bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of race, ethnicity, and socioeconomic characteristics as predictors of cachexia risk and survival in stage IV non–small cell lung cancer (NSCLC).
Authors: Olaechea Santiago , Liu Alison , Sarver Brandon , Alvarez Christian , Gilmore L Anne , Infante Rodney E , Iyengar Puneeth 
Published: September 2022

151 Background: Cachexia, seen in more than a third of patients with non-small cell lung cancer (NSCLC), directly leads to functional and survival detriments. As screening and interventions for cachexia and NSCLC improve, deficits of healthcare access and quality among patients disadvantaged by race and socioeconomic factors must be addressed. Methods: Through retrospective and prospective data collection, we established a cohort of 957 patients diagnosed with stage IV NSCLC between 2014-2020 in Dallas, Texas. Presence of cachexia at diagnosis was determined using consensus criteria for substantial (5% for BMI≥20 and 2% for BMI < 20) unintentional weight loss in the 6 months leading to diagnosis. Analyses including multivariate logistic regression and log-rank testing evaluated for significant associations of variables with cachexia incidence and survival. Results: Black race and Hispanic ethnicity independently associated with more than a 70% increased risk of cachexia at NSCLC diagnosis (Table; P < 0.05). Inclusion of private insurance status as a covariate diminished this finding for Hispanic patients only. Black patients presented at younger ages than White patients (Kruskal-Wallis P =0.0012; T-test P = 0.0002), with an average difference of 3 years. Cachexia at diagnosis was a major predictor of survival, highlighting the importance of addressing differential cachexia risk across race/ethnicity. Conclusions: The elevated cachexia risk observed for Black patients independent of insurance status reveals broader causative factors of disparity. A lack of private insurance may be a primary contributor in Hispanic cachexia prevalence. Targeting these differences could mitigate survival detriments linked to cachexia in minority groups. Supported contributors in broader NSCLC outcome inequities include poor representation in trials substantiating USPSTF guidelines as well as preventable barriers to primary and preventative care. Our interpretation of NSCLC outcome disparity in the context of cachexia demonstrates further consequences of these deficits. Moreover, our findings suggest novel targets for health policy by highlighting the prevalence of undiagnosed unintentional weight loss in minority populations with late-stage NSCLC.[Table: see text]
Harnessing academic-community partnerships to improve colorectal cancer screening rates in medically underserved communities.
Authors: LoConte Noelle K. , Antoine Allison , Corbett A. Michelle , Stehman Carrie , Frazer David , Ticku Abhishek , Williams Aronica , Sprecher Elissa , Kos Allison 
Published: September 2022

166 Background: Colorectal cancer continues to be very common, and a widening racial disparity has been demonstrated. Wisconsin’s Comprehensive Cancer Control Program which is a program of the University of Wisconsin Carbone Cancer Center partnered with nine Federally Qualified Health Centers (FQHCs) on this five-year program to increase colorectal cancer (CRC) screening. Methods: This project was funded by the CDC and was a partner of a state’s comprehensive cancer control program and a variety of community health centers. Activities included clinical and environmental assessment and baseline data review of CRC screening, identification of a CRC screening team at each clinic, selection and implementation and evaluation of a panel of evidence-based interventions (EBI) per the The Community Guide to Preventive Services. Ongoing implementation data tracking and monitoring strategies were used to create opportunities for data-informed decisions at each clinic. Results: FIT kits were the preferred CRC screening modality. The preferred EBI were patient reminder systems, provider reminders, reducing structural barriers, professional education, EMR improvements and small media. Screening rates for CRC increased by 17% over the course of the project with a peak weighted average of screening at 51.8% for eligible average risk adults, which was up from a baseline of 34.8%. Over 9,000 take-home stool kits were distributed, and a 60.7% completion rate was achieved. The positivity rate for the FIT kits across all centers was 7.6%. A subset of the patients with a positive FIT (n = 97) were reviewed and 53.7% (n = 51) did not have a documented colonoscopy in their electronic medical record. Conclusions: This project of an academic-community partnership was successful in increasing CRC screening in medically underserved communities in Wisconsin. The positivity rate in this high needs population was higher than expected based on prior publications. Further efforts should focus on decreasing the gap between positive FIT testing and completion colonoscopy.[Table: see text]
Preliminary findings from a consensus building process to update financial advocacy services guidelines.
Authors: Mangir Christina , Harvey Allison , Santiago Angie , Schneider Lori , Doherty Meredith , Boehmer Leigh , Kajdic Hodzic Rifeta , Lucas Lorna 
Published: September 2022

