Cancer Care Providers Research Articles

Stakeholder perceptions of issues and possible solutions to access to oncology medicines: a case study of multi-stakeholder engagement

Aim This case study reports on a series of multi-stakeholder dialogues on challenges to access to oncology medicines in both the public and private sectors. Methods Key stakeholders, identified from various points in the pharmaceutical supply chain, were invited to attend a series of virtual discussion sessions to address specific medicines access challenges to the provision of cancer care in South Africa. For each session, a case scenario, based on a real world situation/event was presented for discussion, and viable solutions and areas requiring further research or legislative changes were identified. Topics covered in these discussions included registration pathways and obstacles; limitations of current medicine pricing policies; alternate reimbursement models; funders’ initiatives to ensure access to oncology medicines; and essential medicine selection and procurement in the public sector. Findings The key issues raised in the discussions included: non-transparency in the approval and pricing of unregistered medicines accessed in terms of section 21 of the Medicines and Related Substances Act of 1965 (as amended); commercial decisions related to the small market for oncology medicines in South Africa; inequities between public and private sector access; alternate forms of price negotiation in the private sector; the restrictions imposed by the single exit price model; and the role of co-payments for those medicines not included as prescribed minimum benefits. Conclusions There is a clear need for a forum where all stakeholders and actors in this field can engage in discussions to find solutions to the oncology medicines access conundrum, including the development of legislative amendments.

Development and Implementation of a Geriatric Oncology Interdisciplinary Case-Based Educational Intervention for Cancer Care Providers.

To develop and implement a continuing professional development (CPD) activity focused on geriatric assessment (GA) in oncology for oncologists and geriatricians. We evaluated the impact of this activity on knowledge, skills, and performance regarding GA in oncology, as well as its feasibility and acceptability. We included teams composed of an oncologist and a geriatrician working in Mexico. Curriculum content was selected from geriatric oncology guidelines. We used Project Extension for Community Healthcare Outcome (ECHO)'s model to create a 12-week online course. A one-group pretest post-test quasi-experimental design was used to evaluate the intervention's effectiveness. At baseline, participants answered a multiple-choice knowledge assessment, a survey on self-perceived competence in GA, and an adaptation of the Association for Community Cancer Centers Geriatric Oncology Gap Assessment Tool, evaluating self-perceived performance in conducting geriatric interventions. These assessments and a satisfaction questionnaire were also completed postintervention. Baseline and postintervention scores were compared using paired t-tests. We included 40 participants (20 oncologists and 20 geriatricians). Median attendance was 10 sessions (range 2-12). Thirty-eight participants completed the satisfaction questionnaire, with a median score of 10/10 (range 8-10). The mean baseline and postintervention knowledge scores were 59.5 ± 12.8 and 74.4 ± 9.7, respectively (P < .001, effect size 1.14). The mean baseline and postintervention competence scores were 6.42 ± 2.5 and 9.02 ± 0.8, respectively (P < .001, effect size 1.03). The mean baseline and postintervention performance scores were 2.58 ± 0.65 and 3.29 ± 0.5, respectively (P < .001, effect size 1.64). A CPD activity for oncologists and geriatricians on the basis of the Project ECHO model was feasible and acceptable, leading to increased knowledge, competence, and performance in geriatric oncology. This could represent a novel method for increasing the geriatric competence of the cancer care workforce in Latin America and globally.

Strengthening cancer care through the inclusion of audiological services

Aim Commonly used cancer treatments that treat the priority cancers are ototoxic. Ototoxicity can add to the already severe morbidity experienced by cancer survivors. It affects the quality of life and consequently has dire psycho-socio-emotional, cognitive, occupational, and scholastic effects. This article aims to highlight that the inclusion of audiological services, such as ototoxicity monitoring and management, can strengthen cancer care by reducing the morbidity and effects of ototoxicity. It explores the current practices of ototoxicity monitoring and management for cancer patients in South Africa and offers practical and innovative evidence-based solutions on how the practice can be improved. The paper also discusses how the National Care Strategic Framework (NCSF) (2017-2022) can be expanded to support the inclusion of audiological services by including ototoxicity monitoring and management in cancer care. Methods A review of literature was conducted utilising a narrative approach to explore audiological service provision for cancer care in South Africa. Peer-reviewed publications and clinical guidelines related to audiological and/or vestibular ototoxicity caused by cancer treatments were reviewed. Findings Despite the inroads that have been made in South Africa, resource and logistical limitations hinder the effectiveness of ototoxicity monitoring and management programmes. In addition, a lack of awareness of the ototoxic effects of some cancer treatments by oncology nurses, as well as ambiguity regarding the roles and responsibilities of the multidisciplinary cancer team in terms of ototoxicity monitoring, management, and patient counselling, further exacerbate the problem. Conclusions The effectiveness of ototoxicity monitoring and management could be enhanced by having a national and standardised protocol and programme incorporating tele-audiology and task-shifting. In addition, collaborative work among the cancer multidisciplinary team will foster holistic practice and integration of audiological services. Future versions of the NCSF should encompass considerations to reduce the associated burdens of cancer treatment, and audiological services, through ototoxicity monitoring, and ought to be included when providing cancer care to patients being treated with ototoxic agents.

