bluuebunny/crossref_metadata_2025_split huggingface dataset:
Economic evaluation of a non-medical financial assistance program on missed treatment appointments among adults with cancer.
Authors: Biddell Caitlin , Spees Lisa P. , Trogdon Justin G. , Kent Erin E. , Rosenstein Donald L. , Angove Rebekah SM , Rogers Cindy , Wheeler Stephanie B. 
Published: October 2023

282 Background: Addressing patients’ cancer-related financial needs is critical to ensuring equitable cancer care delivery. Although many cancer centers report having financial support programs available to meet patients' medical and non-medical financial needs, formal evaluation of these programs has been limited. We retrospectively evaluated the impact of a program providing non-medical financial assistance on missed treatment appointments among patients receiving cancer treatment at a large, Southeastern public hospital system. Methods: We used patient electronic health records, program records, and cancer registry data to examine the impact of the program on rates of missed (or “no-show”) radiation therapy and infusion chemotherapy/immunotherapy appointments in the six months following treatment initiation. We employed propensity weighting to estimate the average treatment effect on those exposed to the program, stratified by treatment appointment type (radiation therapy, infusion chemotherapy/immunotherapy). We developed a decision tree-based economic model to assess the program’s cost-effectiveness from the health system perspective in a hypothetical cohort over a six-month time horizon. Results: Of 1,347 patients receiving radiation therapy between 2015 and 2019, 53% (N=715) had ≥1 no-shows, and 28% (N=378) received program assistance. Receipt of any assistance was associated with a 2.1 percentage point (95% CI: 0.6 – 3.5) decrease in the proportion of no-shows, corresponding to a 51% decrease in the overall mean no-show proportion. Under the current funding model, the program is estimated to save the health system $153 per missed appointment averted, relative to not providing non-medical financial assistance. Of the 1,641 patients receiving infusion chemotherapy/immunotherapy, 33% (N=541) received program assistance, and only 14% (N=223) had ≥1 no-shows. The financial assistance program did not have a significant effect on no-show proportions among infusion visits. Conclusions: This study employed a novel approach to retrospectively evaluate a non-medical financial assistance program for patients undergoing active cancer treatment. Findings support investment in programs that address patients’ non-medical financial needs, particularly for those undergoing intensive radiation therapy.
Associations among spiritual pain and the frequency and intensity of physical and psychological distress in patients with advanced cancer evaluated in a supportive care center during COVID-19 pandemic.
Authors: Delgado-Guay Marvin Omar , Baez Gonzalez Joannis , Guzman Diana , De la Cruz Maxine Grace , Fellman Bryan M. , Bruera Eduardo 
Published: October 2023

284 Background: Patients with cancer are considered a highly vulnerable group, especially during the COVID-19 pandemic. There is limited literature describing the level of spiritual distress during the COVID pandemic and its association with the physical and psychological and distress in this population. Methods: Retrospective chart review of 1264 patients seen by the Outpatient Palliative Care Team from May 1st, 2020 to December 31st, 2020 (during COVID-19), 85% of the consults was delivered by Telemedicine. The association with ESAS-FS physical symptoms, Spiritual Pain (SP), anxiety and depression (none=0/10, the worst 10/10 were measured. Spiritual Pain was defined as “Pain deep in your Soul/Being that is not physical” (SP ≥1/10). Results: Spiritual Pain was present in 284/1264 (23%). Patients with Spiritual Pain were younger [Median years (Min-Max): 61 (21-90) vs. 62 (21-97), p=0.008], Hispanic [20% vs 16%, p<0.001], more single [15% vs. 10%, p<0.001], and divorced [13% vs. 9% p<0.001]. There was no association with gender and race. The frequency (%) and median intensity (0-10/10, 95%CI) of symptoms in patients with and without Spiritual Pain were, pain [90% vs 81%, 5 (0-10) vs 4 (0-10), p=0.691], fatigue [96% vs 90%, 6 (0-10) vs 5 (0-10), p<0.001], anxiety [90% vs 60%, 5 vs. 2 (0-10), (p<0.001], depression [87% vs 44%, 4 vs 0 (0-10), p<0.001], well-being [97% vs 81%, 5 (0-10) vs 3 (0-10), p=0.011], financial distress [78% vs 26%, 3 (0-10) vs 0 (0-10), p<0.001], total ESAS-FS distress [51 (7-113) vs 30 (0-92), p<0.001], respectively. 49% of patients with spiritual pain were evaluated by our psychological team vs. only 29% of those who did not have it (<0.001). Multivariate analysis for Spiritual Pain was financial distress (OR:1.24, p<0.001) and depression (OR:1.16, p<0.001). Conclusions: Important percentage of patients living with cancer experienced Spiritual Pain during COVID pandemic, this spiritual distress affected the expression of physical, psychological symptoms and worse well-being. An inclusive interdisciplinary team approach including spiritual care is needed. More research is warranted.
Cost-of-care discussions for individuals with newly diagnosed advanced non-small cell lung cancer and melanoma: Findings from a population-based study.
Authors: Yabroff Robin , Halpern Michael T. 
Published: October 2023

