjuvant settings, the proportion of patients at risk for infertility will rise in tandem. Referrals for fertility preservation (FP), however, are low nationally and at our institution. Our study aimed to characterize oncologist attitudes and practices around FP and identify barriers to FP in patients with cancer. Methods: We developed a 21-item anonymous survey informed by literature review and input from FP stakeholders. The survey was distributed electronically to all faculty and fellows (n = 103) within our division of hematology/oncology during a division-wide conference on FP and subsequently emailed to all faculty and fellows, with three weekly follow up reminder emails. Results: 41 respondents completed the survey (response rate 40%), including faculty (46%) and fellows (39%). Respondents were predominantly male (49%), aged 25-40 (51%), white (44%), and non-Hispanic (73%). Most respondents agreed that FP should be offered to all patients with cancer receiving cytotoxic therapy (95%), however fewer respondents agreed that FP should be offered if it would cause a treatment delay by 2 weeks or more (63%). Respondents felt more comfortable counseling male patients (65%) than female patients (54%) and a larger proportion (41%) knew how to make referrals for sperm preservation (compared to 22% for oocyte preservation). The top barriers to counseling were patient past childbearing age (41%), provider did not remember to discuss (37%), and need for urgent treatment initiation (32%). The top barriers for an interested patient to undergo FP were perceived cost by patient (61%), need for urgent treatment initiation (59%), and patient was too overwhelmed to proceed with FP (42%). Conclusions: Oncologists agreed that FP is an important part of cancer care. However, many stated that cancer treatment initiation was often too time sensitive to counsel patients regarding fertility risks and make FP referrals. The FP referral process was not clear to many respondents. Clinic-level interventions are warranted to ensure timely patient access to FP. Based on the results of this study, we will launch a fellow-led Plan-Do-Study-Act Quality Improvement intervention to increase FP referrals in our clinics.
Improving cardiac monitoring in patients with early-stage breast cancer receiving cardiotoxic chemotherapy in a multidisciplinary cancer center.
Authors: DeLuna Hannah , Velikov Dmitriy , Patel Hardik , Feld Jamie , Robin Jason , Rosenberg Carol A. , Saha Poornima
Published: September 2022

191

Background: Patients with early stage breast cancer commonly receive anthracycline and anti-Her2 directed therapies which can result in cardiotoxicity, making cardiac monitoring crucial. In 2018, our rate of obtaining a follow up echocardiogram in this patient population was 38%. Subsequently, use of myocardial strain imaging in conjunction with echocardiography became available at our institution, allowing for potential earlier detection of cardiac dysfunction. We aimed to increase utilization of strain imaging and rate of follow up echocardiogram monitoring to at least 50% in hopes of enhancing prevention efforts. Methods: We developed a standardized protocol for cardiac monitoring in patients receiving cardiotoxic chemotherapy. We provided education to staff and workflow modification to include standard orders for strain echocardiogram in all relevant chemotherapy plans. Chart review for Stage 1-3 breast cancer patients who received anthracycline or trastuzumab based therapy at our ambulatory cancer center from January 2019 to December 2021 was performed. Completion of follow up echocardiogram and rate of strain imaging before and after July 2020 was assessed, as this is when strain imaging became widely available. Results: Rates of obtaining baseline echocardiogram were excellent. Rates of strain echocardiogram use improved from 26.3% to 97.9% following July 2020. Follow up echocardiograms were obtained regularly in those receiving trastuzumab based therapy before and after July 2020 at rates of 91.8% and 87.5%. Rates of follow up echocardiograms in those receiving anthracycline-based therapy also improved to our goal of greater than 50%, but was lower than the trastuzumab group at 57%. However, assessment of follow up cardiac imaging in the 2021 treatment group is still ongoing. Conclusions: We successfully implemented a program to standardize cardiac monitoring in patients undergoing cardiotoxic chemotherapy for breast cancer at our institution. We anticipate this will enhance detection of cardiotoxicity and utilization of consultative cardio-oncology services. Additional efforts to improve follow up cardiac imaging through collaboration with our survivorship program are ongoing.[Table: see text]
Prediction of daily pain and opioid consumption in hospitalized patients with cancer: The importance of psychological symptoms, previous pain, and opioid use.
Authors: Azizoddin Desiree Rachel , Wilson Jenna , Flowers Kelsey Mikayla , Beck Meghan R , Chai Peter , Enzinger Andrea Catherine , Edwards Robert R. , Miaskowski Christine , Tulsky James A. , Schreiber Kristin L.
Published: September 2022

