Cancer Care Services Research Articles

Access and adherence to cancer care through the Veteran Affairs Close to Me cancer care service.

111 Background: Diagnosing and treating more than 56,000 Veterans annually, the Veterans Affairs (VA) National Oncology Program (NOP) is one of the nation’s largest integrated providers of oncology services. Within VA, oncology care and parenteral therapies are primarily offered at VA Medical Centers (VAMCs) in urban areas, often inaccessible to rural patients. Issues with travel distance, parking, time, and caregiver support can prevent patients from adhering to treatment appointments as evidenced by historical annual No-Show rates for VAMC infusion clinics that range from 1.1-6.7%. To mitigate potential barriers to access, NOP launched the Close to Me (CTM) cancer care service. The service deploys Registered Nurses (RNs) to local VA Community Based Outpatient Clinics (CBOCs) to administer cancer treatments. VA has opened 23 CTM clinics across 5 geographical regions since October 2021. Methods: The CTM service was implemented at VAMCs with NOP providing direct project management, safety assessment and resources such as a comprehensive implementation toolkit, standard operating procedures, care coordination tools, a tiered risk drug matrix and a standardized Healthcare Failure Mode and Effect Analysis risk evaluation. RNs followed a standardized workflow to assess patient eligibility and verify treatment clearances. Access to care was reported by numbers of unique patients and treatment visits. Patient appointment adherence was monitored by no-show rates documented in the electronic health record. Infusion reactions and medical emergencies were reported by RNs. Travel miles saved was calculated by subtracting the difference in miles round trip from the patient’s home to main VAMC and from home to CBOC, then multiplied by number of treatment visits to CBOC. Results: From October 2021 through April 2024, 23 new CTM clinics opened across 5 regions. 515 unique patients were enrolled for a total of 1,916 patient visits. Treatment appointment no-show rate was 1% across all CTM clinics. The most commonly administered medication classes include gonadotropin-releasing hormone agonist (30%), immune globulin (14.5%), immune checkpoint inhibitors (9.3%) and bisphosphonates (8.3%). Zero infusion reactions or medical emergencies were recorded across 1,430 treatments administered. A total of 204,000 travel miles were saved by patients enrolled in this program. Conclusions: The CTM cancer care service safely optimizes current VA CBOC infrastructure to increase access points to oncology treatment for patients across various geographical regions. CTM reduced travel burden for patients and increased ability to adhere to treatment appointments as evidenced by the service’s low no-show rate. These consistent results across CTM services at VAMCs nationwide have cemented CTM as a safe and effective treatment delivery model to expand access. CTM will be scaled to an additional 30 regions by end of 2025.

Exploring healthcare workers' barriers to effective cancer pain management at a comprehensive cancer center.

329 Background: Cancer-related pain remains a paramount concern for patients, families, and healthcare providers, significantly impacting quality of life. Numerous barriers often impede optimal pain management strategies, posing challenges to effective care delivery. Methods: This study employed a non-experimental, descriptive, cross-sectional approach within the setting of King Khalid University Hospital (KKUH), a tertiary care facility with a 1100-bed capacity, renowned for its comprehensive cancer care services. A sample of 200 healthcare workers (137 nurses, 68 physicians) working in the oncology center at KKUH participated in the study. Data were collected using the revised Barriers Questionnaire-II (BQ-II). Statistical analysis was performed using SPSS software (version 21), employing descriptive statistics and the unpaired t-test to explore differences in participant categories. Results: Healthcare providers expressed substantial barriers to cancer pain management, reflected in a mean questionnaire score of 2.5 (standard deviation [SD] = 0.8). Particularly noteworthy were the high mean scores for the harmful and physiological effects of medications subscales, at 2.7 (SD = 1.1) and 2.6 (SD = 0.9), respectively. Nurses and physicians had overall BQII scores of 1.8 (SD = 1.1) and 1.7 (SD = 0.9), respectively. A one-way analysis of variance indicated significant differences in the overall BQII scores among physicians and nurses, F(2, 182) = 6.81, p < .01. Significant differences were also found in the communication (F(2, 182) = 10.55, p < .01) and harmful effects (F(2, 182) = 7.26, p < .01) subscales among the two groups. Conclusions: There are significant perceived barriers to cancer pain management among healthcare providers in general with a notable difference between physicians and nurses. These findings suggest the need for improved education and communication to address concerns about medication effects and enhance pain management strategies. Tailored interventions that would lead to more effective and empathetic care have been initiated.

Access to patient assistance programs for rural cancer patients in an NCI designated comprehensive cancer center: A retrospective cohort study.

