Approach In Cancer Care Research Articles

Exploring the Relationship Among Financial Hardship, Anxiety, and Depression in Patients With Cancer: A Longitudinal Study.

Financial hardship (FH) is a complex issue in cancer care, affecting material conditions, well-being, and coping behaviors. This study aimed to longitudinally examine FH, anxiety, depressive symptoms, and their associations while incorporating social determinants of health and health care cost covariates in a sample of patients diagnosed with cancer. This prospective, longitudinal cohort study analyzed data from 2,305 participants from the Northwestern University Improving the Management of Symptoms during and following Cancer Treatment trial. Outcomes assessed at baseline and at 3, 6, 9, and 12 months postbaseline included depressive symptoms, anxiety, and FH. Analysis involved random intercept cross-lagged panel models to explore between- and within-person effects, incorporating factors such as age, sex, insurance status, neighborhood area deprivation, health care charges, out-of-pocket costs, and health literacy. The cohort had a mean age of 60.7 (standard deviation [SD] = 12.7) years and was mostly female (64.9%) and White (86.2%). Correlations were found between FH and depressive symptoms (r = 0.310) and anxiety (r = 0.289). A predictive relationship was observed between FH and depressive symptoms, with baseline and 6-month depressive symptom levels predicting later FH (baseline β = .079, P = .070; 6-month β = .072, P = .081) and 9-month FH significantly predicting 12-month depressive symptoms (β = .083, P = .025), even after accounting for health care charges and out-of-pocket costs. Baseline and 9-month anxiety showed a predictive relationship with subsequent FH (baseline β = .097, P = .023; 9-month β = .071, P = .068). FH emerged as a prominent issue, with nearly half of participants experiencing some level of FH. Depressive symptoms and anxiety were related to FH. These findings underscore the need for a comprehensive approach in cancer care that concurrently addresses anxiety, depressive symptoms, and FH, recognizing their interconnected impact.

Cancer-related cognitive impairment as a key contributor to psychopathology in cancer survivors: implications for prevention, treatment and supportive care

A significant proportion of cancer survivors will experience some form of mental health compromise across domains including mood, anxiety, psychosis, eating disorders, and substance use. This psychopathology within cancer survivors is related to a range of negative outcomes and can also have a substantial negative impact on quality of life. Along with psychopathology, cognitive impairments are also commonly experienced, resulting in deficits in memory, reasoning, decision-making, speed of processing, and concentration, collectively referred to as cancer-related cognitive impairment (CRCI). Within the non-oncology literature, cognitive deficits are consistently demonstrated to be a key transdiagnostic aetiological feature of psychopathology, functionally contributing to the development and perpetuation of symptoms. Whilst there is an acknowledgement of the role mental health concerns might play in the development of and perception of CRCI, there has been limited acknowledgement and research exploring the potential for CRCI to functionally contribute toward the development of transdiagnostic psychopathology in cancer survivors beyond simply psychosocial distress. Given the theoretical and empirical evidence suggesting cognitive deficits to be an aetiological factor in psychopathology, we provide a rationale for the potential for CRCI to be a factor in the development and perpetuation of transdiagnostic psychopathology in cancer survivors. This potential functional association has significant implications for risk identification, prevention, treatment, and supportive cancer care approaches regarding psychopathology in cancer survivorship. We conclude by providing directions for future research in this area.

Improving the understanding of integrative oncology approaches among hospitalized patients with cancer.

e23234 Background: Many integrative oncology (IO) outpatient (OP) cancer care approaches—yoga, acupuncture, massage, physical activity—have demonstrated benefit and are now part of guideline care. We report on a pilot inpatient (IP) IO consultative service aimed at introducing patients and families to IO at a time when cancer- and treatment-related symptoms can be significant. As a measure of patient-centered care, we assessed patient’s change in perceived understanding, intention to promote health, confidence in care, and plan for IO OP follow up. Methods: IO consultations that assess nutrition, activity, and stress were made available to patients in the Bone Marrow Transplant Unit at Thomas Jefferson University Hospital (TJUH) starting in July 2023 as ordered by the primary oncology team. Consultations (69) have been conducted by an Integrative Medicine Fellow and an attending Board Certified in both Medical Oncology and Integrative Medicine. The post-IO consultation survey includes 7 questions with a 5-point Likert Scale (1 = Do Not Agree, 5 = Completely Agree).The survey was initially offered as an online link. A paper format was developed at patient request. Results: A total of 34 patients (50%) completed the post-consultation survey. Conclusions: Patients expressed a greater likelihood of focusing on wellness through diet, nutrition, meditation, and stress reduction (76.4%) and of taking steps to promote their health (87.9%); as well as an improved understanding of the relationship between nutrition and health (88.2%) and stress and health (88.2%). Patients noted a more positive view of TJUH (84.4%) and greater confidence in their treatment (81.8%). In addition, only 10% of patients decided not to pursue an IO appointment after discharge. These pilot data suggest a benefit to IP IO consultation. [Table: see text]

