Purpose: Persons experiencing homelessness (PEHs) represent a medically underserved population with a disproportionately high rate of late-stage cancer diagnoses and cancer mortality. During mobile onsite mammography and breast health education events, we studied PEH's barriers to and uptake of cancer screenings.
Methods: This study used patient surveys and review of the electronic health record. The main outcome measures included mammogram and diagnostic imaging (as needed) results. A questionnaire assessed patient's views and barriers related to social determinants of health. The study included women accessing community organization resources who were 40 years or older or who met criteria for screening mammography.
Results: Forty-six individuals completed mammograms and 41 individuals participated in the survey, for a response rate of 89%. Thirty-five participants (85%) held health insurance provided by a Medicaid managed plan. Thirty-six participants (87%) received a negative mammogram result, and five participants (12%) required follow-up for abnormal results. Of these five, two participants completed diagnostic follow-up with negative results, and three did not complete diagnostic follow-up. In addition to barriers related to housing insecurity, five patients (12%) reported transportation barriers. A majority (n = 28, 68%) disagreed or strongly disagreed with the statement, "I'm afraid the mammogram will be painful." A majority (n = 31, 76%) disagreed or strongly disagreed with the statement, "I'm busy and do not have time." Nearly all participants (n = 37, 90%) responded yes to the statement, "I believe in preventative care screenings." Eight participants (20%) completed at least one additional cancer screening.
Conclusion: By creating enduring programs offering screening, navigation, and education, academic-community partnerships may begin to address the increased cancer mortality among PEHs by improving screening adherence.
目的:无家可归者(PEHs)是医疗服务不足的人群,其晚期癌症诊断率和癌症死亡率都非常高。在流动现场乳房 X 光检查和乳房健康教育活动中,我们研究了无家可归者接受癌症筛查的障碍和接受癌症筛查的情况:本研究采用了患者调查和查阅电子健康记录的方法。主要结果指标包括乳房 X 光检查和诊断成像(根据需要)结果。问卷调查评估了患者对健康社会决定因素的看法和障碍。研究对象包括利用社区组织资源的 40 岁及以上或符合乳房 X 光筛查标准的妇女:46人完成了乳房X光检查,41人参与了调查,回复率为89%。35 名参与者(85%)拥有医疗补助管理计划提供的医疗保险。36 名参与者(87%)的乳房 X 光检查结果为阴性,5 名参与者(12%)需要对异常结果进行复查。在这五名参与者中,两名完成了诊断性随访,结果为阴性,三名没有完成诊断性随访。除了与住房不安全有关的障碍外,还有五名患者(12%)报告了交通方面的障碍。大多数人(28 人,68%)不同意或非常不同意 "我害怕乳房 X 光检查会很痛苦 "这一说法。大多数人(31 人,76%)不同意或非常不同意 "我很忙,没有时间 "这一说法。几乎所有参与者(n = 37,90%)都对 "我相信预防性保健筛查 "做出了 "是 "的回答。八名参与者(20%)至少完成了一次额外的癌症筛查:通过创建提供筛查、指导和教育的持久性计划,学术界与社区的合作可以开始通过提高筛查的依从性来解决 PEHs 癌症死亡率上升的问题。
{"title":"Cancer Prevention for Women Experiencing Homelessness: Onsite Mammography, Navigation, and Education.","authors":"Heather McKee Hurwitz, Chirag Shah","doi":"10.1200/OP.24.00188","DOIUrl":"https://doi.org/10.1200/OP.24.00188","url":null,"abstract":"<p><strong>Purpose: </strong>Persons experiencing homelessness (PEHs) represent a medically underserved population with a disproportionately high rate of late-stage cancer diagnoses and cancer mortality. During mobile onsite mammography and breast health education events, we studied PEH's barriers to and uptake of cancer screenings.</p><p><strong>Methods: </strong>This study used patient surveys and review of the electronic health record. The main outcome measures included mammogram and diagnostic imaging (as needed) results. A questionnaire assessed patient's views and barriers related to social determinants of health. The study included women accessing community organization resources who were 40 years or older or who met criteria for screening mammography.</p><p><strong>Results: </strong>Forty-six individuals completed mammograms and 41 individuals participated in the survey, for a response rate of 89%. Thirty-five participants (85%) held health insurance provided by a Medicaid managed plan. Thirty-six participants (87%) received a negative mammogram result, and five participants (12%) required follow-up for abnormal results. Of these five, two participants completed diagnostic follow-up with negative results, and three did not complete diagnostic follow-up. In addition to barriers related to housing insecurity, five patients (12%) reported transportation barriers. A majority (n = 28, 68%) disagreed or strongly disagreed with the statement, \"I'm afraid the mammogram will be painful.\" A majority (n = 31, 76%) disagreed or strongly disagreed with the statement, \"I'm busy and do not have time.\" Nearly all participants (n = 37, 90%) responded yes to the statement, \"I believe in preventative care screenings.\" Eight participants (20%) completed at least one additional cancer screening.</p><p><strong>Conclusion: </strong>By creating enduring programs offering screening, navigation, and education, academic-community partnerships may begin to address the increased cancer mortality among PEHs by improving screening adherence.</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":"141579658","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}
Faye G Zhang, Risha Sheni, Chenxin Zhang, Shankar Viswanathan, Kevin Fiori, Vikas Mehta
Purpose: Delays in oncologic time to treatment initiation (TTI) independently and adversely affect disease-specific mortality. Social Determinants of Health (SDoH) are increasingly recognized as significant contributors to patients' disease management and health outcomes. Our academic center has validated a 10-item SDoH screener, and we elucidated which specific needs may be predictive of delayed TTI.
