Supportive Care Services Research Articles

Nature and impact of symptoms at time of initial presentation for patients with glioblastoma.

In patients diagnosed with glioblastoma (GBM), minimal data exist on the pathway to presentation and the impact of symptoms on survival outcomes. This study aims to detail the symptoms that occur at time of initial presentation, the response to subsequent intervention, and the factors that predict survival in patients managed for GBM. A retrospective audit was performed from established prospective databases in patients managed consecutively with radiation therapy (RT) for GBM between 2016 and 2019. The major endpoint was median overall survival (mOS). Analysis was performed to determine associations with clinical factors including presenting symptom, performance status, tumour site and extent of resection. The level of carer support and objective perception of carer mastery was also assessed. Overall, 182 patients with GBM were eligible for analysis. The majority of patients presented directly to Emergency (52%), with the most common initial presenting symptom being personality change in 23% of patients. The primary symptoms resolved pre-operatively in 47% of patients, with 9% having worse symptoms postoperatively. The mOS was 16.5 months (95% CI: 14.5-18.5). ECOG Scores 0-1 were associated with improved mOS at both initial ECOG (P < 0.001) and ECOG at 6 months (P = 0.006). Recognised Carer Mastery (P = 0.007) but not presence of carer (P = 0.35) was associated with improved mOS. In patients with GBM initial presenting symptoms, level of performance status and role of carer influence clinical outcomes and survival. These findings can assist to guide clinicians and supportive care services to optimise future patient care.

Service Access and Supportive Care Experiences among Urban and Rural Cancer Survivors: Informing Social Work Practice.

Access to medical and supportive care services is important for the health and quality of life of cancer survivors; however, services are not always available or accessible to all survivors equally. This study aims to explore the experiences of cancer services among cancer survivors in urban and rural settings to inform social work practice. Authors conducted interviews with 25 cancer survivors (colorectal, n = 13; hematological, n = 12) in the West of Ireland, using a narrative inquiry approach. Thematic analysis was used to analyze the data. Authors found variations in the availability of supportive care services for urban and rural cancer survivors. Often, services designed to maximize survivors' individualized choices and needs in community care were limited in rural communities, preventing some survivors from having their physical and psychological needs met. Additionally, access to services proved to be a barrier for rural cancer survivors. Rural survivors stated that traveling to appointments required time and planning, and the implications of travel costs were an increased burden. When rural survivors had good social support, access to services became less of an issue. The study confirms geographical disparities and recommends a review of supports that better meet survivors' needs and informs social work practice.

Using patient-reported performance status to guide management of advanced cancer: A quality improvement initiative.

379 Background: Performance status is a key prognostic factor among patients with advanced cancer and can inform the need for supportive care services. However, assessment and documentation of performance status is inconsistently integrated into standard oncology care. Patient-reported performance status (PRPS) is a surrogate for clinician-assessed performance status and has the potential to address this challenge. We piloted a decision support tool in our electronic health record (EHR) that uses PRPS to prompt clinician assessment of performance status and suggest referrals to supportive care services. Methods: We identified patients with advanced cancer using a pre-built and validated registry driven by ICD codes in our EHR (EPIC). For patients with advanced cancer seen at one of our clinics, a multiple-choice question with options derived from the Eastern Cooperative Oncology Group (ECOG) scale in patient-friendly language was added to the pre-visit questionnaire sent electronically prior to oncology visits. For patients with a poor PRPS (2 or greater), a clinical decision support tool alerted providers of the patient’s self-reported performance status, encouraged input of the clinician’s ECOG assessment, and suggested referral orders to supportive care services such as palliative care, nutrition, and social work. We are currently evaluating how our PRPS-driven decision support tool impacts the rate of clinician-assessed ECOG documentation, referral rates, and clinical outcomes. Results: Between 3/13/24 and 5/13/24, of 336 patients identified by the advanced cancer registry, 70% (235) of patients completed the PRPS questionnaire. Among patients with an available PRPS score, 18% (42) of patients reported a poor performance status (2 or greater) at least once, triggering the decision support tool. Providers entered ECOG assessments for 93% (39) of patients and sent referrals to supportive care services for 10% (4) of the patients. Three patients died during this time period, and all three of them reported a poor performance status of 3 or 4. Oncologists at the clinic reported no significant disruption to routine workflow. Conclusions: Preliminary results suggest feasibility of a PRPS-driven decision support tool to flag patients with advanced cancer and declining function and improve discrete documentation of clinician-assessed performance status. Notably, the rate of referrals to supportive care services remains low. Next steps include obtaining longitudinal data from this pilot, assessing the impact of the pilot on goals of care documentation, and validating the concordance of PRPS and ECOG and their effect on clinical outcomes. Ultimately, we aim to use the resulting data and harness our dashboard of patients with advanced cancer and poor performance status to develop innovative, automated, and targeted quality improvement interventions.

