Access To Cancer Care Research Articles

Strategies to Make Telemedicine a Friend, Not a Foe, in the Provision of Accessible and Equitable Cancer Care.

Telemedicine has the potential to improve access to cancer care, particularly for patients with functional limitations, high symptom burdens, or financial or geographic constraints. However, there is also a risk that telemedicine can widen healthcare disparities among patients facing systemic disadvantages like those with technological barriers, poor digital literacy, older age, or non-English language preferences. To optimize telemedicine usage, we must implement practical strategies like video onboarding programs, user-friendly technology platforms, optimizing the clinician's environment, and best practices for using interpreters. Policy changes such as state licensing requirements, controlled substance prescribing requirements, and payment parity are also crucial. This Perspective highlights these practical strategies and policy recommendations to ensure accessible and equitable cancer care augmented by telemedicine.

An investigation into the awareness of cancer and it's social determinants in the Fiji Islands

Abstract Introduction Cancer is a major public health concern worldwide, with increasing mortality rates, especially in low-middle income countries. The predicted global cancer burden by 2040 is expected to be over 27 million new cases per year, a nearly 50% increase compared to 2018. This research presents recent statistics on cancer incidence and mortality in Fiji from 2010 to 2018 and the barriers associated with early detection of cancer. Methods The study used a mixed-method model to determine cancer incidence and understand the factors associated with accessing breast cancer care in the Fiji Islands. Age-standardized incidence and mortality rates were calculated and semi-structured interviews were conducted with breast cancer patients, community women, a health care professional and a traditional healer. Results This study analysed cancer rates in Fiji from 2010 to 2018. Out of 12,433 reported cases, women had higher incidence rates (8,457 cases) compared to men (3,965 cases), but men had a higher death rate of nearly 59%. Breast, cervical, and endometrial cancer were the top three cancers among women, while prostate, liver, and lung cancer were the top three among men. Education, awareness, culture and distance were some of the factors identified as barriers to accessing cancer care services. Conclusions The findings emphasize the need to understand lifestyle factors affecting cancer risk, especially among women and rural populations. It underscores the importance of prioritizing cancer epidemiology, prevention, and control at the national level and investing in improved cancer treatment delivery. These efforts can help address the challenges of cancer in Fiji and reduce its burden on individuals. Key messages • The analysis serves as a foundation for future research to understand the barrier to access cancer healthcare services. • This research aims to inform strategies for early detection of cancer and timely treatment for men and women in the Fiji Islands.

Hidden Disparities: How Language Influences Patients' Access to Cancer Care.

Patients with limited English proficiency, a vulnerable patient population, remain understudied in the literature addressing cancer disparities. Although it is well documented that language discordance between patients and physicians negatively impacts the quality of patient care, little is known about how patients' preferred spoken language impacts their access to cancer care. Between November 2021 and June 2022, we conducted an audit study of 144 hospitals located across 12 demographically diverse states. Using a standardized script, trained investigators assigned to the roles of English-speaking, Spanish-speaking, and Mandarin-speaking patients called the hospital general information telephone line seeking to access care for 3 cancer types that disproportionately impact Hispanic and Asian populations (colon, lung, and thyroid cancer). Primary outcome was whether the simulated patient caller was provided with the next steps to access cancer care, defined as clinic number or clinic transfer. We used chi-square tests and logistic regression analysis to test for associations between the primary outcome and language type, region type, hospital teaching status, and cancer care requested. We used multivariable logistic regression analysis to determine factors associated with simulated patient callers being provided the next steps. Of the 1,296 calls, 52.9% (n=686) resulted in simulated patient callers being provided next steps to access cancer care. Simulated non-English-speaking (vs English-speaking) patient callers were less likely to be provided with the next steps (Mandarin, 27.5%; Spanish, 37.7%; English, 93.5%; P<.001). Multivariable logistic regression found significant associations of the primary outcome with language spoken (Mandarin: odds ratio [OR], 0.02 [95% CI, 0.01-0.04] and Spanish: OR, 0.04 [95% CI, 0.02-0.06] vs English) and hospital teaching status (nonteaching: OR, 0.43 [95% CI, 0.32-0.56] vs teaching). Linguistic disparities exist in access to cancer care for non-English-speaking patients, emphasizing the need for focused interventions to mitigate systems-level communication barriers.