Abstract PO3-03-07: Patterns of Chemotherapy Utilization among Elderly Patients with Early-Stage Triple-Negative Breast Cancer

Abstract Background: Patterns of adjuvant and neoadjuvant chemotherapy use among patients with breast cancer have changed over time. Historically, adjuvant chemotherapy has been the standard treatment approach for patients with triple-negative breast cancer after surgical resection, aiming to eliminate any remaining cancer cells and reduce the risk of recurrence. Advancements in treatment strategies, research findings, and clinical guidelines have contributed to shifts in cancer care approaches, with an increase in the use of neoadjuvant chemotherapy. In this study, we explore chemotherapy utilization in a large cohort of elderly patients diagnosed with early-stage triple-negative breast cancer (TNBC). Methods: Data were obtained from the SEER- and Texas Cancer Registry (TCR)-linked Medicare databases. We identified female patients aged 66 years or older, diagnosed with early-stage (localized or regional disease) TNBC between 2010 and 2017 with claims until 2019. We identified the use of chemotherapy using HCPCS codes from outpatient and physician’s carrier claims. We used descriptive statistics and analyzed overall chemotherapy utilization and time trends of neoadjuvant versus adjuvant use via the Cochran-Armitage trend test, and evaluated factors associated with chemotherapy use via logistic regression models. This study adhered to the STROBE reporting guidelines for cohort studies. Results: Among 8,848 patients with localized or regional stage TNBC (median age 74) a total of 5,159 (58%) were treated with chemotherapy. The rate of chemotherapy utilization increased yearly from 52% in 2010 to 66% in 2017 (p< 0.001). After multivariable adjustment, any chemotherapy use was associated with recent year of diagnosis (OR=1.77; 95%CI 1.54-2.04), regional stage compared to localized (OR=3.78; 95%CI 3.34-4.27), and Northeastern region compared to South (OR=1.2; 95%CI 1.06-1.37). Conversely, decreased chemotherapy use was associated with age ≥76 (OR=0.24; 95%CI 0.2-0.27), being single (OR=0.76; 95%CI 0.67-0.86), and higher comorbidity score (OR=0.69; 95%CI 0.61-0.78). Among chemotherapy-treated patients, 3,808 (73.8%) received it in the adjuvant setting, 722 (14.0%) received it in the neoadjuvant setting, and 629 (12.2%) received chemotherapy both preoperatively and postoperatively. Among those who were treated with any chemotherapy, the percentage of patients treated with neoadjuvant chemotherapy increased from 15.2% in 2010 to 37.4% in 2017 (p< 0.001). Among patients treated with chemotherapy, neoadjuvant chemotherapy use was associated with recent year of diagnosis (OR=3.38; 95%CI 2.77-4.12), regional stage (OR=3.28; 95%CI 2.86-3.77), and inversely associated with older age (OR=0.77; 95%CI 0.64-0.94), non-White, non-Hispanic, non-Black race or ethnicity (OR=0.64 95%CI 0.45-0.94), non-metro area (OR=0.61; 95%CI 0.5-0.74), and Northeastern region (OR=0.66; 95%CI 0.56-0.78). Conclusion: Our study highlights the significant changes in patterns of adjuvant and neoadjuvant chemotherapy use among elderly patients with early-stage TNBC. We observed an increasing trend in chemotherapy utilization, with a notable shift from adjuvant to neoadjuvant treatment. This transition reflects the evolving landscape of cancer care and the adoption of more personalized approaches to treatment, with increased utilization of neoadjuvant chemotherapy offering opportunities for better risk assessments and tailored treatment strategies. Citation Format: Catalina Malinowski, Xiudong Lei, Sharon Giordano, Marianna Chavez. Patterns of Chemotherapy Utilization among Elderly Patients with Early-Stage Triple-Negative Breast Cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-03-07.

