Kelcie D Willis, Emily A Walsh, Laura E Dunderdale, Kathryn Post, Nora Horick, Michael H Antoni, Steven A Safren, Ann H Partridge, Jeffrey Peppercorn, Elyse R Park, Jennifer S Temel, Joseph A Greer, Jamie M Jacobs
Purpose: Adjuvant endocrine therapy (AET) is a life-saving medication for patients with hormone-sensitive breast cancer, yet many struggle with adherence, warranting behavioral intervention. In our recent trial, participation in a group cognitive behavioral intervention (STRIDE) for symptom management and adherence was associated with improvements in symptom distress, coping, quality of life, and mood. We now explore whether baseline patient- and medication-specific factors-which may be modifiable by clinician-led discussions-moderated the effect of STRIDE on adherence rates.
Methods: From October 2019 to June 2021, 100 patients with early-stage breast cancer reporting AET-related distress were enrolled and randomly assigned to STRIDE or a medication monitoring (MM) control group. All patients stored their AET in electronic pill bottles to track objective adherence. Patients also self-reported their adherence on the Medication Adherence Report Scale-5 and their perceptions of AET on the Cancer Therapy Satisfaction Questionnaire at baseline. We conducted hierarchical linear modeling to test moderators of intervention effects on objective adherence rates. We report the time × group × moderator effects.
Results: Among patients reporting greater perceived difficulties with AET adherence at baseline, STRIDE participants had higher adherence rates over time compared with MM (b = -13.80; SE = 4.56; P < .01). Patients with greater expectations of therapeutic benefit from AET also had improved adherence rates if they were assigned to STRIDE, versus MM (b = 0.25; SE = 0.10; P = .01). Patients who perceived taking AET as convenient and had been taking their AET for less time had higher adherence rates in STRIDE, versus MM.
Conclusion: The current study identified patient- and medication-specific factors that may augment AET adherence interventions and may be modifiable through clinician-led discussions, such as perceptions of adherence problems, therapeutic efficacy, and convenience of AET.
目的:对于激素敏感性乳腺癌患者来说,辅助内分泌治疗(AET)是一种挽救生命的药物,但许多患者在坚持治疗方面存在困难,因此需要进行行为干预。在我们最近进行的试验中,参加针对症状管理和依从性的团体认知行为干预(STRIDE)与症状困扰、应对、生活质量和情绪的改善有关。现在,我们将探讨基线患者和药物特异性因素(这些因素可能可以通过临床医生主导的讨论来改变)是否会影响 STRIDE 对依从率的影响:从2019年10月到2021年6月,100名报告AET相关困扰的早期乳腺癌患者被纳入并随机分配到STRIDE或药物监测(MM)对照组。所有患者都将其 AET 储存在电子药瓶中,以跟踪客观依从性。基线时,患者还通过 "用药依从性报告量表-5"(Medication Adherence Report Scale-5)自我报告其依从性,并通过 "癌症治疗满意度问卷"(Cancer Therapy Satisfaction Questionnaire)自我报告其对 AET 的看法。我们进行了分层线性建模,以检验干预对客观依从率影响的调节因素。我们报告了时间 × 组别 × 调节因子效应:结果:在基线时报告AET依从性有较大困难的患者中,STRIDE参与者的依从率随着时间的推移高于MM(b = -13.80; SE = 4.56; P < .01)。如果患者对 AET 的治疗效果抱有更高期望,那么如果他们被分配到 STRIDE,其依从率也会高于 MM(b = 0.25;SE = 0.10;P = .01)。认为服用 AET 方便且服用 AET 时间较短的患者在 STRIDE 中的依从率高于 MM:目前的研究发现了患者和药物的特异性因素,这些因素可能会增强 AET 的依从性干预,并可通过临床医生主导的讨论进行调整,如对依从性问题、疗效和 AET 便捷性的看法。
{"title":"Effects of Adjuvant Endocrine Therapy-Specific Perceptions on Response to a Behavioral Intervention for Adjuvant Endocrine Therapy Adherence in Patients With Breast Cancer.","authors":"Kelcie D Willis, Emily A Walsh, Laura E Dunderdale, Kathryn Post, Nora Horick, Michael H Antoni, Steven A Safren, Ann H Partridge, Jeffrey Peppercorn, Elyse R Park, Jennifer S Temel, Joseph A Greer, Jamie M Jacobs","doi":"10.1200/OP.24.00316","DOIUrl":"https://doi.org/10.1200/OP.24.00316","url":null,"abstract":"<p><strong>Purpose: </strong>Adjuvant endocrine therapy (AET) is a life-saving medication for patients with hormone-sensitive breast cancer, yet many struggle with adherence, warranting behavioral intervention. In our recent trial, participation in a group cognitive behavioral intervention (STRIDE) for symptom management and adherence was associated with improvements in symptom distress, coping, quality of life, and mood. We now explore whether baseline patient- and medication-specific factors-which may be modifiable by clinician-led discussions-moderated the effect of STRIDE on adherence rates.</p><p><strong>Methods: </strong>From October 2019 to June 2021, 100 patients with early-stage breast cancer reporting AET-related distress were enrolled and randomly assigned to STRIDE or a medication monitoring (MM) control group. All patients stored their AET in electronic pill bottles to track objective adherence. Patients also self-reported their adherence on the Medication Adherence Report Scale-5 and their perceptions of AET on the Cancer Therapy Satisfaction Questionnaire at baseline. We conducted hierarchical linear modeling to test moderators of intervention effects on objective adherence rates. We report the time × group × moderator effects.