Patient Access Research Articles

Integrative medicine : what's new in 2024

This article reports on new findings on integrative and complementary medicine published in 2024. The implementation of guidelines for the management of pain in cancer patients is discussed. Then, a literature review is presented, that aims to clarify the role of complementary approaches in the management of chemotherapy-induced nausea and vomiting and provides a concrete example of how recommendations are established. Finally, a meta-analysis focusing on the efficacy of Echinacea in the treatment of upper respiratory tract infections is summarized. These articles illustrate the complexity of the path from science to practice and underscore the importance of identifiable centers of reference to support the dissemination of knowledge to health care professionals and promote broad patient access to well-coordinated therapies.

Elevated Interleukin-6 Is Associated with an Increased Risk of Long-Term Arteriovenous Fistula Failure for Dialysis

Background/Objectives: The autologous arteriovenous fistula (AVF) is the preferred choice for vascular access in patients with end-stage kidney disease (ESKD) undergoing maintenance hemodialysis. However, in the long term, the primary patency of AVF is suboptimal, with an AVF failure of approximately 30% in one year. The aim of this study is to examine how the pre-operative baseline levels of interleukin-6 (IL-6) affect long-term AVF failure. Methods: This retrospective, observational study involves ESKD patients admitted to the Vascular Surgery Clinic for AVF creation from January 2020 to December 2023. Ultimately, a total of 91 patients whose AVFs matured and began dialysis were enrolled. Prior to surgery, each patient underwent a thorough blood sample collection, with IL-6 levels assessed. The patients were categorized into two groups: those with functioning AVFs and those with dysfunctional AVFs. Their progress was monitored via a review of medical records, telephone interviews, or direct contact. Following the surgery, patients were observed for an average of 1.53 ± 0.94 years. Results: During the follow-up, patients who experienced AVF failure had a higher incidence of diabetes mellitus (p = 0.019) and active smoking (p = 0.012), as well as higher levels of IL-6 (p < 0.001). At ROC analysis, we found a strong association between IL-6 value and AVF failure (AUC: 0.814, p < 0.001), with an optimal cut-off value of 7.08 (76.5% Sensitivity and 79.7% Specificity). Furthermore, at the survival curve Kaplan-Meier analysis, we observed a higher occurrence of AVF failure in patients with baseline IL-6 values above the median (p = 0.004), in tertile 3 (p = 0.002), and above the optimal cut-off value (p < 0.001). At cox-regression analysis, elevated baseline IL-6 levels are associated with AVF Failure (HR: 2.23, p < 0.001). Conclusions: In the current study, we demonstrated that elevated IL-6 levels at baseline are associated with long-term AVF failure, independent of age, sex, and cardiovascular risk factors.

"Cross-Sectional Analysis of Insurance Coverage for Functional Septorhinoplasty in the United States".

The benefits and cost-effectiveness of functional septorhinoplasty have been previously demonstrated. However, reimbursement for functional septorhinoplasty by health insurance companies remains inconsistent. The purpose of this study is to define the current state of insurance coverage for functional septorhinoplasty. A cross-sectional analysis of insurance reimbursement for functional septorhinoplasty in the United States was designed. The top three insurance companies per state based on market share data maintained by the Kaiser Family Foundation were included. Established medical policies were gathered from insurance company websites and phone interviews, and descriptive statistics were performed. Primary outcomes included the level of and criteria for coverage. This study included 67 insurance companies representing 88% of the United States market share. Most insurance companies offered coverage with preauthorization for rhinoplasty (61%) and septoplasty (55%). However, some companies determined coverage on a case-by-case basis (rhinoplasty 25% and septoplasty 22%), while others had no defined policy for coverage (rhinoplasty 14% and septoplasty 23%). The most common criteria for coverage of rhinoplasty included nasal deformity secondary to trauma (98%), congenital anomaly (88%), and other disease (85%). The most common criteria for coverage of septoplasty included nasal obstruction (49%), septal deviation (46%), and recurrent sinusitis (40%). Functional septorhinoplasty offers significant improvement in nasal breathing and quality of life, yet disparate insurance coverage criteria limit patient access to care. Patient-reported outcome measures data will be essential to define an evidence-based list of standardized criteria for insurance coverage of functional septorhinoplasty moving forward.