Beyond standard treatment: A qualitative descriptive study of cancer patients' perceptions of hypnotherapy in cancer care

Background and purposeCancer remains a leading cause of death in Australia. The number of new cancer cases diagnosed each year is expected to surpass 200,000 by 2033. This marks a significant increase from about 88,000 cases in 2000 to an estimated 165,000 cases in 2023. Despite advancements in treatment, emotional and psychological challenges in cancer care are often overlooked. This study focuses on hypnotherapy, a complementary therapy recognized for its efficacy for physical and emotional symptoms, yet underutilized in Australian cancer care. The research aims to explore patients' perceptions of hypnotherapy and identify barriers to its integration, contributing to the development of holistic, patient-centered cancer care models. Materials and methodsA qualitative study employing semi-structured interviews was conducted with 14 adult cancer patients (breast, lung, and colorectal) undergoing active treatment, selected through convenience sampling. The interviews were carried out from May 2022 to August 2023, focusing on participants' experiences and attitudes toward hypnotherapy among other complementary and alternative medicine (CAM) therapies. Thematic analysis using Braun and Clarke's six-step framework was applied to the data. ResultsFive themes were developed following analysis: 1) emotional roller coaster of cancer diagnosis, 2) participants’ perspectives on hypnotherapy among other CAM modalities, 3) hypnotherapy as a psychological vs physiological support, 4) fringe benefits of hypnosis, and 5) the main hurdles: cost and lack of information. Participants expressed a diverse range of experiences and attitudes towards hypnotherapy and CAM, with a strong emphasis on the need for emotional support in cancer care. Although hypnotherapy was recognized for its potential to address both emotional and physical symptoms, its predominant use was for emotional well-being. Participants also highlighted the importance of attitudes and endorsements from healthcare providers in their decision-making process about CAM therapies. ConclusionThe study findings emphasize the need for a more integrative and patient-centered approach in cancer care that includes hypnotherapy as a non-pharmacological intervention for physical and particularly emotional support. Healthcare providers should be aware of the potential value of hypnotherapy and consider patient preferences in their recommendations. In addition, addressing the identified barriers could improve the accessibility and integration of hypnotherapy into cancer care protocols in Australia.

"Cancer Perspectives And Recent Advances In Anti-Cancer Drug Research: A Review In The Lens Of Siddha Medicine"

Introduction: Cancer is a global health challenge, demanding innovative approaches for prevention, diagnosis, and treatment. Despite ongoing research efforts, finding a definitive cure for cancer remains a formidable challenge. In response to these challenges, the concept of integrative oncology has gained prominence, aiming to combine conventional treatments with evidence-based complementary therapies. Objective: This review explores the integration of Siddha medicine, an ancient South Indian system, with modern oncology to offer holistic cancer care. Siddha perspectives on cancer, its classifications, etiopathogenesis, diagnostic methodologies, and treatment modalities are thoroughly analysed in comparison with modern approach. Recent research on Siddha medicines demonstrating anti-cancer potential is also being reviewed through a systematic literature analysis. Methodology: Analyses of various Siddha texts is done to know the terminologies and categories of cancer. Siddha's etiopathogenesis, diagnostic methodologies and Siddha treatment modalities are discussed, emphasizing the balance of humours. Recent research on Siddha medicines for cancer treatment is compiled through a systematic literature review. Discussion: The manuscript decodes Siddha's conceptual framework underlying cancer hallmarks, aligning Vatham, Pitham, and Kabam with the eight hallmark capabilities. Siddha diagnostic methodologies, including pulse reading and urine examination, are compared with modern techniques. Siddha treatment modalities, rooted in herbal formulations, are presented. A comprehensive compilation of Siddha drugs with anti-cancer potential is provided, supported by in-vitro, in-vivo, and clinical studies. Conclusion: The multifaceted nature of cancer necessitates a comprehensive approach, and Siddha medicine provides unique insights. While Siddha may not directly align with modern diagnostics, its holistic principles contribute valuably to cancer discussions. Integrating Siddha into mainstream oncology requires scientific rigor, with further research and clinical trials to validate safety and efficacy. The fusion of Siddha wisdom with modern oncology holds promise for a more holistic and patient-centric cancer care approach.