Cancer care delivery in prisons: From barriers to best practices.

49 Background: Cancer is the leading cause of death in US prisons. Incarcerated patients with cancer have 92% higher 5-year mortality than the general population with cancer, but little is known about how to improve cancer screening, diagnosis and treatment in this high-risk population. Methods: We conducted interviews with state prison medical directors and primary care clinicians, and medical, radiation and gynecologic oncologists who coordinate or provide cancer care for individuals incarcerated in prison. Participants were recruited via 1) email invitation to participants at a correctional health conference, 2) purposeful sampling using targeted emails to clinicians in prison systems selected for diversity in size, geography and correctional health model (e.g., contracted care), and 3) snowball sampling of individuals from research and participant networks. Participants were interviewed about 1) logistics of cancer care delivery from screening and treatment through end-of-life care, 2) barriers and facilitators to cancer care delivery, and 3) evidence-based strategies to facilitate cancer care in prisons, including best practices. Interview transcripts were analyzed using mixed inductive/deductive thematic content analysis to identify emerging themes. Results: 34 participants from 16 prison systems were interviewed (10 medical directors, 6 PCPs, 14 oncologists, 4 other). Participants reported prison clinicians coordinate most cancer care (e.g., screening, diagnosis and symptom management), while cancer treatment largely occurs in community or academic facilities outside of prison. Common barriers identified included underscreening / delays in diagnosis, complex logistical coordination, poor communication (between patients and oncologists, and prison clinicians and oncologists), inadequate symptom management, dehumanizing practices, loss-to-follow-up after release and that patients often come from marginalized populations. Common facilitators were better access to insurance, cancer screening, and general medical and cancer care than incarcerated patients might receive before/after incarceration. Participants identified multiple ways to improve cancer screening (creating enforceable standards, increasing continuing medical education, implementing electronic medical record reminders, reducing logistical barriers), cancer treatment (implementing navigators within prisons and cancer centers, prioritizing care with oncologist input, keeping care in prisons, decarceration), and transitions to the community (Medicaid activation prior to release, community partnerships to facilitate care transitions). Conclusions: Incarceration imposes multiple barriers to cancer care delivery, but clinicians identified numerous tools to improve cancer care in prison. Future studies should test and optimize these strategies to improve cancer outcomes for incarcerated patients.

Protocol for a mixed-methods exploratory investigation into the role of health information technology for the provision of cancer care in Indonesia

Background Cancer and its management can incur high costs, high risks and high demand. In Indonesia, there remains gap in the availability of national cancer data despite the establishment of a National Committee for Cancer Control. Multiple pilot projects have been developed by the Ministry of Health to improve the delivery of care, including interventions utilising digital health approaches and integrated referral information systems. However, it is not yet clear to what extent these approaches influence patient management or the experience of cancer patients themselves. This research aims to explore the current role of health information technology (HIT) in the provision of services and treatments for patients with cancer from primary to tertiary healthcare centres in Yogyakarta, Indonesia. Methods The study will adopt an observational mixed-methods single case study design of health facilities involved in the delivery of cancer services in a sub-national health system. We will collect data through face-to-face interviews with a range of health professionals involved in the delivery of cancer care. Patients will be interviewed to share their views and experiences of the existing cancer referral system and communication with health facilities. Alongside interviews, we will undertake an analysis of routine data from participating health facilities to assess gaps in existing information systems. Data analysis will include framework analysis for qualitative data alongside descriptive analyses of quantitative data. Findings will be used to inform conceptual maps to be presented as part of Theory of Change workshops focused on understanding how the existing cancer referral system works, why and for whom, with a focus on future refinement and intervention development. Conclusion Our findings will inform critical thinking around the design, implementation, adaptation, and evaluation of existing systems. Through early engagement and participation of key stakeholders and project partners, we intend that findings will have immediate utility.