Anesthetic considerations for fetal interventions

Fetal therapy is a well-established but rapidly evolving field discipline. Fetal interventions require a multidisciplinary team approach that emphasizes collaboration and communication. The success of a fetal therapy program relies on the availability of a comprehensive obstetric and neonatal care team, support services, and advanced imaging. Technological advancements in prenatal fetal imaging and genetic diagnosis have improved our understanding of various fetal anomalies. Surgical techniques and anesthetic management have also advanced, leading to better outcomes. Fetal anesthesia presents unique challenges as it involves managing both the mother and the fetus. Anesthetic management focuses on ensuring maternal safety and comfort, maintaining adequate uteroplacental perfusion, optimizing surgical conditions, and minimizing risks for both the mother and the fetus. This article reviews current anesthesia practices for fetal surgery, highlighting recent advances and future directions.

A comparative analysis of supportive care service needs in patients with pancreas versus other gastrointestinal cancers.

272 Background: Pancreatic ductal adenocarcinoma (PDAC) is the third leading cause of cancer death and presents with advanced incurable disease approximately 75% of the time, contributing to the lowest survival rate and worst multidimensional quality of life (QOL) compared to other adult solid tumors. Standardized screening for early integration of interdisciplinary care (IDC) services, advance care planning, and utilization of electronic patient-reported outcomes (ePROs) for improved QOL and symptom management are recommended, yet the literature is lacking in rigorously-conducted PDAC needs assessments, an important prerequisite to care model design. Methods: Between September 12, 2023 and May 7, 2024, 525 patients with gastrointestinal (GI) malignancies were sent a Supportive Care Questionnaire (SCQ), an ePRO survey assessing multi-dimensional IDC needs prior to first visit at an NCI-designated comprehensive cancer center in the Pacific Northwest. The SCQ includes validated surveys and a total of 12 domains chosen by the IDC service responsible for management of the given need(s), who also set trigger thresholds for referral to the IDC service. Rates of positive screens for each service were compared by cancer type (PDAC, Colorectal [CRC], gastroesophageal [GE]). Results: 340 (65%) SCQs were completed (57% via MyChart, 43% in person) similarly across disease groups; with an average of 10 mins to complete. Respondents were 49% female/59% male (Race: White (76.5%), Asian (10%), Black/African-American (4.5%), Other/Unknown (9%)/Ethnicity Non-Hispanic (90%, Hispanic 7.6%), Other/Declined/Unknown 2.4%), with primary language spoken being English (92%), Spanish (3.5%), simplified Chinese (1.5%) and Other (2.5%). Table 1 shows – by GI cancer type –the total number of responses and the proportion of patients who screened positive for one or more IDC services. Conclusions: Patients with PDAC had the greatest need for IDC services with most frequent positive screens indicating need for nutrition, social work, palliative care and patient navigation services when surveyed in our institution-wide program of SC screening for all new GI cancer patients. Results will inform further development of IDC services in PDAC and other GI cancers, including via staff prediction modeling. The SCQ is also being considered for SC screening and management across the Canopy Cancer Collective, a nationwide learning health network of pancreas cancer programs. PDAC CRC GE Surveyed 187 237 101 Completed 122 (65%) 153 (65%) 65 (64%) Positive Screen 68 (56%) 70 (46%) 26 (40%)

Impact on ambulatory palliative appointment lead times by standardizing scheduling protocols based on cognitive computing models.