Trends of travel burdens to access cancer care among children with cancer: analysis of a population-based cancer registry data in Aichi, Japan.

Centralization of childhood cancer treatment in specialized hospitals is necessary for quality treatment and care, but imposes a time and cost burden for patients and their families. We investigated the 20-year trend in the patients' car travel burden to reach cancer-care hospitals in Aichi Prefecture, Japan. From the Aichi population-based cancer registry data, 1,741 cases diagnosed in 1998-2017 under 15 years of age were extracted and assigned to three treatment groups: invasive treatment (n = 697), radiotherapy (n = 371), or chemotherapy groups (n = 1,462), allowing for duplicate assignment. Their travels to access each treatment hospital were estimated and summarized as the estimated travel times (ETT), estimated travel distances (ETD), and direct distances (DD). The ETTs were compared using the Brunner-Munzel test. The average cases per year for each hospital were plotted. The annual trends during 1998-2017 on ETT, ETD, and DD were investigated using Joinpoint regression models. The ETTs were 0.38-0.45 hours on median for three periods (1998-2005, 2006-2012, and 2013-2017) in three treatment groups and increased by 0.02-0.07 hours from 2006-2012 to 2013-2017, with a statistically significant difference in the radiotherapy group (0.07 hours, P = 0.037). The average cases per year increased for the top hospital in each group, and regression model analyses showed no joinpoint on the annual median trend. In conclusion, the increases in travel times were small and not considered clinically significant, and treatment centralization was observed from 2006-2012 to 2013-2017.

Barriers in quest for cancer care access in two states of northeast India.

The cancer burden in northeast India is high, with low survival and low case detection. Despite the availability of cancer institutes in the region, existing literature remarks on the increasing travel outside the region for cancer care. However, research is sparse on identifying impediment factors to the access of state cancer institutes. To examine the barriers to cancer care in five common cancer sites: oral, lungs, stomach, breast and cervix. Following a descriptive multiple-embedded case study design integrating quantitative and qualitative approaches, 388 participants were selected in phase one by stratified random sampling. In phase two, by purposive sampling, 21 semi-structured interviews were conducted. The result suggests that family decision is the central factor in cancer care access. Treatment initiation is delayed because the existing government health insurance scheme does not cover diagnostic tests. Adverse steps are taken to fund cancer treatment. Besides, opting for alternative medicines were due to fear of surgery, chemotherapy and recommendations by relatives. Arranging accommodation, transportation and infrastructure shortage was another hurdle. In contrast, the lack of awareness of the state cancer institutes was a barrier to its access. This paper identifies and describes factors that hinder access to state cancer institutes. The findings could enhance policy interventions for efficient cancer care access in the region. Integration with NGOs working at the state level for cancer services would support ease of access by providing funds for diagnostic tests, accommodation and transportation, especially for those who cannot afford it.

Does community size impact survival with breast cancer? Data from a large population-based cohort in British Columbia.