Abstract PR01: Implementation of a real-time AI-guided navigation service for pancreas cancer

Abstract Patient navigation aims to overcome access barriers and optimize care delivery, but navigators cannot identify pre-diagnosed patients using traditional methods, hindering navigation efficacy. We observed care gaps among patients identified at our institution with suspected pancreatic cancer during January 2023: among 67 patients with new pancreas cancer, only 36% underwent biopsy with 22 days between radiology and biopsy; and 30% were seen by an outpatient oncologist with 32 days between radiology and visit. We sought to improve patient care outcomes through daily prospective AI-guided identification and navigation of patients with radiographic findings suspicious for pancreas cancer. In June 2023, we implemented an AI-guided daily workflow using the following steps: 1) at 24-hour intervals, an NLP model reviewed abdominal imaging reports and flagged reports containing language suspicious for pancreatic cancer; 2) a trained coordinator and GI oncologist validated reports with new masses and sent such reports to a GI navigator, and 3) the navigator facilitated appointments for proper follow-up, including GI services, the multi-disciplinary tumor board, and clinical trial coordinator. During June 2023, the model identified 69 patients with suspicion for new pancreas cancer. 19% were immediately eligible for navigation and scheduled for follow-up within our institution with an average of 8 days between report and navigation - 77% saw an outpatient oncologist with an average of 17.5 days between report and visit, 69% underwent biopsy with an average of 4.5 days between report and biopsy, and 54% were seen at multidisciplinary pancreatic cancer tumor board (pcTB) with an average of 16 days between report and pcTB. Furthermore, of these, we were able to enroll 4 patients to clinical trials and 5 accruals to biospecimen studies during this one-month period. 2 of these accruals were to the P-1000 study, which has been open at our institution for the last 2 years with a 0.5 per month accrual rate. Of the 81% who were not immediately eligible for navigation, 23% were already established with an oncologist in our system, 23% sought care elsewhere, 23% were not eligible for or did not desire further workup, and 30% were still undergoing in-patient workup. We show that an AI-guided workflow can transform referral patterns of pre-diagnosed pancreatic cancer patients, creating a new access stream for navigators to intervene much earlier in a patient’s continuum of cancer care with resultant improvement in healthcare delivery, evidenced by an average of 4.5 days between imaging and biopsy and 17.5 days between imaging and outpatient oncology visit, compared to our traditional cancer care approach with averages of 22 and 32 days, respectively. Furthermore, we have rapidly accelerated pancreas cancer clinical trial enrollment and biospecimen accrual at our institution since implementation of this workflow with 4 patients enrolled and 5 biospecimen accruals in a month alone. We are now working to expand this innovative framework across additional cancer types. Citation Format: Kristen M. John, Joseph Tenner, Yuddy Franco, Rolando Croocks, Melissa Perez, Tara McEvoy, Tiffany Zavadsky, Kristen Beyer, Rita Mercieca, Sandeep Nadella, Anthony Carvino, Matthew Barish, Daniel A. King. Implementation of a real-time AI-guided navigation service for pancreas cancer [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Pancreatic Cancer; 2023 Sep 27-30; Boston, Massachusetts. Philadelphia (PA): AACR; Cancer Res 2024;84(2 Suppl):Abstract nr PR01.

Cancer information-seeking profiles: A self-report measure of patients' distinct preferences for information about their cancer.

Contemporary cancer care approaches, such as value- and strengths-based health care, involve integrating patients' needs and preferences, as the cancer experience unfolds. Distinct cancer information-seeking behaviours among patients are increasingly found to influence patient-provider communication, treatment-related decision-making, health processes and outcomes, as well as patient satisfaction with cancer care services. My program of research has already documented diverse cancer information-seeking profiles (CISP) among patients. These profiles can easily be captured by a theory-driven and empirically sound self-report single-item measure presented herein. Guided by Self-Evaluation Theory (SET) - which posits that individuals vary in their motivation to seek information about the self - quantitative work established that SET motives could be reproduced in health-related contexts (N = 600). Qualitative inquiry subsequently explored information-seeking among individuals with various cancer diagnoses. Based on this series of studies, a CIPS measure (containing a general question which prompts individuals to choose the most representative statement based on five descriptions of distinct informational profiles) was tested in a large sample of individuals with diverse cancers. In this latter sample (N = 2,142), patients were administered the CISP and the Ambulatory Oncology Patient Satisfaction Survey (AOPSS). The most frequently reported CISP was complementary (50.2%, i.e., search for cancer information that added to what patients already knew), followed by minimal (25.2%, i.e., no search for cancer information), then guarded (14.4%, i.e., avoiding negative and only seeking hopeful cancer information), peer-focused (6.4%, i.e., search for cancer information from similar others), and last, intense (3.8%, i.e., seeking as much cancer information as possible). These profiles were also differentially related to care satisfaction with intense profiles being the least satisfied across all cancer care domains. The CISP measure can readily assess patients' profiles in the search for (or avoidance of) information about their cancer so that more personalized interventions can be provided. Future research exploring how CISP evolves, as the cancer experience unfolds, is also worthy of further study.