195

Background: Pain is among the most common reasons that cancer patients present to the emergency department (ED) and are ultimately hospitalized, yet little is known about the patient-level predictors and outcomes of pain-related ED visits and hospitalizations. This study sought to evaluate the predictive association of clinical pain and psychological variables on ED admission with average daily pain and opioid consumption in subsequently hospitalized patients with cancer. Methods: A prospective cohort study of patients with active cancer presenting to the ED with pain severity ≥4/10 on presentation completed baseline surveys that assessed demographic, socioeconomic, cancer diagnosis and treatment, medication use, and psychosocial profiles using validated questionnaires. Daily pain scores and opioids administrated were abstracted from the hospital record. Univariable and multivariable general estimating equation (GEE) analyses examined associations of baseline socioeconomic and clinical variables with the primary outcomes, average daily pain and total daily opioid administration. Results: Patients (N = 113) had various types of cancer, with 91% having a diagnosis of > 1 year, 80% with metastatic solid tumors, 73% reported pain as the primary reason for the ED visit, 43% were taking opioids, and 27% had chronic pain predating their cancer. Average daily pain scores ranged between (3.4 to 5.0 out of 10) and daily MMEs ranged between 0 to 1136 MMEs, yet the majority received lower than 60 MMEs per day. In multivariable models, higher pain catastrophizing (B = 0.1, p= 0.001), more recent surgery (B = -0.2 p= 0.016), outpatient opioid use (B = 1.4, p<0.001), and history of chronic pain (B = 0.8, p= 0.022) before cancer diagnosis were independent predictors of greater average daily pain during hospitalization. Higher pain catastrophizing (B = 1.6, p= 0.049), higher anxiety (B = 3.7, p= 0.030), lower depression (B = -4.9, p= 0.028), metastatic disease (B = 16.2, p= 0.038), and outpatient opioid use (B = 32.8, p<0.001) were independent predictors of greater daily opioid administration during hospitalization. Conclusions: An evaluation of psychological distress and current opioid use may help to identify cancer patients at increased risk for more severe pain and higher analgesic requirements during hospitalization. This identification will facilitate the delivery of more intensive pharmacologic and nonpharmacologic interventions.
Opportunities to improve care for patients with peritoneal carcinomatosis and their caregivers.
Authors: Pozzar Rachel A. , Tavormina Anna , Enzinger Andrea Catherine , Poort Hanneke , Demarsh Andrea , Gorra Madeline , Cooley Mary E. , Wright Alexi A.
Published: September 2022