</p><p><strong>Results: </strong>Among patients reporting greater perceived difficulties with AET adherence at baseline, STRIDE participants had higher adherence rates over time compared with MM (<i>b</i> = -13.80; SE = 4.56; <i>P</i> < .01). Patients with greater expectations of therapeutic benefit from AET also had improved adherence rates if they were assigned to STRIDE, versus MM (<i>b</i> = 0.25; SE = 0.10; <i>P</i> = .01). Patients who perceived taking AET as convenient and had been taking their AET for less time had higher adherence rates in STRIDE, versus MM.</p><p><strong>Conclusion: </strong>The current study identified patient- and medication-specific factors that may augment AET adherence interventions and may be modifiable through clinician-led discussions, such as perceptions of adherence problems, therapeutic efficacy, and convenience of AET.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141975694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Oncology is a complex clinical specialty often requiring the close interaction of teams of different medical specialists for a successful outcome. The field is rapidly evolving scientifically, with successive discoveries of oncologic driver mutations soon followed by therapeutic agents able to interrupt the neoplastic process. Unfortunately, objective quality measurement demonstrates that many patients are not receiving optimal care, from diagnostic accuracy, therapeutic, or end-of-life perspectives. Quality measurement, reporting, and payment programs have the potential to focus attention on these care gaps and drive improvement. The federal government, as the largest single payer of health care services in the United States, has a compelling national interest to ensure that the medical care of Americans is at the highest level achievable. Accordingly, quality reporting and payment programs have been established in federal health care payment programs to drive improvements in care. This article reviews the science of quality measurement, documented gaps in oncology care, and ways to use new information technologies to decrease clinician burden associated with quality reporting. The article reviews how a measure is developed and incorporated into a Centers for Medicare & Medicaid Services (CMS) program. It also summarizes federal programs relevant to oncology care and the individual measures used in these programs. CMS looks forward to working jointly with the oncology community to drive continuous improvements in care.
{"title":"Quality Measurement in Oncology: Time to Take the Next Step!","authors":"Ronald M Kline, Dora L Hughes, Michelle Schreiber","doi":"10.1200/OP.24.00348","DOIUrl":"https://doi.org/10.1200/OP.24.00348","url":null,"abstract":"<p><p>Oncology is a complex clinical specialty often requiring the close interaction of teams of different medical specialists for a successful outcome. The field is rapidly evolving scientifically, with successive discoveries of oncologic driver mutations soon followed by therapeutic agents able to interrupt the neoplastic process. Unfortunately, objective quality measurement demonstrates that many patients are not receiving optimal care, from diagnostic accuracy, therapeutic, or end-of-life perspectives. Quality measurement, reporting, and payment programs have the potential to focus attention on these care gaps and drive improvement. The federal government, as the largest single payer of health care services in the United States, has a compelling national interest to ensure that the medical care of Americans is at the highest level achievable. Accordingly, quality reporting and payment programs have been established in federal health care payment programs to drive improvements in care. This article reviews the science of quality measurement, documented gaps in oncology care, and ways to use new information technologies to decrease clinician burden associated with quality reporting. The article reviews how a measure is developed and incorporated into a Centers for Medicare & Medicaid Services (CMS) program. It also summarizes federal programs relevant to oncology care and the individual measures used in these programs. CMS looks forward to working jointly with the oncology community to drive continuous improvements in care.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141971107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Routine symptom screening may identify unmet needs, but must consider patient engagement and clinician workloads.