Methods: This is a retrospective cohort study at an urban academic center of patients with a SDoH screening and diagnosis of breast, colorectal, endocrine/neuroendocrine, GI, genitourinary, gynecologic, head and neck, hematologic, hepatobiliary, lung, or pancreatic cancer from 2018 to 2022. Variables of interest included household income, tumor stage, and emergency department (ED) or inpatient admission 30 days before diagnosis. Factors associated with delayed TTI ≥45 days were assessed using multivariable logistic regression.
Results: Among 2,328 patients (mean [standard deviation] age, 64.0 (12.8) years; 66.6% female), having >1 unmet social need was associated with delayed TTI (odds ratio [OR], 1.68; 95% CI, 1.54 to 1.82). The disparities most associated with delay were legal help, transportation, housing stability, and needing to provide care for others. Those with ED (OR, 0.49; 95% CI, 0.44 to 0.54) or inpatient (OR, 0.54; 95% CI, 0.50 to 0.58) admission 30 days before diagnosis were less likely to experience delay.
Conclusion: Delays in oncologic TTI ≥45 days are independently associated with unmet social needs. ED or inpatient admissions before diagnosis increase care coordination, leading to improved TTI. Although limitations included the retrospective nature of the study and self-reporting bias, these findings more precisely identify targets for intervention that may more effectively decrease delay. Patients with SDoH barriers are at higher risk of treatment delay and could especially benefit from legal, transportation, caregiver, and housing assistance.
{"title":"Association Between Social Determinants of Health and Cancer Treatment Delay in an Urban Population.","authors":"Faye G Zhang, Risha Sheni, Chenxin Zhang, Shankar Viswanathan, Kevin Fiori, Vikas Mehta","doi":"10.1200/OP.24.00118","DOIUrl":"https://doi.org/10.1200/OP.24.00118","url":null,"abstract":"<p><strong>Purpose: </strong>Delays in oncologic time to treatment initiation (TTI) independently and adversely affect disease-specific mortality. Social Determinants of Health (SDoH) are increasingly recognized as significant contributors to patients' disease management and health outcomes. Our academic center has validated a 10-item SDoH screener, and we elucidated which specific needs may be predictive of delayed TTI.</p><p><strong>Methods: </strong>This is a retrospective cohort study at an urban academic center of patients with a SDoH screening and diagnosis of breast, colorectal, endocrine/neuroendocrine, GI, genitourinary, gynecologic, head and neck, hematologic, hepatobiliary, lung, or pancreatic cancer from 2018 to 2022. Variables of interest included household income, tumor stage, and emergency department (ED) or inpatient admission 30 days before diagnosis. Factors associated with delayed TTI ≥45 days were assessed using multivariable logistic regression.</p><p><strong>Results: </strong>Among 2,328 patients (mean [standard deviation] age, 64.0 (12.8) years; 66.6% female), having >1 unmet social need was associated with delayed TTI (odds ratio [OR], 1.68; 95% CI, 1.54 to 1.82). The disparities most associated with delay were legal help, transportation, housing stability, and needing to provide care for others. Those with ED (OR, 0.49; 95% CI, 0.44 to 0.54) or inpatient (OR, 0.54; 95% CI, 0.50 to 0.58) admission 30 days before diagnosis were less likely to experience delay.</p><p><strong>Conclusion: </strong>Delays in oncologic TTI ≥45 days are independently associated with unmet social needs. ED or inpatient admissions before diagnosis increase care coordination, leading to improved TTI. Although limitations included the retrospective nature of the study and self-reporting bias, these findings more precisely identify targets for intervention that may more effectively decrease delay. Patients with SDoH barriers are at higher risk of treatment delay and could especially benefit from legal, transportation, caregiver, and housing assistance.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141498078","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}
Melina E Marmarelis, Dylan G Scholes, Tara L McWilliams, Wei-Ting Hwang, John Kosteva, Michael R Costello, Lova Sun, Aditi P Singh, Kelsey S Lau-Min, Abigail Doucette, Peter E Gabriel, Anthony O Martella, Megan A Roy, Jeffrey C Thompson, Roger B Cohen, David W Dougherty, Lawrence N Shulman, Corey J Langer, Justin E Bekelman, Erica L Carpenter, Charu Aggarwal
Purpose: Less than half of the patients with newly diagnosed metastatic non-small cell lung cancer (NSCLC) undergo comprehensive molecular testing. We designed an electronic medical record (EMR)-based "nudge intervention" to prompt plasma-based molecular testing at the time of initial medical oncology consultation.