62 Background: Although palliative care is available across the United States, access continues to remain variable. In Texas, only 52% of hospital systems have palliative services. As a result, optimizing existing systems is critical to providing timely services to this vulnerable population. The Supportive Care Services Clinic at University Health in San Antonio, TX provides ambulatory palliative services to patients including physical and psychosocial symptom management and care coordination. For the period April 1, 2023 to June 30, 2023 average lead times for new palliative patient visits (NPPV) and hospital consult discharge visits (HCDV) was 53 days and 39 days respectively. The aim of this project was to decrease the lead times for NPPV and HCDV through standardization of scheduling criteria. We hypothesized that by applying a scheduling protocol utilizing cognitive computing models (CCM) calculating readmission risk scores to prioritize referrals, we could reduce appointment lead times. Methods: During the implementation phase, we developed referral triage criteria to prioritize patients on a scheduling wait list, including patients who were at higher risk of hospitalization or rapid decline based on CCM readmission risk scores calculated within the electronic medical record. Patients were assigned to next available in template. If a cancelation occurred, patients were pulled forward and vacancy was filled based on priority score. Results: For the initial post-implementation period between September 1, 2023 and November 30, 2023 NPPV average lead time was 47 days which was a reduction of 11% from baseline. The average lead time for HCDV was 33 days which was a reduction of 15% from baseline. In a second follow-up period from February 1, 2024 to April 30, 2024, the average lead time of NPPV was 22 days, a 58% decrease from baseline. The average lead time for HCSV was 24 days which was a significant reduction (p-value = 0.011) of 38% from the pre-implementation baseline. Conclusions: Utilization of CCM risk scores to triage NPPV and HCDV significantly reduced the lead times and resulted in more timely services for critical patients. We also noted increased template utilization. Future projects aim to study the effects of scheduling protocols on template utilization, cancellation rates, no-show rates, readmission rates and other health care utilization. Palliative appointment lead times. April-June 2023 Sept-Nov 2023 Feb-Apr 2024 Total Pt Seen 292 364 534 Avg Lead Time (d) 41 38 29 New Patient New Patient New Patient Completed 66 82 74 Avg Lead Time (d) 53 47 22 Hospital Discharge Hospital Discharge Hospital Discharge Completed 27 28 25 Avg Lead Time (d) 39 33 24

Family carers as service producers – insights into psychological contracts

ABSTRACT Family carers and caregiving have a role in the service system but family carers are often invisible and go unnoticed in society. In this article we are interested in family carers as service producers in health and social care. We analyze family care using the concept of a psychological contract. A psychological contract is an unspoken, unconfirmed and unwritten agreement where an exchange is based on perception rather than what is explicitly written and agreed. A psychological contract shapes family carers’ expectations and obligations, while providing a concept for understanding their work. The data were analyzed via theory-driven content analysis. Research question is: what are the features of a psychological contract in a family carer´s work? Data were collected from Finland in 2015. Ten family carers, aged between 64–78 years, who take care of their spouses were interviewed. A psychological contract involves the normative and mental schema of the carers, which direct what kind of care they feel they should provide as a spouse and carer. The psychological contract also guides what kind of support the carers may be willing to accept. The psychological contract clearly shows that family carers are primarily spouses rather than service providers. The concept of the psychological contract provides a workable frame to describe the relationship between family carers and the service system. This study enables the development of family care support services for the needs of family carers.

The Relationship of Perceived Stigma Among PLHIV with Utilization of Care Support and Treatment (CST) Services in Solo Plus Peer Support Group

The Relationship of Perceived Stigma Among PLHIV with Utilization of Care Support and Treatment (CST) Services in Solo Plus Peer Support Group

Association between Social support and Depression in Early Middle Adult Myanmar Migrant Workers

Introduction: It is common for migrant workers to work for difficult, dirty, and dangerous kinds of jobs. Therefore, migrant workers worldwide are commonly susceptible to depression. There are very limited studies focusing on the relationship between depression and social support among early middle-adult Myanmar migrant workers in Thailand. Objectives: The objective is to explore the prevalence of depression and to evaluate the association between social support and depression among early middle-adult Myanmar Migrant Workers. Methods: The study design was a cross-sectional study. From the inclusion and exclusion criteria, the sample size was around 112. Chi-square test was used for bivariate analysis and multiple logistic regression analysis was used for multivariate analysis. Results: Out of 112 total participants, the prevalence of depression was about 47.3%. From the result of multiple logistic regression, social support was associated with depression (adjusted odd ratio=2.48, 95% confidence interval=1.11-5.51; p=0.026). Conclusions: Based on the result, the participants with low social support were 2.48 times more likely to have depression than those with high social support. Therefore, it is recommended that social support is an important variable for reducing depression. Mental health care and social support services should be incorporated into reducing depression.