常规症状筛查可发现未满足的需求,但必须考虑患者的参与度和临床医生的工作量。
{"title":"Routine Symptom Screening to Address Supportive Care Needs.","authors":"Breffni Hannon, Camilla Zimmermann","doi":"10.1200/OP-24-00482","DOIUrl":"https://doi.org/10.1200/OP-24-00482","url":null,"abstract":"<p><p>Routine symptom screening may identify unmet needs, but must consider patient engagement and clinician workloads.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141971108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jessica D Austin, Lila J Finney Rutten, Kristin Fischer, Jennifer Ridgeway, Sarah Minteer, Joan M Griffin, Deirdre R Pachman, Kathryn J Ruddy, Andrea Cheville
Purpose: The enhanced, electronic health record (EHR)-facilitated cancer symptom control (E2C2) trial is a cohort cluster-randomized, stepped-wedge, hybrid type II trial that leverages EHR systems to facilitate a collaborative care model (CCM) approach with the goal of improving cancer symptom management. Understanding factors that influence care team adoption of EHR systems remains a critical understudied area of research. This study examines how oncology care teams' perceptions regarding the feasibility, acceptability, and appropriateness of E2C2 EHR systems preimplementation were associated with adoption 3 months after implementation and characterizes differences in adoption by individual- and system-level factors.
Methods: Care team members completed an electronic survey before and 3 months after implementation of E2C2 for their respective sequence. Adoption was defined as frequency of use to statements aligned with care team-directed EHR systems designed to facilitate CCM approaches. Chi-square tests assessed differences in adoption while logistic regression models estimated associations between baseline mean scores of acceptability, feasibility, and appropriateness on care team adoption at 3 months.
Results: Results from 94 care team members (37.2% oncologists, 72.6% female, 55.3% in their role for 6+ years) found that adoption rates ranged from 48.9% to 71.7%, with significant differences observed by location (community-based health care systems v tertiary medical center) and professional role. Adjusting for professional role, care team members reporting higher levels of perceived acceptability and appropriateness at baseline had greater odds of adopting EHR systems at 3 months.
Conclusion: EHR systems perceived as acceptable and appropriate are more likely to be adopted by oncology care teams in our sample. Future implementation efforts should consider tailored strategies to facilitate adoption of EHR systems designed to promote CCM-based approaches to improve cancer symptom management.
{"title":"Advancing Care Team Adoption of Electronic Health Record Systems for Cancer Symptom Management: Findings From a Hybrid Type II, Cluster-Randomized, Stepped-Wedge Trial.","authors":"Jessica D Austin, Lila J Finney Rutten, Kristin Fischer, Jennifer Ridgeway, Sarah Minteer, Joan M Griffin, Deirdre R Pachman, Kathryn J Ruddy, Andrea Cheville","doi":"10.1200/OP.24.00280","DOIUrl":"https://doi.org/10.1200/OP.24.00280","url":null,"abstract":"<p><strong>Purpose: </strong>The enhanced, electronic health record (EHR)-facilitated cancer symptom control (E2C2) trial is a cohort cluster-randomized, stepped-wedge, hybrid type II trial that leverages EHR systems to facilitate a collaborative care model (CCM) approach with the goal of improving cancer symptom management. Understanding factors that influence care team adoption of EHR systems remains a critical understudied area of research. This study examines how oncology care teams' perceptions regarding the feasibility, acceptability, and appropriateness of E2C2 EHR systems preimplementation were associated with adoption 3 months after implementation and characterizes differences in adoption by individual- and system-level factors.</p><p><strong>Methods: </strong>Care team members completed an electronic survey before and 3 months after implementation of E2C2 for their respective sequence. Adoption was defined as frequency of use to statements aligned with care team-directed EHR systems designed to facilitate CCM approaches. Chi-square tests assessed differences in adoption while logistic regression models estimated associations between baseline mean scores of acceptability, feasibility, and appropriateness on care team adoption at 3 months.</p><p><strong>Results: </strong>Results from 94 care team members (37.2% oncologists, 72.6% female, 55.3% in their role for 6+ years) found that adoption rates ranged from 48.9% to 71.7%, with significant differences observed by location (community-based health care systems <i>v</i> tertiary medical center) and professional role. Adjusting for professional role, care team members reporting higher levels of perceived acceptability and appropriateness at baseline had greater odds of adopting EHR systems at 3 months.