e18618 Background: Patients with breast cancer residing in rural settings have a unique set of challenges in accessing cancer care. How rural residence impacts disease-related outcomes is not fully understood. This study is a descriptive and quantitative analysis of geographically determined differences in patient presentations, treatment choices and outcomes for individuals diagnosed with breast cancer in rural and urban communities in British Columbia. Methods: Using BC Cancer’s Breast Cancer Outcomes Unit database, we identified all patients referred with newly diagnosed invasive breast cancer at any stage between 2005-2018. Using postal code, we then categorized patients as residing in either an urban (population ≥ 100,000) or rural setting ( &lt; 100,000), using the Statistics Canada classification of community size. We analyzed baseline clinical-pathological features, patterns of initial treatment, and outcomes differences between urban and rural settings. We performed a univariable analysis examining differences in locoregional relapse, distant relapse and breast cancer-specific survival (BCSS) between urban and rural cohorts. We then performed a multivariable analysis accounting for age, grade, lymphovascular invasion (LVI), subtype, stage, initial treatment with chemotherapy, endocrine therapy (ET), radiotherapy (RT) and type of definitive surgery. Results: The median follow up was 9.7 years for 35,255 patients. 9244 patients in rural and 26011 in an urban setting. There were no clinically meaningful differences in age, LVI, grade, subtype and stage at diagnosis between the urban and rural cohorts. Patients residing in a rural setting were significantly more likely to be treated with mastectomy (43.4% vs. 39.1%), less likely to receive RT (61.4% vs. 67.7%) and less likely to receive ET (67.2% vs. 71.7%). However, there was no difference in use of chemotherapy or anti-HER2 therapies between cohorts. On univariable analysis, urban residency was associated with improved BCSS (86.5% [86.0-86.9%] vs. 85.3% [95% CI: 84.5-86.1%], p &lt; 0.001), and lower risk of distant relapse (12.1% [11.7-12.6%] vs. 13.4% [12.6-14.1%], p &lt; 0.001). There was no influence on locoregional relapse. On multivariable analysis, urban residency was associated with improved BCSS, with a hazard ratio (HR) of 0.92 [0.86-0.99, p = 0.03], and lower risk of distant relapse (HR = 0.91 [0.85-0.98, p = 0.01]), but no influence on locoregional relapse. Conclusions: Rural residency is a significant and independent risk factor for both distant relapse and mortality from breast cancer. It is also associated with less use of ET and RT. Understanding the factors that contribute to these disparities is necessary to close the gap between rural and urban breast cancer outcomes.

Navigator utilization rates in breast cancer patients by race in a comprehensive cancer center.

e18501 Background: African-Americans have the highest overall cancer death rate and shortest survival time of any racial or ethnic group in the United States. Elucidation of disparities in cancer care access is important since previous work has indicated that when equal access to Radiation Therapy (RT) in prospective randomized trials is granted, race does not independently affect outcomes. The most common cancer studied in African-American radiation therapy (RT) access disparities research is breast cancer. Furthermore, prospective analyses have demonstrated that African-Americans receive hypofractionation following breast-conserving surgery less frequently than Caucasians. As such, the goal of this study is to eventually evaluate the impact of patient navigation on short-course RT access for African-American breast cancer patients. Methods: Our study is a prospective survey-based evaluation of the impact of patient navigation on access to hypo-fractionated RT and financial toxicity in African-American breast cancer patients. As the first step to investigating the impact of patient navigation on RT access in this population, medical records of women with breast cancer in our center (University Hospitals Cleveland Medical Center, Seidman Cancer Center) were identified from support groups. The baseline navigation rate for this population was determined from the initial data collected during tumor board sessions from June 2022 through October 2022. Results: We identified female patients who were diagnosed with breast cancer and thus were eligible for navigation. From June 1st through October 31st, 30 female patients were identified. Nine (30%) were Caucasian and 21 (70%) were African-American. Of the 21 African-American female patients, only four (19%) were connected with patient navigation services. Of the 9 Caucasian female patients, only four (44.4%) were connected with patient navigation services; this difference between African-American and Caucasian patients did not reach statistical significance. The total baseline navigation rate at our center during this period was 26.67% (8 out of 30 patients). Conclusions: Over a recent five-month period, it was determined that the baseline navigation rate for Caucasian female breast cancer patients is numerically more than 2x that of African-American female patients at our comprehensive cancer center. This information is an important precursor to the first investigation of the impact of patient navigation on reducing RT access disparities facing African-American breast cancer patients. We anticipate that after collating and analyzing survey results for patients pre-RT versus post-RT as well as for those with versus without patient navigation, navigation will serve to overcome barriers in compliance to therapy and increase adherence to optimal care.

