bluuebunny/crossref_metadata_2025_split huggingface dataset:
ALCANCE Food for Health Equity: Community-driven development of a food insecurity intervention for patients with cancer.
Authors: Hanna Maria T. , Wood Emily Hayes , Medrano Hector S. , Perez Cynthia , Noyola Andrés , Villicana Gerardo , Lopez Guzman Lesly , Reynaga Jajaira , Trotter Chardria , Koontz Zachary M. , Patel Manali I. 
Published: October 2023

208 Background: Food insecurity is prevalent among patients undergoing cancer treatment and has been associated with decreased adherence to cancer therapies, malnutrition risk, and poor quality of life. While food insecurity disproportionately impacts low-income, immigrant and non-English speaking populations, few studies have assessed the needs and preferences for these populations as it relates to interventions that can address this growing problem. In previous work, we identified that 50% of populations in our partner clinic screened positive for food insecurity. This study aimed to assess the needs and preferences of low-income, culturally diverse patients with cancer who screened positive for food insecurity and to co-develop an intervention to address these needs. Methods: Participants were recruited among low-income and immigrant adults ≥18 years of age who screened positive for food insecurity using the 2-item Hunger Vital Sign as part of an ongoing parent randomized controlled trial evaluating a precision medicine intervention. 1:1 semi-structured interviews were conducted in English or Spanish to assess dietary habits, barriers to obtaining healthy food, and preferences regarding intervention assistance options, including on-site food pantry, home delivery of food boxes, food vouchers, and cash transfers. Interviews responses were transcribed and thematically analyzed. Results: Of the 110 patients screened for food insecurity as part of the parent trial, 40 (36.4%) screened positive for food insecurity. Among these patients, 31 identified as Hispanic or Latinx (77.5%), and 26 (65%) indicated Spanish as their primary language. Nineteen (47.5%) reported a household income of <$34,000, 24 (60%) were on Medicaid, and 14 (35%) identified as disabled. A total of 10 participants were randomly selected and consented to participate in interviews. Three main themes emerged from interviews: 1) cancer diagnoses necessitated changes to food behaviors including emphasis on nutrient dense and symptomatically tolerated foods; 2) contributors to food insecurity included higher costs of healthy food options, lack of employment during treatment, limited support, and coexisting expenses including financial toxicity from cancer treatment; 3) priorities for assistance included limiting sense of reliance on charity, autonomy in choosing desired food items that are culturally preferent, and timing assistance with other expenses to maximally relieve financial strain. Conclusions: Food insecurity is a critical issue among patients with cancer with disproportionate impact on low-income and immigrant populations. Various opportunities for intervention are well-received by patients and have the potential to reduce the burden of food insecurity among these populations.
Impact of the end of public health emergency oral dispensing flexibilities for at-risk patients in a community oncology practice.
Authors: Wilfong Lalan S. , Dave Neal , Hemmen Wendy , Feinberg Erica , Doshi Gury K. 
Published: October 2023

209 Background: Many studies have shown the benefit of medically integrated pharmacies for cancer specialty oral drugs in improving patient adherence and reducing waste compared to external pharmacies. Anti-kickback regulations have limited practice’s ability to deliver prescriptions to patient’s homes from physician offices. During the Covid Public Health Emergency (PHE), flexibility for prescription delivery by a physician owned pharmacy was allowed leading many practices to deliver oral cancer therapies to patients who could not otherwise come to clinics to fill their medications. With the end of the PHE, CMS reversed this flexibility. We sought to determine the impact on patients with this change in CMS regulations. Methods: Utilizing the pharmacy database of prescriptions delivered to a patient’s home for a large statewide community oncology practice in Texas during the PHE, we identified patients with Medicare part D who would no longer be able to utilize their physician’s pharmacy for home delivery of their specialty medications. We determined the distance of those patient’s primary address to the nearest clinic and further matched them to the address deprivation index (ADI) a well-validated approach that rank orders zip codes in deciles from lowest to highest need. Results: We found 970 patients receiving home delivered prescriptions with traditional Medicare Part D. 687 or 71% of patients lived within 20 miles of the nearest clinic. 213 or 22% lived between 20 and 50 miles with 70 or 7% more than 50 miles from the nearest clinic. 60 addresses could not be matched to the ADI database. Focusing on those available addresses in the top half of the ADI at highest need, we found that 40% of patients living within 20 miles of the clinic are at significant risk of disparity vs 67% of those 20-50 miles and 61 % of those living more than 50 miles from the clinic. Conclusions: The removal of the PHE flexibility for home delivery of prescriptions from physician offices will significantly increase the burden on patients in Texas, forcing many to drive long distances to obtain drugs and disproportionately affecting those at greatest risk of disparity. We encourage revising policies to allow medically integrated pharmacies to allow home delivery of cancer specialty drugs to meet CMS stated goals of improving health equity.
Association of state policies modifying Supplemental Nutrition Assistance Program (SNAP) eligibility and cancer stage at diagnosis.
Authors: Barnes Justin Michael , Kazmi Ali Rashed 
Published: October 2023

