bluuebunny/crossref_metadata_2025_split huggingface dataset:
Opioid prescribing practices in adolescent and young adults with sarcomas.
Authors: Beauchemin Melissa , Raghunathan Rohit , Accordino Melissa Kate , Wright Jason Dennis , Kahn Justine , Hershman Dawn L. 
Published: October 2020

136 Background: Adolescents and young adults (AYAs) with sarcoma undergo procedures that can result in acute and chronic pain. Adult cancer patients are at increased risk of chronic opioid use, and AYAs are vulnerable to misuse. However, opioid prescribing practices in AYAs with sarcoma are not known. We described opioid prescribing during active therapy and identify factors associated with continued opioid prescription post-treatment in AYAs with newly diagnosed sarcoma. Methods: Patients 10–26 years who were diagnosed with sarcoma between 2008–2016 were identified using IBM Marketscan database. Included subjects received anti-cancer therapy (chemotherapy, procedures, and/or radiation) within 30 days of diagnosis and were continuously enrolled in one insurance plan (commercial or Medicaid) >12-months both before diagnosis and after last therapy. Primary outcome was opioid use, defined as at least one opioid prescription during the 12 months following treatment completion. Covariates included age, sex, insurance, treatment type, mental health (MH) and substance use (SU) diagnoses. Results: We included 1,349 patients, 75% had commercial insurance, 21% had a previous MH, and 4% had previous SU diagnosis. 63% of subjects used opioids during treatment and 28% received at least 1 prescription in the year post-therapy. Medicaid insurance was associated with 60% higher likelihood of opioid use during treatment and those with prior use were three-times more likely to continue post- therapy. Conclusions: Opioid prescriptions in AYAs with sarcoma are common during treatment. A significant proportion of patients continue to receive opioids post-therapy, particularly those with a history of use pre-diagnosis. Medicaid insurance and MH disorder are also associated with continued use post-therapy. Further research is needed to establish safe and effective opioid prescribing practices in AYAs with sarcoma. [Table: see text]
Quantifying treatment preferences and their association with financial toxicity in women with breast cancer.
Authors: Williams Courtney , Gallagher Kathleen D. , Deehr Katie , Aswani Monica S. , Azuero Andres , Daniel Casey L. , Ford Eric W , Ingram Stacey A. , Balch Alan James , Rocque Gabrielle Betty 
Published: October 2020

141 Background: This study sought to understand treatment preferences and their association with financial toxicity in breast cancer patients served by Patient Advocate Foundation (PAF). Methods: This cross-sectional study used survey data from a nationwide sample of women with breast cancer who received assistance from PAF. Choice-based conjoint analysis elicited patient preferences and trade-offs. Latent class analysis segmented respondents into distinct preference groups. The Comprehensive Score for Financial Toxicity (COST) tool captured financial toxicity (range 0-44, lower scores indicate worse financial toxicity). Cramer’s V determined magnitude of relationships in bivariate associations. COST score differences by preference archetype was estimated by least square means and naïve 95% confidence intervals (CI) from adjusted generalized linear models. Results: Of 220 respondents (65% response rate), median age was 58 years (interquartile range [IQR] 49-66) and 60% had household incomes < $40,000. Most respondents were diagnosed with early stage cancer (91%), with 41% diagnosed within the past 2 years; 38% had recurred. Almost two-thirds (61%) were on active treatment. Treatment choice was most affected by preferences related to affordability and impact on activities of daily living (ADLs). Two distinct treatment preference archetypes emerged. The “Cost-Prioritizing Group” (75% of respondents) was most concerned about affordability, impact on ADLs, and burdening care partners. The “Functional Independence-Prioritizing Group” (25% of respondents) was most concerned about ability to work, physical side effects, and interference with important life events. Cost- vs. functional independence-prioritizing respondents were more often diagnosed with an early stage cancer (88% vs. 78%; V = .22), white (78% vs. 56%; V = .21), or privately insured (45% vs. 36%; V = .12). Functional independence- vs. cost-prioritizing respondents more often had household incomes < $40,000 (76% vs. 54%; V = .20), identified as Hispanic/Latino (20% vs. 9%; V = .15), or had Medicaid (15% vs. 7%; V = .12). COST scores were similar between archetypes in adjusted models (Cost-Prioritizing COST = 12, 95% CI 9-14; Functional Independence-Prioritizing COST = 11, 95% CI 9-13). Conclusions: Patients with breast cancer prioritized affordability or maintaining functional independence when making treatment decisions. Because of this variability, preference evaluation during treatment decision-making could optimize patients’ treatment experiences.
Caregiver burden: Empowering caregivers with shared decision-making strategies and skills to improve patient quality of life and outcomes.
Authors: Raymond Martha Ann , Simonetta Margaret-Ann 
Published: October 2020