Methods: A nonrandomized prospective trial was conducted at the University of Pennsylvania's academic practice and two affiliated community practices. Molecular genotyping was performed by tissue- and/or plasma-based next generation sequencing methods. Comprehensive testing was defined as testing for EGFR, ALK, BRAF, ROS1, MET, RET, KRAS, and NTRK. Guideline-concordant treatment was defined as the use of the appropriate first-line (1L) therapy as per the National Comprehensive Cancer Network (NCCN) guidelines. Proportion of patients with comprehensive molecular genotyping results available at any time, molecular results available before 1L therapy, and guideline-concordant 1L treatment were compared between the preintervention and postintervention cohorts using Fisher's exact test or Pearson's chi-squared test.
Results: Five hundred and thirty-three patients were included, 376 in the preintervention cohort and 157 in the postintervention cohort. After implementation of the EMR-based nudge, a higher proportion of patients underwent comprehensive molecular testing in the postintervention versus the preintervention cohort (100% v 88%, P = <.001), had results of comprehensive molecular testing available before initiating 1L treatment (97.3% v 91.6%, P = .026), and received NCCN guideline-concordant care (89.8% v 78.2%, P = .035).
Conclusion: Across three practice sites in a large health system, implementation of a provider team-focused EMR-based nudge intervention was feasible, and led to a higher number of patients with NSCLC undergoing comprehensive molecular genotyping. These findings demonstrate that behavioral nudges can promote molecular testing and should be studied further as a tool to improve guideline-concordant care in both community and academic sites.
{"title":"Electronic Medical Record-Based Nudge Intervention to Increase Comprehensive Molecular Genotyping in Patients With Metastatic Non-Small Cell Lung Cancer: Results From a Prospective Clinical Trial.","authors":"Melina E Marmarelis, Dylan G Scholes, Tara L McWilliams, Wei-Ting Hwang, John Kosteva, Michael R Costello, Lova Sun, Aditi P Singh, Kelsey S Lau-Min, Abigail Doucette, Peter E Gabriel, Anthony O Martella, Megan A Roy, Jeffrey C Thompson, Roger B Cohen, David W Dougherty, Lawrence N Shulman, Corey J Langer, Justin E Bekelman, Erica L Carpenter, Charu Aggarwal","doi":"10.1200/OP.24.00070","DOIUrl":"https://doi.org/10.1200/OP.24.00070","url":null,"abstract":"<p><strong>Purpose: </strong>Less than half of the patients with newly diagnosed metastatic non-small cell lung cancer (NSCLC) undergo comprehensive molecular testing. We designed an electronic medical record (EMR)-based \"nudge intervention\" to prompt plasma-based molecular testing at the time of initial medical oncology consultation.</p><p><strong>Methods: </strong>A nonrandomized prospective trial was conducted at the University of Pennsylvania's academic practice and two affiliated community practices. Molecular genotyping was performed by tissue- and/or plasma-based next generation sequencing methods. Comprehensive testing was defined as testing for <i>EGFR</i>, <i>ALK</i>, <i>BRAF</i>, <i>ROS1</i>, <i>MET</i>, <i>RET</i>, <i>KRAS</i>, and <i>NTRK</i>. Guideline-concordant treatment was defined as the use of the appropriate first-line (1L) therapy as per the National Comprehensive Cancer Network (NCCN) guidelines. Proportion of patients with comprehensive molecular genotyping results available at any time, molecular results available before 1L therapy, and guideline-concordant 1L treatment were compared between the preintervention and postintervention cohorts using Fisher's exact test or Pearson's chi-squared test.</p><p><strong>Results: </strong>Five hundred and thirty-three patients were included, 376 in the preintervention cohort and 157 in the postintervention cohort. After implementation of the EMR-based nudge, a higher proportion of patients underwent comprehensive molecular testing in the postintervention versus the preintervention cohort (100% <i>v</i> 88%, <i>P</i> = <.001), had results of comprehensive molecular testing available before initiating 1L treatment (97.3% <i>v</i> 91.6%, <i>P</i> = .026), and received NCCN guideline-concordant care (89.8% <i>v</i> 78.2%, <i>P</i> = .035).</p><p><strong>Conclusion: </strong>Across three practice sites in a large health system, implementation of a provider team-focused EMR-based nudge intervention was feasible, and led to a higher number of patients with NSCLC undergoing comprehensive molecular genotyping. These findings demonstrate that behavioral nudges can promote molecular testing and should be studied further as a tool to improve guideline-concordant care in both community and academic sites.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141498079","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}
Inspired by Simone's maxims, a physician shares their search for restoring joy and meaning in modern medicine.
