Oncology Healthcare Professionals Research Articles

Encountering young caregivers: Attitudes and practices of healthcare professionals caring for cancer patients.

Cancer and its treatments severely limit patients' daily lives. Relatives of patients may provide caregiving assistance to help patients cope with these limitations. Many children and adolescents-referred to as young caregivers (YCs)-provide support for patients. However, healthcare professionals do not always recognize YCs, and when they do, healthcare professionals are unsure how to support them. This study aimed to explore healthcare professionals' attitudes toward and practices when encountering YCs and to compare these aspects according to their experiences with YCs. In total, 395 oncology healthcare professionals (mean age 43.3years; 84.8% females) participated in the study and completed an online survey. Only 1 in 2 professionals reported ever meeting a YC. The majority identified YCs by YCs' frequent presence in the department. No significant difference in attitudes was observed between professionals who had met a YC and those who had never met one. The support provided by professionals to YCs generally consisted of vigilance and exchanges. However, many professionals expressed a need to know where they can refer YCs for assistance. These findings underline the importance of improving the practices of healthcare professionals to help them better identify and support the YCs they meet.

The Prevalence of Compassion Fatigue among Oncology Healthcare Professionals in Three Public Healthcare Facilities in Kwazulu-Natal, South Africa.

Compassion fatigue (CF) is a serious global challenge among healthcare professionals dealing with diseases with poor health outcomes in clinical settings. Chronic exposure to the suffering of others is inevitable in the oncology setting and remains one of the main contributors to CF. Therefore, this study determined the prevalence of CF among oncology healthcare professionals (OHPs) in three public healthcare facilities in KwaZulu-Natal, South Africa. This cross-sectional descriptive study was conducted among 73 OHPs using the Professional Quality of Life Scale version 5 questionnaire, and the data were analysed using the Statistical Package for Social Sciences. More than half (56.2%) of the participants reported average scores for CF, with 43.8% of them scoring low. The participants from Inkosi Albert Luthuli Central Hospital had the highest CF mean score (26.8) compared to those from Addington Hospital (21.2) and Greys Hospital (22.9). Female OHPs had a higher mean score (24.3) for CF, compared to their male counterparts (20.6). The CF scores were positively correlated with older age and longer work experience of the OHPs. The prevalence of CF among OHPs was average, compared to those reported by other local and international studies. Nevertheless, these results cannot be taken lightly, given the straining effects of unmanaged CF on the healthcare system generally and on patient care in particular. The results of this study can potentially contribute to policy development and the planning of intervention strategies towards the effective management of CF among OHPs.

Integrative Medicine for Ovarian Cancer

Integrative oncology (IO) services provide a wide range of complementary medicine therapies, many of which can augment the beneficial effects of conventional supportive and palliative care for patients with ovarian cancer. This study aims to assess the current state of integrative oncology research in ovarian cancer care. We review the clinical research both supporting the effectiveness of leading IO modalities in ovarian cancer care as well as addressing potential safety-related concerns. There is growing amount of clinical research supporting the use of IO and implementation of integrative gynecological oncology models of care within the conventional supportive cancer care setting. Additional research is still needed in order to create clinical guidelines for IO interventions for the treatment of female patients with ovarian cancer. These guidelines need to address both effectiveness and safety-related issues, providing oncology healthcare professionals with indications for which these patients can be referred to the IO treatment program.

Abstract P1-08-07: Educational Opportunities to Improve HER2 Testing and Use of Newer Therapies for HER2-Positive MBC Among Community Healthcare Professionals

