Comprehensive Cancer Care Research Articles

Screening for breast cancer: Cost-effective solutions for low- & middle-income countries.

Low- and middle-income countries (LMICs) have limited financial resources and proportionately smaller portions allocated for health budget. With competing health priorities, treatment of the diagnosed cases and establishment of treatment facilities are the main concerns in LMICs. Infectious diseases, reducing infant, child and maternal mortality may seem crucial as compared to early cancer detection. LMICs that are committed to providing comprehensive cancer care, will need to judiciously choose the screening tool depending on specifics of how the tool is expected to perform in the population and the cost-effectiveness with respect to the number of lives expected to be saved. Increasing awareness about breast health in general and common cancers and non-communicable diseases (NCDs), in particular, may lead to symptomatic women approaching the healthcare facilities at an earlier stage. When the limited available resources are mobilized towards cancer screening, increasing awareness would lead to greater acceptability of the programme. The reach of the programme to achieve good population coverage, the establishment of the diagnostic referral linkages and the availability and accessibility of treatment facilities, will all decide the outcome of the screening programme.

Quality of life and factors affecting it in adult cancer patients undergoing cancer chemotherapy in a tertiary care hospital.

BackgroundCancer is the second most common cause of deaths worldwide. Likewise, in India, it is a major health problem, and disease burden is escalating every year. Cancer chemotherapy produces unfavorable effects on the well‐being of an individual. Since the past few years, quality of life (QoL) is considered as the main goal of cancer treatment in the survival of a patient.AimThis current study aimed to assess the QoL and factors affecting it in adult cancer patients undergoing chemotherapy treatment.Methods and ResultsAn analytical, cross‐sectional study was conducted to achieve the objectives, employing the consecutive sampling method. A total of 120 adult (>19 years) patients were recruited from daycare chemotherapy unit of a tertiary care hospital. The data were collected using patient record form and Functional Assessment of Cancer Therapy‐General (FACT‐G), a quality of life (QoL) questionnaire. The overall mean score of quality of life (QoL) was 61.933 ± 5.85502. The domains of functional well‐being and emotional well‐being were most negatively affected after cancer chemotherapy. Education (illiteracy) and occupation (unemployment) were negatively associated with overall quality of life (QoL) of cancer patients on chemotherapy. Adverse drug reactions due to cancer chemotherapy negatively affect the quality of life (QoL) of cancer patients. Education (illiteracy) affects social well‐being domain of cancer patients. Working in the government/private sector has a positive impact on functional well‐being domain of quality of life (QoL).ConclusionThe study findings suggest an overall low quality of life (QoL) among adult cancer patients undergoing chemotherapy at our setup. It has been identified as a stressful therapy, also affecting both psychological and physical well‐being. Poor infrastructure, illiteracy, poverty, and lack of proper treatment facilities at most centres often lead to poor survival outcomes and hence focus has always been on achieving quantity of life rather than quality of life (QoL). This is further complicated due to nonavailability of validated tools in local vernacular, apathy of the treating physicians in the context of QoL aspects and social and cultural factors that are unique to this society. Psycho‐oncology needs to become an integral entity of comprehensive cancer care.

The Impact of Changes in Service Delivery in Patients With Colorectal Cancer During the Initial Phase of the COVID-19 Pandemic