207

Background: Cancers of the gynecologic and gastrointestinal tracts (GYN/GI) often metastasize along the peritoneum (peritoneal carcinomatosis; PC), causing ascites and malignant obstructions of the bowel, urinary tract, and biliary tree. Patients with PC frequently require palliative surgical interventions; e.g., ostomies, gastric tubes, and catheters. To date, few researchers have described the unique needs of these patients and their caregivers. Methods: We recruited adult patients with advanced GYN/GI cancers, a recent hospitalization for PC, and a new complex care need. We invited adult caregivers of enrolled patients to participate. We abstracted patients’ clinical characteristics and outcomes from the medical record. At baseline, patients completed items related to perceived health status and advance care planning, while caregivers completed the Caregiver Reaction Assessment (CRA) and items related to their caregiving role. All participants completed the Hospital Anxiety and Depression Scale. Results: Sixty-five patients and 40 caregivers completed surveys. Fifty-six (86%) patients had GYN and nine (14%) had GI cancers. Most (56/65, 86%) were re-hospitalized within two months, and over a quarter (18/65, 27%) died within six months of enrollment. Twenty-four (37%) reported they were terminally ill, but only nine (14%) had spoken with a physician about the care they would want to receive if they were dying. Caregivers were primarily spouses (27/40, 70%) who provided most or all of the care for their loved one (25/40, 63%) and engaged in caregiving seven days per week (27/40, 68%). Of the four CRA subscales measuring negative caregiving experiences, mean scores were highest for impact on schedule (3.3, SD = 0.8; possible range 1-5, higher scores indicate greater burden), followed by impact on finances (2.3, SD = 1.1), impact on health (2.0, SD = 0.65), and lack of family support (1.8, SD = 0.67). Caregivers reported that they received training on a mean of 1.1 (SD = 1.3) clinical care tasks but performed a mean of 2.9 (SD = 1.7) clinical care tasks. Thirty-two (49%) patients and 9 (23%) caregivers met borderline case or case criteria for depressive symptoms, while 26 (40%) patients and 15 (38%) caregivers met borderline case or case criteria for anxiety symptoms. Conclusions: Patients with PC and their caregivers are highly burdened and distressed. Patients are at high-risk for re-hospitalization, but few have discussed their end-of-life wishes with their medical teams. Interventions that train these patients and their caregivers to perform clinical care tasks, facilitate serious illness conversations, and provide psychosocial support are needed. Clinical trial information: NCT03367247.
Disparities in receipt of financial assistance for patients prescribed oral anti-cancer medications at an integrated specialty pharmacy.
Authors: Ragavan Meera Vimala , Swartz Scott , Clark Mackenzie , White Jared , Lo Mimi , Gupta Arjun , Lin Tracy Kuo , Chino Fumiko
Published: September 2022

217

Background: An increasing number of patients with cancer are prescribed oral anti-cancer medications and face significant challenges in affording them. Financial assistance programs may be a critical resource to mitigate this financial burden but there are often barriers to accessing them. This study evaluated factors associated with receipt of financial assistance among patients with cancer prescribed oral anti-cancer medications. Methods: We conducted a retrospective cohort study including all patients prescribed an oral anti-cancer therapy through the University of California, San Francisco (UCSF) Specialty Pharmacy between January 1,2021 and December 31, 2021. The unit of analysis was patient-drug. Information on financial assistance, including sponsor, type, and amount secured was extracted through Vivor – a financial navigation and grant tracking tool – and linked to clinical and prescription data extracted from the institutional electronic medical record. We employed a multivariate logistic regression analysis to identify variables associated of receipt of financial assistance.Results: Of 1,357 unique patient/drug combinations, 488 (36%) received some form of financial assistance. Mean age of patients was 67 years (SD = 14, range 21-97). Patients were predominantly male (69%), lived in an urban area (42%), were retired (41%), and identified as Non-Hispanic White (61%). A minority of patients (13%) were non-English speaking. The most common type of assistance received was from a foundation (35%), followed by free drug program (24%) and copayment card (23%). Healthwell Foundation (28%) and Patient Access Network Foundation (26%) were the most common sponsors for foundation-based support. Receipt of assistance varied (Χ2 = 60.8, p < 0.001) by disease state. Multivariate logistic regression indicated that patients who identified as Hispanic/Latinx ethnicity (OR 0.49, p = 0.038) or were non-English speaking (OR 0.38, p = 0.015) were less likely to receive financial assistance. Conclusions: There were disparities in receipt of financial assistance by ethnicity and primary language spoken. Some patients may not be equitably connected to existing financial resources and may be disproportionately at risk for the financial, clinical, and psychosocial implications of a high out-of-pocket cost burden. Future studies should develop and implement standardized workflows to ensure equitable access to existing financial resources for patients with cancer.
The association between medical cannabis and prescription opioid medication use in patients with early-stage cancer: A population-based study.
Authors: Karim Safiya , O'Sullivan Dylan E. , Brenner Darren R , Cheung Winson Y.
Published: September 2022