171 Background: In 2018, the Association of Community Cancer Centers (ACCC) developed the Financial Advocacy Services Guidelines to support cancer programs and practices with proactively addressing patients’ financial concerns along the cancer care continuum. Since then, research on financial hardship has expanded and the field of financial advocacy has continued to grow and evolve, necessitating new guidelines. Methods: To assess the current landscape of cancer financial advocacy interventions, ACCC conducted a literature scan of articles published between 2016 and 2021 using key words including financial advocacy, navigation, toxicity, oncology, and cancer. In May 2022, ACCC convened a multidisciplinary group of 49 national experts to begin developing new guidelines through a consensus-based Delphi process. To identify changes and additions to the 2018 guidelines, the panel completed a brief qualitative survey that asked which services are most important to include as a part of financial advocacy programs and necessary resources for effective delivery. Responses were compiled in a document and grouped by similarity using a rapid qualitative analysis approach. Results: The literature scan yielded a total of 55 articles. Several key recommendations emerged including the need to further integrate financial advocacy into care planning services, more training across team members to address financial toxicity, and ensuring services are accessible and equitable. Additional areas for research were ways to leverage technology to enhance services, when and how to screen for financial distress, and the development of care models. From the survey, responses clustered in the following domains and sub-domains: Financial Advocacy Services and Functions (Benefits Verification, Pre-Authorization, & Insurance Optimization; Financial Distress Screening; Patient Communication & Education; Financial Assistance); Program Management Functions (Staffing/Roles & Responsibilities, Staff Training, Infrastructure & Information Exchange, Monitoring & Evaluation); and Stakeholder Management Functions. Conclusions: Early input from the panel illuminated numerous areas for defining new guidelines to increase comprehensiveness, incorporate an explicit focus on health equity, and begin to tease out minimal and optimal services and program components and structure. The information from the literature scan and survey are being used by ACCC and a guidelines task force of field experts to draft new financial advocacy services guidelines, which will then go through at least two rounds of rating by the Delphi panel in order to find areas of consensus. ACCC will also hold a series of roundtables with patient advocacy, commercial, and pharmaceutical stakeholders to allow an opportunity to comment on the guidelines as well. The finalized guidelines are expected to be released before June 2023.
Increasing research to address cancer care disparities in an NCI-sponsored community oncology network.
Authors: Bhattacharya Manami , Geiger Ann M. , Castro Kathleen M. , Adjei Brenda A. 
Published: September 2022

176 Background: Improving the delivery and outcomes of cancer care should be informed by research that aims to reduce disparities among underserved populations and those underrepresented in clinical studies. The NCI Community Oncology Research Program (NCORP), a community-based clinical trials network, conducts such research. In this analysis, we aimed to identify opportunities to develop a robust program of disparities-relevant cancer care delivery research (CCDR). Methods: We reviewed NCORP CCDR studies approved between August 2014-May 2022. Any study with at least one aim addressing care delivery in NIH-health disparity or underrepresented populations was deemed disparities-relevant. Studies were categorized as: primary if they were focused exclusively on cancer disparities within populations of interest; secondary if they had a disparities-related aim in a broader study; and exploratory if the aim assessed differences by race, ethnicity, income, insurance status, or practice-level characteristics. For each CCDR protocol, study and disparities-related characteristics were abstracted by two reviewers, who resolved any disagreements by discussion. Descriptive statistics are summarized. Results: Of 23 CCDR studies, a majority had at least one disparities-relevant aim: 4 primary, 3 secondary, and 10 exploratory. Studies with primary and secondary aims focused on racial/ethnic minorities, rural residents, older adults, adolescent/young adults and socioeconomically disadvantaged populations. Cancer care delivery gaps addressed by these studies included shared decision making, guideline adherence, case management, healthcare expenditures, and healthcare accessibility. Most studies focused on patients undergoing active treatment and included multilevel interventions. Only one of the disparities-relevant studies was available to non-English speaking patients. Conclusions: The inclusion of disparities-relevant aims in most of the care delivery studies is encouraging. The fact that most studies with a primary or secondary aim included an intervention demonstrates strong interest in generating evidence that will support improved cancer care delivery. Studies also addressed several distinct disparity populations across a range of care delivery gaps. These results represent opportunities for targeted network efforts to increase the disparities research portfolio and may inform strategies to optimize equitable care delivery that meets the needs of diverse cancer patient/survivor populations.
A randomized controlled trial of routine financial toxicity screening via electronic patient-reported outcomes (AFT-39).
Authors: Blinder Victoria Susana , Deal Allison Mary , Ginos Brenda F. , Jansen Jennifer , Dueck Amylou C. , Mazza Gina L. , Henson Sydney , Carr Philip M , Rogak Lauren J. , Weiss Anna , Rapperport Anna , Spears Patricia , Gany Francesca , Schrag Deborah , Basch Ethan 
Published: September 2022

