Adrienne G Waks, Emily L Chen, Noah Graham, Anna Mae Frey, Kenneth Almeida, Victoria Attaya, Cari Ryding, Ibrahim Abbass, Anita Fung, Jesse Sussell, Patricia Cortazar, Caroline Harvey, Denise Leth, Meredith Faggen, Natalie Sinclair, Jeanna Walsh, Nadine Tung, Sarah Sinclair, Steve Lo, Denise Yardley, Vicente Valero, Jane Meisel, Tarah J Ballinger, Sylvia Adams, Lisa A Carey, Julia K Rauch, Vandana G Abramson, Nicole O Williams, Wendy Y Chen, Jose P Leone, Susan T Schumer, Nabihah Tayob, Sara M Tolaney
Purpose: The time required for in-clinic drug administration can substantially affect breast cancer patients' quality of life. Subcutaneous (SC) drug administration, as opposed to intravenous (IV), may reduce this time commitment. This study sought to estimate the difference in time burden between IV and SC administration of trastuzumab and pertuzumab (HP).
Methods: We prospectively enrolled a subcohort of patients participating in the ADEPT trial (ClinicalTrials.gov identifier: NCT04569747, investigating adjuvant HP plus endocrine therapy for stage I human epidermal growth factor receptor 2-positive breast cancer) to this single-arm crossover time and motion substudy. Patients received two cycles of IV HP followed by two cycles of SC HP. During each cycle, time points in drug preparation and administration were captured. The primary end point was total patient time in the treatment chair. Additional end points included total patient treatment experience time and total pharmacy workflow time. A sample size of 22 patients was estimated to provide 90.7% power with two-sided alpha .05 to detect a difference of 70 minutes in the primary end point by treatment arm (IV v SC).
Results: Twenty-two patients were enrolled. The mean total patient time in the treatment chair was 61.8 minutes shorter with SC versus IV HP (22.5 v 84.3 minutes; P < .0001). The mean total patient treatment experience time (incorporating time spent waiting for treatment initiation and time spent in the treatment chair) was 81.8 minutes shorter for SC administration (96 v 177.8 minutes; P < .0001). The pharmacy workflow time was 78.2 minutes shorter for SC versus IV formulation (41 v 119.2 minutes; P < .0001).
Conclusion: SC administration of HP shortened patient time burden by approximately 1 hour. SC drug administration can facilitate faster workflows for health care professionals and improve patients' breast cancer treatment experience.
{"title":"Subcutaneous vs Intravenous Trastuzumab/Pertuzumab: A Time and Motion Substudy of a Phase II Trial of Adjuvant Trastuzumab/Pertuzumab for Stage I HER2+ Breast Cancer (ADEPT trial).","authors":"Adrienne G Waks, Emily L Chen, Noah Graham, Anna Mae Frey, Kenneth Almeida, Victoria Attaya, Cari Ryding, Ibrahim Abbass, Anita Fung, Jesse Sussell, Patricia Cortazar, Caroline Harvey, Denise Leth, Meredith Faggen, Natalie Sinclair, Jeanna Walsh, Nadine Tung, Sarah Sinclair, Steve Lo, Denise Yardley, Vicente Valero, Jane Meisel, Tarah J Ballinger, Sylvia Adams, Lisa A Carey, Julia K Rauch, Vandana G Abramson, Nicole O Williams, Wendy Y Chen, Jose P Leone, Susan T Schumer, Nabihah Tayob, Sara M Tolaney","doi":"10.1200/OP.24.00021","DOIUrl":"https://doi.org/10.1200/OP.24.00021","url":null,"abstract":"<p><strong>Purpose: </strong>The time required for in-clinic drug administration can substantially affect breast cancer patients' quality of life. Subcutaneous (SC) drug administration, as opposed to intravenous (IV), may reduce this time commitment. This study sought to estimate the difference in time burden between IV and SC administration of trastuzumab and pertuzumab (HP).