94 Background: 35% of Oregon’s and 14% of Washington’s populations live in rural/frontier communities. These populations often experience a higher incidence of cancer disparities across the care continuum and a disproportionate burden of the high costs associated with cancer care compared to urban populations. Methods: The Oregon Health & Science University (OHSU) Knight Cancer Institute (KCI) operates a multidisciplinary cancer program catering to Oregon and Southwest Washington from its Portland-based campuses. OHSU launched an enterprise Patient Assistance (PA) program partnership with Atlas Health which included an Artificial Intelligence (AI)-powered platform integrated with the electronic health record and 4 Patient Advocates who enrolled patients into matched PA programs. Rural patients receiving intravenous (IV) infusion therapy who benefited from PA programs were compared to the overall treated population at OHSU infusion centers to determine if rural patients who are at high risk for financial toxicity were identified and provided an effective intervention. Patient zip codes were used to designate residence in urban or rural/frontier counties. Results: A retrospective analysis reviewed unique patients treated in the OHSU KCI infusion centers, PA Enrolled, and PA Awarded patient cohorts. Conclusions: The Enterprise PA program partnership notably and proportionately benefited rural communities who are at high risk for financial toxicity and experience significant cost barriers to care. OHSU collected over 599,000 which reduced the risk of bad debt for the institution and cancer related medical debt for patients. Average PA award of 1,426 was significant due to 40% of Americans cannot afford a 1,000 emergency or unexpected medical bill. This underscores that an enterprise PA program may be considered a care delivery intervention to decrease health disparities. Further study is needed to determine if increasing rural cancer patients’ access to PA programs helps improve clinical access and treatment outcomes across the spectrum of cancer care services. Patient cohort comparison 12/15/2023-3/31/2024. Patient Cohort OHSU Infusion Center Cohort Patient Assistance Enrolled Cohort Patient Assistance Awarded Cohort Total Number of Patients 9,197 554 420 Total Number of Patients Residing in Oregon and Washington 9,064 552 418 Total Number of Patients Residing in Oregon and Washington Rural Counties 1,668 117 122 Percentage Rural Patients 18% 21% 29% Drug Manufacturer Co-Pay Programs - $ 590,785.70 $ 459,095.08 Charitable Co-Pay Assistance Programs - $ 96,024.70 $ 139,981.33 Total - $ 686,810.40 $ 599,076.41 Average Expected/Received Award Per Patient - $ 1,239.73 $ 1,426.37

Patient- and Areal-Level Risk Factors Associated With Lung Cancer Mortality in Victoria, Australia: A Bayesian Spatial Survival Analysis.

In Australia, lung cancer is the leading cause of cancer-related deaths. In Victoria, the mortality risk is assumed to vary across Local Government Areas (LGAs) due to variations in socioeconomic advantage, remoteness, and healthcare accessibility. Thus, we applied Bayesian spatial survival models to examine the geographic variation in lung cancer survival in Victoria. Data on lung cancer cases were extracted from the Victorian Lung Cancer Registry (VLCR). To account for spatial dependence and risk factors of survival in lung cancer patients, we employed a Bayesian spatial survival model. Conditional Autoregressive (CAR) prior was assigned to model the spatial dependence. Deviance Information Criterion (DIC), Watanabe Akaike Information Criterion (WAIC), and Log Pseudo Marginal Likelihood (LPML) were used for model comparison. In the final best-fitted model, the Adjusted Hazard Ratio (AHR) with the 95% Credible Interval (CrI) was reported. The outcome variable was the survival status of lung cancer patients, defined as whether they survived or died during the follow-up period (death was our interest). Our study revealed substantial variations in lung cancer mortality in Victoria. Poor Eastern Cooperative Oncology Group (ECOG) performance status, diagnosed at a regional hospital, Small Cell Lung Cancer (SCLC), advanced age, and advanced clinical stage were associated with a higher risk of mortality, whereas being female, presented at Multidisciplinary Team (MDT) meeting, and diagnosed at a metropolitan private hospital were significantly associated with a lower risk of mortality. Identifying geographical disparities in lung cancer survival may help shape healthcare policy to implement more targeted and effective lung cancer care services.

Improving Cancer Care for Women Seeking Services in the Veterans Health Administration Through the Breast and Gynecological Oncology System of Excellence.

Women are the fastest growing population among Veterans and have substantial risk factors that increase their likelihood for developing cancer. To ensure that the Department of Veterans Affairs Veterans Health Administration (VHA) offers the best possible cancer care to women Veterans, it established the Breast and Gynecologic Oncology System of Excellence (BGSoE) in 2021. The BGSoE offers telehealth oncology services and a comprehensive cancer navigation program. Veterans are identified through physician referral or through the BGSoE dashboard which integrates ICD-10 codes and text mining from VA electronic health records to identify eligible Veterans with breast or gynecological cancers. Descriptive statistics, including Veteran demographics and geographical location, were derived from BGSoE dashboard data. From January 1, 2021 to March 15, 2024, the BGSoE identified a total of 7,187 incident cases of breast or gynecological cancer among living Veterans. Most cancers were breast (78%) versus gynecological cancers (22%) and 10% of Veterans with breast cancer were identified as male. The average age at diagnosis was 59 for Veterans with breast cancer and 56 for those Veterans with gynecological cancers. Among Veterans in the BGSoE, 28% identified as Black and 6% identified as Hispanic. As the prevalence of women Veterans requiring cancer-related care continues to rise, it will be essential for VHA to evaluate the equitable reach, quality, and acceptability of women-focused cancer health services. The BGSoE focuses on providing high-quality and coordinated clinical cancer care. Veterans Health Administration also established the Center for Oncology Outcomes Review and Gender (COURAGE) to evaluate the BGSoE and continue to strengthen cancer care services in VHA. Initial evaluation objectives include establishing an evidence base regarding Veterans with breast and gynecological cancers, including their experiences with cancer care in the VHA. Eventually, COURAGE will provide ongoing monitoring and evaluation to continue to grow and improve cancer care in the VHA.