Abstract B120: Understanding Barriers and Facilitators Affecting Participation in Cancer Clinical Research Studies for Racially and Ethnically Diverse Populations in Rural North Carolina

Abstract Increasing representation of minoritized racial and ethnic populations in cancer clinical research studies has been declared a priority in the US for many years. Additionally, it is widely recognized that people living in rural areas of the US have limited access to cancer clinical research studies, and solutions are needed to extend participation opportunities to rural cancer patients. Underrepresentation of minoritized racial and ethnic populations and rural communities perpetuates health inequities, and solutions are needed to remove barriers and implement facilitators for participation. However, a review of existing literature found a lack of attention on the intersection of race and rurality and the needs and values of these populations as it pertains to cancer research. To address this concern, we used a sequential mixed method, community-engaged approach to explore the barriers and facilitators affecting participation in cancer clinical research from the perspectives of cancer survivors and their caregivers, as well as cancer healthcare professionals in rural North Carolina (NC). We used existing publicly available data to identify and characterize four of the most rural, racially and ethnically diverse, and medically underserved counties in NC. The principal investigator collaborated with cancer centers, churches, and American Indian tribal leaders in NC to administer surveys to cancer survivors and caregivers to assess their beliefs and experiences regarding cancer clinical research. Eligible participants included persons who had been diagnosed with cancer or a caregiver of someone diagnosed with cancer. In addition, we conducted key informant interviews with cancer health care professionals providing cancer care in the selected rural NC counties. We analyzed surveys and interview responses with descriptive statistics. Forty-three cancer survivors/caregivers completed surveys and twenty-two cancer healthcare professionals completed semi-structured interviews. Cancer survivors and caregivers indicated that the lack of invitation to participate in cancer clinical research was their greatest barrier to participation, whereas cancer healthcare professionals cited the lack of transportation as the perceived greatest barrier for patients. Cancer survivors, caregivers and healthcare professionals agreed that having support from clinical research personnel would be amongst the most helpful facilitators, along with opportunities to participate in clinical research studies close to home. Cancer healthcare professionals suggested the lack of trust in clinical research was a barrier for their patients; however, cancer survivors and caregivers in this study indicated lack of trust was not a significant barrier to their participation. Recommendations to address barriers and promote facilitators to participation in cancer clinical research include the importance of engaging the community, addressing unconscious bias, decentralizing clinical trials, and providing recruitment materials in culturally responsive formats. Citation Format: Amy Garrett, Karine Dubé, Lisa Spees, Ronny Bell, Marjory Charlot, Sandra Greene. Understanding Barriers and Facilitators Affecting Participation in Cancer Clinical Research Studies for Racially and Ethnically Diverse Populations in Rural North Carolina [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B120.

The scienthetic method: from Aristotle to AI and the future of medicine.

While AI holds immense potential for accelerating advances in oncology, we must be intentional in developing and applying these technologies responsibly, equitably, and ethically. One path forward is for cancer care providers and researchers to be among the architects of AI and its adoption in medicine. Given the limitations of traditional top-down, hypothesis-driven design in an exponentially expanding data universe, on one hand, and the danger of spiraling into artificial ignorance (ai) from rushing into a purely 'synthetic' method on the other, this article proposes a 'scienthetic' method that synergizes AI with human wisdom. Tracing philosophical underpinnings of the scientific method from Socrates, Plato, and Aristotle to the present, it examines the critical juncture at which AI stands to either augment or undermine new knowledge. The scienthetic method seeks to harness the power and capabilities of AI responsibly, equitably, and ethically to transcend the limitations of both the traditional scientific method and purely synthetic methods, by intentionally weaving machine intelligence together with human wisdom.

'Picking up the pieces': primary care practitioners' experiences of cancer care reviews.

