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Survivorship Care for People Affected by Advanced or Metastatic Cancer: MASCC-ASCO Standards and Practice Recommendations. 晚期或转移性癌症患者的生存期护理:MASCC-ASCO 标准和实践建议》。
IF 4.7 3区 医学 Q1 ONCOLOGY Pub Date : 2024-09-01 Epub Date: 2024-04-29 DOI: 10.1200/OP.23.00716
Nicolas H Hart, Larissa Nekhlyudov, Thomas J Smith, Jasmine Yee, Margaret I Fitch, Gregory B Crawford, Bogda Koczwara, Fredrick D Ashbury, Maryam B Lustberg, Michelle Mollica, Andrea L Smith, Michael Jefford, Fumiko Chino, Robin Zon, Meera R Agar, Raymond J Chan

Purpose: People with advanced or metastatic cancer and their caregivers may have different care goals and face unique challenges compared with those with early-stage disease or those nearing the end of life. These Multinational Association for Supportive Care in Cancer (MASCC)-ASCO standards and practice recommendations seek to establish consistent provision of quality survivorship care for people affected by advanced or metastatic cancer.

Methods: A MASCC-ASCO expert panel was formed. Standards and recommendations relevant to the provision of quality survivorship care for people affected by advanced or metastatic cancer were developed through conducting (1) a systematic review of unmet supportive care needs; (2) a scoping review of cancer survivorship, supportive care, and palliative care frameworks and guidelines; and (3) an international modified Delphi consensus process.

Results: A systematic review involving 81 studies and a scoping review of 17 guidelines and frameworks informed the initial standards and recommendations. Subsequently, 77 experts (including eight people with lived experience) across 33 countries (33% were low- to middle-resource countries) participated in the Delphi study and achieved ≥94.8% agreement for seven standards, (1) Person-Centered Care; (2) Coordinated and Integrated Care; (3) Evidence-Based and Comprehensive Care; (4) Evaluated and Communicated Care; (5) Accessible and Equitable Care; (6) Sustainable and Resourced Care; and (7) Research and Data-Driven Care, and ≥84.2% agreement across 45 practice recommendations.

Conclusion: Standards of survivorship care for people affected by advanced or metastatic cancer are provided. These MASCC-ASCO standards support optimization of health outcomes and care experiences by providing guidance to stakeholders (health care professionals, leaders, and administrators; governments and health ministries; policymakers; advocacy agencies; cancer survivors and caregivers). Practice recommendations may be used to facilitate future research, practice, policy, and advocacy efforts.Additional information is available at www.mascc.org, www.asco.org/standards and www.asco.org/survivorship-guidelines.

目的:晚期或转移性癌症患者及其护理者与早期疾病患者或临近生命终点的患者相比,可能有不同的护理目标,并面临独特的挑战。这些多国癌症支持性治疗协会(MASCC)-ASCO 标准和实践建议旨在为晚期或转移性癌症患者提供一致的优质生存期护理:方法:成立 MASCC-ASCO 专家小组。方法:成立了一个 MASCC-ASCO 专家小组,通过开展以下工作制定了为晚期或转移性癌症患者提供优质生存关怀的相关标准和建议:(1) 对未满足的支持性关怀需求进行系统回顾;(2) 对癌症生存关怀、支持性关怀以及姑息关怀框架和指南进行范围回顾;(3) 开展国际性的改良德尔菲共识程序:一项涉及 81 项研究的系统性综述和一项对 17 个指南和框架的范围界定综述为最初的标准和建议提供了依据。随后,33 个国家(33% 为中低端资源国家)的 77 位专家(包括 8 位有亲身经历者)参与了德尔菲研究,并就 7 项标准达成了≥94.8%,在45项实践建议中达成了≥84.2%的一致意见:结论:为晚期或转移性癌症患者提供了幸存者护理标准。这些 MASCC-ASCO 标准通过为利益相关者(医疗保健专业人员、领导者和管理者;政府和卫生部门;政策制定者;宣传机构;癌症幸存者和护理者)提供指导,支持优化健康结果和护理体验。实践建议可用于促进未来的研究、实践、政策和宣传工作。更多信息请访问 www.mascc.org、www.asco.org/standards 和 www.asco.org/survivorship-guidelines。
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引用次数: 0
You're Just Too Good to Be True: Billing for Longitudinal Care With G2211. 你简直好得不像真的:使用 G2211 为纵向护理计费。
IF 4.7 3区 医学 Q1 ONCOLOGY Pub Date : 2024-09-01 Epub Date: 2024-08-22 DOI: 10.1200/OP-24-00619
Jeffrey Peppercorn
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引用次数: 0
Two Centuries Have Shown That Voltaire May No Longer Be Correct About Doctors …At Least Those Treating Advanced Prostate Cancer. 两个世纪的实践表明,伏尔泰对医生的看法可能不再正确......至少对那些治疗晚期前列腺癌的医生是这样。
IF 4.7 3区 医学 Q1 ONCOLOGY Pub Date : 2024-09-01 Epub Date: 2024-07-15 DOI: 10.1200/OP.24.00366
Donald Skip Trump, Derek Raghavan