BackgroundThe Coronavirus disease 2019 (COVID-19) pandemic has imposed significant changes in cancer service delivery resulting in increased anxiety and distress in both patients and clinicians. We aimed to investigate how these changes have been perceived by patients diagnosed with colorectal cancer and identify determinants of increased anxiety. Patients and MethodsAn anonymized 32-item survey in the specialized lower gastrointestinal cancer outpatient clinics at a tertiary cancer center in North West England between May 18 and July 1, 2020. Self-reported anxiety was based on the General Anxiety Disorder-7 screening tool. ResultsOf 143 participants who completed the survey (response rate, 67%), 115 (82%) were male, and the median age group was 61 to 70 years. A total of 112 (78%) participants had telephone consultation (83% met needs), and 57 (40%) had radiologic scan results discussed over the phone (96% met needs). In total, 23 (18%) participants were considered to have anxiety (General Anxiety Disorder-7 score ≥ 5), with 7 (5.5%) scoring for moderate or severe anxiety. Those concerned about getting COVID-19 infection, and worried COVID-19 would have effect on their mental health, and affect their experience of cancer care, were most likely to have anxiety (P < .05, multivariate analysis). The majority did not feel they needed support during this phase of the pandemic. Participants felt that friends and family had been very supportive, but less so the primary care services (P < .05). ConclusionsThe findings of this survey suggest that some of the service changes implemented may have already improved the overall experience of cancer care among patients with colorectal cancer at our institute. Reassuringly, the incidence of participants with moderate to severe anxiety levels during the peak of COVID-19 in the United Kingdom was much lower than anticipated. Importantly, patients were much more concerned about their cancer treatment than COVID-19, emphasizing the need to continue to provide comprehensive cancer care even with a “second wave” of COVID-19.

Role of minimally invasive partial nephrectomy in the management of renal mass.

Partial nephrectomy is recommended for surgical management of small renal masses (SRM), or lesions ≤7 cm. The decision for surgical intervention involves a balanced patient assessment. Minimally invasive approach, which includes laparoscopic and robotic techniques, has shown to have improved blood loss, length of hospitalization, and post-operative pain while maintaining oncologic efficacy when compared to an open approach. Transperitoneal approach is preferred at most centers; however, retroperitoneoscopic minimally invasive surgery (MIS) partial nephrectomy expertise is essential for comprehensive kidney cancer care. With advances in surgical technology and deep penetration of robotics into surgical training and practice, robotic partial nephrectomy has become the modality of choice in modern clinical practice. This review discusses the indications and outcomes for various minimally invasive approaches of partial nephrectomy.

Abstract PO-178: The Kaiser Permanente Research Bank cancer cohort: A diverse resource to improve cancer care

Abstract Kaiser Permanente (KP) is an ideal environment to study the spectrum of cancer prevention and control because it provides comprehensive cancer care to a large and diverse community. The Kaiser Permanente Research Bank (KPRB) is collecting biospecimens and a survey of health-related behaviors and other risk factors from about 400,000 adults aged 18 years and older across all eight KP regions. The KPRB includes a cancer cohort and cases are identified from KP region-specific algorithms designed to identify cancer cases within days of diagnosis, and from linkage with regional tumor registries. KPRB participation involves completing an online informed consent and survey, and providing a blood or saliva sample. KPRB participants consent to linkage to their electronic health record (EHR), which includes comprehensive information about cancer screening, diagnosis and treatment. A key strength of this cohort is its diversity with respect to age, race/ethnicity, and geographic location (Hawai’i, Oregon, Washington state, California, Colorado, Georgia, and the Washington, DC area). To date, the KPRB includes 68,000 cancer cases, 56% are women, and 30% are non-white. Over 8,500 cases were diagnosed before the age of 50 and the cohort includes substantial numbers of cancer cases among Asian and Pacific Islanders (n=8,941), Hispanics (n=7,678), and non-Hispanic blacks (n=5,367). Although all cohort members have insurance, and thus, presumably access to care, we observed disparities in stage at diagnosis. Compared to non- Hispanic whites, non-Hispanic Blacks are more likely to be diagnosed at stage 4 (5% versus 16%, respectively, of all cases); participants describing themselves as multi- racial or “other” race similarly have a very high proportion (25%) of cases diagnosed at stage 4. Research is planned to examine the factors associated with this disparity. The extensive EHR, access to stored tissue specimens, detailed treatment data, and ability to follow patients over time for recurrence and mortality make the KPRB Cancer Cohort an exceptional resource for exploring the factors that contribute to cancer etiology, progression, and survival. We invite investigators to apply to use the KPRB (https://researchbank.kaiserpermanente.org/) to accelerate progress toward improving cancer care. Citation Format: Heather S. Feigelson, Christina Clarke, Andrea Burnett- Hartman, Stephen Van Den Eeden, Sheila Weinmann, Monica Ter-Minassian, Stacey Honda, Deborah Young, Aruna Kamineni, Sarah Rowell, Alan Bauck, Elizabeth McGlynn. The Kaiser Permanente Research Bank cancer cohort: A diverse resource to improve cancer care [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-178.