The number of people who are living with and beyond cancer is increasing in England. Primary care delivers cancer care via structured proactive conversations which are incentivised through the Quality and Outcomes Framework (QoF): 'cancer care reviews' (CCRs). Declining workforce numbers, increasing patient demand, CCR policy changes in 2020 and the onset of the coronavirus disease 2019 (COVID-19) pandemic, highlight a need to explore how staff deliver CCRs. To explore primary care staff experiences with CCRs, identify their view of CCRs, how they conduct CCRs and their perceived value of CCRs. Descriptive qualitative study in general practices in England. Semi-structured online interviews with 15 primary care staff; data analysis using reflexive thematic analysis. Four themes were identified: varied and evolving perception of cancer, the delivery and impact of CCRs, changes to CCR delivery during the COVID-19 pandemic, ways to complement CCRs. Primary care staff felt that the way that cancer was perceived by patients, including those from ethnic minority backgrounds, impacted how CCRs were delivered. Cancer care involved acknowledging the challenge of a cancer diagnosis, helping decode jargon, and addressing unmet care needs. The pandemic resulted in remote CCR delivery for some practices. Staff suggested community cancer teams to provide cancer care alongside existing services. Staff adopted the new 3- and 12-month format CCRs despite the COVID-19 pandemic. Clinical staff may benefit from better training on cancer as a long-term condition and how cancer is perceived by people from diverse ethnic backgrounds.

Disparities in fertility preservation discussions among sexual and gender minority cancer patients and their cancer care providers

Background Cancer providers are advised to inform their reproductive aged patients about fertility preservation given the potential for treatment-related infertility. How consistently fertility preservation discussions (FPDs) occur is understudied in sexual and gender minority (SGM) cancer patients. The effects of bias and heteronormativity may reduce the rate of FPDs. We identified the frequency and correlates of FPD in a sample of SGM cancer patients. Methods Data were from the cross-sectional 2020 OUT National Cancer Survey. The sample was restricted to those diagnosed with cancer between the ages of fifteen and forty-five. FPD was measured with a single item. Multivariable logistic regression was conducted to determine factors significantly associated with FPDs. Results Average age at cancer diagnosis was 34.97 (SD = 8.34). Respondents were mostly non-Hispanic white (77.6%) and college-educated (63.4%), and 32.6% reported FPDs. In the multivariable model, identifying as lesbian (Adjusted odds ratio [aOR] = 0.49; 95% CI: 0.24-0.99), pansexual (aOR = 0.34; 95% CI:0.12-0.94), or queer (aOR = 0.24; 95% CI: 0.08-0.70) was negatively associated with FPDs compared to bisexuals. Being treated more than ten years ago (aOR = 0.47; 95% CI:0.26-0.85) was also negatively associated with FPDs. Conclusion Findings suggest potential bias against some SGM patients based on sexual orientation identity in FPDs, though changes over the past decade may have increased the frequency of FPD with patients more broadly. More research is needed to investigate why some SGM patients of reproductive age are not being counseled about fertility preservation.

Trend analysis of pharmacist involvement in cancer care in Japan from 2015 to 2020: A nationwide survey study on hospital pharmacy practice.

Pharmacists are needed as members of oncology teams. The Japanese Society of Hospital Pharmacists (JSHP) conducts a nationwide survey annually to analyze the actual situation and generate fundamental information about hospital pharmacy practice in Japan. Using data from this large-scale survey, we described pharmacists' involvement in cancer chemotherapy. We explored the factors related to the acceleration of pharmacists' tasks or involvement in clinical practice, primarily in oncology. Data were obtained from annual surveys conducted by JSHP from 2015 to 2020. All variables were expressed as categorical variables and tabulated. The Chi-square and Fisher's exact tests were used to compare the categorical variables. The Cochran-Armitage trend test was used to identify significant trends. From 2015 to 2020, 22,362 responses were recorded. After applying the exclusion criteria, 20,906 were analyzed. The proportion of hospitals enrolling pharmacists with oncology-related certifications significantly increased in all hospitals providing cancer care. Multivariable logistic regression analysis indicated that a smaller number of beds per pharmacist significantly correlated with additional fees for outpatient pharmacy services (p = 0.0002 for trend). Hospitals charging increased fees for outpatient oncology pharmacy services were associated with a smaller number of beds per pharmacist, regardless of hospital size. A balance between the number of beds and pharmacists, particularly certified oncology pharmacists, is crucial for safe and high-quality cancer treatment.

"Just for pregnant women, not for you": a qualitative evaluation of the sexual and reproductive healthcare experiences of transgender and gender diverse cancer survivors.