Oncologists use molecular prediction/pharmacogenomics to improve Rx of cancer. Voltaire now wrong.

肿瘤学家利用分子预测/药物基因组学改进癌症药物治疗。伏尔泰现在错了。
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引用次数: 0
Harnessing the Power of Implementation Science to Improve the Quality of Care for Oral Anticancer Therapies. 利用实施科学的力量提高口服抗癌疗法的护理质量。
IF 4.7 3区 医学 Q1 ONCOLOGY Pub Date : 2024-09-01 Epub Date: 2024-07-01 DOI: 10.1200/OP.24.00397
Charles H Lim, Katherine A Enright
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引用次数: 0
Advancing Equity in Cancer Care: The Critical Role of Sexual Orientation and Gender Identity Data Collection. 促进癌症护理的公平性:性取向和性别认同数据收集的关键作用。
IF 4.7 3区 医学 Q1 ONCOLOGY Pub Date : 2024-09-01 Epub Date: 2024-06-10 DOI: 10.1200/OP.24.00360
Christopher W Wheldon, Tammarah Sklarz, Zachary A K Frosch

New study highlights critical gaps and opportunities to enhance equitable cancer care for sexual and gender minority patients.

新研究强调了在加强对性少数群体和性别少数群体患者的公平癌症护理方面存在的关键差距和机遇。
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引用次数: 0
Time Toxicity Experienced by Early-Phase Cancer Clinical Trial Participants. 早期癌症临床试验参与者的时间毒性。
IF 4.7 3区 医学 Q1 ONCOLOGY Pub Date : 2024-09-01 Epub Date: 2024-06-10 DOI: 10.1200/OP.23.00811
Sienna M Durbin, Debra M Lundquist, Andrea Pelletier, Rachel Jimenez, Laura Petrillo, Janice Kim, Kaitlyn Lynch, Megan Healy, Andrew Johnson, Nicholas Ollila, Vaishnavi Yalala, Benjamin Malowitz, Allison Kehlmann, Nicholas Chevalier, Victoria Turbini, Viola Bame, Hope Heldreth, Jenipher Silva, Casandra McIntyre, Dejan Juric, Ryan D Nipp

Purpose: Early-phase clinical trials (EP-CTs) are designed to determine optimal dosing, tolerability, and preliminary activity of novel cancer therapeutics. Little is known about the time that patients spend interacting with the health care system (eg, time toxicity) while participating in these studies.

Methods: We retrospectively reviewed the electronic health records of consecutive patients enrolled in EP-CTs from 2017 to 2019 to obtain baseline characteristics and number of health care-associated days, defined as all inpatient and outpatient visits while on trial. We used univariable and multivariable analyses to identify predictors of increased time toxicity, defined as the proportion of health care-associated days among total days on trial. For ease of interpretation, we created a dichotomous variable, with high time toxicity defined as ≥20% health care-associated days during time on trial and used regression models to evaluate relationships between time toxicity and clinical outcomes.