EXPRESS: Quality, Necessity, or Accessibility? Impact of Dockless Bike Sharing on Ineffective Use of Medical Resources

In recent years, patients have increasing autonomy in medical decision-making. With great autonomy in selecting medical institutions, patients with low-risk diseases (LRD) may opt for treatment in prestigious hospitals, which limits the access of patients with high-risk diseases (HRD) to these hospitals. Moreover, due to limited medical knowledge and a fear of uncertainty regarding diseases, patients with greater medical autonomy may request various unnecessary medical tests to alleviate their health-related anxiety. This study takes a novel patients’ perspective to investigate how dockless bike sharing, which addresses the “last-mile problem” and improves geographical accessibility to medical institutions, affects two types of ineffective use of medical resources: disease-institution mismatch and overuse of medical tests. By introducing the concept of quality-accessibility trade-off in patients’ decision-making processes, we shed light on the psychological mechanism underlying the effect of dockless bike sharing on patients’ medical institution choices. We also introduce a new concept, perceived necessity of medical tests, to explain how dockless bike sharing reduces unnecessary medical tests. In Study 1, we designed a quasi-experiment and applied a difference-in-differences model based on real-world electronic health record data to show that dockless bike sharing increased the likelihood of patients choosing hospitals over clinics and decreased the number of unnecessary medical tests. In Studies 2a, 2b, 3a, and 3b, four randomized controlled experiments were employed to replicate the findings and reveal the underlying mechanisms. In sum, we found that dockless bike sharing acted as a “double-edged sword” in terms of its impact on exacerbating disease-institution mismatch and alleviating the overuse of medical tests. This study makes significant theoretical contributions to the Operations Management (OM), sharing economy, and medical resource management literature. It also offers important managerial insights for governments, shared mobility platforms, and healthcare providers.

Impact of declared wildfire disasters on survival of lung cancer patients undergoing radiation.

Oncological treatments, such as radiotherapy, which requires consistent electricity, the presence of specialized clinical teams, and daily patient access to treatment facilities, are frequently disrupted by extreme weather events, posing several health hazards to patients. This study explores the association between declared wildfire disasters during radiotherapy and overall survival among patients with non-small cell lung cancer (NSCLC). The study population consisted of 202,935 adults with inoperable Stage III NSCLC, who initiated radiotherapy from 2004 through 2019. Exposure was defined as a wildfire disaster declaration in the county of the treatment facility within 12weeks of initiating radiotherapy. Overall survival was defined as the interval (months) between age at diagnosis and age at death, date of last contact, or study end. Cox proportional hazards was used to estimate crude and adjusted hazard ratios and 95% confidence intervals with inverse probability weighting. Patients exposed to a wildfire disaster declaration during radiation treatment had worse overall survival (HR, 1.03; 95% CI 1.00-1.06; p = 0.02), compared to unexposed patients in adjusted models. Exposure to a wildfire disaster during radiotherapy is associated with worse overall survival among patients with stage III non-operable NSCLC. This finding underscores the critical need for developing adaptation strategies within the healthcare sector, especially in oncology.

What's been tried: a curated catalogue of efforts to improve access to general practice.