在西蒙娜格言的启发下,一位医生分享了他们在现代医学中寻找快乐和意义的过程。
{"title":"In Search of Joy and Meaning in Modern Medicine.","authors":"Rahul D Tendulkar","doi":"10.1200/OP.24.00152","DOIUrl":"https://doi.org/10.1200/OP.24.00152","url":null,"abstract":"<p><p>Inspired by Simone's maxims, a physician shares their search for restoring joy and meaning in modern medicine.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141498080","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}
Xin Hu, Ian McCarthy, K Robin Yabroff, Wen You, Joseph Lipscomb, Ilana Graetz
Purpose: Medicare's differential payments for services delivered in physician offices versus hospital outpatient settings incentivize hospital-physician integration (ie, vertical integration) across many specialties, but evidence for oncologists is mixed. We examined the association of Medicare site-based payment policy and physician practice characteristics, including service volume and diversity, with vertical integration among oncologists in 2013-2019.
Methods: Using the Medicare Provider Utilization and Payment Data and Medicare Data on Provider Practice and Specialty in 2013-2019, we extracted nonintegrated medical/hematologic oncologists (hereafter oncologists) in 2013 and followed them through 2019. We quantified the incentives from Medicare site-based payment policy using the hospital-office ratio-total Medicare payments if all services were delivered in the hospital outpatient department (HOPD) versus physician office. Vertical integration was defined as billing >10% of services to HOPD in a year. Multivariable linear probability regressions estimated the association between hospital-office ratio and vertical integration in 2014-2019 with and without accounting for provider characteristics.
Results: In 2013, the average hospital-office ratio was 1.63, which increased to 1.99 in 2018. A 25th-to-75th percentile increase in the hospital-office ratio was negatively associated with integration (-1.01 percentage points [ppts], 95% CI = -1.45 to -0.57, p < .001) not accounting for physician practice characteristics; this association was attenuated (-0.30 ppts, 95% CI = -0.67 to 0.07, p = .11) after adjusting for these characteristics. Higher baseline (ie, 2013) service volume (Quartile4 v Quartile1 = -3.00 ppts, 95% CI = -4.42 to -1.59, p < .001), more diverse services (Quartile4 v Quartile1 = -3.55 ppts, 95% CI = -4.97 to -2.13, p < .001), and urban location (-5.23 ppts, 95% CI = -6.89 to -3.57, p < .001) were more strongly associated with vertical integration.
Conclusion: Compared to Medicare site-based payment policy, oncologists' practice characteristics emerged as more potent factors for integration and should be considered to ensure the intended impacts of site-based payment reform. Our finding raises questions about the effectiveness of ongoing movements toward site-neutral payment for drug administration services to deter vertical integration in oncology.