228

Background: Medical cannabis (MC) and prescription opioid medication (POM) use is common among cancer patients. There is conflicting evidence on the association of cannabis with POM as to whether cannabis can help decrease/ cease opioid use. In this population-based study, we examine the association between MC authorization and cessation or reduction in POM use among patients with early stage cancer. Methods: This is a retrospective, population-based study of patients with early stage (stage I-III) cancer diagnosed between January 1, 2014 and December 31, 2018 in the province of Alberta, Canada. Cases were identified from the Alberta Cancer Registry (ACR) and linked to the provincial pharmacy information network (PIN) and the database from the College of Physician and Surgeons of Alberta (CPSA). Patient and treatment characteristic were used to identify a comparable non-MC group with prior POM use via probabilistic modelling. Descriptive statistics were used to describe differences between patients with and without a MC authorization. Modified Poisson regression was used to compare the likelihood of opioid cessation and reduction among groups. Results: We identified 8,801 patients of whom 326 (3.7%) had a MC authorization. Patients with a MC authorization were younger, had higher stage disease, underwent radiation and/or systemic therapy and had a higher total oral morphine equivalent (OME) use at baseline (p < 0.01). Patients with a MC authorization were less likely to cease POM at 9-12 months post MC authorization (RR 0.63, 95% CI 0.57-0.70), and less likely to reduce their POM dose by 25% (RR 0.79, 95% CI 0.74-0.85) and 50%. (RR 0.73, 95% CI 0.67-0.79). Conclusions: Patients with early stage, non-metastatic cancer with a MC authorization have higher rates of baseline POM use and are less likely to cease or reduce their POM use up to 1 year after MC authorization. Further study is required to understand the harms of concomitant MC and POM use and the impact on survivorship care.
Sociodemographic and occupational factors associated with receipt of work accommodations among employed breast cancer survivors.
Authors: Hundal Jasmin , Dugan Alicia , Helen Swede
Published: September 2022

231

Background: Many cancer survivors face occupational challenges when staying in or returning to work after treatment yet little is known about sociodemographic and work-related factors associated with receipt of work accommodations (e.g. flexible work time, reduced workload). Methods: We analyzed data from the PinkWorks study (n = 154 female breast cancer survivors), a cross-sectional online survey. Participants were: ≥18+ years, speak English, ended treatment within 36 months, and working ≥20 hours per week at both the time of diagnosis and currently. Due to small n’s in strata, we performed descriptive analyses (frequencies, Chi-Square tests) to identify possible univariate associations between occupational factors and granting of work accommodations. An exploratory multiple Logistic Regression was performed with receipt of accommodations (yes, no) as the dependent variable. Results: Among participants, 43.8% received work accommodations from employers, and 11% reported that their physicians had a direct conversation with their employer. Participants who were native English speakers were more likely to receive work accommodations compared to those where English is a second language (44.8%, 22.2%, respectively, n.s.). Workers who held executive positions were more likely to receive accommodations compared to those in either supervisory or non-supervisory roles (60.0%, 43.1%, 42.9%, respectively, n.s.). We observed a higher prevalence of work accommodations among participants who reported that a discussion between the physician and employer occurred compared to those who did not report such a conversation (58%, 41.9%, respectively, n.s.) An exploratory logistic regression controlling for age and educational attainment was consistent with descriptive findings regarding language and type of position. Conclusions: Less than half of employed breast cancer survivors were provided work accommodations. Suggestive disparities in the receipt of accommodations were observed among those who were not native English speakers or in non-executive positions. The occurrence of a conversation between the participant’s physician and employer was linked to a higher prevalence of accommodations but the cross-sectional design of the study limits interpretation. Additional multivariate analyses are recommended to further explore these relationships, including structural equation modeling to address the strong interconnections among the study variables.
Nurse-Initiated Constipation Education (NICE) protocol: Improved health outcomes in the outpatient oncology setting.
Authors: Tess Laura , Timko Olson Erika , Schafhauser Emily
Published: September 2022