</p><p><strong>Conclusion: </strong>EHR systems perceived as acceptable and appropriate are more likely to be adopted by oncology care teams in our sample. Future implementation efforts should consider tailored strategies to facilitate adoption of EHR systems designed to promote CCM-based approaches to improve cancer symptom management.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141897442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aditi P Singh, Erin P Balogh, Robert W Carlson, Mary Margaret Huizinga, Bradley A Malin, Alexander Melamed, Neal J Meropol, Etta D Pisano, Robert A Winn, K Robin Yabroff, Lawrence N Shulman
Electronic health records (EHRs) are a significant advancement over paper records. However, the full potential of EHRs for improving care quality, patient outcomes, surveillance, and research in cancer care is yet to be realized. The organic evolution of EHRs has resulted in a number of unanticipated consequences including increased time spent by clinicians interfacing with the EHR for daily workflows. Patient access to clinicians and their records has been an important advancement in patient-centered care; however, this has brought to light additional gaps and challenges in EHRs meeting these needs. A significant challenge for EHR design and physician workflows is how best to meet the complex goals and priorities of various stakeholders including providers, researchers, patients, health systems, payors, and regulatory agencies. The National Cancer Policy Forum convened a 2022 workshop, "Innovations in Electronic Health Records for Oncology Care, Research and Surveillance," to address these challenges and to facilitate collaboration across all user groups with the goal of re-envisioning EHRs that will better support shared goals of improving patient outcomes and advancing cancer care and research without overburdening clinicians with administrative tasks. Here, we summarize the current EHR ecosystem as discussed at the workshop and highlight opportunities to improve EHR contributions to oncology evidence and care.
{"title":"Re-Envisioning Electronic Health Records to Optimize Patient-Centered Cancer Care, Quality, Surveillance, and Research.","authors":"Aditi P Singh, Erin P Balogh, Robert W Carlson, Mary Margaret Huizinga, Bradley A Malin, Alexander Melamed, Neal J Meropol, Etta D Pisano, Robert A Winn, K Robin Yabroff, Lawrence N Shulman","doi":"10.1200/OP.24.00260","DOIUrl":"https://doi.org/10.1200/OP.24.00260","url":null,"abstract":"<p><p>Electronic health records (EHRs) are a significant advancement over paper records. However, the full potential of EHRs for improving care quality, patient outcomes, surveillance, and research in cancer care is yet to be realized. The organic evolution of EHRs has resulted in a number of unanticipated consequences including increased time spent by clinicians interfacing with the EHR for daily workflows. Patient access to clinicians and their records has been an important advancement in patient-centered care; however, this has brought to light additional gaps and challenges in EHRs meeting these needs. A significant challenge for EHR design and physician workflows is how best to meet the complex goals and priorities of various stakeholders including providers, researchers, patients, health systems, payors, and regulatory agencies. The National Cancer Policy Forum convened a 2022 workshop, \"Innovations in Electronic Health Records for Oncology Care, Research and Surveillance,\" to address these challenges and to facilitate collaboration across all user groups with the goal of re-envisioning EHRs that will better support shared goals of improving patient outcomes and advancing cancer care and research without overburdening clinicians with administrative tasks. Here, we summarize the current EHR ecosystem as discussed at the workshop and highlight opportunities to improve EHR contributions to oncology evidence and care.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141893415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vishal S Shah, Clayton Irvine, Robert R McWilliams, Parminder Singh, Scott A Soefje
Purpose: Globally, cancer drug expenditure exceeds $185 in US dollars (USD) billion, with the United States contributing $75 (USD) billion. Many cancer drug doses are calculated on the basis of body weight or body surface area, which often results in leftover drug in partially used single-dose vials (SDVs). The cost of wasted drug is a huge financial burden on the US health care system. We evaluated the cost savings resulting from the reduction of SDV wastage, achieved through the implementation of automated dose rounding rules in electronic health records (EHRs).