214 Background: Food insecurity is associated with access to care and is particularly prevalent among adolescents and young adults (AYA) with cancer. The Supplemental Nutrition Assistance Program (SNAP) was designed to minimize food insecurity for low-income households. Under the broad-based categorial eligibility (BBCE) policy, states were given the ability to relax requirements for qualifying for SNAP through increasing the income limit or eliminating the asset test. While most SNAP policy changes under the BBCE policy occurred from 2009-2011, it is unknown whether these policies affect access to care among AYA with cancer. We sought to determine whether state SNAP eligibility policies were associated with stage at diagnosis among AYA patients. Methods: We utilized the Surveillance, Epidemiology, and End Results database to obtain data from 2006-2019 for newly diagnosed patients with cancer ages 18-39 years from 11 states. All cancer types were included with the exception of liquid tumors and other unstaged cancers. Difference-in-differences analyses were utilized to evaluate changes in the percentage of localized and distant stage diagnoses from pre- to post-policy enactment between states that enacted (1) asset test elimination or (2) increased income limit policies. Linear probability models were adjusted for state and year fixed effects, race, ethnicity, sex, metropolitan residence, marital status, county-level income, cancer type, and Medicaid expansion effects. We also accounted for state-level clustering via clustered standard errors. Event study analyses were utilized to assess the plausibility of the parallel trends assumption. Results: A total of 157,380 AYAs with cancer were identified. In adjusted difference-in-differences analyses, there was a 0.67 percentage point (PP) (95% CI = 0.15 to 1.19, P=.012) increase in localized stage cancer diagnoses and a -0.81 PP (95% CI = -1.41 to -0.21, P=.008) decrease in distant stage cancer diagnoses in states with increased income limits for SNAP eligibility relative to other states. There were no statistically significant changes in the percentage of localized (0.87 PP, 95% CI = -1.27 to 3.00, P=.43) or distant (0.05 PP, 95% CI = -1.44 to 1.55, P=.94) stage cancers with policies eliminating the asset test. Among patients with cervical cancer, where screening is recommended in this age group, there were extremely similar patterns. Conclusions: State policies increasing income eligibility limits for the Supplemental Nutrition Assistance Program were associated with a higher percentage of localized stage and a lower percentage of distant stage cancers among adolescents and young adults. These data add to a growing body of literature suggesting that policies that address social determinants of health may improve access to care.
Hospital use at the end-of-life among elderly Medicare beneficiaries diagnosed with poor prognosis cancers.
Authors: Kwon Youngmin , Hu Xin , Shi Kewei Sylvia , Zhao Jingxuan , Jiang Changchuan , Han Xuesong , Warren Joan , Yabroff Robin , Zheng Zhiyuan 
Published: October 2023