Chronic Opioid Therapy in Cancer Survivors at a Specialty Oncology Pain Clinic: Opioid Dosing, Efficacy, and Safety During Five Years of Pain Management

There are limited data regarding long-term safety and efficacy in cancer survivors receiving chronic opioid therapy. With conflicting recommendations on opioid-prescribing practices and lack of available outcome data, this study aimed to provide a longitudinal perspective on opioid prescribing in cancer survivors. A retrospective chart review at a comprehensive cancer care center pain clinic used data from pain clinic provider notes from 2013 to 2018. Inclusion criteria were patients in clinical remission not receiving active chemotherapy or immunotherapy and receiving opioids during the study period. Opioid dosing changes and outcomes between zero and five years were evaluated by standard statistical analysis. Thirty-two patients met inclusion criteria. Solid malignancies were more common than hematologic malignancies (72% vs. 28%). Common pain complaints were related to postsurgical changes (43%), postradiation (32%), and chemotherapy-induced pain syndromes (25%). There were no serious adverse events. One patient exhibited possible aberrant behavior. At the initial visit, the median morphine milligram equivalent per day (MME/day) was 130. Median MME/day at Year 0 (study start) and Year 5 was 135 and 159, respectively (P = 0.475). Functional status was satisfactory in 58% at Year 0 and increased to 91% of patients meeting their functional goals at Year 5. In a carefully monitored group of cancer survivors with persistent pain, chronic opioid therapy was safely managed during extended periods without significant opioid escalation or evidence of serious adverse events including aberrant behaviors. This population benefited when opioid therapy was managed with a focus on function rather than reduction of pain intensity scores.

Impact of Breast Cancer Systemic Therapies on Fertility

Many young women diagnosed with breast cancer will be confronted with premature ovarian insufficiency and infertility as a consequence of systemic therapies used to treat their cancer. This is a concern for nearly half of young women diagnosed with breast cancer. We will review the impact of breast cancer chemotherapy, endocrine therapy, and immunotherapy on fertility and surrogate markers of fertility. Modern breast cancer treatments continue to have an impact on a woman’s fertility potential. This risk is reduced as more patients are able to safely eliminate chemotherapy as part of their treatment plan without compromising cancer-related outcomes. Research is being done to assess whether patient outcomes are affected from pausing endocrine therapy to allow for pregnancy. With varying extent, most breast cancer treatments have some impact on fertility although more data is necessary. Individualized fertility counseling is an important aspect of comprehensive cancer care. This review highlights the special population of premenopausal breast cancer patients and the challenge in their care should they desire children.

A Shared Electronic Health Record in a Rural Setting Maintains Hematological Cancer Services Remotely during the COVID-19 Pandemic