Although increasing numbers of appointments are being provided, public satisfaction with access to UK general practice is declining. Previous attempts to improve access have not been systematically collated. We aimed to identify interventions to improve access to general practice in the UK, to organise these interventions into thematic categories, and to identify which aspects of access are targeted. Narrative systematic review. A three-stage search was conducted to identify interventions used to improve access to NHS general practice. Using an iterative process, we generated thematic categories to classify interventions according to how they are intended to work. We assessed which aspects of access they addressed using the seven-feature Candidacy Framework. The search identified 449 relevant sources reporting on interventions to improve access to general practice over the period 1984-2023. We generated six overarching thematic categories into which we organised these interventions: appointment innovations; direct patient access to services; increasing the number and range of professionals available in general practice; offering contacts beyond core hours, core settings and core services; supporting patient engagement; and supporting the wider structures of general practice. We assessed which features of Candidacy were addressed, with "permeability" (the ease with which people can use) services emerging as the most frequent feature. Multiple and diverse attempts have been made to improve access in general practice over a 40-year period. This curated, thematised catalogue offers an important resource for future efforts to improve access.

Do European regulatory measures accelerate national market access in Belgium? A retrospective analysis of medicines centrally authorised between 2015 and 2020

BackgroundAt the European level, several regulatory measures (ie, priority medicines (PRIME) scheme, accelerated assessment, conditional marketing authorisation and authorisation under exceptional circumstances) are in place with the aim to expedite...

Acute Needs, ACUTE Response: Development and Delivery of a Mental Health Urgent Care in the Bronx.

As mental health needs rise, creative and timely solutions are essential. Leveraging the expansion and flexibility of virtual services to create telehealth and hybrid offerings is crucial for addressing systemic barriers in mental health, enhancing accessibility, and providing flexible, comprehensive care options for diverse patient populations. This article discusses the development of a mental health urgent care program within a large medical system in a densely populated, under-resourced community. The program was designed to address common community mental health barriers across multiple care entry points, including ambulatory settings, emergency care, and consultation services. Using a multipronged approach, this program aims to improve patient access, care continuity, and outcomes. The authors encourage others to consider adopting a similar programmatic infrastructure to reduce mental health care barriers in their communities.

Patients' Use of e-Consultations as an Alternative to Other General Practitioner Services: Cross-Sectional Survey Study.

e-Consultations, defined as asynchronous text-based messaging, have transformed how patients interact with their general practitioner (GP). While e-consultations can improve patient access to GP care, concerns about increased workload for GPs are raised. This study aimed to address three research questions: (1) For what purpose and with what expectations do patients initiate e-consultations? (2) If e-consultations had not been available, what alternative actions would the patient have taken? and (3) How are the alternative actions associated with patient and e-consultation characteristics? A cross-sectional study was conducted through a web-based survey on Helsenorge. Helsenorge is the national citizen portal for digital health services in Norway, including e-consultations with the GP. All users who sent e-consultations through Helsenorge were invited to participate between January and February 2023. The survey addressed questions on users' expectations and experience with e-consultations. The association between patient and e-consultation characteristics and alternative actions to e-consultations were analyzed using multinomial logistic regression. Overall, 13,011 users answered the survey. The most common reason for initiating an e-consultation was requesting a sick certificate (4940/13,011, 38%). Overall, 68.7% (8802/13,011) of respondents expected an answer within 24 hours, and 17.7% (2310/13,011) anticipated that the GP would ask them to attend a physical examination. If e-consultations had not been available, 45.5% (5917/13,011) of respondents would have booked a GP appointment, and 44.9% (5846/13,011) would have called the front desk. Users who expected a quicker response (odds ratio [OR] 1.64, 95% CI 1.46-1.85) and were less concerned about their health issues (OR 1.29, 95% CI 1.18-1.40) were more likely to call the front desk. Only 2.5% (323/13,011) of respondents would have contacted out-of-hours services. Users with longer travel time to the GP office (OR 6.08, 95% CI 3.46-10.66) and with a new health problem (OR 2.71, 95% CI 2.09-3.51) were more likely to choose this option. In addition, 4.7% (609/13,011) of the users would not have sought help if e-consultations had not been available. Younger patients (OR 2.16, 95% CI 1.38-3.37) and those with a longer travel time to the GP office (OR 2.19, 95% CI 1.27-3.80) or a new health issue (OR 1.74, 95% CI 1.43-2.12) had higher odds for not seeking help. e-Consultations were often the patients' first choice of access route, and users expected a fast response. e-Consultations were mostly perceived as an alternative to GP appointments or calling the front desk. Patients with lower availability to the GP office had higher odds of using e-consultations as an alternative to out-of-hours service or waiting and not seeking GP care. Guidance for patient use should be developed to ensure appropriate and safe use. Further research should assess the effect of e-consultations on health outcomes and efficiency.