Patient navigation educational curriculum for cancer care in Mexico.

e18592 Background: In Latin America (LatAm), cancer is a major public health issue with high mortality rates. Patient navigation (PN) programs have emerged as a strategy to improve access to cancer care for underserved populations. Unfortunately, there is a lack of educational opportunities for those willing to become patient navigators in LatAm. The aim of this study was to develop and implement an educational PN curriculum for healthcare workers interested in improving cancer care in Mexico. Methods: A multidisciplinary team of national top-level cancer experts designed an online comprehensive PN curriculum, which was implemented online following the ECHO model. It consisted of a four-day virtual conference including virtual lectures and workshops. Participants were ask to develop or improve PN programs tailored for their specific institutional needs. After the conference, attendees were tasked with implementing their planned programs. They participated in eight monthly conference video calls designed to reinforce PN project implementation, assist in overcoming barriers and continue conversations with expert faculty. Participants completed pre- and post- course knowledge and satisfaction questionnaires. Progress of participants’ individual goals implementation was assessed at 4 and 8 months after the conference. Results: 28 participants attended the online conference, 56% of them were physicians, 16% psychologists, 4% nurses, and 4% social workers. 89% worked in a public hospital, 72% took care of adults with solid cancer, and 28% of children with hematologic/solid cancers. 93% considered the program was excellent and 100% that the information improved their knowledge. Participants’ baseline knowledge score was 66% (range 27-76%) with a significant increase in the proportion of correct answers of 12% (p &lt; 0.01) at the end of the program (final score 74%; range 58-84%). At 4- and 8-month follow-up, participants reported 54% and 60% of progress regarding their goals on implementing a PN program at their institutions. Most common barriers to PN program implementation were communication issues with other healthcare providers in 44% of participants, and lack of financial support in 11%. At 8 months, most participants felt that they were well prepared for providing PN for patients with cancer (mean = 4.2/5; SD 0.42); and well prepared for managing patient and institutional barriers for cancer care (mean = 4/5; SD 0.67). Conclusions: Our results showed that implementing a virtual educational PN curriculum was feasible, that healthcare providers' knowledge on PN topics significantly increased and that it helped with their PN implementation plans. Educational PN programs like the one we propose could help and guide healthcare providers to implement PN programs for cancer care at institutions across countries in LatAm, where patients face similar barriers for accessing cancer care.

Cancer-related information behavior among Black and Hispanic populations in an NCI-designated comprehensive cancer center catchment

ObjectiveThis study aims to better understand health behaviors, particularly health information seeking, and how this impacts cancer care within underserved minority populations in a specific catchment area in Florida. MethodsWe conducted an analysis of survey data from a 2019 community health survey conducted by the Moffit Cancer Center (MCC). We utilized the Comprehensive Model of Information Seeking (CMIS) as a framework and performed structural equation modeling (SEM) and related statistical analyses. ResultsOur findings confirm that characteristics and demographics present a positive relationship to Online Health Information Seeking (OHIS). We also found that Utility had a negative significant relationship to OHIS. ConclusionsWe concluded that the CMIS is a useful framework for studying cancer-related information seeking, and that when properly executed in the confines of a study, can lend itself to in-depth statistical analyses as found in SEM. ImplicationsThe SEM revealed the CMIS to be promising with results in our analysis worthy of further investigation of cancer care and healthcare information access considering undeserved and minority populations. Practice ImplicationsModels such as the CMIS can be useful for understanding information seeking behaviors and to design information and communication interventions to improve access and health outcomes.

Disparities in geospatial patterns of cancer care within urban counties and structural inequities in access to oncology care.