237

Background: Many patients living with cancer experience pain requiring opioid therapy, and appreciation of the risks and benefits of opioids has grown in recent years. Opioid induced constipation (OIC) is one of the potential sequelae of opioid therapy. Evidence-based management strategies for OIC utilize lifestyle modifications and over-the-counter medications as initial steps. At a community cancer center, nurses are often the first team members identifying patients with OIC and suggesting management strategies. Thus, providing updated education and tools to nurses is an appropriate means for improving constipation management for patients living with cancer. Methods: Participants in the intervention included RNs and LPNs working in a specific region of the outpatient oncology practice. An evidence-based teaching tool was developed that included five handouts and a 20-minute pre-recorded educational presentation. Changes in nurse knowledge and confidence level were measured using a pretest/post-test design, and constipation related incidents were measured across a 2 month pre- and post-intervention period through review of the triage call tracking system. Data collection also included OIC incidents during the same timeframe. Results: 14 nurse participants completed a pre- and post-test after watching the presentation. Nursing constipation management knowledge scores increased by almost 30% and confidence ratings increased by 16.2%, indicating both an improved knowledge base and comfort level. Constipation-related incidents decreased by 39% post-implementation. Conclusions: Arming nurses with constipation management tools based on current evidence-based practices resulted in improved knowledge and comfort levels and led to decreased patient-reported incidents of constipation and OIC. Utilizing quality evidence-based tools and resources can help to prevent future negative health outcomes.
An overview of adverse event (AE) management for patients (pts) receiving abemaciclib.
Authors: Rugo Hope S. , Vitko Alexandra , Thoele Kelli
Published: September 2022

239

Background: Abemaciclib is a selective cyclin-dependent kinase 4 & 6 inhibitor, approved for hormone receptor-positive (HR+), HER2- advanced breast cancer (aBC) as monotherapy or in combination with fulvestrant or nonsteroidal aromatase inhibitors. Abemaciclib is also approved in combination with endocrine therapy for the adjuvant treatment of HR+, HER2-, node-positive, high risk early BC (EBC). Despite demonstrated efficacy and overall tolerable safety profile, some pts discontinue abemaciclib without a prior dose reduction, highlighting the need for appropriate symptom management. This analysis aims to provide guidance on management of AEs for pts with aBC or EBC receiving abemaciclib. Methods: Study level data were collected for publications related to MONARCH 1, 2, and 3, and monarchE clinical trials. Endpoints included incidence of any-grade AEs, dose modifications, and discontinuations. Data on monitoring of AEs were also extracted. Results are presented descriptively. Results: Highest any-grade incidence of abemaciclib-associated AEs across trials include diarrhea (82-90%), fatigue (41-65%), nausea (30-64%) and neutropenia (37-50%). Notable AEs leading to dose reduction, omission and discontinuation were: diarrhea (14-21%; 15-24%; 1-5%), neutropenia (8-13%; 16-17%; 1-3%), and fatigue (5%; 5%; 2%) respectively. In the monarchE trial, discontinuations due to AEs were highest in the first month and stabilized after 6 months. AE monitoring and management are presented in Table. Conclusions: Appropriate AE monitoring, symptom management strategies, and patient counseling should be used to manage AEs with a goal to impact early discontinuation of abemaciclib.[Table: see text]
Severe symptom reporting in surgical patients assessed through an EHR-integrated ePRO questionnaire at 6 cancer centers.
Authors: Wong Sandra L. , Hazard-Jenkins Hannah W. , Schrag Deborah , Osarogiagbon Raymond U. , Dizon Don S. , Bian Jessica J , Cronin Christine , Tramontano Angela , Hassett Michael J.
Published: September 2022