目的:医疗保险对在医生诊室和医院门诊提供服务的不同支付方式激励了许多专科的医院-医生一体化(即纵向一体化),但肿瘤学家的证据却不尽相同。我们研究了 2013-2019 年医疗保险基于医疗机构的支付政策和医生执业特点(包括服务量和多样性)与肿瘤医生纵向整合的关系:利用 2013-2019 年医疗保险提供者使用和支付数据以及医疗保险提供者实践和专业数据,我们提取了 2013 年非整合的内科/血液肿瘤学家(以下简称肿瘤学家),并对他们进行了跟踪调查,直至 2019 年。我们使用医院-诊室比率(如果所有服务都在医院门诊部 (HOPD) 和医生诊室提供,则医疗保险支付总额)量化了医疗保险基于诊室的支付政策所带来的激励。垂直整合的定义是在一年内向医院门诊部收取的服务费>10%。多变量线性概率回归估算了 2014-2019 年医院-诊室比率与纵向整合之间的关联,并考虑和不考虑医疗服务提供者的特征:2013年,医院与诊所的平均比例为1.63,2018年增至1.99。在不考虑医生执业特征的情况下,医院-诊室比率从第 25 个百分位数到第 75 个百分位数的增加与整合呈负相关(-1.01 个百分点 [pps],95% CI = -1.45 到 -0.57,p < .001);在调整这些特征后,这种相关性减弱(-0.30 个百分点,95% CI = -0.67 到 0.07,p = .11)。较高的基线(即 2013 年)服务量(Quartile4 v Quartile1 = -3.00 ppts, 95% CI = -4.42 to -1.59, p < .001)、更多样化的服务(Quartile4 v Quartile1 = -3.55 ppts, 95% CI = -4.97 to -2.13, p < .001)和城市位置(-5.23 ppts, 95% CI = -6.89 to -3.57,p < .001)与纵向整合的关联性更强:结论:与医疗保险以医疗机构为基础的支付政策相比,肿瘤医生的执业特点成为更有力的整合因素,应加以考虑以确保以医疗机构为基础的支付改革的预期效果。我们的研究结果提出了一个问题,即目前正在进行的药物管理服务中性支付运动能否有效阻止肿瘤科的纵向整合。
{"title":"Association Between Medicare Site-Based Payment Policy, Physician Practice Characteristics, and Vertical Integration Among Oncologists.","authors":"Xin Hu, Ian McCarthy, K Robin Yabroff, Wen You, Joseph Lipscomb, Ilana Graetz","doi":"10.1200/OP.24.00091","DOIUrl":"https://doi.org/10.1200/OP.24.00091","url":null,"abstract":"<p><strong>Purpose: </strong>Medicare's differential payments for services delivered in physician offices versus hospital outpatient settings incentivize hospital-physician integration (ie, vertical integration) across many specialties, but evidence for oncologists is mixed. We examined the association of Medicare site-based payment policy and physician practice characteristics, including service volume and diversity, with vertical integration among oncologists in 2013-2019.</p><p><strong>Methods: </strong>Using the Medicare Provider Utilization and Payment Data and Medicare Data on Provider Practice and Specialty in 2013-2019, we extracted nonintegrated medical/hematologic oncologists (hereafter oncologists) in 2013 and followed them through 2019. We quantified the incentives from Medicare site-based payment policy using the hospital-office ratio-total Medicare payments if all services were delivered in the hospital outpatient department (HOPD) versus physician office. Vertical integration was defined as billing >10% of services to HOPD in a year. Multivariable linear probability regressions estimated the association between hospital-office ratio and vertical integration in 2014-2019 with and without accounting for provider characteristics.</p><p><strong>Results: </strong>In 2013, the average hospital-office ratio was 1.63, which increased to 1.99 in 2018. A 25th-to-75th percentile increase in the hospital-office ratio was negatively associated with integration (-1.01 percentage points [ppts], 95% CI = -1.45 to -0.57, <i>p</i> < .001) not accounting for physician practice characteristics; this association was attenuated (-0.30 ppts, 95% CI = -0.67 to 0.07, <i>p</i> = .11) after adjusting for these characteristics. Higher baseline (ie, 2013) service volume (Quartile4 <i>v</i> Quartile1 = -3.00 ppts, 95% CI = -4.42 to -1.59, <i>p</i> < .001), more diverse services (Quartile4 <i>v</i> Quartile1 = -3.55 ppts, 95% CI = -4.97 to -2.13, <i>p</i> < .001), and urban location (-5.23 ppts, 95% CI = -6.89 to -3.57, <i>p</i> < .001) were more strongly associated with vertical integration.</p><p><strong>Conclusion: </strong>Compared to Medicare site-based payment policy, oncologists' practice characteristics emerged as more potent factors for integration and should be considered to ensure the intended impacts of site-based payment reform. Our finding raises questions about the effectiveness of ongoing movements toward site-neutral payment for drug administration services to deter vertical integration in oncology.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141491973","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: Fertility preservation was designed to help young patients overcome complications of cancer treatments, but its effectiveness is unknown. We sought to investigate how often patients with cancer are offered fertility preservation and if patients offered fertility preservation are more likely to have offspring.
Methods: We searched Embase (through 2022) and PubMed (through 2022). Our broad computerized search strategy was built upon using the keywords "chemotherapy," "radiation," and "fertility." The search took place on December 1, 2022. We included randomized and observational studies and excluded reviews and case reports/series.