To identify opportunities to improve sexual and reproductive health (SRH) care for transgender and gender diverse (TGD) cancer survivors by describing (1) challenges experienced when navigating SRH care and (2) strategies to help overcome these challenges. We enrolled a purposive sample of 17 adult TGD cancer survivors and 5 co-survivors. We aimed for a diverse sample across cancer experience, age, racial/ethnic background, sexual orientation, and gender identity. We conducted 90-min individual interviews via videoconference and used reflexive thematic analysis, guided by a focus on three social determinants of health. Themes describing challenges were as follows: (1) Cancer treatment's impact on sexual health was insufficiently addressed by cancer care providers; (2) fertility-related information and conversations were complicated by gendered expectations and ultimately did not meet survivors' needs; (3) feeling excluded and uncared-for in healthcare settings due to gendered language and lack of supportive services that met their needs; and (4) TGD survivors commonly reported high financial burden, negatively impacting their access to care. Strategies to overcome these challenges were (1) a solid social support network that can be integrated into the care team to meet the unique SRH needs of TGD survivors and (2) gender-affirming healthcare providers and environments to address SRH care needs and concerns. TGD survivors and co-survivors desire improved access to gender-affirming SRH care in cancer survivorship. Key opportunities to improve gender-affirming SRH care in cancer survivorship include fostering and engaging TGD survivors' support networks and implementing system-level changes in cancer care settings.

Ayurvedic health-care arenas in the management of cancer in present scenario: A scoping review

The changing lifestyle, westernization of diet, and exposure to different types of carcinogens have resulted in the increasing burden of cancer over the globe. According to the National Institute of Cancer, the standard cancer treatment approaches include chemotherapy, hormonal therapy, immunotherapy, photodynamic therapy, radiation therapy, stem cell transplant, surgery, gene-targeted therapy, and drug therapy. Considering the rising burden of cancer, the integrative and Ayurveda-based approach, especially in preventive and promotive aspects of health, is of utmost importance to manage the condition. Thus, an attempt has been made to review available information and to tap the advancements in the field of integrative oncology focusing on Ayurveda and cancer treatment. A search through PubMed has been done, and classical references, wherever applicable, were drawn from Ayurveda Samhita texts. Considering the obtained information from the literature search; different aspects such as risk factors, prevention, Ayurveda-based understanding, Ayurveda interventions in the field of oncology, cytotoxic herbs, nanomedicine in Ayurveda cancer care, and success stories, where Ayurvedic approaches have been provided cancer care, are discussed in detail. The review revealed that Ayurveda can address the newer approach to riskier areas such as cancer. With a more research-oriented approach, Ayurveda can provide evidence-based solutions in the management of malignancies.

The value of patient-reported experience in oncoplastic breast conservation following standardized assessment and shared-decision making. A qualitative study

IntroductionPatient-reported outcomes (PROs) are emerging as a quality marker for breast cancer care provision. Patient-reported experience (PRE) is equally important, but challenges in qualitative research and documentation have resulted in limited data on oncoplastic breast-conserving surgery (OPBCS). This qualitative study aimed to explore the experiences of patients who underwent OPBCS. Patients and methodsWomen who underwent OPBCS between 2015 and 2021 at the Breast Unit of Uppsala University Hospital were followed up longitudinally using PROs. All participants were invited to share their experiences beyond PROs through a “diary.” Patients’ experiences with care, pre- and postoperatively, and other insights and thoughts that they considered important were documented and analyzed. A narrative research methodology, along with thematic analysis, was employed. ResultsOf the 122 women, 60 (49.2 %) desired to further elaborate on their experiences beyond PROs-related aspects. The most common themes included postoperative side effects, challenges responding to questionnaires, adverse effects of adjuvant treatment, external factors contributing to the preoperative and postoperative overall health status, and satisfaction with the surgery and medical staff. Specifically, 26.7 % of the respondents stated that they felt that PROs were not adequately specific and had further reflections. ConclusionsPatients did not report different experiences depending on the operative technique. Their experience focused on the perception of wholeness and potential ambiguities in the PRO questionnaires. Documenting PRE is crucial, as it enables individualized assessment following breast cancer treatment, thereby strengthening patient-centered care.