</p><p><strong>Methods: </strong>We prospectively enrolled a subcohort of patients participating in the ADEPT trial (ClinicalTrials.gov identifier: NCT04569747, investigating adjuvant HP plus endocrine therapy for stage I human epidermal growth factor receptor 2-positive breast cancer) to this single-arm crossover time and motion substudy. Patients received two cycles of IV HP followed by two cycles of SC HP. During each cycle, time points in drug preparation and administration were captured. The primary end point was total patient time in the treatment chair. Additional end points included total patient treatment experience time and total pharmacy workflow time. A sample size of 22 patients was estimated to provide 90.7% power with two-sided alpha .05 to detect a difference of 70 minutes in the primary end point by treatment arm (IV <i>v</i> SC).</p><p><strong>Results: </strong>Twenty-two patients were enrolled. The mean total patient time in the treatment chair was 61.8 minutes shorter with SC versus IV HP (22.5 <i>v</i> 84.3 minutes; <i>P</i> < .0001). The mean total patient treatment experience time (incorporating time spent waiting for treatment initiation and time spent in the treatment chair) was 81.8 minutes shorter for SC administration (96 <i>v</i> 177.8 minutes; <i>P</i> < .0001). The pharmacy workflow time was 78.2 minutes shorter for SC versus IV formulation (41 <i>v</i> 119.2 minutes; <i>P</i> < .0001).</p><p><strong>Conclusion: </strong>SC administration of HP shortened patient time burden by approximately 1 hour. SC drug administration can facilitate faster workflows for health care professionals and improve patients' breast cancer treatment experience.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141727201","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}
Kelsey S Lau-Min, Heather Symecko, Kelsey Spielman, Derek Mann, Ryan Hood, Srishti Rathore, Catherine Wolfe, Peter E Gabriel, Katharine A Rendle, Katherine L Nathanson, Kim A Reiss, Susan M Domchek
Purpose: Germline genetic testing (GT) is recommended for all patients with pancreatic ductal adenocarcinoma (PDAC), but the traditional clinical genetics infrastructure is limited in addressing the unique needs of this population. We describe the integration of point of care (POC) GT into routine clinical practice for all patients with PDAC at an academic medical center.
Methods: We developed a clinical POC workflow that leverages electronic health record (EHR) tools and behavioral nudges to enhance the sustainability and scalability of our previously described research-based POC model. For each of the research and clinical POC cohorts, we calculated the percentage of eligible patients who underwent GT. We used Wilcoxon rank-sum and Pearson's chi-squared tests to compare patients who did and did not undergo GT. We conducted surveys among oncology clinicians to evaluate the acceptability, appropriateness, and feasibility of the clinical POC model.
Results: The research POC cohort included 905 patients, of whom 694 (76.7%) underwent GT. The clinical POC cohort included 148 patients, of whom 126 (85.1%) underwent GT. Patients who underwent GT in the research POC cohort were significantly younger (median age, 67.0 v 70.9 years; P = .031) and more likely to be White (82.1% v 68.7%; P < .001) and commercially insured (41.8% v 28.0%; P < .001) compared with those who did not; there were no significant differences between GT groups in the clinical POC cohort. Oncology clinicians found the clinical POC model to be acceptable (mean 4.4/5), appropriate (4.6/5), feasible (4.0/5), and have a positive impact on their patients (4.9/5).
Conclusion: A clinical POC model leveraging EHR tools and behavioral nudges is acceptable, appropriate, feasible, and associated with a >85% GT rate among patients with PDAC.