Helping Diagnosed Mothers and Their Adolescent-Young Adult Daughters Navigate Challenging Breast Cancer Conversations.

Mothers diagnosed with breast cancer describe daughters as a critical source of support. Talking about breast cancer is especially distressing and challenging for mothers and their adolescent-young adult (AYA) daughters. The over-arching study aim was to generate findings to integrate into an intervention to enhance diagnosed mothers' and AYA daughters' communication skills by identifying approaches they find helpful when talking about cancer. We recruited 27 women (12 dyads). Diagnosed mothers and their AYA daughters (aged 18-29) participated in individual, in-depth, semi-structured interviews. Transcripts were thematically analyzed. Mothers'/daughters' perspectives were compared/ triangulated. Both mothers and daughters identified 3 approaches that helped them navigate cancer communication: (mothers) initiate conversations, keep communication positive, and limit cancer conversations. Only mothers reported it was helpful to downplay the seriousness of cancer. Only daughters identified it was important for them to reframe their perspective of mothers' disclosures. Findings provide clinicians like nurses and families with a "psychosocial map" of communication approaches and associated strategies mothers and AYA daughters can use to talk about breast cancer in ways that promote daughters' comfort and/or alleviate distress. Findings capture communication skills to focus on when tailoring developmentally focused interventions targeting diagnosed mothers and AYA daughters. Nurses can translate findings into practice to help patients talk to AYA daughters about cancer, thereby promoting a family-centered cancer care approach. What Is Foundational: AYA daughters are especially distressed talking about cancer with their diagnosed mothers. They can both use communication strategies to enhance their communal coping.

Impact of a web-based educational program on Japanese nurses tobacco cessation practice and attitudes in oncology settings.

To evaluate the effects of a short web-based educational program on Japanese nurses' self-reported attitudes toward tobacco cessation and their use of interventions to help smokers to quit. Prospective, single-group design with a pre-educational survey, a short web-based educational program, and a follow-up survey at 3months. Clinical nurses were asked to view two prerecorded webcasts about helping smokers quit. They completed two online surveys, one at baseline and one at a 3-month follow-up. Generalized linear models were used to determine changes in nurses' self-reported routine practice after the study intervention. A total of 1401 nurses responded to the baseline survey, 678 of whom completed the follow-up survey. Compared with baseline, nurses at follow-up were more likely to advise smokers to quit (odds ratio [OR]=1.45, 95% confidence interval [CI: 1.15, 1.82]), assess patients' interest in quitting (OR=1.46, 95% CI [1.01, 1.04]), and assist patients with smoking cessation (OR=1.34, 95% CI [1.04, 1.72]). However, the proportion of nurses who consistently recommended resources for tobacco cessation did not significantly improve at follow-up. This study provides preliminary evidence that a web-based educational program can increase nurses' implementation of tobacco dependence interventions in cancer care practice. Sustaining these educational efforts could increase nurses' involvement in providing these interventions, encourage nurses to refer patients to cessation resources, and support nurses' attitudes towards their role in smoking cessation. Our short web-based educational program can increase nurses' use of tobacco-dependence interventions in cancer care practice. This role can be enhanced with additional information about existing cessation resources that nurses could use to refer patients for support post-discharge. Japanese nurses, when properly educated, are willing and significant contributors to promote tobacco use cessation for cancer patients. The contribution can be facilitated through nursing care protocol that integrate tobacco use cessation interventions within evidence-based cancer care approaches.

FAMILY INTERVENTIONS TO DEAL WITH PSYCHO SOCIAL PROBLEMS OF CARETAKERS OF PERSONS LIVING WITH CANCER – CASE STUDY

Family has a central role at the time of crisis. When an individual suffers with terminal illness like Cancer it definitely becomes more supportive. But in a crisisful situation like such, the family requires supportive interventions. This article presents a case study of primary caretaker of a cancer patient who undergoes severe psycho social challenges. Aim of this paper is to highlight the need and effectiveness of family intervention by Medical Social Worker through a case study. Psycho education to family, team work, utilizing the resources has shown remarkable results in reducing the psycho social problems of caretaker. Family environment plays a very significant role in psycho social support of its members. Positive environment and family socialization experiences enhances one’s ability to cope with stress and anxiety. Hence family interventions for caretakers of persons living with cancer can support both care givers and patients. Multidisciplinary approach in cancer care is the need of the hour. It can build a proper support mechanism for the person suffering from cancer and his family. The most important implication of the current study is the unveiling of the need for Medical Social Workers in oncology settings and the interventions they can deliver. A professionally trained medical Social Worker, equipped with psycho social skills to work with caretakers, patients and their families can be a effective oncology Social Worker

Late presentation and suboptimal treatment of breast cancer among Syrian refugees: a retrospective study.