Results: Eighty-five articles that answered at least one of the research questions were included. Studies assessing fertoprotective therapies often rely on surrogate markers for fertility. Multiple factors affect these markers of fertility. The median premature ovarian failure rate among the intervention group was 18% (IQR, 12%-20%), and among the control group, it was 25% (IQR, 19%-33%). Five of 11 studies reported a significant benefit from fertoprotective therapy. Pregnancies occurred in a median of 21% (IQR, 6%-52%) of patients in the intervention group and 11% (IQR, 7-44) of patients in the control group, with three of seven studies reporting a higher percentage of pregnancies among the intervention group.
Conclusion: We reviewed the literature on several questions surrounding fertility preservation and found that there is limited and low-quality research on these therapies in cancer. Hence, there is a strong need for studies, especially randomized studies, that follow patients with cancer who undergo fertility preservation and assess outcomes in which patients are most interested.
{"title":"Cancer Therapy, Gonadal Function, and Fertility Preservation: Narrative Review.","authors":"Christopher O Eden, Alyson Haslam, Vinay Prasad","doi":"10.1200/OP.23.00468","DOIUrl":"https://doi.org/10.1200/OP.23.00468","url":null,"abstract":"<p><strong>Purpose: </strong>Fertility preservation was designed to help young patients overcome complications of cancer treatments, but its effectiveness is unknown. We sought to investigate how often patients with cancer are offered fertility preservation and if patients offered fertility preservation are more likely to have offspring.</p><p><strong>Methods: </strong>We searched Embase (through 2022) and PubMed (through 2022). Our broad computerized search strategy was built upon using the keywords \"chemotherapy,\" \"radiation,\" and \"fertility.\" The search took place on December 1, 2022. We included randomized and observational studies and excluded reviews and case reports/series.</p><p><strong>Results: </strong>Eighty-five articles that answered at least one of the research questions were included. Studies assessing fertoprotective therapies often rely on surrogate markers for fertility. Multiple factors affect these markers of fertility. The median premature ovarian failure rate among the intervention group was 18% (IQR, 12%-20%), and among the control group, it was 25% (IQR, 19%-33%). Five of 11 studies reported a significant benefit from fertoprotective therapy. Pregnancies occurred in a median of 21% (IQR, 6%-52%) of patients in the intervention group and 11% (IQR, 7-44) of patients in the control group, with three of seven studies reporting a higher percentage of pregnancies among the intervention group.</p><p><strong>Conclusion: </strong>We reviewed the literature on several questions surrounding fertility preservation and found that there is limited and low-quality research on these therapies in cancer. Hence, there is a strong need for studies, especially randomized studies, that follow patients with cancer who undergo fertility preservation and assess outcomes in which patients are most interested.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141491974","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}
Linda Watson, Claire Link, Siwei Qi, Andrea DeIure, Lindsi Chmielewski, April Hildebrand, Lisa Barbera
Purpose: Patient-reported outcomes (PROs) information has been routinely collected in Cancer Care Alberta (CCA) for years using the revised Edmonton Symptom Assessment System (ESAS-r) and Canadian Problem Checklist (CPC). There was interest in combining these into a more comprehensive single measure tailored to ambulatory cancer settings. The purpose of this study was to validate an expanded and redesigned ESAS-r called the ESAS-r Cancer.
Methods: Stakeholder engagement, a review of the literature, and 2 years of CPC data collected in the cancer program informed the addition of six symptoms to the ESAS-r. To assess and validate the measure, 1,600 randomly sampled patients were mailed paper copies of the ESAS-r Cancer, ESAS-r, and a validated, comprehensive PRO measure called the Memorial System Assessment Scale-Short Form (MSAS-SF), which is often used with patients with cancer. Canonical Correlation Analysis and exploratory factor analyses were performed to assess concurrent and construct validity of the ESAS-r Cancer against ESAS-r, using MSAS-SF as the reference measure for comparison. Cronbach α was calculated to assess reliability.
Results: Four hundred and sixty-one patients (29% response rate) completed all three questionnaires. ESAS-r Cancer showed higher numerical correlation than ESAS-r and accounted for more information included on MSAS-SF, explaining slightly more variance than ESAS-r (75.2% v 73.5%). The three-dimensional factor structure of ESAS-r Cancer outperformed the two-dimensional factor structure of ESAS-r. The reliability of ESAS-r Cancer was verified and found to be slightly higher than ESAS-r (Cronbach α = .903 v .884).