Abstract B077: La lengua materna: Understanding language challenges experienced by Latino patients and caregivers in rectal cancer care

Abstract Background/Purpose: Language concordance is critical for effective communication between patient and provider. Compared to the percentage of primary Spanish speakers in California, there is a lack of Spanish-speaking providers in healthcare, especially in oncology. In-house hospital interpreters help overcome basic language barriers; however, even with the adoption of these services, there remain gaps in comprehension. Such gaps in communication can compromise the informed decision-making process, necessitating novel approaches to multilingual health communication. This study aimed to (a) explore language barriers Hispanic/Latino patients and their caregivers face when navigating rectal cancer care services and (b) propose a culturally-tailored solution that could address these barriers. Methods/Study Population: We designed a community-based participatory study using qualitative methods. Specifically, we formed a Community Advisory Board and partnered with local promotoras – health navigators with strong ties to the Hispanic/Latino community. Together, we developed a semi-structured interview guide to shape our conversations with individuals residing in the Bay Area or the San Joaquin Valley who identify as Hispanic/Latino, and who reported having either a past or current rectal cancer diagnosis. We also invited their caregiver(s) to attend the interview. Interviews lasted 45-60 minutes in English or Spanish. Over a 6-month period, twenty interviews were conducted with patients alone (n= 14), a caregiver alone (n=2), and patient-caregiver pairs (n=4). Data analysis utilized grounded theory and reflexive thematic analysis to identify core themes. Results: Themes that arose include (1) ineffective and non-satisfactory communication through electronic interpreter services, (2) bilingual caregiver burden in reinforcing interpreter translations due to dialect differences, (3) patients not actively seeking out translation services for concern of causing inconvenience to the healthcare team, (4) patients’ preferred language not accurately captured in the electronic medical record. Conclusion: Interpreter services have helped bridge the language gap in healthcare, but inevitable gaps remain as language involves more than just the spoken word; it includes the culturally influenced non-verbal cues and the management of emotional responses to the information provided, components of communication which interpreters may miss. A solution to address the cultural complexities of language among this population in this setting, could be the adoption of promotoras; these health navigators share multiple aspects of their cultural identities with the patient population, making them uniquely positioned to bridge the gap between the medical system and the Hispanic/Latino community. Citation Format: Eleanor Brown, Julian P Howland, Min Y. Kim, Lucas K. Carpenter, Patricia Castañeda, Maria Gonzalez, Miriam T. Hernandez, Zaria N. Cosby, Kristen M. Davis-Lopez, Ysabel Duron, Gladys M. Rodriguez, Sandra S. Zaky, Arden M. Morris, Aaron J. Dawes. La lengua materna: Understanding language challenges experienced by Latino patients and caregivers in rectal cancer care [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 B077.

Women's Lived Experiences in the Use of Complementary and Alternative Medicine for Breast Cancer Management: A Phenomenological Study.

This study aimed to explore women with breast cancer (WBC) lived experiences on the use of Complementary and Alternative Medicine (CAM) for breast cancer management. van Manen's phenomenology of practice was used as the methodology and method in this study. In-depth interviews guided by semi-structured questions were conducted with 21 WBC recruited using convenience sampling. The thematic analysis generated four main themes: Access, affordability and support for medical treatment, beliefs in CAM treatment, feeling the potential benefits of CAM, and Acknowledging the negative aspects of CAM. The outcomes from using CAM based on the lived experiences of WBC indicated that some CAM treatments could improve quality of life. However, some fraudulent CAM obtained from unprofessional CAM providers could cause harmful effects, delay medical cancer treatment, and increase breast cancer treatment costs. Therefore, there is an urgent need to enhance the awareness of appropriate treatment, including evidence-based CAM, for WBC. Improved understanding in the use of CAM as a part of quality breast cancer care services could contribute to increasing the quality of life and survival rates of women with breast cancer.

Applying a “medical deserts” lens to cancer care services in the North-West region of Romania from 2009 to 2022 – a mixed-methods analysis

BackgroundMedical deserts pose significant challenges to healthcare systems worldwide, leading to unmet healthcare needs and exacerbated health issues, particularly in underserved regions.MethodsThis study aims to characterise cancer care services in the North-West region of Romania through the lens of medical desertification, employing a mixed-methods approach.Quantitative analysis – descriptive statistics – of secondary data from the Activity of Healthcare Units reports from 2009 to 2022, along with qualitative data – thematic analysis – from interviews with cancer patients and healthcare professionals, were employed to uncover the current state of cancer care in Romania.ResultsThe qualitative analysis highlighted the prevalence of medical deserts in oncology, with inadequate human resources, facility deficiencies, prolonged waiting times, high costs, and socio-cultural barriers hindering access to cancer care.Opportunities for action include revising treatment protocols, enhancing palliative care, implementing prevention strategies, promoting collaboration among healthcare professionals, and digitalising the healthcare system. However, challenges persist, including a shortage of oncology specialists, geographical disparities in cancer prevalence, and limited access to advanced treatment modalities in rural areas.ConclusionsAddressing medical deserts in cancer care requires comprehensive approaches, including strategic resource allocation, workforce development, infrastructure investments, access to innovative treatments, and digital health technologies. Collaboration among policymakers, healthcare providers, and communities is crucial to mitigating medical deserts and improving cancer outcomes.Despite limitations, this study provides valuable insights into cancer care services and underscores the need for concerted efforts to overcome medical desertification and ensure equitable access to high-quality cancer care.