Risks for a good life in old age-Importance of selected dimensions of living conditions

Life situation dimensions, such as financial resources, housing, health and social relationships, have asignificant influence on the scope available to older people for coping with everyday life and participation and thus for agood life in old age. As abasis for identifying current and future challenges posed by precarious living conditions in old age, current publicly available data and study results on the income situation, housing, health and care are reported as central dimensions of the living conditions of people aged65 years and over in Germany. The study results presented provide indications as to which groups of older people live in particularly precarious living situations, which provide starting points for municipal action. Inequalities exist in the availability of income, affordable and accessible housing, social networks, health opportunities and care support services. Particular importance is attached to the risk of poverty, which goes hand in hand with the risk of disadvantages in the other dimensions analyzed.

Support services for informal carers: a register-based case–control study of Norwegian care recipients

This article aims to describe support services for informal carers and identify the characteristics of the care recipient and municipality that are associated with the allocation of these services. Care recipients were selected from the Norwegian Registry for Primary Health Care on 31 December 2019. Cases received care benefits (N = 9,816), respite care in institutions (N = 2,594) or respite care at home (N = 7,346); controls received home-based services only (N = 193,402). Municipal data were retrieved from the Municipality-State-Reporting register. Child and adolescent care recipients most often received support services, but allocation to this age group differed extensively between municipalities. Greater cognitive disability and cohabiting increased the odds of support services.

Association of oral fungal profiles with health status and bacterial composition in elderly adults receiving community support and home care service.

The interaction between fungal and bacterial components involved in the virulence of oral microbiota has received attention. This study demonstrates that an increase in fungal components is associated with a dysbiotic bacterial community and poor health status in elderly adults. Among individuals with a high-density fungal population, particularly, those with a non-albicans Candida-dominant profile had lower physical and cognitive functions than those with a C. albicans-dominant profile. These findings indicate that the evaluation of fungal components, in addition to the bacterial components, is important to understand the involvement of oral microbiota in oral and systemic diseases in elderly adults.

Oral health care for individuals with intellectual and developmental disabilities: A statewide model.

Effective strategies and practices can assist in forming future initiatives and policies to improve oral health for individuals with intellectual and developmental disabilities (IDD). This manuscript aims to describe the Tufts Dental Facilities (TDF), a university-state collaboration providing sustained statewide access to comprehensive oral health care for individuals with IDD. The TDF program was established in 1976 as the result of a class action lawsuit to improve medical and dental care for individuals with IDD residing at state institutions in Massachusetts. TDF, A partnership, between Tufts University School of Dental Medicine (TUSDM) and the Commonwealth of Massachusetts, is a network of seven dental clinics strategically positioned across the state. These clinics are specifically designed to meet the oral health needs of individuals with IDD. TUSDM's oral health providers with expertise in special care dentistry deliver comprehensive oral health care for over 6500 individuals with IDD, incorporating supportive care services and access to general anesthesia. Additionally, the program provides training in special care dentistry for dental residents and pre-doctoral dental students. Leveraging state and university resources, TDF provides a model of a sustainable, long-term system for statewide access to oral health care for individuals with IDD.

Cancer risk following onset of type 2 diabetes in New Zealanders with impaired glucose tolerance over 25 years: a matched prospective cohort study