243

Background: Patients (pts) undergoing surgery for suspected malignancy may experience burdensome post-operative symptoms which can compromise outcomes and necessitate acute care. In prior randomized controlled trials at academic medical centers, patient-reported outcome (PRO)-based symptom management solutions improved clinical outcomes. Attempts to generalize this approach to real-world surgical pts have been challenged by perceptions that severe symptoms rarely occur, responding to severe symptoms can be burdensome, and uncertainty about which symptoms are likely to be severe and need interventions. Methods: Six US-based healthcare systems deployed eSyM, an EHR-integrated symptom management program. Pts undergoing surgery for suspected or confirmed thoracic (THOR), gastrointestinal (GI), and gynecologic (GYN) malignancies received automated questionnaires via MyChart portal 1-3 times weekly for up to 3 months after discharge. Questionnaires based on the PRO-CTCAE included 10 required and 20 optional symptoms, all scored as 0 (no symptoms), 1 (mild), 2 (moderate), or 3 (severe). Additional questions assessed functional status, overall wellbeing, wound discharge, and wound redness. Frequency and predictors of severe reporting were assessed using descriptive statistics and logistic regression modeling. Results: 21,012 surgical eSyM questionnaires were submitted between October 2019 - March 2022 by 3,781 unique pts (median age 63 years, 66.9% female, 92.1% white, 57.9% married, and 37.5% retired). 17% of questionnaires (16% of GI, 14% of GYN, and 21% of THOR) included at least 1 severe symptom. Frequencies of severe symptom reporting appear in Table with physical function impairment, general pain, and fatigue as the top three. Severe symptoms were more likely to be reported by younger, female, or unemployed pts(p < 0.01). In comparison to GI pts, GYN pts reported fewer and THOR pts reported more severe symptoms (p < 0.03). Conclusions: A meaningful minority of pts reported severe symptoms, suggesting that symptom monitoring could benefit pts without over-taxing clinicians. There were few strong patient-level predictors of severe symptoms, arguing that population surveillance may be preferable to targeted surveillance. Interventions are needed to address common severe symptoms and future studies should define most effective mitigation strategies for these symptoms. Clinical trial information: NCT03850912. [Table: see text]
Reimaging metastatic breast cancer care delivery: A patient-partnered qualitative investigation.
Authors: Roberson Mya L , Woods Joshua S , Glenn Lesley , Maues Julia , James Deltra , Reid Sonya A. , Elmore Shekinah Nefreteri Cluff
Published: September 2022

259

Background: Treatment advances for metastatic breast cancer (MBC) have markedly increased survival over the last several decades. Despite the clinical innovation that has occurred, there remains substantial fragmentation of care and lack of focused attention on MBC survivorship care. This study partnered with Project Life, an MBC-survivor led patient wellness community to assess MBC patient experiences with treatment experiences and social support services. Methods: We conducted, virtual, in-depth semi-structured qualitative interviews among people who were members of the Project Life Wellness community. The interview guide and study materials were developed in collaboration with Project Life leadership. A study flyer was distributed by Project Life to members that included a link to an eligibility survey. Participants were eligible if they self-identified as having MBC, were a member of the Project Life community, and could complete the interview in English. As part of the interview, we asked, “How would you re-imagine medical care for people with metastatic breast cancer?” We then systematically processed responses with phronetic iterative analysis, using the mixed-methods research software MAXQDA, to uncover contextually grounded, emergent themes through synthetic coding. Results: We interviewed 36 women with MBC who were members of the Project Life Wellness Community in Spring 2022. In terms of age, 8 (22%) participants were 30-45, 15 (42%) were 46-59, and 13 (36%) were 60+. Overall, 22% of participants identified as people of color (Black, Latina, or Asian). In response to how they would reimagine MBC care delivery, all participants touched upon dimensions of care coordination. Aspects of care coordination that participants specifically raised included 1) Organized referral processes for non-oncology care like mental health services, sexual health care, and palliative care; 2) The need for MBC-specific support services within the care setting; 3)Patient connection to psychosocial aspects of care including social work and patient navigation; 4) Streamlined processes for identifying and enrolling in clinical trials. Conclusions: In our investigation, when asked how they would reimagine MBC care delivery, participants overwhelmingly endorsed the need for more care coordination along several key domains. Responses highlighted the unique needs of care coordination specific to MBC patients. Future care innovations should center patient voices to ensure optimal impact.
Health insurance coverage patterns before and after a cancer diagnosis: Findings from adult patients with cancer in an integrated health system.
Authors: Banegas Matthew P. , Dickerson John F. , Petrik Amanda F. , Anderson Melissa L. , Ramaprasan Arvind , Keast Erin , Wallace Jamie , Henrikson Nora B.
Published: September 2022