IntroductionThe COVID-19 pandemic has had drastic effects on healthcare provision across Australia and the world. Rural hematology patients who may rely on visiting medical officers from larger cities or long distance travel for reviews are particularly vulnerable to having their treatment affected by the recent changes to healthcare delivery given severe travel restrictions.The Griffith Hematology/Oncology Unit is based in Griffith Base Hospital, a regional hospital in New South Wales, Australia. It is serviced by consultant hematologists from St Vincent's Hospital at the capital city of Sydney, Australia, who visit fortnightly to run hematology outreach clinics and supervise chemotherapy delivery. Griffith is located 575km from Sydney and has an estimated population of over 26,000(1). The COVID-19 pandemic imposed significant travel restrictions, such that visiting haematologists have been unable to travel to continue in-person clinics since April 2020. This has led to the exclusive reliance on telemedicine (telehealth and telephone reviews) and remote chemotherapy delivery supervision. Having an electronic health record (EHR) containing all relevant patient information which is remotely accessible to treating physicians has been integral to the continuity of comprehensive specialist cancer care in this rural setting via telemedicine.MethodsThe previously reported shared EHR between Griffith and St Vincent's Hospital, Sydney was used to review the impact of COVID-19 on service delivery in Griffith(2). All rural patient information was accessible from the metropolitan location including comprehensive documentation of a patient's clinical findings, routine observations, diagnostic pathology and radiology results, and details of treatment at the Griffith site. Remote chemotherapy prescribing and telemedicine notes were documented through the EHR.ResultsThe number of new referrals, follow ups and total patients over the four months prior to the COVID-19 related changes (December 2019 to March 2020) and the four months following (April to July 2020) were compared. From April 2020 onwards, the Griffith clinic patients underwent reviews via telemedicine or telephone with no in-person reviews able to be conducted in Griffith due to the travel restrictions. The number of new referrals, follows up visits and the total number of patients seen following the change to telemedicine had all increased with no reduction in service delivery seen (Table 1). The total number of patient reviews was 167 visits over the four months prior to the change, which increased to 186 reviews after the travel restrictions were applied.Despite the travel restrictions, the hematology outreach services to Griffith were maintained through telemedicine reviews in a similar manner to the metropolitan service. Griffith rural hematology patients continue to undergo regular telemedicine reviews with monitoring of laboratory and imaging results through the EHR, receiving the same level of care as metropolitan patients.Chemotherapy is still able to be prescribed, adjusted and reviewed from the Sydney location for all patients. The total number of chemotherapy treatment cycles delivered in Griffith only slightly decreased despite the changes to service provision, which was attributed to normal variation in patients requiring treatment over 2020 (Table 2). 32 chemotherapy treatment cycles were delivered prior to the change compared to 26 cycles following, for the primary indications of lymphoma and myeloma.ConclusionIn recent months, the centralised EHR has proven critical in minimising clinical service disruptions caused by the COVID-19 pandemic by facilitating telemedicine links and remote patient management. We demonstrate how the shared EHR has been integral to the continuation of complex rural patient management during the COVID-19 pandemic due to the availability of remotely accessible patient information and chemotherapy prescribing. No significant change in clinical service activity was seen following the drastic travel restrictions due to the pandemic. Given these travel restrictions are expected to continue, it is encouraging that the shared EHR will allow rural Griffith patients continued access to appropriate specialist hematology care over the coming months. This work demonstrates how an EHR is fundamental to the sustainability of vital cancer services for rural communities.DisclosuresHamad:Abbvie: Honoraria; Novartis: Honoraria.

The Anatomy and Physiology of Teaming in Cancer Care Delivery: A Conceptual Framework.

Care coordination challenges for patients with cancer continue to grow as expanding treatment options, multimodality treatment regimens, and an aging population with comorbid conditions intensify demands for multidisciplinary cancer care. Effective teamwork is a critical yet understudied cornerstone of coordinated cancer care delivery. For example, comprehensive lung cancer care involves a clinical "team of teams"-or clinical multiteam system (MTS)-coordinating decisions and care across specialties, providers, and settings. The teamwork processes within and between these teams lay the foundation for coordinated care. Although the need to work as a team and coordinate across disciplinary, organizational, and geographic boundaries increases, evidence identifying and improving the teamwork processes underlying care coordination and delivery among the multiple teams involved remains sparse. This commentary synthesizes MTS structure characteristics and teamwork processes into a conceptual framework called the cancer MTS framework to advance future cancer care delivery research addressing evidence gaps in care coordination. Included constructs were identified from published frameworks, discussions at the 2016 National Cancer Institute-American Society of Clinical Oncology Teams in Cancer Care Workshop, and expert input. A case example in lung cancer provided practical grounding for framework refinement. The cancer MTS framework identifies team structure variables and teamwork processes affecting cancer care delivery, related outcomes, and contextual variables hypothesized to influence coordination within and between the multiple clinical teams involved. We discuss how the framework might be used to identify care delivery research gaps, develop hypothesis-driven research examining clinical team functioning, and support conceptual coherence across studies examining teamwork and care coordination and their impact on cancer outcomes.

Resource and reimbursement barriers to comprehensive cancer care (CCC) delivery: An association of community cancer centers (ACCC) survey research analysis.