232 Background: Hospital care for patients with cancer near the end of life (EOL) may reflect poor symptom management and be associated with worse quality of life. We quantified hospital use and in-hospital deaths among elderly Medicare beneficiaries with cancer. Methods: Medicare fee-for-service beneficiaries aged ≥65 years diagnosed with poor prognosis cancers, i.e., breast (stage IV), prostate (stage IV), non-small cell lung (NSCLC; stages III-IV), small cell lung (SCLC; all stages), and pancreas (all stages) cancers in 2008-2019 and died of cancer in 2014-2019 were identified from the linked SEER-Medicare data. The number of hospitalizations, intensive care unit (ICU) admissions, and in-hospital deaths during the last six months and last 30-days of life were examined with descriptive statistics (proportions, means, and rates per 100 person-months [PM]) by cancer site. Results: The final sample consisted of 40,304 patients diagnosed with poor prognosis cancers (mean age: 75.0 years). Among patients with pancreas and SCL cancers, nearly half died within 6 months of diagnosis. In contrast, six-month mortality was lower among patients with stage IV breast and prostate cancers. Among all patients in the last 6 months of life, there were 31.2 hospitalizations per 100 PM, with a mean of 2.02 hospitalizations among patients with any hospitalization. In patients with last 30 days of life, 34.7% had any hospitalization. Among hospitalized in the last 30 days, 43.4% were treated in an ICU and 35.2% died in hospital. Hospitalizations were high across all cancer types measured. Conclusions: Utilization of inpatient services among patients diagnosed with poor prognosis cancers is high near the EOL, which suggests sub-optimal care. Future studies should investigate patient and provider factors associated with such utilizations and identify opportunities to improve EOL care.[Table: see text]
Quality of end-of-life care for women diagnosed with metastatic breast cancer.
Authors: Brazee Rachel , Rosenzweig Margaret Q. 
Published: October 2023

238 Background: Metastatic breast cancer (MBC) is a progressive, non-curative disease, with multiple therapy options. The toxicities and side effects from these therapies, as well as the signs and symptoms of advancing cancer, can cause patient and family related distress. To address these end-of-life (EOL) care needs, standards of care were established and recommendations provided. However, it is not clear if these standards are comprehensive in describing current MBC populations and their EOL experiences. Methods: This study used a sequential quantitative-qualitative mixed methods design to examine the quality of EOL care. The deceased patient’s designated personal representative (DPR) completed the Quality of Death and Dying (QODD) survey, with a subsequent/optional telephone interview. Results: The DPRs were predominately male (n=18; 72%), white (n=23; 92%), had some college education or more (n=24; 96%), and was the spouse/partner (n=16; 64%). The range in age was 25-95 years (SD 14.51), with the length of relationship varying between 7-63 years (SD 14.38). In the QODD survey (N=25), 40% (n=10), rated the overall quality of their loved one’s dying experience as ‘poor’ (score 0-4), yet 60% (n=15) rated the care they received from their healthcare team as ‘excellent.’ During the interview (N=16), the DPR was then asked to explore what made or what would have made for high quality EOL care. Four major categories emerged: resilience in response to transitions of care and adaptations to lifestyle changes; communication between healthcare providers and the patient/DPR in both content quality and delivery style; perceived support from the healthcare team, family, or spiritual advisors, specifically during changes in treatment goals; and knowledge as it relates to past experiences, when it was perceived as missing, or lack the knowledge regarding how to gather new information. Conclusions: The care needs for both the patient and DPR dynamically evolve throughout an MBC diagnosis and treatment. While resilience, communication, support, and knowledge all play a key role in the perception of the DPR regarding the quality of death experienced by their loved one, it is important to note that these experiences took place well before the EOL occurred and should be considered at the start of MBC treatment.
Implementation and assessment of an advanced practice nurse-led early palliative care initiative for patients with advanced pancreatic cancer.
Authors: Jia Sangyang , Lelond Stephanie , Kim Christina 
Published: October 2023