To examine geospatial patterns of cancer care utilization across diverse populations in New Jersey-a state where most residents live in urban areas. We used data from the New Jersey State Cancer Registry from 2012 to 2014. We examined the location of cancer treatment among patients 20-65 years of age diagnosed with breast, colorectal, or invasive cervical cancer and investigated differences in geospatial patterns of care by individual and area-level (e.g., census tract-level) characteristics. Multivariate generalized estimating equation models were used to determine factors associated with receiving cancer treatment within residential counties, residential hospital service areas, and in-state (versus out-of-state) care. We observed significant differences in geospatial patterns of cancer treatment by race/ethnicity, insurance type, and area-level factors. Even after adjusting for tumor characteristics, insurance type, and other demographic factors, non-Hispanic Black patients had a 5.6% higher likelihood of receiving care within their own residential county compared to non-Hispanic White patients (95% CI: 2.80-8.41). Patients insured with Medicaid and those without insurance had higher likelihoods of receiving care within their residential county compared to privately insured individuals. Patients living in census tracts with the highest quintile of social vulnerability were 4.6% more likely to receive treatment within their residential county (95% CI: 0.00-9.30) and were 2.7% less likely to seek out-of-state care (95% CI: -4.85 to -0.61). Urban populations are not homogenous in their geospatial patterns of cancer care utilization, and individuals living in areas with greater social vulnerability may have limited opportunities to access care outside of their immediate residential county. Geographically tailored efforts, along with socioculturally tailored efforts, are needed to help improve equity in cancer care access.

NCCN Highlights Best Practices for Challenges in Oncology

NCCN Highlights Best Practices for Challenges in Oncology

Access to urologic cancer care for Medicaid-insured patients.

The expansion of state Medicaid programs associated with the Affordable Care Act has led to significant increases in insurance coverage for economically vulnerable patients, however barriers to accessing cancer care still exist. To develop strategies to improve healthcare access, we characterized access to new urologic cancer care for patients with Medicaid insurance in the United States. Using a secret shopper approach, we contacted a representative sample of facilities designated for cancer care in United States. Trained volunteers posed as a family member seeking urologic cancer care using a simulated scenario of a parent with a new diagnosis of a localized kidney tumor. The primary study outcome was acceptance of Medicaid. In addition, we assessed facility characteristics associated with Medicaid acceptance relating to state Medicaid expansion status, Medicare reimbursement rates, and teaching hospital status using data from the Medicare & Medicaid Services Hospital General Information data file, the American Hospital Directory, and the American Medical Association of Colleges Organizational Characteristics Database. We sampled a total of 389 facilities, of which 14.4% did not accept new Medicaid patients. Medicaid acceptance was higher in facilities located in states that elected to expand Medicaid through the ACA vs. non-expansion states (90.1% vs. 77.4% respectively, P < 0.001). Facilities accepting patients with Medicaid were located in states with higher mean Medicaid-to-Medicare fee indexes (0.70 for Medicaid-accepting vs. 0.65 for non-accepting facilities, P < 0.001). In addition, Medicaid acceptance was higher in teaching hospitals vs. non-teaching facilities (93.8% vs. 83.4% P = 0.02), and medical school affiliated facilities (89.2% vs. 79.7% P = 0.01). We identified access disparities for patients with Medicaid insurance seeking urologic cancer care at centers. These findings highlight opportunities to improve the quality and timeliness of cancer care.

An examination of cancer literacy among Appalachian versus non-Appalachian Kentucky college students

Objective Examine factors contributing to high rates of Appalachian female cancer incidences and mortalities by examining cancer literacy and associated sociological influences among Appalachian university students. Participants This study evaluated Appalachian and non-Appalachian undergraduate students in Eastern Kentucky. Methods A Qualtrics survey was disseminated which categorized questions into three parts: demographic, female focused cancer literacy, and cancer care access. Results Overall cancer literacy was low (67.45%, 139 respondents); no difference was found in Appalachian standing. Male students had lower scores (p < 0.05), and both cancer-related majors (p < 0.001) and enhanced academic years (p < 0.05) improved cancer literacy. Limited awareness of mobile cancer screening units was found across respondents, along with, decreased access to health services indicated by Appalachian students (p < 0.05). Conclusions College students represent a population in need of enhanced cancer education. Improving knowledge about accessing healthcare including cancer screenings could reduce Appalachian cancer rates.