180 Background: Financial toxicity affects 20% of cancer survivors and is associated with decreased treatment adherence and poor clinical outcomes. No large-scale programs have been implemented to mitigate financial toxicity among patients undergoing cancer treatment. We evaluated the effect of monthly patient-reported financial toxicity screening as part of a larger digital monitoring intervention. Methods: PRO-TECT (AFT-39) is a cluster-randomized trial of patients undergoing systemic therapy for metastatic cancer. Practices were randomized 1:1 to digital symptom monitoring with patient-reported outcomes (“PRO practices”) or usual care (“control practices”). Digital monitoring consisted of between-visit online or automated telephone patient surveys containing symptom, functioning, and financial toxicity screening questions for up to one year, with automated alerts sent to practice nurses for concerning survey scores. Clinical team actions in response to alerts were not mandated. The primary outcome of this analysis was development or worsening of financial difficulties, assessed via the EORTC QLQ-C30 (“Has your physical condition or medical treatment caused you financial difficulties?”), at any time compared to baseline. A randomly selected subset of patients and nurses were interviewed about their experiences with the intervention. Results: 1,191 patients were enrolled (593 PRO; 598 control) at 52 US community oncology practices. Overall, 30.2% of patients treated at practices that received the intervention developed, or experienced worsening of, financial difficulties, compared to 39.0% of patients treated at control practices (p = 0.01). Patients and nurses interviewed stated that financial toxicity screening identified patients for financial counseling who otherwise would be reluctant to seek, or unaware of the availability of, assistance. Conclusions: Screening for financial toxicity as part of routine digital patient monitoring with PROs reduces the development, or worsening, of financial difficulties among patients undergoing systemic cancer therapy. Clinical trial information: NCT03249090.
Caregiver burden of patients with advanced cancer in Mexico.
Authors: Chavarri Guerra Yanin , Ramos-Lopez Wendy Alicia , Sánchez-Román Sofía , Quiroz Paulina , Covarrubias-Gómez Alfredo , Alcocer Natasha , Morales Alfaro Andrea , Jiménez Sotomayor María Reneé , Gonzalez Salazar Roberto , Carrillo Bedoya Araceli , Jimenez Cruz Ariana Michael , Carrillo Monica , Soto Pérez de Celis Enrique 
Published: September 2022

181 Background: Caregivers of patients with advanced cancer often face significant physical, social, and emotional distress. In many Latin American cultures, family plays a particularly important role in the decision-making process of patients with cancer, and relatives often assume the role of unpaid caregivers. However, there is limited research about the burden associated with cancer unpaid caregiving among patients living in Latin America. We aimed to describe the profile of caregivers and to identify patient-related factors associated with caregiver burden in a third-level cancer center in Mexico City. Methods: We conducted a cross-sectional analysis of baseline data from patients with advanced cancer and their caregivers included in a multidisciplinary patient navigator-led supportive care program in Mexico City ( Te Acompañamos). At the time of enrollment in the program, caregivers completed a short version of the Zarit Burden scale and patients completed a series of screening questionnaires including assessments of quality of life (FACT-G), depression (PHQ-9), and anxiety (GAD-7). Life expectancy was calculated using the palliative performance scale (PPS). We used descriptive statistics, chi-square tests, and multivariate logistic regression analyses to understand which patient factors were associated with higher caregiver burden. Results: A total of 321 patients with advanced cancer (58% women; average age 63.3 +/- 14 years; 32.7 with hepatopancreatobiliary tumors) and 321 caregivers (67.1% women; 44% were the patient’s son/daughter; 29% were their spouses) were included. Sixty-four caregivers (20%) had a high caregiver burden (score > 16 in the Zarit scale). Caregiver burden was more common among the patients’ spouses (24.1 %) followed by brothers/sisters (23.6%). On univariate analysis, moderate/severe levels of depression (p = 0.001), moderate/severe levels of anxiety (p = 0.02), and lower PPS scores (p = 0.002) were associated with a high caregiver´s burden. Multivariate analysis showed that only PPS < 180 days was associated with increased odds of having caregiver burden (2.0; 95% CI 1.8-3.7); p = 0.02). Conclusions: A significant proportion of unpaid caregivers of Mexican patients with advanced cancer report high levels of caregiver burden, and the odds of having caregiver burden are increased when the patient has a calculated life expectancy of <6 months. These results suggest targets for future supportive care interventions to improve caregiver wellbeing in Latin American and Hispanic populations.
Growth and scalability of a palliative care program in a large community oncology practice.
Authors: Mudumbi Sandhya , Schleicher Stephen Matthew , Bilbrey Larry Edward , Sanders Barton , Bosshardt Maribeth , Blakely L. Johnetta , Dickson Natalie R. 
Published: September 2022