262

Background: Patients diagnosed with cancer experience intense medical care and high costs associated with the disease and its treatment. As a result, patients may consider changes to their health insurance coverage to adjust the medical benefits covered and/or the cost-sharing (e.g., annual maximum out-of-pocket [MOOP] limit) requirements. The purpose of this study was to assess the patterns of health insurance plan coverage patterns prior to and following a diagnosis of cancer among adult patients. Methods: Data from 13,237 patients aged ≥18, enrolled at Kaiser Permanente Northwest, diagnosed with cancer between Jan. 1, 2016–March 31, 2021 [index cancer], with ≥12 months of continuous health insurance coverage pre-cancer diagnosis were included. Patients enrolled in hospice prior to index cancer were excluded. Health insurance coverage outcomes included (1) coverage patterns (maintenance, interruption, termination, switch); (2) a composite of any coverage changes; and (3) cost-sharing patterns. Monthly health plan membership enrollment data was used to assess outcomes between two time periods: pre-diagnosis (12 months prior to index cancer) and post-diagnosis (12-18 months following index cancer). Patient sociodemographic, enrollment, health plan and clinical data were extracted from the electronic health record (EHR). Descriptive statistics were used to assess outcomes. Results: Approximately 40% of patients were ages 18-64, 54% were female and 9% were non-White. At index cancer diagnosis, 60% of patients had Medicare, 37% had a commercial plan and 3% had Medicaid. Among patients aged 18-64, 62% had any change in health insurance coverage between pre- to post-cancer diagnosis, including 41% who switched plans, 19% who terminated and 2% with an interruption. Among patients aged 65+, 50% of patients had any change in health insurance coverage, including 20% who switched plans, 30% who terminated and < 1% with an interruption. For those who switched plans between the pre- to post-diagnosis periods, the most common patterns included switching out of commercial plans (-11% points) and switching into either Medicare (+9% points) or Medicaid (+5% points). Among all patients, 14% changed to a higher cost-sharing plan (difference in mean individual, in-network MOOP limit: $938) and 10% changed to a lower cost-sharing plan (difference in mean individual, in-network MOOP limit: -$1701). Conclusions: Our novel findings provide valuable information about health insurance plan coverage patterns among adults diagnosed with cancer and suggest a large proportion of patients may undergo changes to their health insurance coverage. Future studies that assess the implications of health insurance changes on care access and cancer outcomes are warranted.
Sociodemographic difference in patients who enroll and decline remote symptom monitoring (RSM).
Authors: Hildreth Keyonsis , Caston Nicole E. , Dent D'Ambra , Ingram Stacey A. , Lalor Fallon , Franks Jeffrey , Azuero Andres , Young Pierce Jennifer , McGowen Chelsea L. , Andrews Courtney J. , Huang Chao-Hui , Dionne-Odom James Nicholas , Weiner Bryan J , Jackson Bradford E. , Basch Ethan , Stover Angela M. , Howell Doris , Rocque Gabrielle Betty
Published: September 2022

268

Background: Remote symptom monitoring (RSM) using patient-reported outcomes has been shown to reduce symptom burden and hospitalizations in clinical trials. However, little is known about how willing patients are to participate in remote symptom monitoring in real-world settings, particularly for vulnerable patient populations. This study aims to compare characteristics of cancer patients enrolled vs. patients who declined enrollment into RSM. Methods: This prospective study used data that assessed the characteristics of patients who enrolled vs. patients who declined enrollment into RSM. Inclusion criteria included participants’ age ≥18 with cancer who received chemotherapy, targeted therapy, or immunotherapy at the University of Alabama at Birmingham. Race and ethnicity (Black or African American, White, Asian, other and unknown), sex, cancer type (breast, gastrointestinal [GI], genitourinary [GU], gynecological [GYNX], head and neck, leukemia, lymphoma, melanoma, myeloma and other), urban/rural residence, Area Deprivation Index (ADI), and insurance type (Medicaid, Medicare, none, other and private) were abstracted from electronic medical records (EMR) and PRO platform (Carevive). Descriptive statistics were calculated using frequencies and percentages for categorical variables and medians and interquartile ranges for continuous variables. Differences in enrollment status characteristics were calculated using measures of effect size such as Cramer’s V. Results: Of the 307 patients, two thirds of patients were female (71%); 25% were Black or African American and 66% were White patients; 15% lived in an area of higher disadvantage. For insurance, 46%, 26%, 10%, 8%, and 9% of patients had Private, Medicare, Medicaid, other insurance, and no insurance, respectively. The proportion of patients who declined enrollment was higher for males than females (22% vs. 10%), Black or African American than White (18% vs 13%); and having Medicare than private insurance (22% vs. 10%). Compared to those who enrolled, patients who declined enrollment were more often to be male (V:0.2), Black or African American (V:0.1); and have Medicare insurance (V:0.2). Patients enrolled vs. declined in RSM had similar ADI scores (V:0.01). Conclusions: This study demonstrates that potentially vulnerable patients, including Black patients and those with public insurance, have lower RSM engagement. Future analysis is needed to understand participation barriers and how to better engage diverse populations to ensure optimal healthcare delivery to all patients.
Integration of patient-reported outcomes into survivorship care.
Authors: Gilmore Katherine Ramsey , Chapman Patricia Hansberry , Rollins Johnny , Lee-Kim Soo , Robinson Justine , Mullen Ellen , Mistry Haleigh , Singh Prachee , Coyne Robin , Nelson Ana , Osai William , Stolar Karen , Knippel Susan , Fournier Danielle M. , Plair Tamera , Peek Angela , Rodriguez Maria Alma
Published: September 2022