{"title":"Integration of Germline Genetic Testing Into Routine Clinical Practice for Patients With Pancreatic Adenocarcinoma.","authors":"Kelsey S Lau-Min, Heather Symecko, Kelsey Spielman, Derek Mann, Ryan Hood, Srishti Rathore, Catherine Wolfe, Peter E Gabriel, Katharine A Rendle, Katherine L Nathanson, Kim A Reiss, Susan M Domchek","doi":"10.1200/OP.24.00356","DOIUrl":"10.1200/OP.24.00356","url":null,"abstract":"<p><strong>Purpose: </strong>Germline genetic testing (GT) is recommended for all patients with pancreatic ductal adenocarcinoma (PDAC), but the traditional clinical genetics infrastructure is limited in addressing the unique needs of this population. We describe the integration of point of care (POC) GT into routine clinical practice for all patients with PDAC at an academic medical center.</p><p><strong>Methods: </strong>We developed a clinical POC workflow that leverages electronic health record (EHR) tools and behavioral nudges to enhance the sustainability and scalability of our previously described research-based POC model. For each of the research and clinical POC cohorts, we calculated the percentage of eligible patients who underwent GT. We used Wilcoxon rank-sum and Pearson's chi-squared tests to compare patients who did and did not undergo GT. We conducted surveys among oncology clinicians to evaluate the acceptability, appropriateness, and feasibility of the clinical POC model.</p><p><strong>Results: </strong>The research POC cohort included 905 patients, of whom 694 (76.7%) underwent GT. The clinical POC cohort included 148 patients, of whom 126 (85.1%) underwent GT. Patients who underwent GT in the research POC cohort were significantly younger (median age, 67.0 <i>v</i> 70.9 years; <i>P</i> = .031) and more likely to be White (82.1% <i>v</i> 68.7%; <i>P</i> < .001) and commercially insured (41.8% <i>v</i> 28.0%; <i>P</i> < .001) compared with those who did not; there were no significant differences between GT groups in the clinical POC cohort. Oncology clinicians found the clinical POC model to be acceptable (mean 4.4/5), appropriate (4.6/5), feasible (4.0/5), and have a positive impact on their patients (4.9/5).</p><p><strong>Conclusion: </strong>A clinical POC model leveraging EHR tools and behavioral nudges is acceptable, appropriate, feasible, and associated with a >85% GT rate among patients with PDAC.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141723653","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}
Fadi G Haddad, Koji Sasaki, Jayastu Senapati, Lianchun Xiao, Grace Park, Tareq Abuasab, Sangeetha Venugopal, Daniel Rivera, Alexandre Bazinet, Rodrick Babakhanlou, Kunhwa Kim, Faustine Ong, Sai Desikan, Naveen Pemmaraju, Sanam Loghavi, Gautam Borthakur, Courtney DiNardo, Hussein A Abbas, Nicholas J Short, Naval Daver, Elias Jabbour, Guillermo Garcia-Manero, Farhad Ravandi, Hagop Kantarjian, Tapan Kadia
Purpose: AML presenting with hyperleukocytosis is associated with poor outcomes. We aim to understand the factors associated with early mortality and overall survival (OS) to help guide management and improve early mortality.
Methods: We retrospectively reviewed data from 129 consecutive patients with newly diagnosed AML and a WBC count ≥100 × 109/L between January 2010 and April 2020. Logistic regression models estimated odds ratios for 4-week mortality. Cox proportional hazard models estimated hazard ratios for OS.
Results: The median age was 65 years (range, 23-86); the median WBC was 146 × 109/L (range, 100-687). Seventy-five (58%) patients had clinical leukostasis (CL). FLT3, NPM1, and RAS pathway mutations were detected in 63%, 45%, and 27% of patients, respectively. Cytoreduction consisted of hydroxyurea in 124 (96%) patients, cytarabine in 69 (54%), and leukapheresis in 31 (24%). The cumulative 4-week and 8-week mortality rates were 9% and 13%, respectively, all in patients age 65 years and older. By multivariate analysis, older age, CL, and thrombocytopenia <40 × 109/L were independently associated with a higher 4-week mortality rate. After a median follow-up of 49.4 months, the median OS was 14.3 months (95% CI, 7 to 21.6), with 4-year OS of 29%. Age 65 years and older, CL, tumor lysis syndrome, elevated LDH ≥2,000 U/L, elevated lactate ≥2.2 mmol/L, and poor-risk cytogenetics were independent factors associated with worse OS.
Conclusion: Hyperleukocytosis is a life-threatening hematologic emergency. Early recognition and intervention including cytoreduction, blood product support, antibiotics, and renal replacement therapy may help mitigate the risk of morbidity and early mortality.