Results: Among 408 EP-CT participants (mean age, 60.5 years [standard deviation, SD, 12.6]; 56.5% female; 88.2% White; 96.0% non-Hispanic), patients had an average of 22.5% health care-associated days while on trial (SD, 13.8%). Those with GI (B = 0.07; P = .002), head/neck (B = 0.09; P = .004), and breast (B = 0.06; P = .015) cancers and those with worse performance status (B = 0.04; P = .017) and those receiving targeted therapies (B = 0.04; P = .014) experienced higher time toxicity. High time toxicity was associated with decreased disease response rates (odds ratio, 0.07; P < .001), progression-free survival (hazard ratio [HR], 2.10; P < .001), and overall survival (HR, 2.16; P < .001).

Conclusion: In this cohort of EP-CT participants, patients spent more than one-fifth of days on trial with health care contact. We identified characteristics associated with higher time toxicity and found that high toxicity correlated with worse clinical outcomes. These data could help inform patient-clinician discussions about EP-CTs, guide future trial design, and identify at-risk patients.

目的:早期临床试验(EP-CT)旨在确定新型癌症治疗药物的最佳剂量、耐受性和初步活性。人们对患者在参与这些研究时与医疗系统的互动时间(如毒性时间)知之甚少:我们回顾性地查看了 2017 年至 2019 年连续入组 EP-CT 患者的电子健康记录,以获得基线特征和医疗相关天数(定义为试验期间的所有住院和门诊就诊)。我们使用单变量和多变量分析来确定时间毒性增加的预测因素,时间毒性被定义为医疗相关天数在试验总天数中所占的比例。为便于解释,我们创建了一个二分变量,将高时间毒性定义为试验期间与医疗相关的天数≥20%,并使用回归模型评估时间毒性与临床结果之间的关系:在 408 名 EP-CT 参与者(平均年龄 60.5 岁[标准差,SD,12.6];56.5% 为女性;88.2% 为白人;96.0% 为非西班牙裔)中,患者在试验期间的平均医疗相关天数为 22.5%(标准差,13.8%)。消化道癌(B = 0.07;P = .002)、头颈癌(B = 0.09;P = .004)和乳腺癌(B = 0.06;P = .015)患者以及表现状态较差(B = 0.04;P = .017)和接受靶向治疗(B = 0.04;P = .014)的患者的时间毒性较高。高时间毒性与疾病应答率下降(几率比,0.07;P < .001)、无进展生存期(危险比 [HR],2.10;P < .001)和总生存期(HR,2.16;P < .001)相关:在这组 EP-CT 参与者中,患者在试验期间与医护人员接触的天数超过五分之一。我们确定了与较高时间毒性相关的特征,并发现高毒性与较差的临床结果相关。这些数据有助于为患者与医生之间关于 EP-CT 的讨论提供信息,指导未来的试验设计,并识别高危患者。
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引用次数: 0
Implementing a Clinical Pathway for Needs Assessment and Supportive Care Interventions. 实施需求评估和支持性护理干预的临床路径。
IF 4.7 3区 医学 Q1 ONCOLOGY Pub Date : 2024-09-01 Epub Date: 2024-05-06 DOI: 10.1200/OP.23.00482
Nicole L Stout, Catherine M Alfano, Raymond Liu, Niharika Dixit, Michael Jefford

Despite advances in clinical cancer care, cancer survivors frequently report a range of persisting issues, unmet needs, and concerns that limit their ability to participate in life roles and reduce quality of life. Needs assessment is recognized as an important component of cancer care delivery, ideally beginning during active treatment to connect patients with supportive services that address these issues in a timely manner. Despite the recognized importance of this process, many health care systems have struggled to implement a feasible and sustainable needs assessment and management system. This article uses an implementation science framework to guide pragmatic implementation of a needs assessment clinical system in cancer care. According to this framework, successful implementation requires four steps including (1) choosing a needs assessment tool; (2) carefully considering the provider level, clinic level, and health care system-level strengths and barriers to implementation and creating a pilot system that addresses these factors; (3) making the assessment system actionable by matching needs with clinical workflow; and (4) demonstrating the value of the system to support sustainability.