Resolving disparities in access to cancer care in LMIC-positive learning using a 10-year-old model.

156 Background: Despite significant advances in cancer diagnosis and treatment, there are wide disparities in access to cancer care, more so in low- and middle-income countries. The problem is multifactorial, such as patient-related, health system-related, socio-cultural-related to language and literacy, and socio-cultural-related to beliefs and stigma. These disparities extend across the cancer continuum, from diagnosis to end-of-life care. It is imperative to address these disparities. Here we report 10-year experience from an innovative access delivery model in one go, comprehensively addressing many of these challenges. Methods: Learning from the WHO framework of health system strengthening, a model that affects the major contributors to health system strengthening was developed. These include government-owned health departments, district hospitals, and physicians. Various regulations strengthened each of these components. The regulations were issued to create systems in district hospitals, train an alternative oncology workforce, and make oncology drugs available in the periphery. This measure allowed cancer-care-related services to be feasible in the existing peripheral health system. Results: In 2014, one of the states in India decided to initiate cancer care services in government-run district hospitals. One physician and two nurses from every district hospital were trained to offer cancer-related services locally from diagnosis to end-of-life, including cancer chemotherapy, under the 24 x7 mentorship of a senior oncologist. To date, more than 250 physicians and 500 nurses have been trained in this field. The program has been extended to eight states and 198 districts, covering an area of over a million square kilometers and a population of over 380 million. Data from only one district alone showed that nearly 7000 new patients availed of services (average 700 per year) with more than 17000 sessions of chemotherapy (Table). Conclusions: The majority of the world, including LMICs, is dependent on the services provided by government-run health institutions. The empowerment of government health systems appears to be the single most important factor in improving access to cancer care. This model of cancer cere delivery has consistently proven its robustness, replicability, and scalability. This finding deserves consideration for further research and expansion to other countries. [Table: see text]

Quantitative exploration of barriers to access cancer services experienced by cancer patients in Lesotho

Background: Cancer mortality has been estimated to increase in sub-Saharan Africa to more than a million deaths in 2023. There is a need for an increase in cancer screening, diagnosis and treatment infrastructure to curb this rise in cancer mortality. Many people with cancer face significant barriers to accessing treatment.Aim: The study aimed to explore barriers to accessing cancer care services experienced by cancer patients in Lesotho.Setting: This study was conducted at the Senkatana oncology clinic in Maseru, Lesotho.Methods: The study adopted a quantitative cross-sectional design. Cancer patient interviews were conducted using a structured questionnaire.Results: A total of 115 patients responded to the questionnaire, and 79.1% were female. Over half of the participants (53.9%) found it difficult to access cancer services because they had to get services from multiple healthcare facilities in different areas. All of them had to join long queues. Distance from the healthcare facilities was also a challenge for a significant number (64.3%), and a substantial number (66.1%) had difficulties arranging transport to such facilities. Finally, financial issues, such as paying for transport, healthcare and diagnostic tests, were determined to be major constraints.Conclusion: The study concludes that most cancer patients face financial and practical barriers. This affects access to cancer services, particularly for patients not residing in Maseru.Contribution: The study shares information regarded as barriers to cancer services in a low- and middle-income country.

Strengthening of cancer care services in Bihar: A situational analysis

ABSTRACT Background: The status of cancer care in Bihar is in elementary stages, with limited knowledge of epidemiology and insufficient comprehensive cancer care centers. State Cancer Institute (SCI) of Bihar is actively working to address these gaps by continuously upgrading its facilities and services. Objectives: The present article aims to define the problem and conduct a situational analysis for strengthening cancer care services in Bihar through the expansion and integration of services at SCI, Indira Gandhi Institute of Medical Sciences (IGIMS), Patna. Materials and Methods: A problem statement was initially developed following a comprehensive review of the literature from January 2023 to September 2023, with an updated review conducted in August 2024. Full-text articles containing the keywords “cancer,” “incidence,” and “Bihar” were searched on PubMed and manually screened for relevance based on titles and abstracts. Additional information was collected through Google searches of public domain websites and newspaper portals, and relevant articles were also identified through a manual review of references. Furthermore, a situational analysis was conducted using SWOT analysis and power-interest matrix to identify and evaluate the stakeholders. Results: Accurate cancer incidence data for Bihar are lacking. Almost half of the estimated new cancer cases seem to be registered within the state, while the rest remain unaccounted. Presently, there are only eight comprehensive cancer centers operational in the state. The SWOT analysis highlighted opportunities for SCI based on inherent strengths, while limited manpower and inadequate collaborations were identified as critical weaknesses. Key stakeholders were identified as the crucial players in mitigating threats and supporting positive policy and financial frameworks. Conclusion: Properly addressing the needs of stakeholders and fully utilizing available opportunities are essential for strengthening healthcare services in the state. The SCI could play a vital role in the process. The article also provides background on devising strategies to address the current cancer care needs of the state.

Barriers to access to cancer care for patients from the conflict-affected region of the Nagorno-Karabakh Republic: A qualitative study.

