bluuebunny/crossref_metadata_2025_split huggingface dataset:
Financial hardship experienced in adults with metastatic breast cancer (MBC) from diverse racial, ethnic, and socio-economic backgrounds.
Authors: Rosenberg Shoshana M. , Zeng Caroline , An Anjile , Lombardo Gina , Stein Taylor , Ssebyala Shakirah , Taiwo Evelyn , Elreda Lauren , Walker Desiree , Mercurio Anne Marie , Hershman Dawn L. , Pinheiro Laura C 
Published: October 2023

276 Background: MBC profoundly impacts physical, psychosocial, and financial well-being. With treatment advances, patients often manage ongoing treatment for extended durations, which has employment and financial implications (e.g., missed work for appointments). As part of a study evaluating the “collateral damage” of MBC, we sought to describe employment and financial challenges, with a focus on Black and Hispanic adults living with MBC. Methods: From 5/22-5/23, English or Spanish speaking adults with MBC (de novo stage IV or recurrent) treated at 4 New York Presbyterian (NYP) sites (Weill Cornell Medicine-Manhattan, NYP-Brooklyn Methodist, NYP-Queens, and NYP-Columbia) were invited to complete a survey that included a measure of collateral damage (SHINE-financial and employment concerns) and social determinants of health. Fisher’s Exact tests were used to assess differences by race and ethnicity. Results: Of 87 respondents, 14% identified as Hispanic, 28% non-Hispanic Black (NHB), 41% non-Hispanic White (NHW), 7% Asian American Pacific Islander (AAPI), and 10% other/multiracial; 41% did not have a college degree, 32% were employed, 19% unemployed, 9% homemakers, 27% retired, and 13% disabled. Employment concerns were prevalent across racial and ethnic groups; Black, Hispanic, and AAPI participants were more likely to report financial concerns (Table). While 100% of Hispanic, NHW, and AAPI participants reported having stable housing, 29% of NHB participants were worried about losing housing (p=.002). 42% of Hispanic and 45% of NHB participants (vs. 8%, NHW and 0%, AAPI, p=.007) were food insecure; 18% of Hispanic and 17% of NHB adults indicated lack of reliable transportation in the last year (vs. 0%, NHW/AAPI, p=.041). Conclusions: NHB and Hispanic MBC patients report higher levels of financial concern and are more likely to experience food and transportation insecurity, compared to NHW patients. Evaluating the role of screening to systematically connect patients with resources to address unmet social and financial needs should be prioritized in an effort to identify feasible approaches to support economically vulnerable patients following an MBC diagnosis.[Table: see text]
Risk for anxiety and depression among men with prostate cancer.
Authors: Morris Victoria G. , Rogers Kimberly Papay , Doughtie Kara , Popalis Madyson , Miller Melissa F. 