尽管癌症临床治疗取得了进步,但癌症幸存者仍经常反映出一系列持续存在的问题、未满足的需求和担忧,这些问题和需求限制了他们参与生活的能力,降低了生活质量。需求评估被认为是癌症治疗的一个重要组成部分,理想的做法是在积极治疗期间就开始评估,以便将患者与支持性服务联系起来,及时解决这些问题。尽管这一过程的重要性已得到认可,但许多医疗保健系统仍在努力实施可行且可持续的需求评估和管理系统。本文采用实施科学框架来指导癌症治疗中需求评估临床系统的务实实施。根据该框架,成功实施需要四个步骤,包括:(1)选择需求评估工具;(2)仔细考虑提供者层面、诊所层面和医疗保健系统层面的优势和实施障碍,并针对这些因素创建一个试点系统;(3)通过将需求与临床工作流程相匹配,使评估系统具有可操作性;以及(4)展示该系统的价值,以支持其可持续发展。
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引用次数: 0
Impact of a Multidisciplinary Supportive Care Model Using Distress Screening at an Asian Ambulatory Cancer Center: A Cluster Randomized Controlled Trial. 亚裔门诊癌症中心使用压力筛查的多学科支持性护理模式的影响:集群随机对照试验。
IF 4.7 3区 医学 Q1 ONCOLOGY Pub Date : 2024-09-01 Epub Date: 2024-06-05 DOI: 10.1200/OP.23.00505
Yu Ke, Patricia Soek Hui Neo, Grace Meijuan Yang, Shirlyn Hui-Shan Neo, Yung Ying Tan, Yee Pin Tan, Mothi Babu Ramalingam, Kiley Wei-Jen Loh, Daniel Song Chiek Quah, Lita Chew, Phebe En Hui Si, Raymond Javan Chan, William Ying Khee Hwang, Alexandre Chan

Purpose: The Accessible Cancer Care to Enable Support for Cancer Survivors (ACCESS) program adopts a multidisciplinary supportive care model with routine distress screening to triage newly diagnosed cancer survivors for additional support on the basis of distress levels. This study aimed to evaluate the clinical impact of ACCESS over 1 year.

Methods: We performed cluster random assignment at the oncologist level in a 1:1 ratio to receive ACCESS or usual care. Participants 21 years and older, newly diagnosed with breast or gynecologic cancer, and receiving care at National Cancer Centre Singapore were included. Outcomes assessed every 3 months for 1 year included quality of life (QoL) (primary), functioning, physical and psychological symptom burden, and activity levels. Data were analyzed using mixed-effects models.

Results: Participants from 16 clusters (control = 90, intervention = 83) were analyzed. The ACCESS program did not significantly improve QoL (primary outcome). However, compared with usual care recipients, ACCESS recipients reported higher physical functioning (P = .017), role functioning (P = .001), and activity levels (P < .001) at 9 months and lower psychological distress (P = .025) at 12 months. ACCESS recipients screened with high distress had poorer QoL, lower role and social functioning, and higher physical symptom distress at 3 months but had comparable scores with ACCESS recipients without high distress after 12 months.

Conclusion: Compared with usual care, participation in the ACCESS program did not yield QoL improvement but showed earlier functioning recovery related to activities of daily living and reduced psychological distress. Routine distress screening is a promising mechanism to identify survivors with poorer health for more intensive supportive care.