142 Background: Data from the National Cancer Institute’s Surveillance, Epidemiology & End Results (SEER 2016) program estimates there are 15.5 million cancer survivors in the United States who rely on cancer caregivers every day. Caregivers play an essential role throughout the care continuum greatly impacting a patient’s quality of survivorship. Methods: August 2019–March 2020 the Raymond Foundation hosted nationwide caregiver focus groups and an online survey. Primary goals were reaching caregivers and the patients they serve in rural, urban, and community oncology settings to gain perspective from diverse populations. Focus groups were held in person and online via video conferencing. Results: 1012 caregivers and the patients they care for (41% male, 59% female) participated in our focus groups and online survey: 92% reported a lack of educational resources necessary to participate in shared decision making regarding treatment protocol; 90% reported they lacked communication strategies required to effectively communicate with their healthcare team; 87% reported they would like to learn more about clinical trials but did not know where to start; 85% reported they did not feel comfortable reporting treatment adverse effects; 94% reported working toward a patient-centered, advocate based care approach would lead to enhanced quality of life and improved outcomes. Conclusions: Cancer caregivers and the patients they assist understand the importance of shared decision-making and patient centered care. Based on our focus groups and survey findings, our call to action includes developing the Cancer Caregiver Advocacy Plan. This unique educational resource will provide key information to address educational gaps and empower caregivers to become informed healthcare advocates. The Cancer Caregiver Advocacy Plan will be a companion resource to the Raymond Foundation’s 2018 Cancer Caregiver Action Plan as we continue to expand our education and outreach to minimize cancer burdens for patients and caregivers.
The impact of a cancer diagnosis on worker productivity: Results from a survey of cancer patients and caregivers.
Authors: May Suepattra Grace , Chiu Kevin , MacEwan Joanna P. , Bognar Katalin , Peneva Desi , Zhao Lauren , Yong Candice , Amin Suvina , Batt Katharine , Bolinder Bjorn , Baumgardner James 
Published: October 2020

144 Background: Traditional approaches to capturing health-related productivity loss--e.g. the human capital method--focus only on the foregone wages of affected patients, overlooking the losses caregivers can incur. Thus, the value of lost productivity is often underestimated. This study comprehensively estimates and describes work-related productivity losses due to a cancer diagnosis among working-age (18-65) breast cancer (BC) and non-small cell lung cancer (NSCLC) patients and their unpaid caregivers in the United States. Methods: A cross-sectional survey of BC and NSCLC patients and caregivers measured loss associated with time absent from work (absenteeism) and reduced effectiveness (presenteeism). Respondents reported pre- and post-cancer diagnosis income, hours worked, and time to complete tasks. Exploratory multivariable analyses examined correlations between respondents’ clinical and demographic characteristics—including industry of employment—and post-diagnosis productivity. Results: Of 204 patients (104 BC, 100 NSCLC) and 200 caregivers (100 BC, 100 NSCLC) who completed the survey, 319 participants (162 BC, 157 NSCLC) working ≥40 weeks/year pre-diagnosis were included in the analysis. Over a third of the NSCLC (33%) and BC (43%) patients left the workforce post-diagnosis, whereas 15% of caregivers left. Estimated mean annual productivity loss equaled $125,975 ($50,328 using traditional method) for NSCLC patients and $120,404 ($37,445 using traditional method) for BC. For caregivers, estimated mean annual productivity loss was $97,062 ($39,751 using traditional method) for NSCLC and $123,669 ($33,410 using traditional method) for BC. Exploratory analyses found that greater patient age and later stage at diagnosis were correlated with greater absenteeism. Conclusions: Although patients typically experience greater absenteeism, productivity loss incurred by caregivers is also substantial. Our results underscore the importance of holistic approaches to understanding the broad impact of cancer on both patients and their caregivers.
Missed work, lost income, and job loss in survivors of colorectal cancer and their partners: A dyadic study.
Authors: Veenstra Christine M , Abrahamse Paul , Morris Arden M. , Hawley Sarah T. 
Published: October 2020