Methods: Mayo Clinic implemented automated dose rounding rules within the EHR. These rules were designed to round calculated doses to the nearest SDV if the vial size closely matched the original calculated dose, within a 10% threshold. We assessed doses administered between January 2019 and December 2021, and computed cost-savings, waste reduction, and cost of waste for chemotherapy drugs.
Results: In 3 years, 36.1% of doses were rounded down, 35.8% were rounded up, and 28.1% were exact doses. By rounding doses down to a vial size, we achieved cost-savings of $39.75 (USD) million and prevented 62,065 SDV of cancer drugs from going to waste. By rounding doses up, we avoided wasting $9.95 (USD) million worth of drugs. However, there were still instances where the rounding fell outside of the 10%, resulting in wasted drugs worth $25 (USD) million.
Conclusion: The substantial burden imposed on patients and the US health care system because of cancer drug wastage is of significant concern. Although the automated dose rounding system represents a partial solution for this issue, a comprehensive approach involves the imperative development of policy and legislative solutions to effectively mitigate the challenges associated with cancer drug waste.
{"title":"Reducing Cancer Drug Cost: 3-Year Analysis of Automated Dose Rounding in Electronic Health Records.","authors":"Vishal S Shah, Clayton Irvine, Robert R McWilliams, Parminder Singh, Scott A Soefje","doi":"10.1200/OP.23.00688","DOIUrl":"https://doi.org/10.1200/OP.23.00688","url":null,"abstract":"<p><strong>Purpose: </strong>Globally, cancer drug expenditure exceeds $185 in US dollars (USD) billion, with the United States contributing $75 (USD) billion. Many cancer drug doses are calculated on the basis of body weight or body surface area, which often results in leftover drug in partially used single-dose vials (SDVs). The cost of wasted drug is a huge financial burden on the US health care system. We evaluated the cost savings resulting from the reduction of SDV wastage, achieved through the implementation of automated dose rounding rules in electronic health records (EHRs).</p><p><strong>Methods: </strong>Mayo Clinic implemented automated dose rounding rules within the EHR. These rules were designed to round calculated doses to the nearest SDV if the vial size closely matched the original calculated dose, within a 10% threshold. We assessed doses administered between January 2019 and December 2021, and computed cost-savings, waste reduction, and cost of waste for chemotherapy drugs.</p><p><strong>Results: </strong>In 3 years, 36.1% of doses were rounded down, 35.8% were rounded up, and 28.1% were exact doses. By rounding doses down to a vial size, we achieved cost-savings of $39.75 (USD) million and prevented 62,065 SDV of cancer drugs from going to waste. By rounding doses up, we avoided wasting $9.95 (USD) million worth of drugs. However, there were still instances where the rounding fell outside of the 10%, resulting in wasted drugs worth $25 (USD) million.</p><p><strong>Conclusion: </strong>The substantial burden imposed on patients and the US health care system because of cancer drug wastage is of significant concern. Although the automated dose rounding system represents a partial solution for this issue, a comprehensive approach involves the imperative development of policy and legislative solutions to effectively mitigate the challenges associated with cancer drug waste.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141893414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Arjun Gupta, Michelle Tregear, Makala B Pace, Rachel I Vogel
Time and other considerations when evaluating a switch to newer drug formulations (eg, subQ vs IV).
评估改用较新药物配方(例如,亚急性与静脉注射)时的时间和其他考虑因素。
{"title":"Stick With Intravenous or Give Subcutaneous a Shot? Time and Other Considerations When Evaluating Cancer Drug Formulations.","authors":"Arjun Gupta, Michelle Tregear, Makala B Pace, Rachel I Vogel","doi":"10.1200/OP-24-00501","DOIUrl":"10.1200/OP-24-00501","url":null,"abstract":"<p><p>Time and other considerations when evaluating a switch to newer drug formulations (eg, subQ vs IV).</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141878737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Purpose: Early-onset colorectal cancer (EOCRC), defined as CRC diagnosed before age 50 years, has increased significantly worldwide. The majority of EOCRCs do not appear to be driven by genetic factors and may be influenced by environmental factors. We hypothesized that sociodemographic disparities exist in EOCRC. The purpose was of the study was to examine the geographic disparities in patients with EOCRC.