{"title":"Outcomes of Patients With Newly Diagnosed AML and Hyperleukocytosis.","authors":"Fadi G Haddad, Koji Sasaki, Jayastu Senapati, Lianchun Xiao, Grace Park, Tareq Abuasab, Sangeetha Venugopal, Daniel Rivera, Alexandre Bazinet, Rodrick Babakhanlou, Kunhwa Kim, Faustine Ong, Sai Desikan, Naveen Pemmaraju, Sanam Loghavi, Gautam Borthakur, Courtney DiNardo, Hussein A Abbas, Nicholas J Short, Naval Daver, Elias Jabbour, Guillermo Garcia-Manero, Farhad Ravandi, Hagop Kantarjian, Tapan Kadia","doi":"10.1200/OP.24.00027","DOIUrl":"https://doi.org/10.1200/OP.24.00027","url":null,"abstract":"<p><strong>Purpose: </strong>AML presenting with hyperleukocytosis is associated with poor outcomes. We aim to understand the factors associated with early mortality and overall survival (OS) to help guide management and improve early mortality.</p><p><strong>Methods: </strong>We retrospectively reviewed data from 129 consecutive patients with newly diagnosed AML and a WBC count ≥100 × 10<sup>9</sup>/L between January 2010 and April 2020. Logistic regression models estimated odds ratios for 4-week mortality. Cox proportional hazard models estimated hazard ratios for OS.</p><p><strong>Results: </strong>The median age was 65 years (range, 23-86); the median WBC was 146 × 10<sup>9</sup>/L (range, 100-687). Seventy-five (58%) patients had clinical leukostasis (CL). <i>FLT3</i>, <i>NPM1</i>, and <i>RAS</i> pathway mutations were detected in 63%, 45%, and 27% of patients, respectively. Cytoreduction consisted of hydroxyurea in 124 (96%) patients, cytarabine in 69 (54%), and leukapheresis in 31 (24%). The cumulative 4-week and 8-week mortality rates were 9% and 13%, respectively, all in patients age 65 years and older. By multivariate analysis, older age, CL, and thrombocytopenia <40 × 10<sup>9</sup>/L were independently associated with a higher 4-week mortality rate. After a median follow-up of 49.4 months, the median OS was 14.3 months (95% CI, 7 to 21.6), with 4-year OS of 29%. Age 65 years and older, CL, tumor lysis syndrome, elevated LDH ≥2,000 U/L, elevated lactate ≥2.2 mmol/L, and poor-risk cytogenetics were independent factors associated with worse OS.</p><p><strong>Conclusion: </strong>Hyperleukocytosis is a life-threatening hematologic emergency. Early recognition and intervention including cytoreduction, blood product support, antibiotics, and renal replacement therapy may help mitigate the risk of morbidity and early mortality.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141626775","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}
Alexandre Chan, Ding Quan Ng, Daniela Arcos, Matthew Heshmatipour, Benjamin J Lee, Alison Chen, Lan Duong, Linda Van, Thomas Nguyen, Vuong Green, Daniel Hoang
Purpose: There is a lack of systematic solutions to manage supportive care issues in racial/ethnic minorities (REM) receiving treatment for cancer. We developed and implemented an electronic patient-reported outcome (ePRO)-driven symptom management tool led by oncology pharmacists in a majority-minority cancer center located in Southern California. This study was designed to evaluate the implementation outcomes of our multilevel intervention.
Methods: This was a prospective, pragmatic, implementation study conducted between July 2021 and June 2023. Newly diagnosed adult patients with cancer receiving intravenous anticancer therapies completed symptom screening using ePRO that consists of the Patient-Reported Outcomes Measurement Information System measures at each infusion visit during the study. ePRO results were presented to an oncologist pharmacist for personalized symptom management and treatment counseling. The RE-AIM framework was used to guide implementation outcomes. Differences in symptom trajectories and clinical outcomes between groups were tested using generalized estimating equations.
Results: We screened 388 patients of whom 250 were enrolled (acceptance rate: 64.4%), with 564 assessments being completed. The sample consisted of non-Hispanic White (NHW, 42.4%), Hispanic/Latinx (H/L, 30.8%), and non-Hispanic Asian (20.4%), with one (21.6%) of five participants preferring speaking Spanish. Compared with NHW, H/L participants had greater odds of reporting mild to severe pain interference (odds ratio [OR], 1.91 [95% CI, 1.18 to 3.08]; P = .008) and nausea and vomiting (OR, 2.08 [95% CI, 1.21 to 3.58]; P = .008), and higher rates of urgent care utilization (OR, 1.92 [95% CI, 1.04 to 3.61]; P = .04) within 30 days. Nausea and vomiting (n = 131, 23.2%), pain (n = 91, 16.1%), and fatigue (n = 72, 12.8%) were most likely to be intervened, with 90% of the participants expressing satisfaction across all visits.