145 Background: Many survivors of colorectal cancer face long-term job loss stemming from their diagnosis. However, little is known about employment outcomes among their partners and virtually nothing is known about employment impacts among survivor-partner dyads. Methods: In 2019-20 we surveyed 1150 patients who, in 2014-18, underwent resection of Stage III colorectal cancer and were seen at a community oncology practice, academic cancer center, or reported to Georgia SEER (51% RR). Patients gave a separate survey to their partner. 299 partners (73% RR) completed surveys. Patients and partners were asked about employment consequences of the patient’s cancer. Availability of job support benefits and prevalence of adverse employment outcomes were described among partners. Descriptive statistics were generated to identify trends in job loss within dyads. Results: Among partners, 56% were <age 65, 63% female, 86% white, 27% had < high school education. 61% were employed at time of patient’s diagnosis. Among these, 15% had no job support benefits. 33% had paid sick leave, 47% had flexible work schedule, 28% had unpaid time off. Due to the patient’s cancer, 43% missed 7-30 days work and 13% missed >1 month. Due to the patient’s cancer, 18% lost $2000-$10,000 in income and 11% lost >$10,000. 27% were no longer working at the time of survey. In 47% of dyads, both patient and partner were working before patient’s diagnosis. Among those, in 29% only 1 member of dyad was still working at time of survey and in 11% neither member of dyad was still working. In 15% of dyads, only the partner was working before patient’s diagnosis. Among those, in 50% the partner was no longer working at time of survey. In 16% of dyads, only the patient was working before diagnosis. Among those, in 48% the patient was no longer working at time of survey. Job loss in dyads was associated with older age, lower annual income, and lack of flexible work schedule. Conclusions: Missed work and loss of income are common among partners of patients with colorectal cancer. Job loss affects nearly half of dyads in the survivorship period. Employer accommodations such as flexible scheduling may help mitigate job loss among survivors and their partners. [Table: see text]
Using retrospective adverse event data to assess the impact of visitor management during a pandemic emergency plan at a community oncology practice.
Authors: Bilbrey Larry Edward , Dickson Natalie R. 
Published: October 2020

146 Background: During the COVID-19 pandemic, our community oncology practice, with over 150 providers at 33 locations, incorporated infection control guidance from the CDC into our Pandemic Emergency Plan, including visitor restrictions at all locations. There was an increase in patient fall events in our clinics after visitor restrictions were implemented in March 2020, as there were fewer care-givers available in the clinics to assist patients. Methods: Using our adverse event reporting system, we abstracted and trended all safety events that involved patient falls from March 2019 through May 2020. We compared patient fall events during the period of visitor restriction (March-May 2020) to the same period in 2019, and to the 3 months preceding March 2020 and the implementation of COVID-19 restrictions. We report patient fall events per 1,000 patient visits. Results: Prior to COVID-19, patient fall events averaged .207 falls per 1,000 patient visits for March thru May 2019 and .137 falls per 1,000 patient visits for Dec 2019 thru Feb 2020. Following the implementation of visitor restrictions in March 2020, patient fall events increased to .271 per 1000 visits, with a vast upward trend resulting in .435 patient fall events per 1,000 visits in May of 2020 when the restrictions were tightened, more than double previous averages prior to COVID-19. Conclusions: Family members and care-givers play an important role in the patient’s care team. We are confident that the significant increase in patient falls in May 2020 is attributed to visitor restrictions. These findings support the vital role of family and care-givers in patient safety. They not only provide transportation, emotional support and information on patient health status, but assist with ADLs, ambulation and transfer needs during the patients’ visits to the clinics. Healthcare facilities are often under-resourced and under-staffed to fully address patients’ physical needs. Limiting care-givers during a pandemic may reduce the transmission of infection, but also may lead to other unexpected adverse events. Using these findings, we will be implementing standard fall prevention procedures. The practice’s emergency pandemic plan on visitor restrictions will also be amended to take this into account.
Healthy lifestyle challenges among older female cancer survivors.
Authors: Krok-Schoen Jessica L. , Pisegna Janell , Arthur Elizabeth , Ridgway Emily , Stephens Christian , Rosko Ashley Elizabeth 
Published: October 2020

156 Background: Healthy lifestyles including consuming a healthy diet, being physically active, and maintaining a normal weight can improve prognosis and health-related quality of life (HRQoL) among cancer survivors. The largest proportion of cancer survivors are older adults (≥65 years), yet their lifestyle behaviors are understudied. This study examined the lifestyle behaviors (diet quality, physical activity, maintaining healthy weight) of older female cancer survivors and associations with HRQoL. Methods: Women aged 65 years or older, with all cancer subtypes and stages, who had completed primary cancer treatment (i.e., chemotherapy, surgery, radiation) within the past five years, were eligible to participate. Older female cancer survivors (n = 171) completed one-time surveys to assess HRQoL (RAND-36), unintentional weight loss, body mass index (BMI), diet quality (Diet History Questionnaire II), and physical activity. Demographic information and medical record data were also collected. Diet History Questionnaire II results were converted to Healthy Eating Index (HEI)-2015 scores. Descriptive analyses, correlations, and stepwise linear regressions were utilized. Results: The majority of the sample (median age = 74.50±8.43 years) were white (90%), married (54.7%), breast cancer survivors (67.7%), and completed at least a bachelor’s degree (54.7%). Physical and mental HRQoL of the sample were low; 41.94±10.50 and 48.47±7.18, respectively, out of 100. Physical activity was low; 75.3%, 54.2%, and 68.1% reported no strenuous, moderate, and mild physical activity, respectively. Mean BMI was 27.71±6.24 (overweight), with 64% of the participants being overweight or obese. Mean HEI-2015 scores were 66.54+10.0 out of 100 and below the cutoff score of 80, which represents a “good diet”. Participating in moderate physical activity was associated with higher physical HRQoL (β = 0.42, p = 0.004). Being older (β = 0.27, p = 0.025), white (β = 0.53, p < 0.001), and having higher HEI scores (β = 0.30, p = 0.011) was associated with higher mental HRQoL. Conclusions: Older female cancer survivors reported lifestyle challenges including poor diet quality, low levels of physical activity, and high rates of being overweight or obese, which were associated with HRQoL. Results indicate the need for tailored health interventions for older female cancer survivors regarding their lifestyle behaviors to improve prognosis and HRQoL.
Evaluating compliance of NCCN cancer and chemotherapy-induced anemia guidelines in a community healthcare setting.
Authors: Haber Jamie , Byrne Brian J. 
Published: October 2020