Student and Physician Views of How the Dobbs Decision Affects Training and Practice Location Preferences: Cross-Sectional Questionnaire Study.

By allowing for abortion bans and restrictions to take effect in the majority of US states, the 2022 Dobbs v Jackson Women's Health Organization decision portends to have lasting impacts on patient care and the physician workforce. Notably, it is already beginning to impact practice location preferences of US health care workers, evidenced by declining application rates to residency programs in abortion-restrictive states since 2022. Yet, there remains a gap in the literature regarding why this trend exists. This study aims to describe what factors are driving the practice location preferences of medical students and physicians after the Dobbs decision. This study analyzes qualitative data from a web-based, cross-sectional study. In August 2022, a nonprobabilistic sample of physicians and medical students were surveyed on social media about the impact of overturning Roe v Wade on practice location preferences, which included the free-text question "Please share your thoughts about the overturning of Roe v Wade and how it will affect your decision about your (residency/job or fellowship) programs." A total of 3 independent team members completed an inductive thematic analysis of 524 free responses, resolving differences by discussion. Approximately 1 in 4 survey respondents also completed the free-response item (524/2063, 25.4%); a total of 219 were medical students, 129 were residents and fellows, and 176 were practicing physicians. Of them, approximately half (261/524, 50.5%) resided in states where abortion bans were in place or anticipated. Those who answered the free-response item were relatively more likely to hail from states with restrictive abortion bans (P<.001) compared to those who did not, with other demographic characteristics being largely similar between the groups. Inductive thematic analysis yielded 2 broad thematic categories: patient-related and workforce-related factors influencing practice decision preferences. The 3 most common themes overall were respondent concerns regarding their patient's access to care (249/524, 47.5%), their desire not to practice or train in a state with abortion restrictions regardless of current residence (249/524, 47.5%), and their personal belief that abortion bans are human rights and/or body autonomy violation (197/524, 37.6%). Some respondents stated that the Dobbs decision would not impact their choice of practice location (41/524, 7.8%), and some supported it (35/594, 6.7%). This study shows that abortion restrictions are having an impact on the practice location preferences of the physician workforce due to both patient care and personal factors. It is important that state policy makers and others who are considering abortion restrictions also consider how to address these concerns of physicians and medical students, to avoid worsening geographic maldistribution of physicians and worsening access to care from physicians for their citizens.

Percutaneous VT Ablation via RA-to-LV Access in Patients With Double Mechanical Valves

Percutaneous VT Ablation via RA-to-LV Access in Patients With Double Mechanical Valves

A Comprehensive Resource for Patients Undergoing Elective Surgeries in Lmics: Addressing Challenges and Opportunities

Elective surgeries are increasingly common in developing nations, yet patients often face challenges related to access, information, and post-operative care. This manuscript proposes a one-stop resource model aimed at addressing these challenges. By examining the role of health insurance, innovative healthcare models like Pristyn Care’s asset-light approach, and the integration of comprehensive services, we highlight strategies for improving patient experiences and outcomes in the context of elective surgeries. The findings suggest that a centralized resource can significantly enhance the quality of care and accessibility for patients in low- and middle-income countries.

Exploring the Efficacy of Artificial Intelligence: A Comprehensive Analysis of CHAT-GPT's Accuracy and Completeness in Addressing Urinary Incontinence Queries.