Conclusion: Our multilevel ePRO-driven intervention led by oncology pharmacists helps facilitate symptom assessments and management and potentially reduce health disparities among REM.
{"title":"Electronic Patient-Reported Outcome-Driven Symptom Management by Oncology Pharmacists in a Majority-Minority Population: An Implementation Study.","authors":"Alexandre Chan, Ding Quan Ng, Daniela Arcos, Matthew Heshmatipour, Benjamin J Lee, Alison Chen, Lan Duong, Linda Van, Thomas Nguyen, Vuong Green, Daniel Hoang","doi":"10.1200/OP.24.00050","DOIUrl":"https://doi.org/10.1200/OP.24.00050","url":null,"abstract":"<p><strong>Purpose: </strong>There is a lack of systematic solutions to manage supportive care issues in racial/ethnic minorities (REM) receiving treatment for cancer. We developed and implemented an electronic patient-reported outcome (ePRO)-driven symptom management tool led by oncology pharmacists in a majority-minority cancer center located in Southern California. This study was designed to evaluate the implementation outcomes of our multilevel intervention.</p><p><strong>Methods: </strong>This was a prospective, pragmatic, implementation study conducted between July 2021 and June 2023. Newly diagnosed adult patients with cancer receiving intravenous anticancer therapies completed symptom screening using ePRO that consists of the Patient-Reported Outcomes Measurement Information System measures at each infusion visit during the study. ePRO results were presented to an oncologist pharmacist for personalized symptom management and treatment counseling. The RE-AIM framework was used to guide implementation outcomes. Differences in symptom trajectories and clinical outcomes between groups were tested using generalized estimating equations.</p><p><strong>Results: </strong>We screened 388 patients of whom 250 were enrolled (acceptance rate: 64.4%), with 564 assessments being completed. The sample consisted of non-Hispanic White (NHW, 42.4%), Hispanic/Latinx (H/L, 30.8%), and non-Hispanic Asian (20.4%), with one (21.6%) of five participants preferring speaking Spanish. Compared with NHW, H/L participants had greater odds of reporting mild to severe pain interference (odds ratio [OR], 1.91 [95% CI, 1.18 to 3.08]; <i>P</i> = .008) and nausea and vomiting (OR, 2.08 [95% CI, 1.21 to 3.58]; <i>P</i> = .008), and higher rates of urgent care utilization (OR, 1.92 [95% CI, 1.04 to 3.61]; <i>P</i> = .04) within 30 days. Nausea and vomiting (n = 131, 23.2%), pain (n = 91, 16.1%), and fatigue (n = 72, 12.8%) were most likely to be intervened, with 90% of the participants expressing satisfaction across all visits.</p><p><strong>Conclusion: </strong>Our multilevel ePRO-driven intervention led by oncology pharmacists helps facilitate symptom assessments and management and potentially reduce health disparities among REM.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141619983","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}
Steven Leonard, Emma Helstrom, Andres Correa, Mohit Sindhani, Nicole Uzzo, Angela Y Jia, Alexander Kutikov, Robert Uzzo, Sarah P Psutka, Adam Calaway, Zachary Klaassen, Michael Staehler, Marc Smaldone, Christopher J D Wallis, Laura Bukavina
Purpose: This study leverages CDC National Health Interview Survey data to examine Financial Distress (FD) among genitourinary (GU) cancer survivors, specifically prostate cancer (PC), kidney cancer (KC), and bladder cancer (BC). It investigates the economic impacts faced by these patients, especially in relation to disparities in insurance coverage and its effects on material, psychological, and behavioral aspects of FD.
Methods: We retrospectively analyzed responses from GU cancer survivors, stratifying by cancer status and age (18-64 years, ≥65 years). Medical financial hardship was divided into three domains: material, psychological, and behavioral. Associations between cancer history, hardship, and clinical factors were assessed using generalized ordinal logistic regressions.