BackgroundIn people with prediabetes, the link between developing type 2 diabetes (T2D) and cancer risk among those with impaired glucose tolerance (IGT) remains uncertain. We examined this association in IGT individuals from primary care in South and West Auckland, New Zealand, spanning 1994–2019, assessing 5- and 10-year cancer risks.MethodsStudy cohorts were extracted from the Diabetes Care Support Service in Auckland, New Zealand, linking it with national registries for death, cancer, hospital admissions, pharmaceutical claims, and socioeconomic status. We compared cancer risks in individuals with IGT newly diagnosed with or without T2D within a 1–5-year exposure window. Employing tapered matching and landmark analysis to address potential confounding effects, we formed comparative IGT cohorts. Weighted Cox regression models were then employed to assess the association between T2D onset and 5- and 10-year cancer risks.ResultsThe study included 26,794 patients with IGT, with 629 newly diagnosed with T2D within 5 years and 13,007 without such a diagnosis. Those progressing to T2D had similar 5-year cancer risk but significantly higher 10-year risk (HR 1.35; 95% CI 1.09–1.68). This association was stronger in older individuals, the socioeconomically deprived, current smokers, those with worse metabolic measures, and lower renal function. Patients with IGT of NZ European ethnicity had lower 10-year cancer risk.ConclusionsT2D diagnosis influences cancer risk in individuals with IGT. Developing risk scores for high-risk IGT individuals and implementing cancer screening and structured diabetes prevention, especially in deprived or minority ethnic populations, is essential.

An overview of down syndrome

The most prevalent chromosomal disorder linked to intellectual disability is down syndrome, often known as Down's syndrome (DS), which is marked by a number of distinct clinical symptoms. About 1 in 800 newborns globally experience it. Approximately 500 live births are caused by DS each year in the US, while over 200,000 people are affected by the disorder. The first account of the syndrome dates back to 1866 and is credited to the English physician John Langdon Down of Cornwall. When the chromosomal cause of the disorder was identified more than 90 years later, it was termed Down syndrome. Although there is still inequality in access to health care and other supportive services, the potential for the development and socialization of people with Down syndrome has been more widely recognized, and early support for impacted children and their families is extensively adopted. Patients vary greatly in their phenotypic characteristics; intellectual disability is typically moderate but can be mild to severe, and social function is frequently good in comparison to cognitive impairment. Geographical location and ethnic origin also have an impact on the incidence and presentation of DS.

Exploring the Support Needs of Chinese Family Carers of People Living with Dementia in New Zealand during the COVID-19 Pandemic: A Resilience Resources Framework Perspective.

Caring for people living with dementia during the novel coronavirus disease 2019 (COVID-19) pandemic significantly impacted the emotional, physical, and social well-being of carers. However, no study has focused on the well-being of Chinese carers of people living with dementia in New Zealand during the pandemic. This study aimed to explore the support needs of Chinese carers of people living with dementia in New Zealand during the COVID-19 pandemic. Semi-structured interviews were conducted by two bilingual and bicultural researchers. Thematic analysis was used to explore the resilience resources for Chinese carers. Twelve Chinese carers were recruited from four community organizations in New Zealand. Four themes were identified: (1) social isolation, (2) emotional loneliness, (3) ambivalent feelings of being a carer, and (4) a variety of unmet needs. The findings of our study provide new insights into the multiple support needs of Chinese carers of people living with dementia during the COVID-19 pandemic. Implications for practice include the establishment of culturally appropriate care support services and the development of tailored resilience-building interventions to address the unmet needs of Chinese carers of people living with dementia.

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.

Current and anticipated future state of cachexia care in patients with cancer.

Aims: We assessed care in cancer patients with cachexia across leading health systems (LHSs).Patients & methods: Qualitative interviews and quantitative surveys were conducted with LHSs executives and frontline health care personnel, representing 46 total respondents and 42 unique LHSs and including oncology service line leaders, supportive care services, dietitians and surgical oncologists.Results: Cachexia was not considered a top priority, and formal diagnoses were rare. Participants highlighted the importance of addressing barriers to increase clinical trial enrollment and support frontline health care personnel and patients in early detection of cachexia.Conclusion: Cachexia prioritization needs to be elevated across LHSs executives to obtain capital and strategic imperatives to advance related care.

Geriatric assessment-directed supportive care intervention (GAIN-S)-implementation via telehealth in a lower-resourced community.