Access to essential health services is a basic human right, yet many cancer patients living in conflict-affected regions face multiple obstacles to service use. The (former) Nagorno-Karabakh Republic was a conflict-affected region in the South Caucasus populated predominantly by ethnic Armenians. Multiple acute armed conflicts, the recent military occupation of the region, and the prolonged military blockade of the Lachin Corridor (a humanitarian corridor connecting Nagorno-Karabakh to Armenia) exacerbated existing social, health, economic, and political fragilities in this region. As a result, cancer services were disrupted, with limited clarity on how the ongoing military blockade of a humanitarian corridor affected cancer patients' experiences of accessing cancer care locally and in bordering Armenia. Our study aimed to describe the experiences of patients from Nagorno-Karabakh in accessing the cancer care services they needed. We conducted remote semi-structured interviews with adult (aged ≥18 years) cancer patients receiving cancer care from three university hospitals in Armenia and face-to-face interviews with cancer care professionals from these hospitals. Interviews were conducted during the blockade of the Lachin Corridor between March and May 2023. Data were analysed thematically using a deductive approach. Twelve adult cancer patients (9 women) and 12 cancer care professionals participated. A key barrier to accessing cancer services was attributed to the Azerbaijani military occupation of the region and the blockade of a major roadway connecting Nagorno-Karabakh to Armenia. Patients talked in length about the challenges of finding transport and travelling long distances to reach essential cancer services in Armenia. Policies of free anti-cancer medication provision and decentralised medication supply were paused because of the military occupation, affecting patients' timely access to anti-cancer medication. Out-of-pocket expenses for treatment, anti-cancer medication, travel, and temporary accommodation in Armenia placed a significant financial burden on cancer patients, exacerbated by the humanitarian crisis. Conflict-affected regions blockaded by military forces lack the capacity and targeted support to sustain their essential health services and provide care to those in need of life-saving treatments. Coordinated action from national and international organisations and governments is urgently needed to enhance humanitarian assistance and healthcare support to patients, their families and wider communities affected by military blockades and armed conflicts.

Applying the Unified Theory of Acceptance and Use of Technology to Identify Factors Associated With Intention to Use Teledelivered Supportive Care Among Recently Diagnosed Breast Cancer Survivors During COVID-19 in Hong Kong: Cross-Sectional Survey.

Many supportive cancer care (SCC) services were teledelivered during COVID-19, but what facilitates patients' intentions to use teledelivered SCC is unknown. The study aimed to use the unified theory of acceptance and use of technology to investigate the factors associated with the intentions of breast cancer survivors (BCS) in Hong Kong to use various types of teledelivered SCC (including psychosocial care, medical consultation, complementary care, peer support groups). Favorable telehealth-related perceptions (higher performance expectancy, lower effort expectancy, more facilitating conditions, positive social influences), less technological anxiety, and greater fear of COVID-19 were hypothesized to be associated with higher intentions to use teledelivered SCC. Moreover, the associations between telehealth-related perceptions and intentions to use teledelivered SCC were hypothesized to be moderated by education level, such that associations between telehealth-related perceptions and intentions to use teledelivered SCC would be stronger among those with a higher education level. A sample of 209 (209/287, 72.8% completion rate) women diagnosed with breast cancer since the start of the COVID-19 outbreak in Hong Kong (ie, January 2020) were recruited from the Hong Kong Breast Cancer Registry to complete a cross-sectional survey between June 2022 and December 2022. Participants' intentions to use various types of teledelivered SCC (dependent variables), telehealth-related perceptions (independent variables), and sociodemographic variables (eg, education, as a moderator variable) were measured using self-reported, validated measures. Hierarchical regression analysis results showed that greater confidence using telehealth, performance expectancy (believing telehealth helps with daily tasks), social influence (important others encouraging telehealth use), and facilitating conditions (having resources for telehealth use) were associated with higher intentions to use teledelivered SCC (range: β=0.16, P=.03 to β=0.34, P<.001). Moreover, 2-way interactions emerged between education level and 2 of the telehealth perception variables. Education level moderated the associations between (1) performance expectancy and intention to use teledelivered complementary care (β=0.34, P=.04) and (2) facilitating conditions and intention to use teledelivered peer support groups (β=0.36, P=.03). The positive associations between those telehealth perceptions and intentions were only significant among those with a higher education level. The findings of this study implied that enhancing BCS' skills at using telehealth, BCS' and their important others' perceived benefits of telehealth, and providing assistance for telehealth use could increase BCS' intentions to use teledelivered SCC. For intentions to use specific types of SCC, addressing relevant factors (performance expectancy, facilitating conditions) might be particularly beneficial for those with a higher education level.

'I Do It All Alone': The Burdens and Benefits of Being Diagnosed With, and Treated for, Colorectal Cancer During the Covid-19 Pandemic.