Results: Significant health care access disparities were found, particularly for mental health services, with 25% of younger BC survivors and 4.7% of younger KC survivors reporting affordability issues, in contrast to 2.7% of noncancer individuals. Dental care was also problematic, with higher avoidance rates among younger BC (27%) and KC (15%) survivors compared with the general population. Surprisingly, noncancer individuals reported more difficulty in affording prescriptions than BC survivors across both age groups. PC survivors, however, showed lower FD across all domains versus noncancer controls, indicating fewer concerns about medical bills and a lesser tendency to forgo care.
Conclusion: The study underscores significant gaps in the financial support system for GU cancer survivors, with urgent needs in mental and dental health care access. Policy interventions, including comprehensive insurance reforms, are imperative to alleviate the financial burdens on these individuals.
目的:本研究利用疾病预防控制中心全国健康访谈调查的数据,研究泌尿生殖系统癌症(GU)幸存者的财务困境(FD),特别是前列腺癌(PC)、肾癌(KC)和膀胱癌(BC)。本研究调查了这些患者所面临的经济影响,尤其是与保险覆盖面的差异及其对 FD 的物质、心理和行为方面的影响有关的影响:我们回顾性分析了泌尿系统癌症幸存者的回复,并按癌症状况和年龄(18-64 岁,≥65 岁)进行了分层。医疗经济困难分为三个方面:物质、心理和行为。使用广义序数逻辑回归评估了癌症病史、困难和临床因素之间的关联:结果发现,在获得医疗保健服务方面存在显著差异,尤其是在心理健康服务方面,25%的年轻 BC 癌症幸存者和 4.7% 的年轻 KC 癌症幸存者表示在负担能力方面存在问题,而非癌症患者中只有 2.7%的人表示在负担能力方面存在问题。牙科护理也存在问题,与普通人群相比,年轻的 BC 癌症幸存者(27%)和 KC 癌症幸存者(15%)有更高的回避率。令人惊讶的是,在两个年龄组中,非癌症患者都比 BC 幸存者更难负担处方药费用。然而,与非癌症对照组相比,PC 幸存者在所有领域的 FD 都较低,这表明他们对医疗费用的担忧较少,放弃治疗的倾向也较小:本研究强调了 GU 癌症幸存者经济支持系统中存在的巨大差距,以及在精神和牙科保健方面的迫切需求。要减轻这些人的经济负担,政策干预(包括全面的保险改革)势在必行。
{"title":"Financial Distress in Genitourinary Cancer: Insights From CDC National Health Interview Survey.","authors":"Steven Leonard, Emma Helstrom, Andres Correa, Mohit Sindhani, Nicole Uzzo, Angela Y Jia, Alexander Kutikov, Robert Uzzo, Sarah P Psutka, Adam Calaway, Zachary Klaassen, Michael Staehler, Marc Smaldone, Christopher J D Wallis, Laura Bukavina","doi":"10.1200/OP.23.00733","DOIUrl":"10.1200/OP.23.00733","url":null,"abstract":"<p><strong>Purpose: </strong>This study leverages CDC National Health Interview Survey data to examine Financial Distress (FD) among genitourinary (GU) cancer survivors, specifically prostate cancer (PC), kidney cancer (KC), and bladder cancer (BC). It investigates the economic impacts faced by these patients, especially in relation to disparities in insurance coverage and its effects on material, psychological, and behavioral aspects of FD.</p><p><strong>Methods: </strong>We retrospectively analyzed responses from GU cancer survivors, stratifying by cancer status and age (18-64 years, ≥65 years). Medical financial hardship was divided into three domains: material, psychological, and behavioral. Associations between cancer history, hardship, and clinical factors were assessed using generalized ordinal logistic regressions.</p><p><strong>Results: </strong>Significant health care access disparities were found, particularly for mental health services, with 25% of younger BC survivors and 4.7% of younger KC survivors reporting affordability issues, in contrast to 2.7% of noncancer individuals. Dental care was also problematic, with higher avoidance rates among younger BC (27%) and KC (15%) survivors compared with the general population. Surprisingly, noncancer individuals reported more difficulty in affording prescriptions than BC survivors across both age groups. PC survivors, however, showed lower FD across all domains versus noncancer controls, indicating fewer concerns about medical bills and a lesser tendency to forgo care.</p><p><strong>Conclusion: </strong>The study underscores significant gaps in the financial support system for GU cancer survivors, with urgent needs in mental and dental health care access. Policy interventions, including comprehensive insurance reforms, are imperative to alleviate the financial burdens on these individuals.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141619984","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}
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。
{"title":"Two Centuries Have Shown That Voltaire May No Longer Be Correct About Doctors …At Least Those Treating Advanced Prostate Cancer.","authors":"Donald Skip Trump, Derek Raghavan","doi":"10.1200/OP.24.00366","DOIUrl":"https://doi.org/10.1200/OP.24.00366","url":null,"abstract":"<p><p>Oncologists use molecular prediction/pharmacogenomics to improve Rx of cancer. Voltaire now wrong.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141619986","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}
Discussing the less recognized financial toxicities of cancer care, including mental health and dental care.