Methods: We retrospectively examined the SEER database from 1976 to 2016 to examine the geographic disparities in EOCRC. A total of 73,378 patients with EOCRC were included in the analysis. We performed univariate and multivariable analyses to evaluate overall survival (OS) and disease-specific survival (DSS). Sociodemographic factors, including the location of residence (metropolitan areas [MA] or rural areas [RA]), sex, race, insurance status, and marital status, were included in the statistical analysis.
Results: The incidence and mortality rates were consistently higher in RA versus MA during the study period. Multivariable analysis showed that patients living in RA had worse OS (hazard ratio [HR], 1.14; P < .01) and DSS (HR, 1.15; P < .001) compared with those living in MA. Similarly, non-Hispanic Black ethnicity and uninsured patients had significantly worse survival when compared with non-Hispanic White and insured patients, respectively. Married status showed better survival outcomes.
Conclusion: Patients with EOCRC living in RA have worse outcomes. Understanding the mechanisms behind such socioeconomic disparities is important so that future studies can reduce these disparities.
{"title":"Exploring Demographic Differences and Outcomes in Early-Onset Colorectal Cancer.","authors":"Beas Siromoni, Adrienne Groman, Kanak Parmar, Sarbajit Mukherjee, Deepak Vadehra","doi":"10.1200/OP.23.00671","DOIUrl":"10.1200/OP.23.00671","url":null,"abstract":"<p><strong>Purpose: </strong>Early-onset colorectal cancer (EOCRC), defined as CRC diagnosed before age 50 years, has increased significantly worldwide. The majority of EOCRCs do not appear to be driven by genetic factors and may be influenced by environmental factors. We hypothesized that sociodemographic disparities exist in EOCRC. The purpose was of the study was to examine the geographic disparities in patients with EOCRC.</p><p><strong>Methods: </strong>We retrospectively examined the SEER database from 1976 to 2016 to examine the geographic disparities in EOCRC. A total of 73,378 patients with EOCRC were included in the analysis. We performed univariate and multivariable analyses to evaluate overall survival (OS) and disease-specific survival (DSS). Sociodemographic factors, including the location of residence (metropolitan areas [MA] or rural areas [RA]), sex, race, insurance status, and marital status, were included in the statistical analysis.</p><p><strong>Results: </strong>The incidence and mortality rates were consistently higher in RA versus MA during the study period. Multivariable analysis showed that patients living in RA had worse OS (hazard ratio [HR], 1.14; <i>P</i> < .01) and DSS (HR, 1.15; <i>P</i> < .001) compared with those living in MA. Similarly, non-Hispanic Black ethnicity and uninsured patients had significantly worse survival when compared with non-Hispanic White and insured patients, respectively. Married status showed better survival outcomes.</p><p><strong>Conclusion: </strong>Patients with EOCRC living in RA have worse outcomes. Understanding the mechanisms behind such socioeconomic disparities is important so that future studies can reduce these disparities.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139939881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01Epub Date: 2024-03-14DOI: 10.1200/OP.23.00650
Monica S Chatwal, Polo Camacho, Banu Symington, Abby Rosenberg, Leslie Hinyard, Marianna Chavez Mac Gregor, Colleen Gallagher, Areej El-Jawahri, Molly McGinnis, Richard T Lee
{"title":"Ethics of Patient-Clinician Boundaries in Oncology: Communication Strategies for Promoting Clinician Well-Being and Quality Patient Care.","authors":"Monica S Chatwal, Polo Camacho, Banu Symington, Abby Rosenberg, Leslie Hinyard, Marianna Chavez Mac Gregor, Colleen Gallagher, Areej El-Jawahri, Molly McGinnis, Richard T Lee","doi":"10.1200/OP.23.00650","DOIUrl":"10.1200/OP.23.00650","url":null,"abstract":"","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140131452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-01Epub Date: 2024-05-29DOI: 10.1200/OP.24.00286
Jacob Waitzman, Pranit R Sunkara, Nicholas Lenze, Michael Brenner, John D Cramer
{"title":"Reply to Y. Kwon et al.","authors":"Jacob Waitzman, Pranit R Sunkara, Nicholas Lenze, Michael Brenner, John D Cramer","doi":"10.1200/OP.24.00286","DOIUrl":"10.1200/OP.24.00286","url":null,"abstract":"","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141175585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}