Published: October 2023

280 Background: Men with prostate cancer (PC) commonly experience symptoms of anxiety, depression, and suicidality; yet, identifying men in need of mental health support can be difficult, particularly as gender role socialization may deter men from seeking care. We aimed to identify sociodemographic, clinical, and social factors associated with risk for clinically significant anxiety and depression among men with PC. Methods: 118 men with PC completed the Cancer Experience Registry, provided sociodemographic and clinical information, degree of symptom and side effect (SSE) burden in the prior month (16 items), completed the CancerSupportSource Risk for Anxiety and Risk for Depression 2-item subscales , and PROMIS Emotional Support and Instrumental Support 4-item subscales. Bivariate analysis was used to identify significant variables associated with risk for anxiety or depression to be included in subsequent models. Multivariable logistic regression was used to determine which factors significantly predicted risk (1=At risk; 0=Not) for 1) anxiety and 2) depression Independent variables included sociodemographic (age, race/ethnicity, employment, income, marital status), and clinical factors (time since diagnosis, staging, treatment status, history of recurrence, radical prostatectomy, chemotherapy, hormone or radiation therapy, total SSE burden), and social support (caregiver (Y/N), emotional and instrumental support). Results: The sample was 84% Non-Hispanic (NH) White, 9% NH Black. Mean age was 66 years ( SD=9.8). 42% NED, 23% localized, 26% metastatic disease. 53% were retired, 35% employed, and 10% unemployed due to disability (UDTD). 31% were at risk for clinical levels of anxiety; 25% were at risk for clinical levels of depression. In multivariable logistic regression analysis: significant predictors of risk for anxiety ( p<.001) included age (OR =0.88, p<.01), not having a caregiver (OR =5.02, p=.02), and emotional support (OR =0.81, p=.04). Risk for depression ( p<.001) was significantly predicted by instrumental support (OR=0.67, p=.01) and higher among those with active, localized disease compared to NED (OR =10.84, p=.02), and among those UDTD compared to employed (OR =11.09, p=.03). Significant correlates of risk for anxiety and depression in bivariate but not multivariate analysis: marital status, time since diagnosis, and total SSE burden. Conclusions: Younger age, UDTD, localized cancer status, social support, and not having a caregiver were significant predictors of risk for clinical levels of anxiety or depression. Routine risk assessment for anxiety and depression, coupled with multidimensional distress screening can help triage patients to tailored care. Further, those with greater social support and those with a caregiver had lower odds of being at risk for anxiety or depression, emphasizing the need for connecting men with cancer to emotional and instrumental supportive services in their community.
“Bad memories and a big debt—not a legacy I want to leave.” Patient perspectives on cancer treatment choices, cost of care, and legacy goals.
Authors: Figueroa Gray Marlaine , Banegas Matthew P. , Henrikson Nora B. 
Published: October 2023

283 Background: Legacy—how one hopes to be remembered and how one impacts others after death—is an unexplored and important dimension of care decision-making for people facing serious illness. This study examined 1) how people with cancer facing serious illness conceive of legacy, 2) the types of treatment choices people make with legacy in mind and 3) if and how patients want to discuss their legacy goals with their care team. Methods: We conducted a scoping literature review to characterize the legacy construct and identify legacy-related treatment choices. We conducted semi-structured telephone interviews with cancer patients at an integrated health system who had received at least 1 palliative care consult in the past year. Interview topics included patient definitions of legacy, the importance of legacy over time, and what mattered most as they made treatment choices. We used Atlas.ti to thematically analyze interview transcripts. Results: In the scoping review, we identified three major intersecting legacy goals that influence patients’ care choices: being remembered as an individual, being remembered for one’s social role, and impacting others' well-being. Financial legacy—the material artifacts related to one’s estate—cut across all three legacy domains and emerged as a substantial factor at the intersection of care decision-making and legacy planning. In qualitative interviews, many people worried that the cost of care and necessary medications would negatively impact the legacy they were able to leave behind. Examples included choosing less expensive or forgoing treatment to preserve their financial legacy (e.g. not wanting to lose their house because of medical costs); feeling shame at experiencing financial hardship due to cancer care costs (“I don’t want to be remembered begging people for gas money to get to my appointments”); and death planning with cost in mind (“I don’t want to leave a horrible mess behind.”). Few people had discussed their legacy goals with their health care team, but many wanted support to do so, especially as these goals were threatened by high out of pocket costs. Conclusions: People with cancer consider their legacy goals, and in particular their financial legacy, as they make treatment choices. Further work is needed to identify how and for whom legacy goals should be addressed as part of patient-centered care, including for whom legacy and financial legacy is most important.
Sociodemographic and clinical characteristics associated with utilization of rehabilitation services in breast cancer survivors.