262 Background: Early palliative care (EPC) referral reduces health care costs and improves quality of life and survival in some advanced cancers. Barriers to EPC exist. In April 2022, our provincial cancer centre (CCMB) implemented a clinical nurse specialist (CNS)-led intervention for patients with advanced pancreatic cancer (PANC), circumventing known barriers. New PANC referrals received at the provincial centralized referral office are triaged by an oncologist and concurrently referred to the CNS. CNS consultation focuses on physical and psychological symptoms, medication review, patient and family coping, and goals of care. Education is provided on PANC diagnosis, prognosis, symptoms, potential treatment options, navigating the cancer system, and community palliative care/hospice supports, with close collaboration with the patient’s primary care provider. This study reports on the impact of the CNS role and patient perceptions of this role on patient-centered care. Methods: We compared patients with PANC in the pre-implementation period (Jan 1, 2021, to December 31, 2021) to the post-implementation period (April 1, 2022, to March 31, 2023). Patients were identified using the Manitoba Cancer Registry and the CNS clinical database. Descriptive statistics were used to report quality measures. Results of patient reported perception of patient-centered care during the post-implementation period will also be reported. Results: In the pre-implementation period, 83 patients were referred to CCMB with PANC. In the post implementation period, 135 patients were referred. 125 (93%) accepted a consultation with the CNS, with a median time to meeting of 5 days (range, 0-18). After CNS consultation, 35% declined biopsy, oncology appointment or both. In the pre-implementation period, 29 (55%) patients were referred to palliative care/hospice within 8 weeks of diagnosis, compared to 66 (77%) in the post-implementation period. The mean time to palliative care referral was 18.2 weeks pre-implementation vs 8.0 weeks post-implementation (p=0.0007). Data on number of diagnostic biopsies, medical oncology consultations, and receipt of chemotherapy are in the attached table. Conclusions: This novel approach of CNS assessment and education soon after diagnosis of PANC, at the time of referral to CCMB, is acceptable to patients. It results in increased early referral to community-based palliative care/hospice. Exploring patient goals early may also spare patients from treatments that are time-consuming and associated with adverse effects, allowing those with a life limiting illness to focus on quality of life.[Table: see text]
Does financial assistance reduce catastrophic spending for patients prescribed oral anti-cancer medications at an integrated Specialty Pharmacy?
Authors: Swartz Scott , Clark Mackenzie , Lo Mimi , Gupta Arjun , Chino Fumiko , Lin Tracy Kuo , Ragavan Meera Vimala 
Published: October 2023

27 Background: High copayments for oral anti-cancer medications (OAMs) can lead to detrimental financial and clinical outcomes for patients. Most patients insured by Medicare and prescribed an OAM reach the catastrophic phase of spending.1 Financial assistance programs are increasingly used to defray high out of pocket costs, though their ultimate impact on catastrophic spending has not been well-characterized. This study investigated whether receipt of financial assistance reduced likelihood of catastrophic spending for patients prescribed OAMs. Methods: This retrospective, single-institution, cross-sectional study included all patients prescribed an OAM with a >$0 annual copay at an academic integrated Specialty Pharmacy between 1/1-12/31/2021. Data were sourced through a prescribing-level pharmacy database and through a third-party (Vivor/TailorMed) database. A fixed-effects linear regression model was used to identify the impact of financial assistance (binary predictor) on catastrophic spending (binary outcome), defined as spending above $4430/yr based on the average Medicare Part D threshold from 2022 to enter the catastrophic copayments phase. The model was adjusted for demographic and clinical covariates. Results: 1,186 patients were included in the analysis. Average annual copayment on OAMs was $862.50 (SD = $4,673.47) with 5.6% of patients faced catastrophic spending. 37% of patients received some form of financial assistance. Patients who received assistance had significantly lower annual spending on OAMs overall (ß= -$1236; 95% CI: -$1841-658, p<0.001), but assistance was not associated with less catastrophic spending (OR=0.44; 95% CI: 0.14-1.38, p=0.16). Patients who were male, older, retired, insured by Medicare, and had higher annual household income by census tract were more likely to face catastrophic spending. Those who spoke English as a second language and lived in rural settings were less likely to face catastrophic spending. (Table). Conclusions: Financial assistance programs can decrease overall spending on OAMs but may not address financial burden for patients facing catastrophic level spending. Older adults with incomes too high to qualify for safety net or financial assistance programs may be at uniquely increased risk of catastrophic spending. Future studies should evaluate OAM-induced financial toxicity across diverse delivery systems and develop targeted interventions for patients who spend at catastrophic levels. [Table: see text]
Receipt of only palliative care among patients with advanced-stage head and neck cancer.
Authors: Abouelella Dina K , Gonzalez Katherine , Watts Tammara L , Pusapadi Ramkumar Shreya , Adjei Boakye Eric , Osazuwa-Peters Nosayaba 
Published: October 2023