The Covid-19 pandemic dramatically altered the way cancer care services were accessed and delivered, including for colorectal cancer (CRC). In the United Kingdom, patients were discouraged from presenting in primary care, many consultations took place remotely, investigative procedures and screening programmes were temporarily suspended, and fewer operations and treatments were delivered. People had to face the practical consequences of having cancer during a pandemic and navigate never before seen pathways, often alone. We examined the experience of being diagnosed and treated for CRC during the pandemic, and the implications of this on people's cancer journeys. Semi-structured interviews were undertaken with people diagnosed with CRC during the Covid-19 pandemic (January 2020-May 2021), in the North East of England. An iterative topic guide was used during interviews, which took place remotely (telephone or Zoom), were audio recorded, pseudo-anonymised and transcribed. Initial transcripts were independently coded by two researchers, and a code 'bank' developed for application across transcripts. Development of themes and overarching analytical constructs was undertaken collaboratively by the research team. Interviews were conducted with 19 participants, analysed and four key themes identified: (1) The relative threats of Covid-19 and Cancer were not comparable, with cancer seen as posing a far greater risk than Covid-19; (2) Remote consultations were problematic, affecting patients' abilities to build rapport and trust with clinicians, assess nonverbal communication, and feel able to disclose, comprehend and retain information; (3) Stoma follow-up care was seen to be lacking, with long wait times for stoma reversal experienced by some; Finally, (4) Being alone during consultations negatively impacted some peoples' abilities to absorb information, and left them without the support of loved ones at an emotionally vulnerable time. However, some participants preferred being alone at certain points in their pathways, including receiving a diagnosis, and most frequently when receiving in-patient treatment. Being alone brought unexpected benefits, absolving people from undertaking emotions work for others, and instead focus on their recovery, however, remote consultations negatively impacted patients' experiences. This study highlights the complex benefits and burdens of pandemic-located cancer journeys, including how these shifted at different points across cancer pathways. Lorraine Angell, a cancer survivor, has been central to this study from idea conception, contributing to: development of study focus and design; securing funding; production of patient-facing materials; development of interview topic guides; analysis and interpretation of data; and drafting of key findings and manuscripts.

Cancer care service use intensity in Medicare Advantage versus traditional Medicare.

11054 Background: Prior studies have found evidence of lower cost of care and preserved care quality among Medicare Advantage (MA) plans vs. traditional Medicare (TM). However, MA performance for patients with serious conditions such as cancer is yet to be explored. MA plans are incentivized to reduce expenditures, and the high financial cost (often with marginal clinical benefit) of chemotherapy might be an opportunity for savings. We compared service use intensity and quality between MA and TM cancer patients receiving systemic therapy. Methods: Medicare claims data and MA encounter records (including only MA contracts that had highly complete data), 2015-2019. We included patients with select major cancer types, and measured outcomes during a 6-month chemotherapy episode, defined by the date of systemic therapy initiation after a 1-year washout period. Service use intensity was measured in dollar terms using standardized Medicare prices. Quality measures included treatment-related emergency department (ED) visits and hospitalizations, avoidable ED visits, preventable hospitalizations, and overall survival. To estimate the association between MA enrollment and these outcomes, we used regression models with county-level fixed effects and inverse probability of treatment weighting to balance the MA and TM samples on patient demographics, cancer type, health-risk score, metastatic status, frailty, and area characteristics. We performed separate analyses by cancer type. Results: The study sample comprised 96,501 MA and 206,274 TM beneficiaries who had one of seven cancer types: breast cancer, chronic leukemia, colon cancer, lung cancer, lymphoma, multiple myeloma, and prostate cancer, and who initiated systemic therapy between 2016 and 2019. Estimated mean overall service use among MA enrollees was $62,599, compared to $71,317 for TM beneficiaries (-$8,718, p&lt;0.01). A majority of the overall difference was accounted for by Part B-covered systemic therapy drugs ($20,691 in MA versus $25,723 in TM, difference -$5,032, p&lt;0.01). Although MA enrollees received slightly cheaper drugs (-$277 per treatment day, p&lt;0.01), the lower cost of systemic therapy was driven largely by a lower number of treatment days occurring per 6-month episode for MA enrollees (-1.06 days, p&lt;0.01). MA enrollees had fewer treatment-related ED visits and hospitalizations (-2.5%, p&lt;0.01 and -0.7%, p&lt;0.01 respectively) but had more avoidable ED visits (+0.5%, p&lt;0.01). There was no difference in survival or preventable hospitalizations. Results were similar within individual cancer types. Conclusions: MA enrollment is associated with reduced service utilization but not shorter survival among cancer patients receiving systemic therapy. Further research is needed into the mechanisms of these savings to identify areas where care may be delivered more cost-effectively without negatively impacting outcomes.

An AI-assisted navigation approach for patients with radiographic suspicion of new pancreas cancer.

11002 Background: The traditional cancer care paradigm relies on passive referral streams, resulting in suboptimal care delivery. Here, we assessed the results of an AI-assisted navigation approach to proactively coordinate specialty cancer care services for patients with radiographically suspected pancreas cancer. Methods: A natural language processing (NLP) classifier was trained to identify radiology reports suspicious for pancreas cancer from imaging reports generated within Northwell Health. The daily workflow consists of the following: the NLP flags reports with suspicion of pancreas cancer, a coordinator validates the finding, a GI oncologist and navigator coordinates specialty oncology and tumor board referral, and a clinical research coordinator pre-screens for research studies. Patients determined to be hospice-bound or with non-PDAC malignancy are excluded. Care delivery metrics were compared by Mann-Whitney U tests. Results: Prior to implementation, patients with new suspicion of pancreas cancer at our institution experienced a mean of 22 days to biopsy, 32 days to oncology visit, and 56 days to treatment initiation from radiology report with 17% referred to pancreatic multidisciplinary clinic (PMDC). Per monthly average, 1.8 patients were approached for biospecimen studies, 1.5 were consented, and 0.9 were enrolled. In the month following implementation of the AI-assisted navigation pilot, reports from 1666 patients were flagged, resulting in 38 patients with new suspicion of pancreas cancer identified (Table). Of these, 53% underwent biopsy, 50% were seen by an outpatient oncologist, 29% were referred to PMDC, and 42% received treatment at our institution. From date of radiology report, these patients underwent biopsy at a mean of 7 days (p&lt;0.01), outpatient oncology visit at 15 days (p=0.285), and treatment initiation at 34 days (p=0.3479). A monthly average of 4 patients were approached for biospecimen studies, 4 were consented, and 3.2 were enrolled. Conclusions: An AI-guided navigation workflow identified patients earlier in the diagnostic timeline; reduced time to biopsy, follow-up, and treatment initiation; increased patient referrals to PMDC; and tripled participation in biospecimen studies at our institution. [Table: see text]