Disparities in cancer outcomes: A comprehensive analysis of cancer incidence, mortality, and prevalence in Europe

Cancer poses a substantial challenge in Europe&amp;rsquo;s public health landscape, contributing significantly to illness burden, diminished productivity, and escalating health-care costs. This article investigates the extent to which disparities in cancer outcomes are associated with factors influencing the performance of cancer control initiatives within the European Union (EU). The characteristics of health-care systems play a pivotal role in shaping cancer outcomes through three key mechanisms: (i) Access to screening programs; (ii) quality and efficiency of health-care services; and (iii) health education and awareness programs. A multifactorial regression analysis was employed, utilizing the GLOBOCAN 2020 projections of cancer incidence, mortality, and prevalence based on the data from the International Agency for Research on Cancer. This analysis was delineated across 36 distinct cancer classifications by both gender and age categories. In countries with incomplete population coverage, patients may face limitations in accessing certain services or contend with significant financial obstacles. Furthermore, disparities in health-care service implementation, including diagnostic procedures, treatment modalities, and follow-up care, significantly affect cancer outcomes. In addition, systematic distinctions in care quality, such as early diagnosis, timely access to specialized care, and the presence of coordinated efforts, contribute significantly to diverse cancer outcomes. In conclusion, this article highlights the variations in cancer care provision across European countries, offering valuable insights for enhancing cancer patient care.

Addressing misinformation about cancer care in the clinical setting: A pilot study of a conversation guide and training for cancer care providers.

e23250 Background: Medical misinformation about cancer care is understudied despite its pervasiveness and harmful effects on patients. This misinformation causes a) delays in care or forgoing of treatment for curable conditions; b) economic harm such as spending and travel on ineffective or harmful treatments; c) potentially toxic effects of the suggested test/treatment; and d) harmful medical interactions with standard curative treatments. Recently, in an IRB study we surveyed MD Anderson clinicians about their ability to successfully address patients who endorse medical misinformation. We found that ~40% of physicians report success rates below 60% for correcting misinformation. ~50% of respondents answered that they have insufficient resources to address patients who endorse misinformation; ~65% answered that they have insufficient training, and ~50% answered that there is insufficient institutional support. In response to these findings, we developed (as far as we know) the first pilot conversation guide and training to improve provider skills and confidence in addressing misinformation about cancer in clinical encounters. Methods: For our quality improvement project, we partnered with clinicians in integrative oncology and gynecologic oncology to develop the conversation guide. The techniques, strategies, and model dialogue in the guide are adapted from best practices developed for addressing vaccine hesitancy. Before the training, we asked 11 physicians to provide a self-assessment of their comfort, confidence, and competence in addressing patients who endorse misinformation about cancer. Then we provided a 25min training in which participants role-played to learn strategies and model dialogue for four common scenarios. After, we resurveyed participants’ self-assessment measures and assessment of the training’s utility. Results: All participants believed the conversation guide and training will be significantly (82%) or moderately (18%) helpful for correcting patients/families who endorse medical misinformation about cancer. 91% said the conversation guide and training significantly (9% moderately) improved their ability to correct patients/patients’ families who endorse medical misinformation. All participants reported improved comfort, confidence, and competence in their ability to address patients/families who endorse misinformation about cancer care. 100% would recommend the guide and training to their peers. Conclusions: Given the prevalence of medical misinformation generally, the training and resources we have developed will be valuable to clinicians effectively address the growing number of patients who endorse misinformation about their care. Our long-term goal is to conduct a larger study and turn our conversation guide and training into a replicable model available for widespread use.

Development and implementation of a geriatric oncology interprofessional case-based educational intervention for cancer care providers.