ObjectivesThe crisis in Syria has had a profound impact on the entire region. In this study, we report the patterns of presentation and management of Syrian patients with breast cancer treated at our institution.MethodsWe retrospectively collected data on Syrian refugees treated for breast cancer over the past 10 years at our center. Management was compared against our approved clinical practice guidelines.ResultsA total of 113 patients were eligible and included. The median age (range) at diagnosis was 47 (21–84) years and most women presented with locally advanced or metastatic disease (n = 74, 65.5%). Breast-conserving surgery and breast reconstruction were performed in 27 (33.8%) and 11 (35.4%) patients, respectively. Only a few patients received targeted (35.5%) or advanced endocrine therapy (30.0%). In total, 37 (32.7%) patients had considerable deviations from our institutional treatment guidelines and had worse outcomes.ConclusionsSyrian refugees with breast cancer present late, have more advanced-stage disease, and are more likely to receive delayed and suboptimal therapy. An international systematic approach for cancer care among such vulnerable populations is urgently needed.

Precision Oncology via NMR-Based Metabolomics: A Review on Breast Cancer.

Precision oncology is an emerging approach in cancer care. It aims at selecting the optimal therapy for the right patient by considering each patient’s unique disease and individual health status. In the last years, it has become evident that breast cancer is an extremely heterogeneous disease, and therefore, patients need to be appropriately stratified to maximize survival and quality of life. Gene-expression tools have already positively assisted clinical decision making by estimating the risk of recurrence and the potential benefit from adjuvant chemotherapy. However, these approaches need refinement to further reduce the proportion of patients potentially exposed to unnecessary chemotherapy. Nuclear magnetic resonance (NMR) metabolomics has demonstrated to be an optimal approach for cancer research and has provided significant results in BC, in particular for prognostic and stratification purposes. In this review, we give an update on the status of NMR-based metabolomic studies for the biochemical characterization and stratification of breast cancer patients using different biospecimens (breast tissue, blood serum/plasma, and urine).

Abstract PS7-73: Late presentation and suboptimal treatment of breast cancer among Syrian refugees. A call for systematic international action

Abstract Introduction: The Syrian crisis, started in 2011, has had a profound impact on the entire region. Jordan, a low-middle income country with limited resources is ranked first in the region in relation to the number of refugees hosted. The latest national census reported over a million Syrian refugee in the country. Lack of sufficient funding, from either the host country or international refugee aid organizations, may lead to suboptimal treatment of cancer patients. The total number of Syrian cancer patients registered at King Hussein Cancer Center (KHCC) hospital-based cancer registry was 510 patients. Local and regional funds covered the treatment of almost two thirds of these patients. In this study, we report on patterns of presentation and management of Syrian patients with breast cancer treated and followed at our institution. Patients and methods: This is a retrospective data collection of Syrian refugees who presented to our institution with a diagnosis of breast cancer from January 2011 to December 2019. Adult patients aged 18 year or older with pathologically-confirmed diagnosis of breast cancer were required to have at least one medical encounter. Data was collected from the electronic medical records for eligible patients. Management was compared against our approved clinical practice guidelines (CPG). Results: During the study period, a total of 147 adult Syrian refugee patients with breast cancer had at least one medical encounter at our institution. All were females and median age (range) at diagnosis was 47 (21-84) years. Thirty-four (23.1%) patients did not complete the work up and missed subsequent visits and will be excluded from analysis. The remaining 113 patient had biopsy proven invasive (n=110) or ductal carcinoma in situ (n=3) and continued their treatment and follow up; 39 (34.5%) had early stage disease, 48 (42.5%) locally advanced and 26 (23.0%) presented with metastatic disease. Estrogen receptors (ER) were positive in 75 (66.4%) patients while 63 (55.8%) had positive progesterone receptor (PR). HER2 positive disease was documented in 31 (27.4%) while 18 (15.9%) patients had triple negative disease. Eighty (70.8%) patients underwent surgery, 60 (75.0%) were at KHCC. The median time from first encounter to surgery for those who underwent upfront surgery was 2 months. Breast conserving surgery (BCS) was done for 27 (45.0%). However, only 11 (35.4%) of the 31 patients eligible for breast reconstruction underwent such procedure. Adjuvant radiation was given to 49 (77.7%) of 63 candidate patients and some were delayed. Systemic treatment with chemotherapy was given to 103 patients; as neoadjuvant (n=37, 35.9%), adjuvant (n=45, 43.7%) and palliative (n= 21, 20.4%). Among the 31 patients with HER2-positive disease, only 11 (35.5%) patients received it. Additionally, only 3 (30.0%) of 10 patients who were candidates for CDK4/6 inhibitors received it. Genetic Testing and counselling were also suboptimal, only 8 (12.3%) of 65 candidate patients underwent genetic testing. Across all needed treatment, 37 (32.7%) patients had significant deviations when judged against our institutional CPGs. Conclusions: Syrian refugees with breast cancer had late presentation and more advanced-stage disease. They are more likely to receive delayed and suboptimal surgeries, genetic counseling and systemic therapy highlighting the urgent need for international systematic approach for cancer care among such unprivileged population. Citation Format: Hikmat Abdel-Razeq, Faris Tamimi, Maryam El-Atrash, Baha' Sharaf, Razan Mansour, Rawan Mustafa. Late presentation and suboptimal treatment of breast cancer among Syrian refugees. A call for systematic international action [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-73.