讨论癌症护理中不为人知的经济毒性,包括心理健康和牙科护理。
{"title":"Mental Health Matters: Bringing Awareness to the Less Recognized Financial Toxicities of Cancer Care.","authors":"Megan Sears-Smith, Thomas G Knight","doi":"10.1200/OP.24.00425","DOIUrl":"https://doi.org/10.1200/OP.24.00425","url":null,"abstract":"<p><p>Discussing the less recognized financial toxicities of cancer care, including mental health and dental care.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141619985","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}
Addressing ageism in clinical practice & research: #awareness #education #language and #geriassessment.
解决临床实践和研究中的年龄歧视问题:#意识、教育、语言和老年评估。
{"title":"Addressing Ageism With Geriatric Assessment in Clinical Practice and Research.","authors":"Kah Poh Loh, Enrique Soto-Perez-de-Celis","doi":"10.1200/OP.24.00324","DOIUrl":"https://doi.org/10.1200/OP.24.00324","url":null,"abstract":"<p><p>Addressing ageism in clinical practice & research: #awareness #education #language and #geriassessment.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141619982","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}
Austin R Waters, Stephanie B Wheeler, Kelly R Tan, Donald L Rosenstein, Mya L Roberson, Anne C Kirchhoff, Erin E Kent
Purpose: Driven by anti-LGBTQ+ stigma, emerging literature suggests that lesbian, gay, and bisexual (LGB) cancer survivors experience financial hardship (FH) more frequently than heterosexual survivors. However, few studies have used nationally representative samples to estimate this inequity.
Methods: National Health Interview Survey data from 2019 to 2022 were pooled and weighted. Outcomes included material, psychological, and behavioral FH. The behavioral domain was further broken down into subdomains including medical care, prescription medications, and mental health care. Multivariable logit models controlling for a variety of factors were used to generate LGB and heterosexual predicted probabilities and differential effects for each FH outcome. Stratified estimates were generated by sex and age groups.
Results: A total of N = 374 LGB and N = 12,757 heterosexual cancer survivors were included in this analysis. In adjusted analyses, LGB cancer survivors had significantly higher material (19%, 95% CI, 15 to 24 v 12%, 95% CI, 11 to 13; P = .004), psychological (44%, 95% CI, 38 to 51 v 37%, 95% CI, 36 to 38; P = .035), and behavioral (23%, 95% CI, 18 to 28 v 13%, 95% CI, 13 to 14; P < .0001) FH than heterosexual survivors. LGB cancer survivors also had higher medical behavioral (11%, 95% CI, 7 to 15 v 7%, 95% CI, 6 to 7; P = .030), prescription medication behavioral (14%, 95% CI, 10 to 19 v 10%, 95% CI, 9 to 10; P = .032), and mental health behavioral (9%, 95% CI, 6 to 13 v 3%, 95% CI, 3 to 4; P < .0001) FH than heterosexual survivors. Stratified estimates revealed young LGB cancer survivors had the highest probability of each outcome (material: 31%, 95% CI, 23 to 40; psychological: 58%, 95% CI, 50 to 66; behavioral: 45%, 95% CI, 36 to 53).