206 Background: Tennessee Oncology (TO) is a large community oncology practice with over 180 oncology providers spanning over 30 clinics throughout Tennessee and northern Georgia. In 2017, TO began embedding palliative care (PC) providers in clinics. However, the program growth was slow and by the end of 2019, TO offered PC services within only five clinics. In early 2020, TO implemented various initiatives to expand access and improve utilization of palliative care. Methods: In May 2020, TO hired a palliative care physician to grow and oversee the program. TO physician leadership established and communicated the importance of PC to providers and began providing feedback to each provider on utilization of PC for metastatic lung and pancreatic cancer patients. These diseases were selected due to poor prognosis, high morbidity, and known benefit of palliative care. Expansion of telemedicine reimbursement helped our PC team offer in person and telemedicine visits. Increasing demand allowed for expansion of the team and hiring of additional physicians, advanced practice providers (APPs), and a PC nurse coordinator to provide triage, follow-up and scheduling for PC providers. Results: Between the end of 2019 and the end of 2021, the average number of PC visits per quarter (averaged across three quarters) increased from 1,279 to 2,480, representing a growth of 194%. During this time, TO provided over 19,600 PC visits for 3,955 unique patients, of which 53% were female and 47% were male. Of visits provided, 40% were performed through telemedicine. The program has grown from five providers to 11 providers (three physicians, eight APPs). The number of clinics offering in person PC services has grown from five to 13. The three most common malignancies associated with patient visits were lung (16%), breast (10%), and colorectal (7%). Conclusions: Embedding palliative care within a large community oncology practice is feasible and can grow rapidly. A combination of in-person and telemedicine visits can expand reach to improve accessibility across a large patient population.
Cancer care beyond the clinic: An analysis of participation at The Gathering Place, a stand-alone cancer support community.
Authors: Mitchell Carley , Apisdorf Cheryl , Bennett Beth , Hsu Melinda Laine 
Published: September 2022

214 Background: A wealth of published data exists highlighting the benefits of alternative and supportive therapies when used in combination with traditional medical approaches for individuals diagnosed with cancer. Many physical and emotional symptoms, along with quality of life, can be improved through exercise, artistic expression, mind-body practices and support group participation. While many of these services are offered through healthcare systems or large national foundations, fewer community-run organizations exist. The Gather Place (TGP) uniquely serves the Greater Cleveland area at two stand-alone locations. A wide variety of programs and services are offered, free-of-charge, to those affected by cancer. Since spring of 2020, most services have been provided virtually due to the COVID-19 pandemic. While few studies have evaluated predictors of support group utilization, there is limited data on the demographics of participants at individual support communities. Methods: De-identified, retrospective data was gathered from 04/01/2021 to 03/31/2022. Participant data including age, gender, ethnicity, residential zip code, cancer type, treatment center, date of first attendance, programs attended, and frequency of program attendance were collected and analyzed. Results: 1,494 participants with cancer utilized services at TGP with varying rates of unknown data among each category. Educational opportunities, support groups and one-on-one emotional support sessions were most frequently attended. Female involvement was greater than males (83.9% v. 15.7%), with higher participation among Caucasians compared to African Americans (79.5% v. 16.2%). 67.1% of participants resided in zip codes above the median household income of Cuyahoga County. Participants with breast and gynecologic cancers made up the majority (44.3% & 10.1%), while those with cutaneous, head/neck and hepatobiliary malignancies comprised the smallest distribution (1.6%, 1.7% & 1.8%). Conclusions: TGP is a unique organization unaffiliated with a major healthcare system providing nutrition, fitness, healing arts, education and individual/group support programs. Despite a high incidence of prostate and lung cancer diagnoses in Northeast Ohio, participants with these malignancies were a small percentage of total attendees, differing from the high disease incidence and program participation seen in patients with breast cancer. As information was gathered solely during the COVID-19 pandemic when program delivery shifted to the virtual setting, racial or income disparities reported here may reflect similar disparities seen in tele-health during the pandemic. The gaps in utilization we identified highlight opportunities for targeted areas of improved education and referral.