目的:"为癌症幸存者提供支持的无障碍癌症护理(ACCESS)"项目采用了一种多学科支持性护理模式,通过常规痛苦筛查,根据痛苦程度对新诊断的癌症幸存者进行分流,为其提供额外支持。本研究旨在评估 ACCESS 一年来的临床效果:我们按 1:1 的比例在肿瘤学家层面进行了分组随机分配,让患者接受 ACCESS 或常规护理。参与者年龄在 21 岁及以上,新诊断出患有乳腺癌或妇科癌症,并在新加坡国立癌症中心接受治疗。在为期 1 年的时间里,每 3 个月进行一次结果评估,包括生活质量(QoL)(主要)、功能、身体和心理症状负担以及活动水平。数据采用混合效应模型进行分析:对来自 16 个群组(对照组 = 90 人,干预组 = 83 人)的参与者进行了分析。ACCESS 计划并未明显改善 QoL(主要结果)。不过,与常规护理受助者相比,ACCESS 受助者在 9 个月时的身体机能(P = .017)、角色机能(P = .001)和活动水平(P < .001)均有所提高,在 12 个月时的心理压力(P = .025)也有所降低。被筛查出有严重心理困扰的 ACCESS 受助者在 3 个月时的 QoL 较差,角色和社会功能较低,身体症状困扰较高,但在 12 个月后,其得分与没有严重心理困扰的 ACCESS 受助者相当:结论:与常规护理相比,参与 ACCESS 计划并不能改善 QoL,但却能更早地恢复与日常生活相关的功能,并减少心理困扰。常规的心理困扰筛查是一种很有前景的机制,可以识别出健康状况较差的幸存者,为其提供更深入的支持性护理。
{"title":"Impact of a Multidisciplinary Supportive Care Model Using Distress Screening at an Asian Ambulatory Cancer Center: A Cluster Randomized Controlled Trial.","authors":"Yu Ke, Patricia Soek Hui Neo, Grace Meijuan Yang, Shirlyn Hui-Shan Neo, Yung Ying Tan, Yee Pin Tan, Mothi Babu Ramalingam, Kiley Wei-Jen Loh, Daniel Song Chiek Quah, Lita Chew, Phebe En Hui Si, Raymond Javan Chan, William Ying Khee Hwang, Alexandre Chan","doi":"10.1200/OP.23.00505","DOIUrl":"10.1200/OP.23.00505","url":null,"abstract":"<p><strong>Purpose: </strong>The Accessible Cancer Care to Enable Support for Cancer Survivors (ACCESS) program adopts a multidisciplinary supportive care model with routine distress screening to triage newly diagnosed cancer survivors for additional support on the basis of distress levels. This study aimed to evaluate the clinical impact of ACCESS over 1 year.</p><p><strong>Methods: </strong>We performed cluster random assignment at the oncologist level in a 1:1 ratio to receive ACCESS or usual care. Participants 21 years and older, newly diagnosed with breast or gynecologic cancer, and receiving care at National Cancer Centre Singapore were included. Outcomes assessed every 3 months for 1 year included quality of life (QoL) (primary), functioning, physical and psychological symptom burden, and activity levels. Data were analyzed using mixed-effects models.</p><p><strong>Results: </strong>Participants from 16 clusters (control = 90, intervention = 83) were analyzed. The ACCESS program did not significantly improve QoL (primary outcome). However, compared with usual care recipients, ACCESS recipients reported higher physical functioning (<i>P</i> = .017), role functioning (<i>P</i> = .001), and activity levels (<i>P</i> < .001) at 9 months and lower psychological distress (<i>P</i> = .025) at 12 months. ACCESS recipients screened with high distress had poorer QoL, lower role and social functioning, and higher physical symptom distress at 3 months but had comparable scores with ACCESS recipients without high distress after 12 months.</p><p><strong>Conclusion: </strong>Compared with usual care, participation in the ACCESS program did not yield QoL improvement but showed earlier functioning recovery related to activities of daily living and reduced psychological distress. Routine distress screening is a promising mechanism to identify survivors with poorer health for more intensive supportive care.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"1207-1218"},"PeriodicalIF":4.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11398295/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141261939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Financial Toxicity and Willingness-to-Pay for Cancer Treatment Among People With Multiple Myeloma. 多发性骨髓瘤患者治疗癌症的经济毒性和支付意愿。
IF 4.7 3区 医学 Q1 ONCOLOGY Pub Date : 2024-09-01 Epub Date: 2024-06-17 DOI: 10.1200/OP.24.00016
Mark A Fiala

Purpose: This study used willingness-to-pay (WTP) exercises to explore the relationships between race, financial toxicity, and treatment decision making among people with cancer.

Methods: A convenience sample of people with multiple myeloma who attended an academic medical center in 2022 was surveyed. Financial toxicity was assessed by the Comprehensive Score for financial Toxicity, with scores <26 indicating financial toxicity. WTP was assessed with (1) a discrete choice experiment (DCE), (2) fixed-choice tasks, and (3) a bidding game.