31 Background: CCC delivery is recommended in guidelines, required by accreditation bodies, and essential for high-quality cancer management. Barriers, such as insufficient reimbursement and lack of specialist staff, prevent consistent access to and delivery of CCC, particularly supportive oncology services. Challenges especially persist in community programs, where access to philanthropy and similar funding is limited. ACCC conducted a representative survey of its member programs to elucidate capacity and barriers to CCC delivery in the community/academic setting in order to inform policy and value-based payment reform. Methods: Survey development methodology included item generation with expert review, iterative piloting and cognitive interviews to achieve content and internal validity. An online survey was piloted at the ACCC 2018 Annual Meeting and sent to member programs via email link. The final survey included 22 questions on availability and funding for supportive services. Twenty-seven supportive oncology services were assessed for availability, reasons not offered, reimbursement/funding and patient payment. Analyses were conducted with SAS. Results: 172 of 704 ACCC member programs responded and completed the majority of survey as of 10/7/19. Despite a high proportion of programs offering supportive oncology services, gaps between cost and reimbursement were present for all (Table). Deficits in reimbursement are compensated by patient out-of-pocket payments, grants and donations. Most centers report needing more staffing in psychology (61%), social work (60%), navigation (59%), nutrition (57%), palliative care (56%), genetic counseling (52%), and financial counseling (53%). Gaps were observed regardless of region or practice type. Conclusions: There is a lack of sufficient reimbursement, staffing, and budget to provide CCC across the U.S., regardless of region or practice type. Oncology care models and reimbursement policies must include CCC services to optimize delivery of care.

Effect of time to treatment and comprehensive care at commission on cancer-accredited practices on survival in rural patients with colorectal cancer.

109 Background: Rural cancer care in the United States has unique challenges from variable access to care. This study examined differences in time to first treatment (TTT), a surrogate for access, and predictors of overall survival (OS) between rural and non-rural colorectal cancer (CRC) patients. Methods: Patients with stage I-III CRC from 2004-2012 in the National Cancer Database of Commission on Cancer (CoC)-accredited facilities were included and categorized into rural and non-rural groups. Differences in demographic, disease characteristics, socioeconomic (SE) factors and TTT (&lt; 4 weeks, 4-8 weeks and &gt; 8 weeks) between rural and non-rural patients were assessed by Chi-square test. The effect of demographics, SE factors, and TTT on OS were assessed using Cox models. Results: The study population comprised 605,913, 11,649 (2%) of whom were rural. Compared to non-rural patients, rural patients were more likely to be age &gt; 65, male, Caucasian, receive care at non-academic centers, have government insurance, have lower income and less education (p&lt;0.0001 for all). Significant demographic and SE differences are shown in Table. Rural patients had similar mean TTT compared to non-rural patients (2.76 vs. 2.84 weeks, p = 0.35). Slightly more rural patients had TTT &lt; 4 weeks (77% vs. 75%, p &lt;0.0001). Shorter TTT (both &lt;4 weeks vs. 8 weeks and 4-8 weeks vs. &gt; 8 weeks) was associated with improved OS (HR: 0.87, 95% CI: 0.85-0.89, p&lt;0.0001 and HR: 0.74, 95% CI: 0.73-0.76, p&lt;0.0001, respectively). After adjusting for demographic, disease and SE factors, rural status was associated with modestly better OS compared to non-rural status (HR: 0.96, 95% CI: 0.92-0.99, p=0.006). Conclusions: Despite several adverse demographic and socioeconomic factors, rural CRC patients had modestly better OS compared to non-rural patients. Rural and non-rural CRC patients had similar TTT in this cohort. These data suggest the comprehensive cancer care delivered by CoC-accredited practices is associated with rapid TTT and improved OS in rural CRC patients. It is unclear whether our data apply to non-CoC-accredited facilities in rural United States. [Table: see text]

Head and Neck Cancer and Social Media: The Patient Experience and Cancer Survivorship.