271

Background: Patient reported outcomes (PRO) can be valuable clinical tools to embed the voice of patients into the clinical experience. The use of PROs in the context of cancer survivorship is relatively under-explored. Methods: Disease-specific modules of the MD Anderson Symptom Inventory (MDASI) PRO were integrated into the electronic health record (EHR), and distributed 3-7 days prior to survivorship clinic visits through the patients’ EHR portal. Patients with virtual visits were called 24 hours prior, instructed how to video link, and how to complete the MDASI PRO. For patients who completed the PRO electronically, results were reviewed during clinic visit. High symptom alerts (> = 7) for four key symptoms were established and triggered an automatic message to care teams for review. Results: From Sept 1, 2020 – August 31, 2021, 2,196 PRO surveys were sent to patients with 1,268 submitting results (57.74%) (see Table). Within specific clinics, the submission rates varied greatly between in-person and virtual appointments (33% vs. 83%). Submission rates varied by clinics, with responses ranging from 28.57% - 73.59%. Clinics with higher overall rates had a higher proportion of virtual visits. Conclusions: Electronic distribution of PROs can be successfully integrated into long term survivorship clinic visits. Virtual visits had overall much higher PRO response rates, due to pre-visit workflows which encouraged the completion of PROs. We conclude that patient education and real time support is needed to facilitate patients’ completion of PRO surveys through the electronic portal.[Table: see text]
Adaptation of remote symptom monitoring using electronic patient-reported outcomes for implementation in real-world settings.
Authors: Dent D'Ambra , Ingram Stacey A. , Caston Nicole E. , Thigpen Haley , Lalor Fallon , Jamy Omer , Giri Smith , Azuero Andres , Young Pierce Jennifer , McGowen Chelsea L. , Daniel Casey L. , Andrews Courtney J. , Huang Chao-Hui , Dionne-Odom James Nicholas , Weiner Bryan J , Howell Doris , Jackson Bradford E. , Stover Angela M. , Rocque Gabrielle Betty
Published: September 2022

272

Background: Despite evidence of clinical benefits, widespread implementation of remote symptom monitoring has been limited. We describe a process of adapting a remote symptom monitoring intervention developed in a research setting to a real-world clinical setting at two cancer centers. Methods: This formative evaluation assessed core components and adaptations to improve acceptability and fit of remote symptom monitoring using Stirman’s Framework for Modifications and Adaptations. Implementation outcomes were evaluated in pilot studies at the two cancer centers testing technology (Phase I) and workflow (Phase II and III) using electronic health data; qualitative evaluation with semi-structured interviews of clinical team members; and capture of field notes from clinical teams and administrators regarding barriers and recommended adaptations for future implementation. Results: Core components of remote symptom monitoring included electronic delivery of surveys with actionable symptoms, patient education on the intervention, a system to monitor survey compliance in real-time, the capacity to generate alerts, training nurses to manage alerts, and identification of personnel responsible for managing symptoms. In the pilot studies, while most patients completed > 50% of expected surveys, adaptations were identified to address barriers related to workflow challenges, patient and clinician access to technology, digital health literacy, survey fatigue, alert fatigue, and data visibility. Conclusions: Using an implementation science approach, we facilitated adaptation of remote symptom monitoring interventions from the research setting to clinical practice and identified key areas to promote effective uptake and sustainability.