Conclusion: In this nationally representative analysis, LGB cancer survivors experience substantial inequities in all FH outcomes. It is crucial that future FH interventional work should prioritize populations at the highest risk of FH, such as LGB cancer survivors.
{"title":"Material, Psychological, and Behavioral Financial Hardship Among Lesbian, Gay, and Bisexual Cancer Survivors in the United States.","authors":"Austin R Waters, Stephanie B Wheeler, Kelly R Tan, Donald L Rosenstein, Mya L Roberson, Anne C Kirchhoff, Erin E Kent","doi":"10.1200/OP.24.00114","DOIUrl":"https://doi.org/10.1200/OP.24.00114","url":null,"abstract":"<p><strong>Purpose: </strong>Driven by anti-LGBTQ+ stigma, emerging literature suggests that lesbian, gay, and bisexual (LGB) cancer survivors experience financial hardship (FH) more frequently than heterosexual survivors. However, few studies have used nationally representative samples to estimate this inequity.</p><p><strong>Methods: </strong>National Health Interview Survey data from 2019 to 2022 were pooled and weighted. Outcomes included material, psychological, and behavioral FH. The behavioral domain was further broken down into subdomains including medical care, prescription medications, and mental health care. Multivariable logit models controlling for a variety of factors were used to generate LGB and heterosexual predicted probabilities and differential effects for each FH outcome. Stratified estimates were generated by sex and age groups.</p><p><strong>Results: </strong>A total of N = 374 LGB and N = 12,757 heterosexual cancer survivors were included in this analysis. In adjusted analyses, LGB cancer survivors had significantly higher material (19%, 95% CI, 15 to 24 <i>v</i> 12%, 95% CI, 11 to 13; <i>P</i> = .004), psychological (44%, 95% CI, 38 to 51 <i>v</i> 37%, 95% CI, 36 to 38; <i>P</i> = .035), and behavioral (23%, 95% CI, 18 to 28 <i>v</i> 13%, 95% CI, 13 to 14; <i>P</i> < .0001) FH than heterosexual survivors. LGB cancer survivors also had higher medical behavioral (11%, 95% CI, 7 to 15 <i>v</i> 7%, 95% CI, 6 to 7; <i>P</i> = .030), prescription medication behavioral (14%, 95% CI, 10 to 19 <i>v</i> 10%, 95% CI, 9 to 10; <i>P</i> = .032), and mental health behavioral (9%, 95% CI, 6 to 13 <i>v</i> 3%, 95% CI, 3 to 4; <i>P</i> < .0001) FH than heterosexual survivors. Stratified estimates revealed young LGB cancer survivors had the highest probability of each outcome (material: 31%, 95% CI, 23 to 40; psychological: 58%, 95% CI, 50 to 66; behavioral: 45%, 95% CI, 36 to 53).</p><p><strong>Conclusion: </strong>In this nationally representative analysis, LGB cancer survivors experience substantial inequities in all FH outcomes. It is crucial that future FH interventional work should prioritize populations at the highest risk of FH, such as LGB cancer survivors.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141590248","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}
In a randomized clinical trial, instead of allocating patients equally between the treatment arms, some trials in oncology assign a higher proportion of patients to receive the experimental treatment arm (eg, a two-to-one randomization). In this commentary, we first briefly review the common reasons given for the use of a two-to-one randomization and provide some examples of trials using these designs. We then explain why the risk-benefit ratio of this approach may not be favorable as is commonly assumed.
{"title":"Two-to-One Randomization: Rarely Advisable.","authors":"Boris Freidlin, Edward L Korn","doi":"10.1200/OP.24.00217","DOIUrl":"https://doi.org/10.1200/OP.24.00217","url":null,"abstract":"<p><p>In a randomized clinical trial, instead of allocating patients equally between the treatment arms, some trials in oncology assign a higher proportion of patients to receive the experimental treatment arm (eg, a two-to-one randomization). In this commentary, we first briefly review the common reasons given for the use of a two-to-one randomization and provide some examples of trials using these designs. We then explain why the risk-benefit ratio of this approach may not be favorable as is commonly assumed.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141579659","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}