272 Background: Roughly two-thirds of patients diagnosed with head and neck cancer (HNC) have advanced-stage disease and many are eligible for palliative care. However, only approximately 20% of patients actually receive palliative care after their HNC diagnosis. The factors that affect access to palliative care for these individuals are not well understood. This study investigates the sociodemographic and clinical variables associated with receipt of only palliative care among patients with HNC. Methods: Based on data from the National Cancer Database (NCDB), a retrospective cohort was built, consisting of adult individuals diagnosed with advanced-stage (stages III and IV) HNC between 2004 and 2018. Outcome of interest was receipt of only palliative care. Independent variables included race/ethnicity, sex, distance from the treatment facility, health insurance status, and comorbidity burden. To estimate the likelihood of receiving palliative care, we used a multivariable logistic regression model that took accounted the independent variables and adjusted for other demographic and clinical factors. Results: Among the 233,109 patients included in our cohort, 6,146 received only palliative care, forming our analytic cohort. In our final models, male patients had a lower odds of receiving palliative care only (adjusted odds ratio [aOR] = 0.91; 95% confidence interval [CI]: 0.84, 0.99). Non-Hispanic Black (NH Black) patients had a higher odds of receiving only palliative care, (aOR = 1.37; 95% CI: 1.22, 1.53), compared to Non-Hispanic White (NH White) patients. Patients who were uninsured (aOR = 2.22; 95% CI: 1.88, 2.61), on Medicaid (aOR = 2.66; 95% CI: 2.36, 3.00), or Medicare/other government insurance (aOR = 1.60; 95% CI: 1.44, 1.79) had a higher odds of receiving only palliative care compared to those with private insurance/managed care. Additionally, higher comorbidity burden was associated with higher the odds of receiving only palliative care only (aOR = 1.67; 95% CI: 1.37, 2.02). Conclusions: Among patients with HNC presenting with advanced-stage disease, receipt of only palliative care is mostly associated with being a Black patient, having a greater comorbidity burden, and inadequate health insurance status. It is critical to improve equitable access to care for patients with HNC in order to optimize survivorship and mitigate disparities in HNC.
Evaluating the impact of therapy dogs on patients with cancer.
Authors: Curley Priya Belur , Patel Abhishek , Famoso Justin 
Published: October 2023

278 Background: Chemotherapy/Immunotherapy infusion visits are unique experiences for cancer patients that can often increase stress and anxiety. Multiple papers have shown that therapy dogs can decrease anxiety, improve mental health, and increase relaxation. It has not been established that therapy dog visits during infusions can improve stress and anxiety similar to other clinical experiences. Our purpose was to explore if during this stressful experience therapy dogs would have the same impact as previously researched situations. Methods: At Virginia G. Paper Cancer Care Network North Scottsdale (HonorHealth) we drafted a survey. This anonymous and voluntary survey abstracted patient data that included: age, gender, dog ownership, and pet affinity. Patients were asked prior to a therapy dog visit to grade their anxiety and relaxation level and answered identical questions post-visit. Questions were drafted with Yes/No and scale of 1-10. Surveys were collected over an eight-week period from January 1, 2023 through February 28, 2023. Patients were surveyed in an outpatient infusion center. Results: 61 surveys were collected and analyzed. Statistical analysis was performed with a t-test for numeric and a binomial regression was fit to the data. 100% of patients surveyed liked animals & felt that therapy dogs helped with anxiety and relaxation. Anxiety levels significantly decreased by 31.1% (p <0.00001) after a therapy dog visit and relaxation levels increased by 25.8% (p = 0.0001). Age surveyed ranged from 40-85 with an average age of 63, with more females than males being surveyed. Conclusions: Patients at a small community hematology/oncology center can benefit from additional supportive services. In our prospective survey project, having a visiting therapy dog significantly decreased patient anxiety and improved relaxation during chemotherapy/immunotherapy infusion visits.