Web-Based Patient Self-Reported Outcome After Radiotherapy in Adolescents and Young Adults With Cancer: Survey on Acceptance of Digital Tools.

BackgroundeHealth and mobile health (mHealth) are an evolving trend in the medical field. The acceptance of digital tools is high, and the need is growing.ObjectiveYoung adults (18-40 years) confronted with a cancer diagnosis present unique needs and require special care. They often have a strong affinity and are familiar with modern technology. On that account, we implemented a web-based symptom and quality of life (QoL) assessment to address patients’ attitudes and willingness to use mHealth tools. The study also aims to evaluate sociodemographic parameters that could influence patients’ opinions.MethodsA total of 380 young patients aged 18-40 treated with radiotherapy between 2002 and 2017 were included in the trial. We assessed QoL via the European Organization for Research and Treatment of Cancer-Core 30 (EORTC C30) questionnaire and added general questions about mHealth technology. The added questions inquired patients’ opinions regarding general aspects, including technical advances in medicine, mobile and app assistance during cancer treatment, data transfer, and app-specific features. The survey was conducted for 12 months. Participation was voluntary and pseudonymized; prior written consent was obtained.ResultsWe achieved a participation rate of 57.6% (219/380) and a completion rate of 50.2% (110/219). The median age was 33 years (range 18-40). Of all participants, 89.1% (98/110) considered new technologies in medicine as positive; 10.9% (12/110) answered with neutral. Nearly all patients (96.4%, 106/110) stated that they would send further data via a web-based platform. Of all, 96.4% (106/110) considered the provided pseudonymization of their data as safe. We further asked the patients if they would use a mobile app for symptom and QoL assessment similar to the present web-based system: 74.5% (82/110) answered with yes and 25.5% (28/110) said they would not use a mobile app in the future. We tested the willingness to use an app on several sociodemographic parameters, such as age, gender, education, health insurance status, and cancer-related parameters: tumor stage, time since radiation treatment, and treatment intention. None of these parameters correlated with app use in this group of young adults. Patients who were generally positive regarding using an app rated several possible functions of a future app. The 3 most requested features were appointment reminders (89.0%, 73/82), contact overview of all involved clinics and physicians (87%, 71/82), and making an appointment via app (78%, 64/82).ConclusionseHealth and mHealth tools should be available as an integrated part of a comprehensive cancer care approach. It provides automated, thorough documentation of health parameters during therapy and follow-up for doctors, medical staff, and tumor patients to optimize treatment. With this study, we could show that young adults are the ideal patient population to use eHealth/mHealth tools. Such tools offer further digital support and improve the patients’ need for constant QoL during cancer care.

Challenges and solutions to sharing a cancer follow-up e-care plan between a cancer service and general practice.