3 Background: Growing costs of cancer care can result in patient financial hardship and many professional organizations, including the American Society for Clinical Oncology, recommend patient-physician discussions about expected treatment costs as part of high-quality care. Documentation of these discussions is critical as even privately insured patients may find care unaffordable without additional assistance. This study examined medical records of individuals diagnosed with advanced non-small cell lung cancer (NSCLC) and melanoma, cancers with recently approved expensive treatment options, for documentation of cost discussions. Methods: Individuals newly diagnosed 2017-2018 with stage III/IV NSCLC (n = 1767) and melanoma (n = 689) in participating SEER regions were randomly selected for the population-based National Cancer Institute Patterns of Care study. Medical records were reviewed for reported cost discussions; terms used and record location were abstracted. Patient-, treatment- and hospital- factors, including age, sex, race/ethnicity, comorbidities, and health insurance coverage, were examined for associations with cost discussions in multivariable logistic regression analyses. Results: Cost discussions were documented in the medical records of 24.6% of NSCLC and 25.5% of melanoma patients. “Out-of-pocket costs”, “patient assistance plan”, and “inability to pay” were most commonly used terms. Cost discussions were most frequently noted in physician or nursing progress notes and assessment plans. Documentation of cost discussions varied little by patient and hospital factors. In adjusted analyses, privately insured (vs. publicly insured) patients were less likely to have documented cost discussions (odds ratio (OR) = 0.54; 95% CI:0.37-0.80). Patients who did not receive systemic therapy or did not receive any cancer-directed treatment were less likely to have documented cost conversations than patients who received systemic therapy (OR = 0.39; 95% CI:0.19-0.81 and OR = 0.46; 95% CI:0.30-0.70, respectively). Conclusions: Cost discussions were infrequently documented in medical records of patient with newly diagnosed advanced NSCLC and melanoma; variability in documentation may hinder identifying this information and tracking referrals to address patients’ financial needs. The findings underscore the importance of systematic documentation of cost of care discussions to ensure high quality care for all patients.
Reducing stress and anxiety in cancer patients with the use of virtual reality.
Authors: Muzammil Zeeshan , Rajendran Ramji Ramaswamy , Gordon Alex 
Published: October 2023

303 Background: Applications of virtual reality (VR) have impacted every sphere of civilization, from speculative architecture to the practice of medicine. Building on the body of research already showing the benefits of immersive VR experiences, the goal of our study was to determine whether the stress and anxiety experience of different types of cancer could be mitigated by using virtual reality, specifically through relaxing VR experiences. Methods: A comparative observational study was conducted at community outpatient offices for patients who wanted to improve patient experience throughout their cancer treatment. Patients who had symptoms of nausea, dizziness, and vision issues were excluded from the study. The VR intervention consisted of patients watching a relaxation VR 360 video on the YouTube app every day for one week on the Google Cardboard VR headset. Pre- and post VR intervention scores were recorded using a DASS21 questionnaire. The mean differences in scores as well as t-tests were compared between individuals to see if VR improved patient’s experience through one’s cancer treatment. Results: There were 115 subjects ( n = 115). There was an average reduction score of 6.50 points with stress seeing the biggest drop in score of 2.71 points. Breast cancer was the most common cancer diagnosis. Metastatic cancer was the cancer with the biggest change in VR intervention with an average decrease of 12.83 points. Conclusions: Virtual reality (VR) has been proven to significantly reduce the psychological discomfort, including stress, anxiety, and depression experienced during treatment, in the context of caring for cancer patients. The empirical results strongly imply that VR is an effective therapeutic intervention modality in the inpatient setting, with compelling implications for the use of VR technology in the future to lessen the physical and psychological suffering of cancer patients.[Table: see text]
Improving lung cancer screening starts with the primary care provider: Enhancing shared decision making for optimal patient outcomes.
Authors: Menakuru Sasmith R. , Beirat Amir F. , Dhillon Vijaypal S. , Emran Joseph , Salih Ahmed , Hanna Nasser H. 
Published: October 2023