Cost-efficiency analysis of conversion to biosimilar filgrastim for supportive cancer care and resultant expanded access analysis to supportive care and early-stage HER2+ breast cancer treatment in Saudi Arabia: simulation study

AimsThis study estimated, for Saudi Arabia, the cost-efficiency of converting patients from reference Neupogen and Neulastim to one of two filgrastim biosimilars (Nivestim, Zarzio); the budget-neutral expanded access to supportive care with biosimilar filgrastim and therapeutic care to ado-trastuzumab emtansine thus afforded; and the number-needed-to-convert (NNC) to provide supportive or therapeutic treatment to one patient.Materials and methodsReplicating prior studies, we modeled the cost-efficiencies gained from converting varying proportions of a hypothetical panel of 4,000 patients undergoing six cycles of cancer treatment from Neupogen or Neulastim to one of the two biosimilar G-CSF formulations, using national cost inputs. Cost-savings in USD were used to estimate the additional doses of biosimilar G-CSF and expanded access to ado-trastuzumab emtansine on a budget-neutral basis, and NNC to purchase one additional dose of supportive or therapeutic treatment.ResultsSavings from conversion from reference to a biosimilar filgrastim were $3,086,400 (Nivestim) and $3,460,800 (Zarzio). With reference pegfilgrastim, savings from conversion were $11,712,240 (Nivestim) and $12,086,640 (Zarzio). Biosimilar conversion from reference to biosimilar filgrastim enabled expanded access to ado-trastuzumab emtansine ranging from 61 patients (5 days, Nivestim) to 191 patients (14 days, Zarzio). For supportive care, biosimilar conversion enabled expanded access ranging from 8,244 patients (5 days, Nivestim) to 25,882 patients (14 days, Zarzio). For biosimilar conversion from daily filgrastim, the NNC for treatment with ado-trastuzumab emtansine decreased as days of injections increased [5 days: 395 (Nivestim), 352 (Zarzio); 14 days: 141(Nivestim), 126 (Zarzio)]. Alternately, for biosimilar conversion from single-injection pegfilgrastim to daily biosimilar filgrastim, the NNC for treatment with ado-trastuzumab emtansine rose as days of injections increased, being highest under the 14-day scenario (146, Nivestim; 130, Zarzio).ConclusionThis simulation study demonstrated significant potential cost-savings from biosimilar conversion. These savings provide budget-neutral increased access to supportive and therapeutic cancer care.

Bridging the cancer care gap and inequities in radiation treatment in India: A narrative review

Cancer is the fifth leading cause of death in India, yet India's cancer care landscape remains fragmented. In this paper, we review the current state of access to radiation therapy and the inequities involved, as well as identify potential solutions to improve access to radiation therapy in cancer. We undertook this narrative literature review, which encompassed database searches (PubMed, Embase, Scopus) and scrutiny of the grey literature (Google Scholar, OpenGrey), using the search terms: “cancer care access disparities,” “radiotherapy accessibility challenges,” “out-of-pocket expenditure in cancer treatment,” “value-based cancer care models,” “cost-effective radiotherapy strategies,”and“resource-limited cancer care solutions.” Our search strategy focused on articles addressing barriers to radiation treatment, inequities in radiation treatment equipment, and optimal radiation techniques in resource-limited settings in India, thereby identifying key challenges and potential interventions. Of the 1933 articles initially retrieved, we included 46 for the preparation of this review. Among the various modalities utilized for the management of cancer, radiation treatment is the most resource-intensive, requiring expensive and dedicated infrastructure. Scarce infrastructure, perpetuating inequities across geographical regions and socioeconomic strata, is responsible for inequities in access to radiation treatment in India. With the advent of newer radiation techniques requiring specialized equipment for the delivery of advanced radiation treatment, these inequities widen in low- and middle-income countries such as India. The challenge lies in providing affordable and equitable radiation treatment without compromising on quality within India's diverse and populous expanse. Bridging these gaps mandates the improvement of the existing infrastructure, fostering local production of quality medical equipment like linear accelerators, establishing and adhering to country-specific standardized treatment guidelines based on volumes, optimally utilizing available equipment like indigenous telecobalt machines and cost-effectiveness evidence, establishment of rural cancer care centers, optimization of private sector capacities and economic support through national insurance schemes.