To characterize the head and neck cancer patients' lived experiences with survivorship through Instagram and examine opportunities for health professionals to provide support and outreach specifically targeting these needs. Descriptive observational study. We analyzed key head and neck cancer-related hashtags by querying medical and layman terminology. The top English-language posts for #headandneckcancer underwent further content examination using thematic analysis based in grounded theory for categorization for user engagement (determined by "likes" and comments), type of content, and category of the account that created the post. Of the survivorship posts by patients, the content of posts in top user accounts was further analyzed. There were 11,600 Instagram posts on #headandneckcancer, 1,300 posts on #headandneckcancerawareness, 1,100 posts on #headandneckcancersurvivor, and several thousand posts for additional layman terms. The majority of posts were from patients (65%), with few from head and neck surgeons or medical organizations (26%). User engagement was primarily by nonmedical accounts (95%). Posts by patients discussed medical appointments and treatments (81%), managing treatment effects and symptoms (66%), and cancer screening and prevention (23%). Specific concerns included fatigue (53%), postsurgical cosmetic appearance (27%), and weight and nutrition (34%). Our study suggests that Instagram accounts can be intimate records of the patient experience, and gaining a better understanding of the daily experience of survivorship may be critical for head and neck surgeons and other oncology providers to provide truly comprehensive cancer care. 4 Laryngoscope, 131:E1214-E1219, 2021.

WHAT DO WOMEN NEED TO KNOW TO MAKE INFORMED DECISIONS ABOUT FERTILITY PRESERVATION? A DELPHI ANALYSIS OF PROVIDER-RECOMMENDED KEY FACTS

To support national guidelines that all reproductive-age women should be offered fertility counseling prior to starting cancer treatment, this study sought to identify the key facts newly-diagnosed female cancer patients should know to make an informed decision about fertility-preservation. Pilot Study. Challenging Choices: Understanding the Specific Fertility Needs of Providers and Newly Diagnosed Female Cancer Patients in High and Low Resource Settings was a clinical pilot study completed at MD Anderson Cancer Center and the Harris County Health System to understand and address gaps in fertility preservation counseling. A portion of the study involved engaging oncologists (medical, pediatric, young adult, and gynecologic) and reproductive endocrinologists in a Delphi survey. Providers completed three rounds of online questionnaires, with anonymized results that were reviewed and revised between rounds. Round 1: provider perception of fertility preservation counseling in a low resource setting. Round 2: A) a fertility facts quiz and B) ranking of facts in order of importance. Facts with more than 5 providers choosing “strongly agree” were retained for round 3. Round 3: provider ranking of most important final “key facts” (6 total). The majority of the 33 providers were female (73%) with mean age of 51 years old. Overall, 34 reproductive endocrinologists and 25 oncologists were polled. The majority (80%) of providers agreed that newly diagnosed female cancer patients of reproductive age should be counseled on fertility preservation options regardless of parity, partnership or financial status, or literacy level. The top ranked key-facts were: 1) Many cancer treatments can lead to infertility (the inability to get pregnant), 2) Fertility preservation should be done before starting cancer treatment, 3) Freezing eggs takes about 2 weeks, 4) If your insurance does not fully cover fertility preservation, there may be funds available through your employer (eg Johnson and Johnson, Starbucks) or other organizations (i.e. LIVESTRONG Fertility or Walgreens/Ferring Heart Beat Program) 5) Fertility preservation does not increase the risk of cancer recurrence in the future, and 6) If you choose not to do fertility preservation before cancer treatment, you can consider other family building strategies (i.e. adoption, fostering, third-party options) later. Providers confirmed the importance of fertility preservation counseling for all reproductive-age women with cancer prior to initiation of treatment. Before deciding about fertility preservation, women should understand these key facts – infertility is a risk, preserve before cancer treatment (takes 2 weeks) if possible, confirm insurance coverage (or apply for funding), no increase in future cancer risk, and there are alternatives for family building. These facts may be used to guide shared decision making discussions, develop measures (knowledge tests, decision quality indices), design tools (patient decision aids), and inform reimbursement policies for high quality comprehensive cancer care.