Strategies for General Practitioners to Enhance Cancer Care: Insights from a Patient-Centered Questionnaire Survey in Southern China.

The incidence of cancer is increasing, and cancer survivors are also growing exponentially. Cancer is defined as a new chronic disease. Nevertheless, the management of cancer in the form of chronic diseases in China is still in its infancy, without a standardized care model. This study aimed to explore the current status of management of cancer care from the patient's perspective. This cross-sectional study was a questionnaire survey of patients diagnosed with cancer, including information of the current situation of daily medical consultation, status of comorbidity, and expectations of seeking cancer care in future. Chi-square test and logistic regression analysis were used to explore the factors influencing patients' choice of cancer management mode. A total of 200 cancer patients were included in the study. The majority (n = 150) of cancer patients chose an oncologist in a tertiary hospital for cancer care. Difficulty in registration (45%), time-consuming (34.5%), repeated examinations (34.5%) and different treatment opinions (12.0%) were the main difficulties they encountered currently during tertiary hospital visits. In community hospital, lack of trust in general practitioners (n = 33) and the necessary drugs or testing items in community hospitals (n = 47) were the main difficulties during their visits. Logistic regression analysis showed that male (OR = 2.737, 95% CI, 1.332-5.627, p = 0.006) and elderly patients (OR = 3.186, 95% CI, 1.172-8.661, p = 0.023) were more likely to choose general practitioners (GPs) in community hospitals. Twenty-nine (14.5%) patients hope to have an integrated multidisciplinary management in tertiary and community hospitals with the active participation of GPs for cancer care. Improving drug availability, equipment and quality of cancer care services can help to increase cancer patients' recognition of community hospital. In addition, the multidisciplinary management integrated tertiary hospitals and communities with the participation of GPs is a worth exploring mode that improves the management of cancer care.

NCCN Policy Summit: Cancer Across Geography.

Geographic location of a patient directly impacts access to care, including preventive screenings and early detection. Although there is a higher prevalence of the most common cancers in urban areas, mortality rates are higher in rural communities. Notably, indigenous communities residing on tribal lands often experience heightened access issues and environmental exposure to known and probable human carcinogens. The burdens associated with a cancer diagnosis can be exacerbated by various barriers to accessing quality care; however, there are emerging best practices to overcome these barriers. Understanding the interplay between geography and a patient's access to cancer care services is crucial for addressing existing disparities and ensuring equitable health care provision across regions. By leveraging innovative policy and practice solutions, communities can begin to close care gaps and establish bidirectional trust between patients and providers across the care continuum, which is necessary to enact meaningful reforms. To advance the conversation on geographic disparities and strategies that mitigate associated barriers to care, NCCN hosted the Policy Summit "Cancer Across Geography" on June 15, 2023, at the National Press Club in Washington, DC. Through keynote addresses and multistakeholder panel discussions, this hybrid event explored care imbalances across geography, recent policy and technology advancements, and current challenges associated with cancer care. This created a forum for a diverse group of attendees to thoughtfully discuss policies and practices to advance high-quality, effective, efficient, equitable, and accessible cancer care for all. Speakers and attendees featured multidisciplinary clinicians, epidemiologists, community oncologists, researchers, payers, patient advocates, industry, providers, policymakers, and leaders representing underserved communities, among others.

Abstract PO3-11-02: Characterizing Breast Cancer Care Fragmentation Among Young Black Women Diagnosed with Breast Cancer