Leveling Up the Access to Radiation Therapy in Latin America: Economic Analysis of Investment, Equity, and Inclusion Opportunities Up to 2030

Latin America faces a shortage in radiation therapy (RT) units and qualified personnel for timely and high-quality treatment of patients with cancer. Investing in equitable and inclusive access to RT over the next decade would prevent thousands of deaths. Measuring the investment gap and payoff is necessary for stakeholder discussions and capacity planning efforts. Data were collected from the International Atomic Energy Agency's Directory of Radiotherapy Centers, industry stakeholders, and individual surveys sent to national scientific societies. Nationwide data on available devices and personnel were compiled. The 10 most common cancers in 2020 with RT indication and their respective incidence rates were considered for gap calculations. The gross 2-year financial return on investment was calculated based on an average monthly salary across Latin America. A 10-year cost projection was calculated according to the estimated population dynamics for the period until 2030. Eleven countries were included in the study, accounting for 557,213,447 people in 2020 and 561 RT facilities. Approximately 1,065,684 new cancer cases were diagnosed, and a mean density of 768,469 (standard deviation ±392,778) people per available unit was found. By projecting the currently available treatment fractions to determine those required in 2030, it was found that 62.3% and 130.8% increases in external beam RT and brachytherapy units are needed from the baseline, respectively. An overall regional investment of approximately United States (US) $349,650,480 in 2020 would have covered the existing demand. An investment of US $872,889,949 will be necessary by 2030, with the expectation of a 2-year posttreatment gross return on investment of more than US $2.1 billion from patients treated in 2030 only. Investment in RT services is lagging in Latin America in terms of the population's needs. An accelerated outlay could save additional lives during the next decade, create a self-sustaining system, and reduce region-wide inequities in cancer care access. Cash flow analyses are warranted to tailor precise national-level intervention strategies.

Impact of COVID-19 on access to cancer care in Rwanda: a retrospective time-series study using electronic medical records data

IntroductionThe COVID-19 pandemic has caused disruptions in access to routine healthcare services worldwide, with a particularly high impact on chronic care patients and low and middle-income countries. In this study,...

Core functions of a financial navigation intervention: An in-depth assessment of the Lessening the Impact of Financial Toxicity (LIFT) intervention to inform adaptation and scale-up in diverse oncology care settings.

Lessening the Impact of Financial Toxicity (LIFT) is an intervention designed to address financial toxicity (FT) and improve cancer care access and outcomes through financial navigation (FN). FN identifies patients at risk for FT, assesses eligibility for financial support, and develops strategies to cope with those costs. LIFT successfully reduced FT and improved care access in a preliminary study among patients with high levels of FT in a single large academic cancer center. Adapting LIFT requires distinguishing between core functions (components that are key to its implementation and effectiveness) and forms (specific activities that carry out core functions). Our objective was to complete the first stage of adaptation, identifying LIFT core functions. We reviewed LIFT's protocol and internal standard-operating procedures. We then conducted 45-90 min in-depth interviews, using Kirk's method of identifying core functions, with key LIFT staff (N = 8), including the principal investigators. Interviews focused on participant roles and intervention implementation. Recorded interviews were transcribed verbatim. Using ATLAS.ti and a codebook based on the Model for Adaptation Design and Impact, we coded interview transcripts. Through thematic analysis, we then identified themes related to LIFT's intervention and implementation core functions. Two report back sessions with interview participants were incorporated to further refine themes. Six intervention core functions (i.e., what makes LIFT effective) and five implementation core functions (i.e., what facilitated LIFT's implementation) were identified to be sufficient to reduce FT. Intervention core functions included systematically cataloging knowledge and tracking patient-specific information related to eligibility criteria for FT relief. Repeat contacts between the financial navigator and participant created an ongoing relationship, removing common barriers to accessing resources. Implementation core functions included having engaged sites with the resources and willingness necessary to implement FN. Developing navigators' capabilities to implement LIFT-through training, an established case management system, and connections to peer navigators-were also identified as implementation core functions. This study adds to the growing evidence on FN by characterizing intervention and implementation core functions, a critical step toward promoting LIFT's implementation and effectiveness.