The Ipaac Evaluation Tool: how to select Quality Indicators for Comprehensive Cancer Care Networks

Abstract Background The Comprehensive Cancer Care Networks (CCCNs) represent innovative approaches for the management of cancer patients consisting of multiple cooperating health units with specific expertise in the different steps of care. Quality Indicators (QIs) constitute valid and reliable tools that allow to measure the quality of care among similar structures belonging to different health systems. Objective of this project was to develop a standardized tool in order to define a multi-step process for the selection of QIs for the evaluation of CCCNs. Methods Under the coordination of the Innovative Partnership for Action Against Cancer (IPAAC) joint action, our research team performed a systematic review of the scientific literature to identify the reported methodology for the selection of QIs applicable for the CCCNs' setting. An additional search of national and international Quality Assurance organizations was performed to detect any missing information. Results The IET (Ipaac Evaluation Tool) for QIs was developed: a methodological tool describing an 8-step process that leads to the selection of QIs feasible for the CCCN setting. The tool was implemented accordingly with the reporting standards for guideline-based performance measures of the Guideline International Network (GIN). A pilot testing of the tool was performed in order to identify its strengths and weaknesses. Conclusions The IET for QIs represents an innovative methodological instrument to select valid and reliable indicators for the assessment of the quality of care within the CCCN settings. Key messages The Quality Indicators represent valid and reliable tools to measure and compare the quality of care delivered to cancer patients in Comprehensive Cancer Care Networks. The development of the Ipaac Evaluation Tool leads to a standardized assessment of the quality of care provided for cancer patients within the CCCN setting.

Access to Gynecologic Oncologists in Ohio: The Role of Insurance Marketplaces and the Patient Protection and Affordable Care Act

Background The Affordable Care Act was passed in 2010, which provided a platform for states to develop insurance marketplaces. The goal of this legislation was to improve insurance coverage by providing more affordable options to patients. One metric of the Affordable Care Act was to improve access to comprehensive cancer care. Objective To identify to the effect of the Affordable Care Act on access to Gynecologic Oncologists in Ohio. Study design The Patient Protection and Affordable Health Care Act increased access to health insurance in Ohio, through Medicaid expansion and creation of a healthcare marketplace. We accessed information on access and usage of the healthcare marketplace in Ohio through Healthinsurance.org. We identified Gynecologic Oncology practices in Ohio through the Society of Gynecologic Oncology, and confirmed these practices by telephone. We communicated with each practice and identified which practices took marketplace health insurance. We also gathered information on changes in usage from 2014-2018. We then used descriptive statistics to identify access to a Gynecologic Oncologist though these exchanges. Results In 2017, there were 238,843 people enrolled in marketplace insurance (2% of the Ohio population). We identified 11 practices in Ohio with 39 Gynecologic Oncologists, and 11 marketplace insurance providers. Of these insurers, 7 could be clearly identified as providing access to 5 different Gynecologic Oncology practices. Of the 11 practices, 5 were confirmed to accept marketplace insurance (46%). Interestingly, 3 practices were unsure whether they took patients on marketplace insurance (27%), and 3 definitively did not take patients on marketplace insurance (27%). Each practice varied with how many exchanges they accepted, with 4 out of 5 accepting insurance through more than one insurer. Conclusions About half of the Gynecologic Oncology practices in Ohio accepted insurance through the insurance marketplace, which may limit patient access to a Gynecologic Oncologist.

Distress and problem assessment among people living with cancer from Culturally and Linguistically Diverse backgrounds.

To examine whether routine assessment of distress, recommended as part of comprehensive cancer care, is utilised equally with culturally and linguistically diverse (CALD) vs non-CALD people living with cancer. A medical records review of all patients attending cancer-specific treatment units at a single tertiary hospital in Melbourne, Australia between 2015-2018. Recording of administration of the Distress Thermometer and Problem Checklist (DT and PC) was extracted for all patients. Details regarding how the DT and PC (used together) was administered were extracted for a random sub-sample of 294 CALD patients and 294 matched non-CALD patients. A total of 6977 patients were identified (12.0% CALD). Just over half of the CALD (54.7%) and non-CALD (58.2%) patients had a recorded DT and PC (P > 0.05). For the sub-sample analysis, CALD patients were less likely to complete the form themselves (14.8% vs 75.9% non-CALD) and were more likely to have a family member complete the form (55.1% vs 15.1% non-CALD). CALD patients reported a similar level of distress to non-CALD patients. Distress scores for CALD and non-CALD patients were higher when family members completed the form. Provision of discussion, written information, referral offers and rates of referral acceptance were similar between CALD and non-CALD patients. Assessment of distress and associated problems, and the process following assessment, were similar for CALD and non-CALD patients. However, differences in how the form was completed highlight the need for further improvements to ensure that CALD patients are actively involved in their care.