Abstract Introduction Fragmented cancer care is defined as receiving care across multiple institutions. The National Academy of Medicine has identified cancer care fragmentation as a priority area for cost reduction. However, little is known about the role of fragmented care on receipt of guideline-recommended care patient-reported outcomes, particularly among populations affected by health inequities like Black women. The objective of this study was to characterize breast cancer care fragmentation among a population-based cohort of young Black women with breast cancer. Methods Study participants were a population-based sample of self-identified Black women diagnosed with invasive breast cancer at or below age 50, recruited since 2017 through the Florida and Tennessee state cancer registries. As part of the study, participants completed baseline questionnaires about their cancer care delivery experiences. Participants were eligible if they self-reported the locations where they received their cancer treatment (i.e., diagnosis, surgery, chemotherapy, and radiation). Indicator variables for care fragmentation were created to identify participants who received their diagnosis, surgery, chemotherapy, and radiation within the same health system and those who received their cancer care across multiple health systems. Chi-squared tests were used to assess the relationship between care fragmentation, receipt of guideline-recommended genetic testing, and self-rated health. Self-rated health was dichotomized into Excellent/Very Good/Good and Fair/Poor. Results A total of 183 Black women diagnosed breast cancer ≤ age 50 were included in the analysis. Among the included participants, 11% (n=20) only had surgery, 15% (n=27) had surgery and radiation, 17% (n=31) had surgery and chemotherapy, and 57% (n=105) had surgery, chemotherapy, and radiation. Among the 105 women who had surgery, chemotherapy, and radiation, 17% (n=17) received all cancer treatment within the same health system of diagnosis, 21% (n=21) received all cancer treatment within the same health system but were diagnosed within a different health system, and the remaining 62% of participants received their cancer treatment across different health systems, representing care fragmentation. In chi-squared analyses, fragmented care was not associated with lower receipt of genetic testing(p=0.33) or self-rated health (p=0.28). Conclusion In this population-based study, most participants had fragmented breast cancer care, however fragmentation was not associated with lower self-rated health or receipt of guideline-recommended germline genetic testing. Current approaches for assessing care fragmentation are often too coarse to capture the complexity of breast cancer care delivery and service availability. Patient-centered conceptual models of what drives cancer care fragmentation and the specific aspects of fragmentation that have the potential to drive adverse outcomes are critical. Citation Format: Mya Roberson, Jordyn Brown, Brianna Taffe, Anne Weidner, Lindsay Venton, Sonya Reid, Tuya Pal. Characterizing Breast Cancer Care Fragmentation Among Young Black Women Diagnosed with 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 PO3-11-02.

Abstract PO5-06-10: Evaluating Disparities in Access to Quality Cancer Care for Black Women with Triple Negative Breast Cancer in the US: A Provider Perspective

Abstract Introduction: Triple-negative breast cancer (TNBC) presents unique challenges due to its aggressive nature and limited treatment options. Black women are disproportionately affected by TNBC, experiencing higher incidence rates and poorer outcomes compared to other racial/ethnic groups. This study aims to evaluate disparities in access to quality cancer care for Black women with TNBC from the perspective of oncology healthcare providers. Methods: From December 2022 to February 2023, the Association of Community Cancer Centers conducted a survey of 84 multidisciplinary care team members who provided care to Black patients with TNBC. The online survey captured quantitative and qualitative data on challenges related to accessing timely TNBC diagnosis and treatment services, care coordination for work-up and biomarker testing, confidence in TNBC treatment, clinical trial enrollment, supportive care services, and related referrals. Additionally, a follow-up focus group was conducted in May 2023 to further interpret select survey data, with a focus on shared decision-making, patient-provider communication, and ways to support cancer programs in improving screening, biomarker testing, and care coordination for individuals with TNBC. Results: Respondents reported several barriers to accessing timely diagnosis and treatment services for Black women with TNBC, including challenges in coordinating care for work-up and biomarker testing, providers' confidence in providing guideline-concordant comprehensive cancer care services for this patient population, enrolling patients in clinical trials, and making referrals for supportive care services. The survey revealed that community cancer programs treated an average of 21-50 patients with TNBC annually, with 31% of them being Black. Perceived patient-level factors contributing to challenges in accessing TNBC diagnosis and treatment included geographic distance to care facilities (14%), health literacy (18%), and insurance-related factors (21%). Practice-level barriers included limited accessibility of practice location (19%), capacity to accommodate new patients (27%), and insurance-related factors (34%). Additional findings highlighted slightly lower provider confidence in areas such as tobacco cessation (only 54% very confident), breast reconstruction (59% very confident), fertility counseling (52% very confident), and coordinating care across a fragmented healthcare system (52% very confident). Respondents identified the most commonly offered comprehensive cancer care services as palliative care (82%), nutrition support (77%), telemedicine (68%), psychological counseling (68%), and financial advocacy (68%). Less commonly offered services include recreational therapy (21%), legal aid (17%), and childcare (16%). Conclusion: This study highlighted the barriers faced by providers in delivering quality cancer care to Black women with TNBC. The findings underscore the importance of addressing challenges related to timely diagnosis and treatment services, care coordination, confidence in treatment options, clinical trial enrollment, and referrals for supportive care services. Insights from the focus group discussions further highlight the need for shared decision-making, improved patient-provider communication, and identification of opportunities to support cancer programs in addressing the specific needs of Black women with TNBC. To advance equity in cancer care, targeted interventions should focus on enhancing provider education, improving care coordination systems, and promoting cultural sensitivity. Efforts should also be made to overcome barriers related to limited accessibility of practice location, and insurance-related factors. By addressing these gaps, providers can play a crucial role in reducing disparities and improving outcomes for Black women with TNBC. Citation Format: Doreen Effange, Niharika Dixit, Ruth O'Regan, Ogori Kalu, Ryann Norcereto, Richard Simonds, Elizabeth Valencia, LaToya Bolds-Johnson, Aubrey Van Kirk Villalobos, Christie Mangir, Elana Plotkin, Karen Tacka, Leigh Boehmer. Evaluating Disparities in Access to Quality Cancer Care for Black Women with Triple Negative Breast Cancer in the US: A Provider Perspective [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 PO5-06-10.