Authors: Gorzelitz Jessica Susan , Brick Rachelle Sophia , Deng Luqin , Mollica Michelle , Stout Nicole Lynn , Stoller Stefanie , Williams Courtney 
Published: October 2023

286 Background: Breast cancer treatment is increasingly efficacious, but commonly results in functional morbidity and decreased quality of life for survivors.Rehabilitation services, including physical and occupational therapy, are recommended by clinical practice guidelines to counteract these impairments, yet these supportive services may be underutilized. Little is known about how use of rehabilitation services may vary by patient-level characteristics. Methods: Data from the Surveillance, Epidemiology and End Results (SEER)-Medicare linked database was used to identify women aged ≥66 years diagnosed with stage 0-III breast cancer between 2011-2016. Rehabilitation services (evaluation/treatment by a physical and/or occupational therapist) delivered in the initial phase of care (0-11 months post-diagnosis) were identified via outpatient or physician visit claims. Descriptive statistics compared rehabilitation usage by patient sociodemographics and clinical characteristics (age, race, dual eligibility status, rural/urban residence, cancer stage, subtype, treatment type). Associations between patient characteristics and rehabilitation services were calculated using modified Poisson models estimating relative risk (RR) and corresponding 95% confidence intervals (CIs). Results: Of 55,539 breast cancer survivors, 33% (n=18,244) had received any type of rehabilitative services. Survivors were a mean age of 75 years (SD 6.7), 88% White, 86% urban-dwelling, 21% Medicare/Medicaid dually enrolled, and 82% had HR+ breast cancer. Clinically, 88% of survivors had received chemotherapy, 69% lumpectomy, and 27% mastectomy. In adjusted models, patients aged >75 vs. ≤75 and dual-eligible beneficiaries vs. those with other insurance were 6% (RR 0.94, 95% CI 0.92-0.96) and 4% (0.96, CI 0.93-0.99) less likely to have received rehabilitative services, respectively. Patients with at least a high school education vs. less than high school, White vs. non-White, or living in a rural vs. urban area were 26% (1.26, CI 1.22-1.30), 6% (1.06, CI 1.02-1.11), and 6% (1.06, CI 1.02-1.10) more likely to have received rehabilitative services, respectively. Patients with invasive vs. in situ cancer and those who received surgical treatment vs. none were 13% (1.13, CI 1.06-1.21) and 15% (1.15, CI 1.02-1.32) more likely to have received rehabilitative services, respectively. Conclusions: Rehabilitation services use differed by patient sociodemographic and clinical characteristics, with the largest differences seen for survivors of differing educational and treatment statuses. Further research is needed on barriers for, access to, and delivery of rehabilitation services, specifically for women with breast cancer who are less educated, older-aged, non-White, or Medicare/Medicaid dual eligible.
Financial toxicity in patients with newly diagnosed pancreatic cancer: A prospective cohort study.
Authors: Tehranchi Kian , Halbert Brian , Hsieh Tina Yi Jin , Garita Esteban , Sucre Santiago , Hacker Michele R. , Bullock Andrea J. 