Abstract Background: The management of HER2-positive (HER2+) metastatic breast cancer (MBC) has continued to evolve, with multiple FDA approvals of novel HER2-targeted agents since late 2019. Considering the growing HER2+ MBC treatment armamentarium and the emerging HER2-low MBC subtype, we undertook an analysis of the current implementation of guideline and expert recommendations for HER2 testing and treatment of HER2+ MBC with recently approved agents among oncology healthcare professionals (HCPs) participating in educational programs on these topics. Methods: Between January 2020 and April 2022, we conducted several expert-designed educational activities for HCPs focusing on recommended HER2 testing and treatment of HER2+ MBC. Polling questions on HCP knowledge, practice patterns, and confidence in the evaluation of HER2 status and the use of newer targeted therapies in the setting of HER2+ MBC were assessed across the activities and compared with expert recommendations. Results: Among 129 HCPs participating in 2 educational activities held from July 2020 to March 2021, 53% reported confidence to appropriately apply current HER2 testing guidelines to patient care. Similarly, among 407 HCPs who participated in 4 educational programs from May 2020 to January 2021, 24% reported confidence to incorporate recently approved drugs (including trastuzumab deruxtecan [T-DXd], neratinib, and tucatinib) into the care of patients with HER2+ MBC. The percentage of HCPs reporting confidence in the use of these new drugs remained low over this time period. Comparison of treatment recommendations for various HER2+ MBC case scenarios across 7 educational activities from January 2020 through April 2022 showed considerable discordance between experts and HCPs regarding the implementation of newly approved HER2-targeted regimens (Table 1). For patients with disease progression after 2 lines of therapy and no central nervous system (CNS) metastases, 27% to 57% of HCPs (n = 571) chose T-DXd in agreement with experts. For patients with disease progression after 2 lines of therapy with CNS metastases, 27% to 42% of HCPs (n = 597) chose a tucatinib-based regimen in agreement with experts. Treatment choice concurrence between HCPs and experts did not increase over the course of this study for either of these patient scenarios. Conclusions: These data suggest that some HCPs are challenged to optimally incorporate recommendations for HER2 testing and the implementation of novel HER2-targeted therapies in the care of patients with HER2+ MBC. Educational activities designed to improve the knowledge and confidence of HCPs would benefit patients with HER2+ MBC. A detailed analysis of trends over time and by role on the care team will be presented. Table 1. Expert and HCP Treatment Selections for Case Scenarios in HER2+ MBC. Citation Format: Ryan P. Topping, Rachael M. Andrie, Kristen Rosenthal, Timothy A. Quill. Educational Opportunities to Improve HER2 Testing and Use of Newer Therapies for HER2-Positive MBC Among Community Healthcare Professionals [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-08-07.

Clinical practice guideline recommendation summaries for pediatric oncology health care professionals: A qualitative study.

To develop a summary format of clinical practice guideline (CPG) recommendations to improve understandability among health care professionals. We developed a summary format based on current research and used the "Think Aloud" technique in one-on-one cognitive interviews to iteratively improve it. Interviews of health care professionals from Children's Oncology Group-member, National Cancer Institute Community Oncology Research Program sites were conducted. After every five interviews (a round), responses were reviewed, and changes made to the format until it was well understood and no new, substantive suggestions for revision were raised. We took a directed (deductive) approach to content analysis of the interview notes to identify concerns related to recommendation summary usability, understandability, validity, applicability and visual appeal. During seven rounds of interviews with 33 health care professionals, we identified important factors that influenced understandability. Participants found understanding weak recommendations more challenging than strong recommendations. Understanding was improved when the term 'conditional' recommendation was used instead of 'weak' recommendation. Participants found a Rationale section to be very helpful but desired more information when a recommendation entailed a practice change. In the final format, the recommendation strength is clearly indicated in the title, highlighted, and defined within a text box. The rationale for the recommendation is in a column on the left, with supporting evidence on the right. In a bulleted list, the Rationale section describes the benefits and harms and additional factors, such as implementation, that were considered by the CPG developers. Each bullet under the supporting evidence section indicates the level of evidence with an explanation and the supporting studies with hyperlinks when applicable. A summary format to present strong and conditional recommendations was created through an iterative interview process. The format is straightforward, making it easy for organizations and CPG developers to use it to communicate recommendations clearly to intended users.