16 Background: The National Comprehensive Cancer Network has released guidelines for management of cancer- and chemotherapy-induced anemia which are defined as Hb less than 11g/dL or a greater than 2g/dL decrease from baseline. The myelosuppressive effects of cancer, chemotherapy and associated treatments, can accumulate with each cycle leading to severe and worsening anemia. It is important to properly identify and treat anemia in cancer patients in a timely manner. This project evaluates the degree to which NCCN guidelines are followed within a multi-site community healthcare setting. Methods: Obtained patient medical records within Hartford Healthcare system in a 4 month period (Nov. 2019-Feb. 2020), who were started on new cancer chemotherapy treatment plans. Patients on single agent immunotherapy or hormone therapy only plans were excluded. Reviewed patient’s medical records to identify who met criteria for cancer- and chemotherapy-induced anemia and who received recommended work up and treatment based on NCCN guidelines. Age, sex, disease, renal function, and goals of treatment were also recorded. Results: A total of 869 patient records were obtained. 598 patients met the inclusion criteria. 452 patients (75.6%) met criteria for cancer- and chemotherapy-induced anemia. 235 patients (52%) had anemia appropriately documented in the physician medical record. 111 patients with anemia (24.6%) had an iron panel performed and 29 patients (6.4%) had a reticulocyte count resulted. For those eligible by NCCN criteria for anemia specific interventions 27 patients (40%) received appropriate iron supplementation, 95 patients (85.6%) received appropriate blood transfusions and 10 patients (7.7%) received appropriate EPO. Conclusions: It is apparent that based on NCCN guidelines, monitoring, evaluation, and treatment of anemia is not being appropriately performed in this healthcare setting. Based on this data a quality improvement project for proper documentation, workup, and treatment of anemia is being developed. [Table: see text]
Demographic, socioeconomic, and clinical factors associated with oncology patient experience in the Ontario cancer system.
Authors: Mahler Mary , Nicholls Brett , Chan Catherine , Nazeri-Rad Narges , Chan Kelvin K. , Singh Simron 
Published: October 2020

160 Background: Your Voice Matters (YVM) is an electronic real time Patient Reported Experience Measure (PREM) collected on all adult patients accessing cancer services in Ontario by Cancer Care Ontario/Ontario Health. To our knowledge, this is the largest oncology PREM dataset worldwide. A total of 25 Items are assessed including care coordination, wait times, access to care and satisfaction with healthcare providers. We attempted to identify demographic, socioeconomic and disease factors that predict for a positive patient experience. Methods: Responses were collated from 18 individual cancer centers between Jan 2017 and Dec 2019. Each item was dichotomized into positive/negative experiences. Multivariable logistic regression was constructed for each of the 25 items. Results: Demographics are described in table. Males (OR=1.11, p=0.0032), genitourinary patients (OR=1.30, p=0.0031) and those receiving radiation (OR=1.39, p=<0.0001) were more likely to have a positive experience. Patients aged 18-39 (OR=0.74, p=<0.0001), receiving chemotherapy (OR=0.76, p=0.0002), and with central nervous system or lung cancer (OR= 0.56, p=<0.001; OR=0.79 p=0.0059, respectively) were more likely to have a negative experience. Lowest income patients were more likely to have a negative experience with healthcare providers (OR=0.83, p=0.0119) and patients from the highest immigration areas had a worse quality experience (OR=0.82, p=0.0029). Conclusions: Age, sex, disease site, visit type, income and immigration status significantly influence patients cancer care experience. This information helps promote equity and the use of PREM data to improve cancer care delivery. [Table: see text]