Published: October 2023

29 Background: Financial toxicity (FT) refers to the financial strain and distress experienced by patients due to the costs associated with cancer care. Patients with pancreatic ductal adenocarcinoma (PDA) experience unique challenges including limited treatment options, aggressive disease progression, complex multidisciplinary care needs and an overall limited prognosis. The aim of this preliminary analysis was to measure FT in patients newly diagnosed with PDA and determine factors associated FT. Methods: In this prospective cohort study, patients with newly diagnosed PDA prior to treatment initiation were enrolled through a pancreatic multi-disciplinary clinic at a single institution. The Comprehensive Score for Financial Toxicity (COST), a validated instrument for measuring FT, was used to measure participant’s baseline FT upon initial clinic visit and at two-month intervals via online survey. Mean baseline COST scores were compared using a two-sided t test for binary variables and an ANOVA test for categorical variables with >2 categories. Demographic information including age, race, educational experience, income and insurance status was also collected by questionnaire. Results: Between July 2021 and March 2023, 63 patients were enrolled of which 45 participants completed the baseline surveys (71% response rate). Patients with higher stage disease experienced higher baseline financial toxicity, with mean COST score 38.0 for resectable disease, 26.9 for borderline resectable disease, 22.1 for unresectable disease and 17.5 for metastatic disease (p = 0.03). Participants enrolled in Medicaid experienced the highest FT (mean COST 16.0), while those enrolled in Medicare reported the lowest FT (mean COST 31.8). Participants having private insurance fell in-between with a mean COST score 22.1. Baseline FT also varied inversely with household income with participants with annual household incomes <$50,000 experiencing the most FT (mean COST = 12.7) and participants with annual household incomes >$200,000 experiencing the least FT (mean COST = 34.6). Conclusions: Patients with more advanced pancreatic cancer not only face a worse prognosis but also experience heightened financial strain even before initiation of therapy, emphasizing the early vulnerability of these individuals both medically and financially. Future analyses will measure FT longitudinally after treatment initiation and measure the association between FT, response to therapy and mortality. [Table: see text]
Factors associated with the decision to continue adjuvant endocrine therapy for five more years in a diverse sample of breast cancer survivors.
Authors: Hawley Sarah T. , Kurian Allison W. , Furgal Allison Kate Cullen , Katz Steven , Ward Kevin C , Hamilton Ann S. , Wallner Lauren P. 
Published: October 2023

319 Background: Guidelines suggest that breast cancer survivors consider taking adjuvant endocrine therapy for 10 years post diagnosis to maximize recurrence prevention. Little is known about how patients decide to continue endocrine therapy beyond 5 years. Methods: iCanCare is a longitudinal study of women diagnosed with breast cancer in 2014-15 and reported to the Los Angeles County and Georgia Surveillance, Epidemiology and End Results (SEER) registries. Women were surveyed during initial treatment and again 6 years later (2021-22) (Expected final N=1430, 60% current response rate). The proportion of respondents who completed 5 years of endocrine therapy was determined from SEER and patient report (N=793). This group was queried regarding their decision to continue for an additional 5 years (yes/no/undecided). Patients were asked about the importance of personal values in making this decision (all categorized into very/quite/somewhat important vs. a little/not important), and perceived benefit of continuing (none, small/moderate, large/huge). They were also asked to report on how the decision was made (decision style, involvement of oncologist and primary care physician, PCP). We conducted bivariate analyses to assess associations between the decision to continue (yes vs. no/undecided) and decision-making factors. Results: In the sample of 793 women who completed 5 years of endocrine therapy, 40% decided to take it for more than 5 years, 54% decided not to, and 5% were undecided. Overall, 44% reported that it was a shared decision between them and their physician(s). The values survivors reported as most important in their decision to continue were doing what their oncologist wanted them to do (77%) and worry about recurrence (61%). Medication costs (11%) was the least important factor. Among survivors who chose to continue, most important were doing what their oncologist wanted them to do, worry about recurrence, and desiring the most extensive treatment possible (all p <0.001). A greater proportion of those who perceived a large/huge benefit (vs. less benefit) of continued therapy chose to continue (87% vs. 13%, P<0.001). Having received a strong oncologist recommendation was strongly associated with the decision to continue, as was PCP involvement in the decision (both p<0.001). Conclusions: In this population-based sample of breast cancer survivors who completed 5 years of adjuvant endocrine therapy, less than half decided to extend therapy for 5 more years. Personal values and role of physicians weighed heavily into the decision to continue. Further work to understand how to incorporate and address patient values in endocrine therapy decision making is needed.
Reducing 30% of waiting time in the administration of antineoplastic oral drugs in patients with urological cancer.