306 Background: Despite the critical importance of lung cancer screening (LCS), its uptake remains dismally low, with only 5.8% of eligible individuals undergoing screening. To harness the potential benefits of LCS, there is an urgent need for shared decision making (SDM) between patients and primary care physicians (PCPs), who often serve as the initial point of contact. Recognizing this need, the Centers for Medicare and Medicaid Services endorse LCS through low-dose computed tomography (LDCT) following SDM. This study aims to enhance SDM and increase LCS utilization by providing PCPs with a comprehensive checklist to address key points and better utilize their time. Methods: A concise checklist was created, which included pertinent points to address during an SDM meeting. This checklist was then given to the PCPs. Fifty-eight (58) PCPs affiliated with two hospitals in the Indiana University Health system agreed to implement the LCS-SDM checklist during office visits with eligible patients. All participating PCPs had existing relationships with LCS-eligible patients, received specific instructions for implementing the LCS-SDM checklist, and agreed to allocate a portion of their visits for SDM. In total, 194 patients on Medicare participated in this study and were interviewed: 158 had no documented history of LCS discussions, while 36 had previously been offered and refused LDCT. Following SDM interviews, PCPs completed written surveys to evaluate the impact of the LCS-SDM checklist on their practice and the perceived effectiveness of SDM. The patients were also surveyed to assess their receptiveness to the SDM process. Results: The majority of the 58 PCPs expressed support for utilizing SDM in LCS; however, time constraints emerged as a significant limiting factor. Despite feeling rushed during the SDM sessions, the PCPs acknowledged the value of the checklist as a helpful reference tool. Among the 158 patients who had not previously discussed LCS, 91 out of 158 patients (57.6%) opted to undergo screening. Among the 36 patients who initially declined LDCT, 20 out of 36 patients (55.5%) chose to participate in LCS after revisiting the topic. Impressively, 192 out of 194 patients (98.9%) expressed appreciation for the opportunity to engage in SDM. Conclusions: The results underscore the significant benefits of SDM in LCS, demonstrating its potential to improve uptake and patient outcomes. While time constraints present challenges for PCPs, both patients and physicians generally respond positively to SDM sessions. By implementing comprehensive checklists and facilitating dedicated time for SDM, primary care providers can effectively enhance LCS utilization and empower patients to make informed decisions regarding their lung health.
Addressing barriers in care management, shared decision-making alignment, and educational needs on novel immunotherapy combinations in melanoma.
Authors: Ackbarali Tariqa , Arnone Maria , Schollenberger Megan Davis , Hamid Omid , Lipson Evan J. 
Published: October 2023

309 Background: Immunotherapy is being used increasingly to treat patients with locally-advanced unresectable or metastatic melanoma. To optimize patient care, members of the multidisciplinary healthcare team and their patients need up-to-date information about the latest therapies and the myriad factors that can influence outcomes. To assess patient-clinician alignment on perceptions of care, an educational initiative was designed for clinicians and patients/caregivers. Methods: A patient/caregiver educational activity was held in January 2023 in partnership with the Melanoma Research Foundation and remains on-demand at CancerCoachLive.com. An accredited clinician activity was held in February 2023 in collaboration with Partners for Advancing Clinical Education and remains on-demand at OMedLive.com. The Melanoma Action Coalition collaborated on both the patient and clinician activities. Behavioral assessment of preferences, attitudes, and barriers toward managing patients with melanoma were examined throughout the CME and patient/caregiver program. Data from these sessions were analyzed to determine behavioral and/or practice impact. Outcomes from the patient program were analyzed and provided as a supplemental resource for participants in the CME activity. Results: To date, 456 patients and 2,797 clinicians have participated in the educational initiative. Of the patient-reported experiences and preferences: 43% indicated they are under the care of a multidisciplinary team and only 42% were very satisfied with their current treatment regimen. The top two identified barriers in managing melanoma were anxiety about treatment efficacy (33%) and participating in normal activities (25%); these barriers were not aligned with those identified by clinicians. Upon evaluation of confidence in treatment decision-making; 70% of patients were not confident collaborating with their team while 74% of clinicians indicated low confidence in shared decision-making with their patients. At baseline, there was low awareness of safety and efficacy data regarding novel immunotherapy combinations and only 50% were likely to consider administering novel combinations to patients with unresectable locally advanced or metastatic melanoma. Clinicians additionally provided insight into barriers to patient enrollment in clinical trials with lack of trials at their institution being the greatest barrier (56%). Conclusions: Patient and clinician assessments provided an opportunity to determine misalignments in perceptions of barriers and insights into patient care experiences as well as clinician education needs. As novel immunotherapy combinations continue to become available for patients with unresectable melanoma, it is important to increase awareness of the clinical data and foster practical strategies to improve patient-centered care.
A randomized controlled trial of treatment planning process to enhance shared decision-making in patients with metastatic breast cancer.
Authors: Rocque Gabrielle Betty , Eltoum Noon , Caston Nicole E. , Williams Courtney , Oliver Marian Mead , Moradi Lauren , Ingram Stacey A. , Azuero Andres , Pisu Maria , Bhatia Smita 
Published: October 2023