Results: In total, 156 people were approached, and 130 completed the survey. The majority of the sample was White (n = 99), whereas 24% (n = 31) was African American or Black. Forty-six percent (n = 60) of the sample were experiencing financial toxicity. In the DCE, the relative importance of cost was twice as high for those with financial toxicity (30% compared with 14%; P < .001). In the fixed-choice tasks, they were twice as likely to accept a treatment with shorter progression-free survival but lower costs (adjusted odds ratio [aOR], 2.47; P = .049). In the bidding game, the median monthly WTP of those with financial toxicity was half that of those without ($100 in US dollars [USD] compared with $200 USD; P < .001). Only in the bidding game was race statistically associated with WTP; after controlling for financial toxicity, African American or Black participants were three times as likely (aOR, 3.06; P = .007) to report a lower WTP.

Conclusion: Across all three exercises, participants with financial toxicity reported lower WTP than those without. As financial toxicity disproportionally affects some segments of patients, it is possible that financial toxicity contributes to cancer disparities.

目的:本研究使用支付意愿(WTP)练习来探讨癌症患者的种族、经济毒性和治疗决策之间的关系:方法:我们对 2022 年在一家学术医疗中心就诊的多发性骨髓瘤患者进行了方便抽样调查。财务毒性通过财务毒性综合评分进行评估,评分结果:共接触了 156 人,其中 130 人完成了调查。大多数样本为白人(n = 99),24%(n = 31)为非裔美国人或黑人。样本中有 46% (n = 60)的人正在经历财务危机。在 DCE 中,财务毒性患者的成本相对重要性是其他患者的两倍(30% 比 14%;P < .001)。在固定选择任务中,他们接受无进展生存期较短但费用较低的治疗方法的可能性是其他患者的两倍(调整后的几率比 [aOR],2.47;P = .049)。在竞标游戏中,有经济毒性者的月WTP中位数是无经济毒性者的一半(100美元对200美元;P < .001)。只有在竞标游戏中,种族与 WTP 有统计学关联;在控制了财务毒性后,非裔美国人或黑人参与者报告 WTP 较低的可能性是其他参与者的三倍(aOR,3.06;P = .007):结论:在所有三种练习中,有财务毒性的参与者报告的 WTP 都低于没有财务毒性的参与者。由于财务毒性对部分患者的影响不成比例,因此财务毒性有可能导致癌症差异。
{"title":"Financial Toxicity and Willingness-to-Pay for Cancer Treatment Among People With Multiple Myeloma.","authors":"Mark A Fiala","doi":"10.1200/OP.24.00016","DOIUrl":"10.1200/OP.24.00016","url":null,"abstract":"<p><strong>Purpose: </strong>This study used willingness-to-pay (WTP) exercises to explore the relationships between race, financial toxicity, and treatment decision making among people with cancer.</p><p><strong>Methods: </strong>A convenience sample of people with multiple myeloma who attended an academic medical center in 2022 was surveyed. Financial toxicity was assessed by the Comprehensive Score for financial Toxicity, with scores <26 indicating financial toxicity. WTP was assessed with (1) a discrete choice experiment (DCE), (2) fixed-choice tasks, and (3) a bidding game.</p><p><strong>Results: </strong>In total, 156 people were approached, and 130 completed the survey. The majority of the sample was White (n = 99), whereas 24% (n = 31) was African American or Black. Forty-six percent (n = 60) of the sample were experiencing financial toxicity. In the DCE, the relative importance of cost was twice as high for those with financial toxicity (30% compared with 14%; <i>P</i> < .001). In the fixed-choice tasks, they were twice as likely to accept a treatment with shorter progression-free survival but lower costs (adjusted odds ratio [aOR], 2.47; <i>P</i> = .049). In the bidding game, the median monthly WTP of those with financial toxicity was half that of those without ($100 in US dollars [USD] compared with $200 USD; <i>P</i> < .001). Only in the bidding game was race statistically associated with WTP; after controlling for financial toxicity, African American or Black participants were three times as likely (aOR, 3.06; <i>P</i> = .007) to report a lower WTP.</p><p><strong>Conclusion: </strong>Across all three exercises, participants with financial toxicity reported lower WTP than those without. As financial toxicity disproportionally affects some segments of patients, it is possible that financial toxicity contributes to cancer disparities.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":" ","pages":"1263-1271"},"PeriodicalIF":4.7,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141419128","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}
引用次数: 0
Association of Community-Level Social Vulnerability With Clinical Trial Discussion and Participation Among Cancer Survivors. 社区层面的社会脆弱性与癌症幸存者讨论和参与临床试验的关系
IF 4.7 3区 医学 Q1 ONCOLOGY Pub Date : 2024-08-29 DOI: 10.1200/OP.24.00206
Rishi R Sekar, Avinash Maganty, Kristian D Stensland, Lindsey A Herrel