Authors: Diaz De Cerio Amaya , Marfil Peña Carmen , Rodriguez Montani Hernan Alberto , Alonso de Pablo Virginia , Marron Maria Cruz 
Published: October 2023

325 Background: In order to reduce waiting time in the administration of oral antineoplastics we participated in ASCO/ECO QTP. We propose the creation of an oncology nursing office, trained to evaluate and administer oral antineoplastic medication. Methods: The waiting times of patients diagnosed with urological cancer and receiving treatment with oral antineoplastic drugs are collected, between their arrival at the hospital and the drug’s dispensation. Waiting times are calculated using a prospective qualitative analysis and we represent the data using SPC graphs such as R-Charts, process maps, Pareto and cause-effect diagram, objectifying, the longest waiting time between the oncology consultation appointment and the entrance to consultation. An oncology nursing consultation, with protocols based on checklists (where the most frequent adverse effects are collected, blood pressure is measured and the corresponding analytical parameters are assessed) is created to facilitate the job and train nursing for the administration of drugs. Subsequently, the waiting times are analyzed again, after the implementation of the nursing consultation and a month after it. Results: Along a period of 6 months (time from when we started the ASCO/ECO QTP course, until we implemented the medical oncology consultation), we have reduced the median time between the patient's appointment to the drug dispensation, from 35 minutes to 5 minutes, approximately a reduction higher than the 80%. One month after the implementation of the nursing consultation, waiting times are analyzed again, and the improvement is maintained. Conclusions: The creation of a specific nursing consultation has made possible to reduce waiting times in the administration of oral antineoplastic drugs, reducing the waiting list and managing to quote 3 more patients each day in medical oncology consultation.
Prospective study looking at expectations and perceptions of women attending a robust gynecologic oncology support group (SG).
Authors: Suhner Jessa M. , Mysona David , Meehan Riley , Dorr Katherine , Wheatley Donna , Pyrzak Adam , Johnson Marian Symmes , Rungruang Bunja Jane , Higgins Robert , Ghamande Sharad A. 
Published: October 2023

334 Background: In contrast to breast cancer, there is limited data looking at the effects of SG on patient perceptions and expectations in gynecologic cancers. At our institution, we have a well-establish, grass-roots level SG that is unique to women with gynecologic cancers that meets monthly. Our goal was to explore the perceived benefits of SG participation on patient physical and emotional side effects, and quality of life as patients cope with diagnosis and therapy. Methods: An original questionnaire was developed to evaluate SG participant’s expectations of the group and if they felt they were being met as well as perceived effects of attending SG on their side effects. Validated FACT-G surveys evaluated physical well-being (PWB), emotional well-being (EWB), social well-being (SWB) and functional well-being (FWB) of those who did and did not attend SG. Surveys were prospectively collected from 2015 to 2023. Descriptive statistics were reported as means with standard deviation. Due to non-parametric distribution, other statistical analysis was performed by Kruskal-Wallis test. Results: 86 original SG questionnaires were completed. 24.4% were Black, 39.5% had at least an Associate degree and 51.1% had annual income < $50,000. Majority of patients had ovarian cancer (54.7%) and diagnosed at advanced stage (65.4%) with 59.3% on active treatment. 48.8% had attended >5 meetings. The top reasons for attending SG were at physician request (25%), to meet others with same diagnosis (23%) and learn more about their cancer (18%). Those who attended >5 meetings felt that SG improved their cancer education (p=0.002), provided support (p=0.001) and provided bonding and companionship (p=0.02) more than those who attended 1-5 meetings. There was no significant difference found between physical and emotional side effects when stratified by meetings (p>0.05). 140 FACT-G surveys were completed by 71 who did not attend SG and 69 who attended at least one meeting. There was no difference in total FACT-G, PWB or SWB scores between the two groups (p=0.649, p=0.729 and p=0.589 respectively). However, those who attended SG had a higher FWB than those who did not (p=0.009). Conclusions: SG is overall meeting the expectations of participants. Patients who attended reported significantly improved FWB. With increasing treatment options and survivorship, more research in this area is essential to understanding how to best support our patients.[Table: see text]