9020 Background: Geriatric assessment (GA) is recommended as part of the standard of care for older adults with cancer. However, the GA has not been fully adopted as part of routine practice in oncology in Mexico, mainly due to lack of qualified personnel and limited knowledge. We designed an interprofessional case-based educational intervention to address the main barriers for implementation of GA in oncology. Methods: We followed Kern’s six-step approach to design a continuing professional development (CPD) activity. Our targeted learners consisted of teams comprised of one oncologist and one geriatrician who practiced at the same site in Mexico. By the end of the intervention, participants would be able to perform GA in older adults with cancer, and to integrate information obtained through a GA in a cancer treatment plan through adequate interventions. We used Project ECHO’s model to create a CPD activity consisting of 12 weekly 75-minute online sessions via Zoom, with content selected from international geriatric oncology guidelines. At baseline, and at the end of the course, participants answered a 36-item multiple choice knowledge assessment (scale 0-100), a survey on self-perceived competence in GA skills (scale 0-10), and an adaptation of the Association for Community Cancer Centers Geriatric Oncology Gap Assessment Tool, which assesses subjective performance of the GA (scale 0-4). Participants also completed a satisfaction questionnaire. We compared baseline and post-intervention scores through paired t tests; results from the satisfaction questionnaire are reported descriptively. Results: We included 56 participants (28 geriatricians and 28 oncologists). Median participant attendance was 10 sessions (IQR 9-11). Thirty-eight participants completed the satisfaction questionnaire: median satisfaction was 10/10 (range 8-10). There was no difference in satisfaction scores between oncologists and geriatricians. Mean baseline knowledge score was 59.5±12.8 and mean post-intervention knowledge score was 74.4±9.7 (p&lt;0.001, effect size 1.14). Mean baseline competence score was 6.42±2.5 and mean post-intervention competence score was 9.02±0.78 (p&lt;0.001, effect size 1.03). Mean baseline performance score was 2.58±0.65 and mean post-intervention knowledge score was 3.29±0.5 (p&lt;0.001, effect size 1.64). Increases in knowledge, competence, and performance scores were observed both in oncologists and in geriatricians separately. Conclusions: This interprofessional curriculum on GA in oncology was feasible and acceptable, and led to significant increases in knowledge, competence, and performance among participants. Project ECHO’s case-based learning model is adequate to provide interprofessional education, which is crucial in multidisciplinary areas such as geriatric oncology.

Breaking barriers for cancer clinical trials: A multi-tiered interventional approach to boost racial and ethnic minority participation in early-phase studies.

TPS1639 Background: Racial and ethnic minority populations are underrepresented in cancer clinical trials. The USC Norris Comprehensive Cancer Center (USC NCCC) has multiple clinical trial recruitment sites, including the Los Angeles General Medical Center (LAG), the largest safety-net hospital in the western USA. LAG partners with USC to provide cancer care to the underserved minority population of LAC, including clinical trials. As a result, between 2015-2022 a total of 120 LAG patients were accrued to phase I clinical trials; enrolled subjects were 66% Hispanic, 21% Asian, 4% Black, and 9% other. An interventional study was designed to further enhance the referral and participation of racial and ethnic minority patients from other Los Angeles County (LAC) safety-net facilities. The study is funded by the Stand up to Cancer Diversity in Early Development Clinical Trials Research Grants Program. Methods: This interventional study has 3 specific aims. First, to identify barriers to referral for minority and underserved patients: Qualitative interviews will be conducted with key stakeholders in the LAC safety net system which will uncover barriers to referring minority and underserved patients. A screening tool developed by the NCI to characterize barriers will be used. Second, to implement a multi-component program to enhance the referral of patients to early-phase clinical trials. The intervention addresses system-level, provider-level, and patient-level factors to improve the process, with a demonstration site compared to a non-demonstration site. Key features include a streamlined referral process for healthcare professionals with a singular centrally operated email managed by a specialized facilitator, weekly meetings to assign trials to prospective patients, and facilitation of approval and scheduling for referrals. We will educate providers regarding trials and exchange feedback on the referral process. We will extend resources to patients to assist with financial and transportation limitations. We will compare change in referral and enrollment rates at baseline and after the intervention for both the demonstration site and non-demonstration site. Third, to explore the impact of remotely conducted clinical trials: A clinical trial (NCT05340309) administers study drug subcutaneously and uses telemedicine visits, wearable sensors, and a smartphone app for monitoring. This pilot trial will be analyzed to determine the model’s impact on barriers to enrollment. The above interventions may provide a model that can be adapted in other healthcare delivery settings to optimize referral and enrollment of racial and ethnic minorities.

Temporal Association Rule Mining: Race-Based Patterns of Treatment-Adverse Events in Breast Cancer Patients Using SEER-Medicare Dataset.