This paper describes the process of developing a shared cancer care approach in follow-up, and identifies the e-health options that support an interactive e-care plan shared between a public cancer service, general practitioners (GPs) and cancer survivors. Type of program/service: The cancer service improvement initiative for shared care in follow-up targets colorectal cancer patients who have completed active treatment and who agree to shared care between specialists, GPs and other care team members. The intiative is supported by an agreed shared care pathway and an interactive e-care plan that is dynamic, can be shared and has functionalities that support collaboration. Design and development: A consultative process with stakeholders (local and state health services, a Primary Health Network, GPs and a consumer) was undertaken. Responses from individual consultations (25 stakeholders) were collated and commonalities identified to inform a workshop with 13 stakeholders to obtain consensus on the care pathway and e-health solution. Implications for policy and practice were identified throughout the process. The stakeholders agreed to a shared care pathway, which included assessment and consent, GP engagement, tailoring the care plan and communicating results and information as tasks are completed. The nurse coordinator monitored care. No interactive e-care plans were available at national, state or local health service levels. A web-based GP interactive e-care plan was selected. The main concerns raised were uncertainty about the security of e-health systems not controlled by the local health service and sharing clinical information with external health providers, engaging GPs, and patient anxiety about the capacity of general practice to provide care. The e-care plan provided a low-risk solution to sharing patient information and supported collaborative care. Challenges to share e-care plans have implications for policy and practice. Stakeholders and the project team agreed that finding an e-health system that supported shared cancer care in follow-up and addressed the security and information sharing concerns could not all be adequately addressed at the local level. A GP interactive e-care plan provides a promising solution to a number of the barriers.

Virtual Oncology in the Time of COVID-19 Pandemic: Moving Forward!

Virtual Oncology in the Time of COVID-19 Pandemic: Moving Forward!

Benefits and Limitations of a Multidisciplinary Approach in Cancer Patient Management.

Over the years, a growing body of literature has confirmed as beneficial the implementation of a multidisciplinary approach in the so-often-intricate scenario of cancer patients’ management. Together with the consolidation of tumor-board experience in clinical practice, certain aspects have emerged as controversial and a source of current debate. In this systematic literature review, we focused our attention on the impact of multidisciplinary tumor boards, assessing benefits and limitations as a result of the dissemination of such approaches. On the bright side, adherence to clinical guidelines, treatment outcomes, and overall improvement in decision-making processes have been recognized as advantages. On the other side, our analysis highlights a few limitations that should be taken into account to optimize cancer patients’ management. Of note, some issues, such as costs, legal responsibility, geographic barriers, and treatment delays, have yet to be resolved. In order partly to address this matter, software platforms and novel methods of computational analysis may provide the needed support. Therefore, the aim of our analysis was to describe the multidisciplinary approach in cancer care in terms of adherence to clinical guidelines, treatment outcomes, and overall improvement in decision-making processes through a systematic review of the literature.

Saudi Cancer Patient Experience: Benchmarking a single center report to the United Kingdom National Experience.

e14138 Background: Diagnosis and treatment of cancer are regarded as stressful experiences impacting the patients and their families. This study aims at comparing the Saudi cancer patient experience with the United Kingdom cancer patient experience throughout their continuum of care. Methods: Results from the United Kingdom (UK) National Cancer Patient Experience Survey (NCPES 2017) were compared to the reported results from the experience of 100 cancer patients for the same year at the National Guard Health affairs Health system in Riyadh, Saudi Arabia. Similar concepts relating to the experience were investigated and compared. Results: Compared to the UK survey, the Saudi survey had mainly higher score regarding receiving an overall positive cancer care. Scores related to provision of clear answers to all important questions, judging the hospital staff as always working well together, and family members being given the opportunity to communicate with the doctor were significantly higher among Saudis. The UK patient scored significantly higher on receiving information about diagnostic tests, treatment side effects, and discharge instructions, and being informed about support groups and on-going cancer research. Conclusions: The overall experience of the Saudi cancer patients compared favorably to the UK cancer patients; however, in the domain of information provision as an essential part of the cancer experience is still lacking in the Saudi cancer care approach. Quality improvement should focus on the findings of this study for better health outcomes. [Table: see text]

Taking control over our health: Empowerment as perceived by young adults living with advanced cancer.

Health-related empowerment is a key concept in person-centred care. However, little is known of its core elements in young adults diagnosed with advanced cancer. To explore empowerment in the context of young adults' healthcare experiences who are now in advanced stages of cancer. Twelve young adults (aged 21 to 39 years) were recruited from a large cancer centre in Montreal, Quebec. In-depth interviews lasting between 36 and 90 minutes were conducted individually, audio-recorded, transcribed verbatim, and analyzed using thematic analysis. Throughout the cancer trajectory, participants reported a sustained desire to be actively involved in their treatment and care. Four themes emerged from the data representing processes of waiting, managing, acting, and revisiting. Subsumed under these were notions of body ownership, facing obstacles to care, optimizing health, and (re)considering their legacy. Overall, participants wanted to remain in control of their situation despite the multiple challenges related to advanced cancer. If corroborated further, these findings should inform supportive cancer care approaches that are truly tailored to the needs of young adults.