Conclusion: ESAS-r Cancer is now in use with patients throughout CCA. This valid and reliable PRO measure can be used by other cancer or specialized health care programs who wish to routinely assess common symptoms.
目的:多年来,阿尔伯塔癌症护理中心(CCA)一直使用修订版埃德蒙顿症状评估系统(ESAS-r)和加拿大问题清单(CPC)收集患者报告结果(PROs)信息。人们有兴趣将这两种方法结合起来,为非卧床癌症患者量身定制一种更全面的单一测量方法。本研究旨在验证经过扩展和重新设计的 ESAS-r,即 ESAS-r Cancer:方法:通过利益相关者的参与、文献综述以及在癌症项目中收集的两年 CPC 数据,在 ESAS-r 中增加了六个症状。为了评估和验证该测量方法,我们向 1600 名随机抽样的患者邮寄了 ESAS-r 癌症、ESAS-r 和一种名为 Memorial System Assessment Scale-Short Form(MSAS-SF)的经过验证的综合 PRO 测量方法的纸质副本,该方法常用于癌症患者。为了评估ESAS-r癌症版与ESAS-r版的并发效度和结构效度,我们使用MSAS-SF作为参照量表进行比较,并进行了典型相关分析和探索性因子分析。计算Cronbach α以评估信度:461名患者(回复率为29%)完成了所有三份问卷。癌症ESAS-r的数值相关性比ESAS-r高,并且包含了MSAS-SF中更多的信息,比ESAS-r(75.2%对73.5%)能解释更多的方差。癌症 ESAS-r 的三维因子结构优于 ESAS-r 的二维因子结构。ESAS-r《癌症》的信度经验证略高于ESAS-r(Cronbach α = .903 v .884):结论:ESAS-r Cancer 现已用于整个 CCA 的患者。结论:ESAS-r Cancer 目前已在整个 CCA 的患者中使用,这种有效可靠的 PRO 测量方法可用于其他希望对常见症状进行常规评估的癌症或专业医疗保健项目。
{"title":"Designing and Validating a Comprehensive Patient-Reported Outcomes Measure for Ambulatory Cancer Settings: The Revised Edmonton Symptom Assessment System for Cancer.","authors":"Linda Watson, Claire Link, Siwei Qi, Andrea DeIure, Lindsi Chmielewski, April Hildebrand, Lisa Barbera","doi":"10.1200/OP.24.00088","DOIUrl":"https://doi.org/10.1200/OP.24.00088","url":null,"abstract":"<p><strong>Purpose: </strong>Patient-reported outcomes (PROs) information has been routinely collected in Cancer Care Alberta (CCA) for years using the revised Edmonton Symptom Assessment System (ESAS-r) and Canadian Problem Checklist (CPC). There was interest in combining these into a more comprehensive single measure tailored to ambulatory cancer settings. The purpose of this study was to validate an expanded and redesigned ESAS-r called the ESAS-r Cancer.</p><p><strong>Methods: </strong>Stakeholder engagement, a review of the literature, and 2 years of CPC data collected in the cancer program informed the addition of six symptoms to the ESAS-r. To assess and validate the measure, 1,600 randomly sampled patients were mailed paper copies of the ESAS-r Cancer, ESAS-r, and a validated, comprehensive PRO measure called the Memorial System Assessment Scale-Short Form (MSAS-SF), which is often used with patients with cancer. Canonical Correlation Analysis and exploratory factor analyses were performed to assess concurrent and construct validity of the ESAS-r Cancer against ESAS-r, using MSAS-SF as the reference measure for comparison. Cronbach α was calculated to assess reliability.</p><p><strong>Results: </strong>Four hundred and sixty-one patients (29% response rate) completed all three questionnaires. ESAS-r Cancer showed higher numerical correlation than ESAS-r and accounted for more information included on MSAS-SF, explaining slightly more variance than ESAS-r (75.2% <i>v</i> 73.5%). The three-dimensional factor structure of ESAS-r Cancer outperformed the two-dimensional factor structure of ESAS-r. The reliability of ESAS-r Cancer was verified and found to be slightly higher than ESAS-r (Cronbach α = .903 <i>v</i> .884).</p><p><strong>Conclusion: </strong>ESAS-r Cancer is now in use with patients throughout CCA. This valid and reliable PRO measure can be used by other cancer or specialized health care programs who wish to routinely assess common symptoms.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141491975","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}
Karen Mustian, Christina Lacchetti, Suzanna Zick, Julienne E Bower
{"title":"Management of Fatigue in Adult Survivors of Cancer: American Society of Clinical Oncology - Society for Integrative Oncology (ASCO-SIO) Guideline Update Clinical Insights.","authors":"Karen Mustian, Christina Lacchetti, Suzanna Zick, Julienne E Bower","doi":"10.1200/OP.24.00372","DOIUrl":"https://doi.org/10.1200/OP.24.00372","url":null,"abstract":"","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141491976","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 : 2024-07-01Epub Date: 2024-03-11DOI: 10.1200/OP.24.00076
Arnold L Potosky, Jaeil Ahn, Yi Xia, Li Lin, Ronald C Chen, Kristi D Graves, Wei Pan, Jane M Fall-Dickson, Theresa H M Keegan, Lisa E Paddock, Xiao-Cheng Wu, Anshu Shrestha, Bryce B Reeve
Purpose: Our purpose was to describe the prevalence and predictors of symptom and function clusters related to physical, emotional, and social components of general health-related quality of life (HRQOL) in a population-based sample of prostate cancer (PCa) survivors.