311 Background: A unique opportunity exists for patients with metastatic breast cancer (MBC) to engage in shared decision-making. Presenting patient-reported data, including patient treatment preferences, to oncologists before or during a treatment planning decision may improve patient engagement in MBC treatment decisions. This study tested the impact of a patient-reported data-driven, oncologist-engaged, shared decision-making treatment planning process compared to the standard treatment planning process. Methods: This randomized controlled trial tested a novel treatment planning process focused on shared decision-making, including oncologist review of patient-reported data and treatment preferences (e.g., impact on daily activities, financial concerns), prior to or during treatment decisions compared to the standard of care treatment planning process where this data was infrequently viewed and treatment plans were delivered as education following decisions. The trial was conducted in women with metastatic breast cancer receiving cancer treatment at a single National Cancer Institute-designated comprehensive cancer center. The primary outcome was patient perception of shared decision-making. Secondary outcomes included patient activation, physician perception of treatment decision-making, and physician use of the intervention. Descriptive statistics were calculated for all study outcomes. Cramer’s V and logistic regression models were used to evaluate effect. Subgroup analyses were conducted by race. Results: Among the 109 evaluable patients enrolled from 12/2018-6/2022, median age at consent was 59 years (interquartile range 49-65); 28% were Black, 12% lived in highly disadvantaged neighborhoods, and 24% lived in a rural setting. Patients receiving the intervention had a slightly higher perception of shared decision-making than patients receiving standard of care (63% vs 59%; V=0.05; OR 1.19; 95% CI 0.55-2.57). Among Black patients receiving the intervention, 77% of patients perceived the treatment decision to be shared, compared to 65% of Black patients in the control arm (V=0.10). Almost a third (31%) of patients in the intervention arm were at the highest level of patient activation compared to 19% of those in the control arm (V=0.18). In 82% of decisions, oncologists agreed the patient-reported data helped engagement in shared decision-making and 45% reported changing management due to patient-reported data. Conclusions: Oncologist review of patient-reported data in decision-making may be a promising approach to improve patient activation and patient-centric decision-making, particularly for Black women who may face challenges effectively communicating preferences during treatment discussions. This intervention should be tested in larger studies. Clinical trial information: NCT03806738 .
Evaluating shared-decision making among women with metastatic breast cancer.
Authors: Hendrix Emma , Henderson Nicole , Bourne Garrett , Thigpen Haley , Ingram Stacey A. , Triebel Kristen , Rocque Gabrielle Betty 
Published: October 2023

313 Background: There are a multitude of treatment trajectories available for patients with metastatic breast cancer (MBC). Shared decision-making (SDM), which involves the incorporation of patient preferences and concerns into clinical conversations, is recommended in this context in order to encourage well-informed, patient-centered decisions. Little is known about how these conversations occur in practice. Methods: This qualitativestudy includedwomen with MBC participating in a randomized control trial (RCT) of a SDM intervention at the University of Alabama at Birmingham. Real-world MBC treatment decision-making encounters were audio-recorded, transcribed, and inductively analyzed using thematic content analysisvia NVivo software by two independent coders. Key themes and quotes were identified pertaining to patient treatment preferences and their influence on patient-oncologist treatment decisions. Results: From January 2020-December 2020, 59 decision-making encounters were recorded. Participants were primarily middle aged (Mean: 57.3, SD 10.8), White (70%), and many had travelled over an hour to their appointment (46.7%). Encounter discussions typically consisted of patient histories, scan or test results, symptoms, and treatment options. Key preference themes included logistics, ability to continue daily activities, physical side effects, previous experience with a particular treatment, survival, cosmetic concerns, and time with family. Patients most frequently expressed logistical preferences (“ We were hoping that, like if I have to go through any kind of chemo, if there's things that we could do in Tuscaloosa as opposed to driving up here.”). Some preferences were indirectly expressed via questions about treatment cost, efficacy, physical side effects, and cosmetic concerns. In 44% of the conversations (n=26), the oncologist explicitly invited the patient to share in decision-making by asking about their specific preferences. Most patients (77%, n=20) accepted the invitation ( “I will try [exemestane] again. I've had the same thought, maybe I should give it a wing. Maybe I'm different. And see if that helps.”), while 23% (n=8) deferred the decision to their physician (“ Whatever you think, because you the doctor. You know more than I do.”). Conclusions: More work is necessary in order to incorporate patient preferences efficiently and accurately into medical decision-making. Patients have varied needs and preferences that are not all directly related to efficacy or survival and are willing to participate in SDM care when directly engaged by oncologists.