Purpose: Community factors and structural barriers may contribute to disparities and underrepresentation in cancer clinical trials. We evaluate the influence of community-level social determinants of health, as measured by the Centers for Disease Control and Prevention Social Vulnerability Index (SVI), on disparities in cancer clinical trial discussion and participation.

Methods: We performed a cross-sectional analysis of the 2021 Health Information National Trends Survey-SEER, a representative survey of cancer survivors sampled from three SEER registries. The primary outcomes included patient-reported clinical trial discussion and participation. The primary exposure was county-level SVI, linked to each survey respondent by ZIP code of residence and categorized into quintiles. Survey-weighted bivariate comparisons and multivariable logistic regression were performed to evaluate the association between SVI and clinical trial discussion and participation, adjusting for age, sex, race and ethnicity, education, income, and cancer stage.

Results: We identified 1,220 respondents residing in 153 counties with a median SVI of 0.41 (IQR, 0.27-0.62), representing a population of over 400,000 cancer survivors on weighted analysis. Of the cohort, 15.1% reported clinical trial discussion and 7.7% reported clinical trial participation. Patients who are most socially vulnerable (fifth quintile of SVI) had significantly lower odds of clinical trial discussion (odds ratio [OR], 0.36 [95% CI, 0.15 to 0.87]; P = .02) and clinical trial participation (OR, 0.15 [95% CI, 0.03 to 0.75]; P = .02) compared with patients who are least socially vulnerable (first quintile of SVI).

Conclusion: These findings suggest interventions to identify socially vulnerable communities for expansion of clinical trial opportunities and infrastructure may be an impactful strategy toward improving diversity and representation in cancer clinical trials.

目的:社区因素和结构性障碍可能会导致癌症临床试验中的差异和代表性不足。我们评估了由美国疾病控制和预防中心社会脆弱性指数(SVI)衡量的社区层面的健康社会决定因素对癌症临床试验讨论和参与差异的影响:我们对 2021 年健康信息全国趋势调查--SEER 进行了横断面分析,这是一项从三个 SEER 登记处抽样调查癌症幸存者的代表性调查。主要结果包括患者报告的临床试验讨论和参与情况。主要暴露是县级 SVI,通过居住地的邮政编码与每位调查对象相关联,并分为五等分。在对年龄、性别、种族和民族、教育程度、收入和癌症分期进行调整后,进行了调查加权二元比较和多变量逻辑回归,以评估 SVI 与临床试验讨论和参与之间的关联:我们确定了居住在 153 个县的 1,220 名受访者,他们的 SVI 中位数为 0.41(IQR,0.27-0.62),根据加权分析,他们代表了超过 400,000 名癌症幸存者。在这些人群中,15.1% 的人报告了临床试验讨论情况,7.7% 的人报告了临床试验参与情况。与社会脆弱性最低的患者(SVI 的第五个五分位数)相比,社会脆弱性最高的患者(SVI 的第五个五分位数)进行临床试验讨论(几率比 [OR],0.36 [95% CI,0.15 至 0.87];P = .02)和参与临床试验(OR,0.15 [95% CI,0.03 至 0.75];P = .02)的几率明显较低:这些研究结果表明,为扩大临床试验机会和基础设施而对社会弱势群体进行识别的干预措施,可能是提高癌症临床试验多样性和代表性的有效策略。
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引用次数: 0
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