Methods: Participants (N = 1,162) completed a baseline survey at a median of 9 months after diagnosis to ascertain the co-occurrence of eight symptom and functional domains that are common across all cancers and not treatment-specific. We used latent profile analysis (LPA) to identify subgroup profiles of survivors with low, moderate, or high HRQOL levels. Multinomial logistic regression models were used to identify clinical and sociodemographic factors associated with survivors' membership in the low versus moderate or high HRQOL profile.
Results: The LPA identified 16% of survivors who were categorized in the low HRQOL profile at baseline, indicative of the highest symptom burden and lowest functioning. Factors related to survivors' membership in the low versus higher HRQOL profile groups included less than age 65 years at diagnosis, identifying as non-Hispanic Black race, not working, being a former versus never smoker, systemic therapy, less companionship, more comorbidities, lower health care financial well-being, or less spirituality. Several factors remained associated with remaining in the low versus higher HRQOL profiles on the follow-up survey (n = 699), including younger age, Black race, comorbidity, and lower financial and spiritual well-being.
Conclusion: About one of six PCa survivors experienced elevated physical and psychosocial symptoms that were independent of local curative therapy, but with younger age, race, comorbidity, and lower financial and spiritual well-being as stable risk factors for poor HRQOL over time.
{"title":"Demographic and Clinical Factors Associated With Health-Related Quality-of-Life Profiles Among Prostate Cancer Survivors.","authors":"Arnold L Potosky, Jaeil Ahn, Yi Xia, Li Lin, Ronald C Chen, Kristi D Graves, Wei Pan, Jane M Fall-Dickson, Theresa H M Keegan, Lisa E Paddock, Xiao-Cheng Wu, Anshu Shrestha, Bryce B Reeve","doi":"10.1200/OP.24.00076","DOIUrl":"10.1200/OP.24.00076","url":null,"abstract":"<p><strong>Purpose: </strong>Our purpose was to describe the prevalence and predictors of symptom and function clusters related to physical, emotional, and social components of general health-related quality of life (HRQOL) in a population-based sample of prostate cancer (PCa) survivors.</p><p><strong>Methods: </strong>Participants (N = 1,162) completed a baseline survey at a median of 9 months after diagnosis to ascertain the co-occurrence of eight symptom and functional domains that are common across all cancers and not treatment-specific. We used latent profile analysis (LPA) to identify subgroup profiles of survivors with low, moderate, or high HRQOL levels. Multinomial logistic regression models were used to identify clinical and sociodemographic factors associated with survivors' membership in the low versus moderate or high HRQOL profile.</p><p><strong>Results: </strong>The LPA identified 16% of survivors who were categorized in the low HRQOL profile at baseline, indicative of the highest symptom burden and lowest functioning. Factors related to survivors' membership in the low versus higher HRQOL profile groups included less than age 65 years at diagnosis, identifying as non-Hispanic Black race, not working, being a former versus never smoker, systemic therapy, less companionship, more comorbidities, lower health care financial well-being, or less spirituality. Several factors remained associated with remaining in the low versus higher HRQOL profiles on the follow-up survey (n = 699), including younger age, Black race, comorbidity, and lower financial and spiritual well-being.</p><p><strong>Conclusion: </strong>About one of six PCa survivors experienced elevated physical and psychosocial symptoms that were independent of local curative therapy, but with younger age, race, comorbidity, and lower financial and spiritual well-being as stable risk factors for poor HRQOL over time.</p>","PeriodicalId":14612,"journal":{"name":"JCO oncology practice","volume":null,"pages":null},"PeriodicalIF":4.7,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140101599","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}