Artificial intelligence models are increasingly gaining popularity among patients and healthcare professionals. While it is impossible to restrict patient's access to different sources of information on the Internet, healthcare professional needs to be aware of the content-quality available across different platforms. To investigate the accuracy and completeness of Chat Generative Pretrained Transformer (ChatGPT) in addressing frequently asked questions related to the management and treatment of female urinary incontinence (UI), compared to recommendations from guidelines. This is a cross-sectional study. Two researchers developed 14 frequently asked questions related to UI. Then, they were inserted into the ChatGPT platform on September 16, 2023. The accuracy (scores from 1 to 5) and completeness (score from 1 to 3) of ChatGPT's answers were assessed individually by two experienced researchers in the Women's Health field, following the recommendations proposed by the guidelines for UI. Most of the answers were classified as "more correct than incorrect" (n = 6), followed by "incorrect information than correct" (n = 3), "approximately equal correct and incorrect" (n = 2), "near all correct" (n = 2, and "correct" (n = 1). Regarding the appropriateness, most of the answers were classified as adequate, as they provided the minimum information expected to be classified as correct. These results showed an inconsistency when evaluating the accuracy of answers generated by ChatGPT compared by scientific guidelines. Almost all the answers did not bring the complete content expected or reported in previous guidelines, which highlights to healthcare professionals and scientific community a concern about using artificial intelligence in patient counseling.

The Effect of Racial Concordance for Black Patients in Addiction Treatment: A Scoping Review of the Literature.

In the United States, Black people with substance use disorders (SUDs) have less access to treatment and worse treatment outcomes compared to White people. Though systemic racism is the root of these inequities, adapting treatment settings to serve this population may be a pragmatic way to improve access and outcomes. Shared racial identity between a patient and a provider, or racial concordance, is one feature of culturally tailored care that may improve treatment access, experiences, and outcomes for Black people. There is some evidence that racial concordance improves medical treatment for Black patients in non-addiction settings, but it is unknown whether racial concordance affects experiences or outcomes in addiction treatment. We conducted a scoping review guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-to understand the effect of racial concordance on Black patients in addiction treatment. Three reviewers read each title and abstract to identify eligible articles. The inclusion criteria were: (1) Black patients; (2) treatment access, experiences, or outcomes; and (3) patient-provider racial concordance in addiction treatment. One reviewer completed full-text reviews and data extraction. We identified 259 nonduplicate articles and completed full-text reviews of 77 articles. Eleven articles, published between 1971 and 2016, met criteria. Racial concordance was not associated with treatment access or engagement, though it was associated with some positive outcomes including increased perceived provider empathy. Few studies met the review criteria and there were no randomized controlled trials. The studies identified in this review did not provide adequate evidence that racial concordance improved treatment access, experiences, or outcomes for Black patients. Future research should include a wider range of outcome measures, including relational measures (eg, medical trust, discrimination) and examine whether and under what circumstances racial concordance improves experiences and outcomes for Black patients in addiction treatment.

Feasibility of Distal Radial Access in High Bleeding Risk Patients Who Underwent Percutaneous Coronary Intervention.

The distal radial access (DRA), a potential alternative to the trans-radial approach (TRA), may offer advantages in terms of access site complications due to its smaller vessel diameter, especially for high bleeding risk (HBR) patients. This study aims to investigate the feasibility of DRA in HBR patients. Based on data from the KODRA registry, a prospective, multicenter cohort, this study analyzed 1,586 patients who underwent successful percutaneous coronary intervention (PCI) via DRA. Patients were categorized into HBR and non-HBR groups. The primary endpoint of the study is DRA-related bleeding, and the secondary endpoints of the study are overall access site complications and each component of the access site complications. To reduce the effect of potential confounders, a multivariable adjustment analysis was performed. The mean age of the total population was 71.1±10.8 years, and 40.3% of patients were female. Both DRA-related bleeding (odds ratio [OR], 1.15; 95% confidence interval [CI], 0.67-1.97; p=0.616) and overall access site complications (OR, 1.08; 95% CI, 0.67-1.72; p=0.761) were not significantly different between the HBR group and non-HBR group after multivariable adjustment. No major bleeding before discharge was observed in both groups. Furthermore, the incidence of distal and conventional radial artery occlusion was less than 1% at 1-month follow-up in both groups. Our study results showed the safety of DRA for both DRA-related bleeding and access site complications among HBR patients who underwent PCI. ClinicalTrials.gov Identifier: NCT04080700.