Disparities in the screening, treatment, and survival of African American (AA) patients with breast cancer extend to adverse events experienced with systemic therapy. However, data are limited and difficult to obtain. We addressed this challenge by applying temporal association rule (TAR) mining using the SEER-Medicare dataset for differences in the association of specific adverse events (AEs) and treatments (TRs) for breast cancer between AA and White women. We considered two categories of cancer care providers and settings: practitioners providing care in the outpatient units of hospitals and institutions and private practitioners providing care in their offices. We considered women enrolled in the Medicare fee-for-service option at age 65 who qualified by age and not disability, who were diagnosed with breast cancer with attributed patient factors of age and race, marital status, comorbidities, prior malignancies, prior therapy, disease factors of stage, grade, and ER/PR and Her2 status and laterality. We included 141 HCPCS drug J codes for chemotherapy, biotherapy, and hormone therapy drugs, which we consolidated into 46 mechanistic categories and generated AE data. We consolidated AEs from ICD9 codes into 18 categories associated with breast cancer therapy. We applied TAR mining to determine associations between the 46 TR and 18 AE categories in the context of the patient categories outlined. We applied the spark.mllib implementation of the FPGrowth algorithm, a parallel version called PFP. We considered differences of at least one unit of lift as significant between groups. The model's results demonstrated a high overlap between the model's identified TR-AEs associated set and the actual set. Our results demonstrate that specific TR/AE associations are highly dependent on race, stage, and venue of care administration. Our data demonstrate the usefulness of this approach in identifying differences in the associations between TRs and AEs in different populations and serve as a reference for predicting the likelihood of AEs in different patient populations treated for breast cancer. Our novel approach using unsupervised learning enables the discovery of association rules while paying special attention to temporal information, resulting in greater predictive and descriptive power as a patient's health and life status change over time.

The impact of socioeconomic inequality on access to health care for patients with advanced cancer: A qualitative study

ObjectiveIn Canada, populations experiencing socioeconomic inequality have lower rates of access to screening and diagnosis and higher mortality rates than people from higher-income areas. Limited evidence exists concerning their experiences when living with advanced cancer. We explored how socioeconomic inequality shapes the experiences of patients with advanced cancer. MethodsWe utilized a qualitative study design that combined tenets of hermeneutic phenomenological inquiry and critical theory. Four individuals with advanced cancer from low-income neighborhoods, three family members, and six cancer care providers were accrued through a tertiary cancer center in a western Canadian city. One-on-one interviews and brief notes were used for data collection. Data were analyzed through thematic analysis. ResultsThree interrelated themes were identified: ‘Lack of access to socioeconomic supports,’ ‘Gaps in access to health care resources and services,’ and ‘Limited access to symptom relief.’ Patients experienced inadequate finances, housing, and transportation. Most patients lived alone and had limited family and social support. Patients reported lack of knowledge of available resources and health system navigation issues, including communication problems with providers and among levels of care. Cancer care providers and patients described issues achieving symptom relief as well as challenges associated with extensive disease. ConclusionsStudy findings suggest that socioeconomic inequality interferes with the ability of persons with advanced cancer to access health care and contributes to less optimal cancer outcomes. Socioeconomic inequality may increase symptom severity. Findings call for the development of tailored interventions for populations with advanced cancer and socioeconomic inequality.

Rural comprehensive cancer care: Qualitative analysis of current challenges and opportunities.

While limited resources can make high-quality, comprehensive, coordinated cancer care provision challenging in rural settings, rural cancer patients often rely on local hospitals for care. To develop resources and strategies to support high-quality local cancer care, it is critical to understand the current experiences of rural cancer care physicians, including perceived strengths and challenges of providing cancer care in rural areas. METHODS: Semi-structured interviews were conducted with 13 cancer providers associated with all 12 non-metropolitan/rural Iowa hospitals that diagnose or treat >100 cancer patients annually. Iterative thematic analysiswas conducted to develop domains. Participants identified geographic proximity and sense of community as strengths of local care. They described decision-making processes and challenges related to referring patients to larger centers for complex procedures, including a lack of dedicated navigators to facilitate and track transfers between institutions and occasional lack of respect from academic physicians. Participants reported a desire for strengthening collaborations with larger urban/academic cancer centers, including access to educational opportunities, shared resources and strategies to collect and monitor data on quality, and clinical trials. Rural cancer care providers are dedicated to providing high-quality care close to home for their patients and would welcome opportunities to increase collaboration with larger centers to improve coordination and comprehensiveness of care, collect and monitor data on quality of care, and access continuing education opportunities. Further research is needed to develop implementation approaches that will extend resources, services, and expertise to rural providers to facilitate high-quality cancer care for all cancer patients.