Hospital Rurality and Gene Expression Profiling for Early-Stage Breast Cancer among Iowa Residents (2010-2018).

Objective Given the challenges rural cancer patients face in accessing cancer care as well as the slower diffusion and adoption of new medical technologies among rural providers, the aim of our study was to examine trends in gene expression profiling (GEP) testing and evaluate the association between hospital rurality and receipt of GEP testing. Methods Data from the Iowa Cancer Registry (ICR) were used to identify women with newly diagnosed, histologically confirmed breast cancer from 2010 through 2018 who met eligibility criteria for GEP testing. Patients were allocated to the hospitals where their most definitive surgical treatment was received, and Rural-Urban Commuting Area codes were used to categorize hospitals into urban (N = 43), large rural (N = 16), and small rural (N = 48). Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated using multivariable logistic regression to evaluate the association between hospital rurality and GEP test use, adjusting for demographic and clinical characteristics. The association between test result and treatment received was assessed among patients who received Oncotype DX (ODX) testing. Results Of 6,726 patients eligible for GEP test use, 46% (N = 3,069) underwent testing with 95% receiving ODX. While overall GEP testing rates increased over time from 42% between 2010 and 2012 to 51% between 2016 and 2018 (Ptrend < 0.0001), use continued to be the lowest among patients treated at hospitals in small rural areas. The odds of GEP testing remained significantly lower among patients treated at hospitals located in small rural areas (aOR 0.55; 95% CI 0.43–0.71), after adjusting for demographic and clinical characteristics. ODX recurrence scores were highly correlated with chemotherapy use across all strata of hospital rurality. Conclusions GEP testing continues to be underutilized, especially among those treated at small rural hospitals. Targeted interventions aimed at increasing rates of GEP testing to ensure the appropriate use of adjuvant chemotherapy may improve health outcomes and lower treatment-related costs.

Cancer Care Access in Chile's Vulnerable Populations During the COVID-19 Pandemic.

Objectives. To examine the COVID-19 pandemic's impact on cancer care access in Chile, analyzing differential effects by insurance type, gender, and age. Methods. We conducted a quasi-experimental study using interrupted time series analysis. We used multiple data sources for a broad evaluation of cancer-related health care utilization from January 2017 to December 2020. We fit negative binomial models by population groups for a range of services and diagnoses. Results. A sharp drop in oncology health care utilization in March was followed by a slow, incomplete recovery over 2020. Cumulative cancer-related services, diagnostic confirmations, and sick leaves were reduced by one third in 2020; the decrease was more pronounced among women and the publicly insured. Early diagnosis was missed in 5132 persons with 4 common cancers. Conclusions. The pandemic stressed the Chilean health system, decreasing access to essential services, with a profound impact on cancer care. Oncology service reductions preceded large-scale lockdowns and supply-side disruptions. Importantly, not all population groups were equally affected, with patterns suggesting that gender and socioeconomic inequalities were exacerbated. (Am J Public Health. 2022;112(S6):S591-S601. https://doi.org/10.2105/AJPH.2021.306587).