Impact of COVID-19 pandemic on Radiation Oncology Residency- Experience and Perspective from a Tertiary Cancer Centre of Northeast India

The novel corona virus disease 2019 has emerged as a global pandemic affecting the healthcare system. It became extremely difficult to carryout comprehensive cancer care services in the midst of this pandemic. As resident trainees in the department of Radiation Oncology, we faced many difficulties during this unprecedented crisis. We the radiation oncology residents from a tertiary cancer centre of northeast India want to highlight our preparedness and precautionary measures taken to ensure uninterrupted patient services and the impact of this crisis on our academics.

Esophageal Cancer: A Case Study of a Rare Metastatic Esophageal Squamous Cell Carcinoma.

The expected pattern of spread in metastatic esophageal squamous cell carcinoma involves the upper torso and thorax. This article presents an unusual instance of an isolated osseous metastasis of esophageal squamous cell carcinoma to the distal bone of the left ankle and describes the contributions of advanced practice nursing assessment and clinical judgment to improve patient outcomes. This case study also highlights comprehensive cancer care by an interprofessional palliative care team.

Not seeing the forest for the trees: a systematic review of comprehensive distress management programs and implementation strategies.

Clinically significant distress is common in patients with cancer and if untreated can be associated with adverse outcomes. This article offers a review of current approaches to implementing and reporting the minimum components of distress screening and management interventions in cancer services. Twenty-two relevant published articles were identified from January 2018 to February 2020. The reporting of recommended minimum components of distress screening and management interventions in these articles was not consistent. The majority of studies used validated tools to conduct initial screening. However, recommendations were either not reported or not followed regarding subsequent pathway components, secondary assessment, referral pathways linked to screening results and rescreening. The majority of studies did not include a description of the implementation of the distress screening program. A small number of studies described a comprehensive set of implementation strategies. Distress screening and management interventions in cancer are an important component of comprehensive cancer care. To improve patient outcomes and guide researchers and services to identify effective models, studies must include and evaluate minimum recommended components and implementation strategies. Addressing these limitations with high-quality, robust interventions is vital for advancing the implementation of effective distress management.

Democratizing Access to Best Practice Cancer Care in Low-Resource Settings: Project ECHO

PURPOSE The aim of this study was to understand how telementoring and training through the ECHO model can build the cancer workforce and bring best practice cancer care to low-resource settings. METHODS The ECHO Institute launched a 5-year project to expand the use of the ECHO model to improve the capacity of local providers to bring cancer prevention, diagnostic, treatment, and survivorship knowledge to rural and underserved populations. The ECHO model leverages technology, telementoring, and case-based learning to connect rural populations to specialty cancer care, improve access to evidence-based therapies and practices, and provide state-of-the-art training and mentorship to build the cancer workforce, particularly in underserved regions. Through the ECHO model, local providers are paired with experts and doctors at National Cancer Institute–designated Comprehensive Cancer Care Centers and academic medical centers for ongoing training, technical assistance, and mentorship. Although originally developed to bring best practice care for hepatitis C to rural communities, the ECHO model is now being used to treat 70 conditions or topics globally. RESULTS Since 2016, the ECHO model has been replicated by 73 partner hubs in 13 countries that are operating 130 cancer programs focused on diverse cancer prevention and treatment topics, including increasing clinical trial enrollment, cancer control and best practices, cervical cancer prevention and treatment, tobacco cessation, and more. To date, 21 peer-reviewed publications have documented the ECHO model’s efficacy in improving the use of best practices in cancer care and expanding access to care in low-resource settings. CONCLUSION Use of the ECHO model to train and mentor local providers is building the cancer workforce and increasing capacity to address critical topics in cancer screening, diagnosis, care, and survivorship. The ECHO Institute is successfully strengthening the cancer health system and accelerating the transmission of best practice cancer care from cancer centers to health care workers in underserved communities.