A retrospective review of infant-inducible laryngeal obstruction a subtype of paradoxical vocal fold motion: Evaluation and management

IntroductionThere is a paucity of literature on pre-adolescent paradoxical vocal fold motion (PVFM), PVFM is a sub-type of inducible laryngeal obstruction. Studies typically focus on older patients, however the discovery of this entity in pre-adolescent pediatric patients has led to more questions about how this entity manifests differently and is treated differently in younger populations. Initially considered psychosomatic and commonly mistaken for asthma, PVFM etiology is now thought to be associated underlying neurologic conditions and may have irritant triggers with proposed mechanisms related to laryngeal hypersensitivity. Treatment is multimodal. Diagnosis is with flexible laryngoscopy and clinical exam but other modalities like functional endoscopic evaluation of swallow may provide more information than flexible laryngoscopy alone. MethodsAfter obtaining IRB approval, a retrospective review of all charts of patients ages 0–18 months (pre-adolescent pediatric patients) who underwent flexible endoscopic evaluation of swallow and/or flexible laryngoscopy from 1/2013–8/2021 was performed. Twenty-four subjects diagnosed with PVFM were identified. ResultsThe most common presenting symptom was stridor or coughing with feeds. 63 % were male, mean age at time of diagnosis was 3.4 months, and mean follow-up length was 11.4 months. Comorbidities included reflux (45 %), pulmonary diagnoses (25 %) and neurologic diagnoses (54 %). 16/24 subjects had otolaryngology diagnoses (laryngomalacia, tracheomalacia, subglottic stenosis, or ankyloglossia). 12/24 subjects were treated with conservative management such as anti-reflux medications or precautions. 33 % of patients treated with conservative management had complete symptom resolution. PVFM patients with neurologic comorbidities were more likely to require alternative feeding access (p < 0.05). All 11 subjects who required surgical feeding access had neurologic diagnoses. 5/10 of patients with neonatal abstinence syndrome (NAS) required alternative feeding means, and 40 % tolerated oral feeds after medical management of NAS. ConclusionOur findings suggest PVFM is most commonly seen in pre-adolescent pediatric patients with medical comorbidities. Healthy pre-adolescent pediatric patients with PVFM frequently improved with conservative management. The differential diagnosis of the stridulous infant should include PVFM. It is imperative to consider nutritional access in PVFM patients with neurologic comorbidities.

Implementing zero-knowledge proof authentication on Hyperledger fabric to enhance patient privacy and access control

In recent years, the healthcare sector has encountered significant challenges in authenticating identities for online medical services. A predominant reliance on centralized identity management systems (IDMs) has presented obstacles to the seamless exchange of patient identities among various healthcare institutions, often resulting in data isolation within individual silos. Of paramount concern are the potential privacy breaches associated with centralized IDMs, which may compromise patient confidentiality. In response to these challenges, we propose a novel approach to securely sharing patient details across multiple hospitals utilizing the zero-knowledge access protocol (MediCrypt-ZKAP) within the Hyperledger Fabric blockchain framework. By adopting MediCrypt-ZKAP, hospitals can effectively verify the identities of requesting entities without disclosing sensitive patient information, thereby ensuring the highest levels of confidentiality and privacy protection. The proposed system represents a proactive step towards addressing the critical need for secure and interoperable patient data exchange within the healthcare sector. Through the integration of MediCrypt-ZKAP into existing blockchain infrastructure, our solution aims to enhance data security and privacy while promoting seamless collaboration among healthcare institutions.

Accelerating CAR T cell manufacturing with an automated next-day process.