1510 Background: Based on randomized controlled trials,ASCO guidelines recommend use of geriatric assessment (GA)-directed interventions for older adults with cancer. The translation of these models to lower resourced settings has been limited. We assessed the feasibility of implementing GA-directed supportive care (GAIN-S) via telehealth in a lower resourced community setting. Methods: A quality improvement study was conducted in a high poverty, limited access, and low resourced community oncology practice (City of Hope - Antelope Valley [COH-AV]). Eligible participants were 65+ years with a new diagnosis of a malignant neoplasm under evaluation for cancer therapy. Before starting therapy, patients completed: baseline GA, SupportScreen, and the Fulmer SPICES assessment. A geriatric nurse practitioner (GNP) reviewed GA results and implemented multidisciplinary supportive care interventions (GAIN-S) via telehealth between April 2020 and January 2023. Key evaluation measures included: number of patients who completed GAIN-S; number of referrals to multidisciplinary supportive care services and completion rate; advance directives (ADs); and patient satisfaction with telehealth visits. Participants’ demographics, including distance traveled for care, type of cancer, stage, treatment, and telehealth satisfaction items, were summarized using descriptive statistics. To analyze and visualize the implementation process, run charts were utilized. Results: 251 patients (mean age 74, 62% Non-Hispanic White, 22% live 60+ miles from COH-AV, 56% stage II or less, 30% received chemotherapy) completed baseline assessments. 242 had initial visits with GNP, 197 via televideo and 45 via telephone. GNP reviewed vulnerabilities with 209 patients and generated 460 referrals for supportive care services, with 85% of services implemented. Highest numbers of referrals were to pharmacy (177), social work (142), occupational therapy (76), and physical therapy (48). GNP discussed GA-guided care plans with all patients and 43 patients completed AD after discussion with GNP. Over 92% of patients were satisfied with telehealth-based GAIN-S in terms of both ease of visit and access to care with their provider and with telehealth. Conclusions: Telehealth-based GAIN-S has proven to be feasible in providing accessible healthcare to older patients with cancer in a lower resourced community setting. This approach, well-received by most patients, highlights the potential of telehealth in delivering GAIN-S effectively in such settings.

Disparities uncovered: LGBTQ+ patients report on their cancer care journey.

1516 Background : In the U.S, LGBTQ+ people face higher cancer rates and worse outcomes than the general population. Few studies have described the experiences of LGBTQ+ people and their caregivers during treatment. As part of an implementation science initiative aimed at improving care for LGBTQ+ patients, we conducted a large survey (n=817) to understand treatment experiences of this population. Here we report our findings which provide insight into how stigma and incorrect assumptions may contribute to medical mistrust and worse experiences. Methods: In 2023, 817 diverse LGBTQ+ cancer patients from academic and community-based settings, as well as patient advocacy groups, completed web-based surveys evaluating their care experiences during cancer treatment. Participants included patients with gastric (n=165), breast (n=238), ovarian (n=218), prostate (n=56), and colorectal cancers (n=140), including 83 gender non-conforming patients. Results: Most LGBTQ+ patients (80%) reported not receiving appropriate preventative cancer screening, with top barriers including provider did not mention cancer screening tests (40%) and did not have a healthcare provider (28%). Additionally, only 24% felt at least moderately comfortable disclosing their LGBTQ+ status. Inclusive measures that helped patients feel most comfortable included care teams sharing/displaying their own pronouns (39%), making public statements of support (43%), or wearing personal items indicating acceptance (39%). Of those who did disclose their identity, only 50% of gender-expansive patients reported consistently being referred to by the correct names and pronouns. Importantly, patients reported that only 34% of their partners/caregivers felt welcome at appointments, and only 4% felt respected by the care team. Few patients reported receiving key supportive care services, including counseling/support groups (23%), quality-of-life related care, such as sexual function counseling (23%), and LGBTQ-specific resources/education (19%). Furthermore, less than half of LGBTQ+ patients discussed with HCPs how cancer treatment affects fertility (41%), fertility preferences (26%), or fertility preservation (14%), even though only 22% of patients reported not being eligible for fertility services. Interestingly, many of these gaps in care differed based on cancer type. For example, prostate, colorectal, and gastric patients were more likely to report not feeling safe disclosing their LGBTQ+ status (80%, 69%, and 54% respectively), while breast cancer patients were more likely to report having discussed fertility prior to starting treatment (64%). Conclusions: This study offers insights into experiences of LGBTQ+ patients and confirms disparities in care are real and pervasive. Ongoing education and inclusion efforts can help create a safe and welcoming environment, enabling equitable care and improved outcomes.