The traditional method of CAR T cell production involves lengthy ex-vivo culture times which can result in the reduction of crucial naïve T cell subsets. Moreover, traditional CAR T cell therapy manufacturing processes can prolong time-to-patient, potentially delaying patient treatment, and contribute to disease progression. In this study, we describe an innovative and semi-automated 24-hour CAR T manufacturing process that yields a higher percentage of naïve/stem-cell like T cells which showed high cytotoxic activity and cytokine release in vitro. The data supports the feasibility of implementing this streamlined manufacturing process in clinics. This approach also has the potential to enhance CAR T therapy efficacy and improve patient access to therapy.

Digital healthcare services in community pharmacies in Switzerland: Pharmacist and patient acceptability, and pharmacist readiness–the Pneumoscope™ pilot study

Background The integration of artificial intelligence (AI)-based pharmaceutical services in community pharmacy (CP) settings has the potential to enhance point-of-care services and improve informed patient access to healthcare. The Pneumoscope™, an innovative AI-powered digital stethoscope that analyses lung sounds to detect specific respiratory pathologies, could be a valuable tool for pharmacists in conducting respiratory screening. To understand how this device can be implemented in the healthcare system, this exploratory research aims to assess the acceptability of pharmacists and patients, and the pharmacists’ readiness to use the Pneumoscope™ in CPs for respiratory disease management. Methods A 2-stage exploratory approach was conducted using mixed methods: 1) a qualitative analysis of pharmacists’ acceptability and readiness was developed using semi-structured interviews and focus groups ; 2) followed by a quantitative cross-sectional survey of patients’ acceptability of the device in CPs. Results Pharmacists were generally positive about the integration of e-health services into their daily clinical practice, recognizing their potential to improve advanced pharmaceutical triage and collaboration with physicians. Most patients were satisfied with the care provided by CPs, and their acceptability to use the Pneumoscope™ was significantly associated with their level of confidence in AI (p = 0.0092) and with the location of their CP (p = 0.0276). Conclusions Digital devices such as the Pneumoscope™ have the potential to reinforce the pharmacists’ clinical roles within an interprofessional team and improve patient care, but further scientific evaluation and implementation are necessary to support its integration and ensure its reimbursement by health insurers.

Patient access to perioperative chemotherapy with fluorouracil, leucovorin, oxaliplatin and docetaxel in patients with resectable gastric cancer in the Netherlands.

The FLOT4 trial demonstrated superior survival of perioperative chemotherapy with 5-fluorouracil, oxaliplatin, and docetaxel (FLOT) compared to anthracycline triplets for resectable gastric cancer. These results were presented at the American Society of Clinical Oncology (ASCO) congress in June 2017 and published in April 2019. However, adoption of novel treatments in clinical practice often encounters delays. This study assesses the patterns of perioperative chemotherapy utilization and FLOT uptake in clinical practice within the Netherlands. A retrospective cohort study was conducted with resectable gastric cancer patients (cT1-4a,XcNallcM0) between 2015-2020 from the Netherlands Cancer Registry. Descriptive statistics, Cochran-Armitage tests, Fisher's exact or unpaired T-tests, and Jonckheere-Terpstra tests were used to analyze chemotherapy trends and FLOT uptake across hospitals. Among 3290 included patients, 42.9% received neoadjuvant treatment. In 2015, 43.6% of patients received perioperative chemotherapy versus 43.5% in 2020 (p=0.63). 40 out of 62 hospitals (64.5%) adopted FLOT between the ASCO presentation and the full publication. FLOT increased from 42.9% before publication to 86.8% after publication (p<0.0001), while anthracycline triplet use decreased to 0.9% (p<0.0001). Higher hospital volume was associated with fewer days to adoption (p=0.04) but not with adoption of FLOT before publication (p=0.14). Timing of FLOT adoption varied among Dutch hospitals, leading to unequal patient access to effective treatments. Establishing (inter)national guidelines on provisional treatment adjustment pending publication is crucial to reduce variation in access. Moreover, rapid publication of final trial results is imperative to reduce variation in practice and ensure fair patient treatment.