Practice Gaps and Barriers in Optimal Care Among Healthcare Professionals Treating Patients with CLL and MCL with BTK Inhibitors: Results of a 2-Phase Qualitative/Quantitative Study

Background: Multiple BTK inhibitors (BTKis) are approved for treating patients with chronic lymphocytic leukemia (CLL) and mantle cell lymphoma (MCL), with further approvals expected in the near future, increasing the clinical complexity of decision-making in patient care. This study sought to quantify knowledge and practice gaps among oncology healthcare professionals (HCPs) in the use of BTKis to treat patients with CLL and MCL, with the goal of informing the design of evidence-based education interventions aimed at addressing these gaps. Methods: From November 2021 - January 2022, 488 eligible HCPs (including physicians, physician assistants, nurse practitioners, and pharmacists) participated in a 2-phase study focused on knowledge and use of BTKis for CLL and MCL. Participants were required to be active practitioners who treated patients with CLL and/or MCL. In the exploratory qualitative phase of this study, 30 US participants completed a 45-minute telephone interview focusing on factors that influence clinical reasoning in selecting and providing treatment for CLL and MCL. Interviews were transcribed, and thematic analysis was performed. The quantitative phase of this study consisted of an online survey composed of multiple-choice questions and semantic differential rating scales. Respondents' answers to each question in the quantitative survey were compared with optimal answers as identified by treatment guidelines and specialists in CLL and MCL patient care. Results: Of responding HCPs, 59% were physicians, 64% had been in practice >10 years, 73% practiced in a nonacademic setting, and 73% cared for ≤10 patients with CLL and/or MCL per week. A group of 7 core practice gaps were identified through combined analysis of data from the qualitative and quantitative surveys; these included optimal therapy selection in the first- and later-line settings for CLL and MCL, awareness of mechanisms of resistance to approved BTKi therapy, and knowledge of investigational therapies and appropriate clinical trial referral. For example, of 270 responding HCPs, 47% were unable to select preferred first-line therapy (per expert recommendations) for a patient with CLL and high tumor burden and renal insufficiency, with 9% recommending a chemoimmunotherapy regimen. Likewise, a significant percentage of surveyed HCPs lacked confidence in their approach to therapy selection for patients with relapsed/refractory CLL or MCL, with optimal sequencing identified as a primary concern. Many HCPs were unfamiliar with BTKi mechanisms of action. Gaps in knowledge were particularly evident with novel BTKis, including pirtobrutinib, with 46% of online survey respondents uncertain about the noncovalent mechanism of this agent and only 33% aware that pirtobrutinib has shown activity in patients with CLL and disease progression on ibrutinib due to the appearance of a BTK C481 mutation. In total, 60% of respondents would not consider recommending a newly approved agent if they were not familiar with the class or mechanism of action of this agent. Conclusions: Many HCPs lack confidence and knowledge in applying optimal care for patients with CLL and MCL, particularly with regard to the use of BTKis, both in first- and later-line therapy. A lack of familiarity with promising novel BTKis under clinical investigation may lead to missed opportunities to enroll eligible patients on clinical trials and potentially delay integration of these agents into clinical practice as new indications emerge. Results of this study provide evidence to support the design of clinical tools, educational programs, and performance improvement interventions. Detailed findings will be presented, including group-specific analyses and investigation of the causalities of each of the identified practice gaps.

Co-designing Healthy Living after Cancer Online: an online nutrition, physical activity, and psychosocial intervention for post-treatment cancer survivors

PurposeThe aim of the present study was to co-design Healthy Living after Cancer Online (HLaC Online), an online intervention supporting cancer survivors to set and meet their healthy living goals.MethodsAdapted from an initial telephone-delivered Healthy Living after Cancer program, wireframes (PDF black and white mock-ups) of the proposed online program were presented in a series of focus groups and interviews to our stakeholder group, which consisted of cancer survivors, oncology healthcare professionals, and representatives from cancer support organisations. Stakeholders were prompted for feedback on the wireframe and given end-user scenarios to encourage deeper engagement with the co-design process. Transcriptions underwent thematic analysis to determine which features of the program needed change or expansion.Results27 participants took part in one of 8 focus groups or 10 interviews. Five themes were identified relating to (a) website design elements, (b) promoting and maintaining long-term engagement, (c) relatability and relevance, (d) navigating professional support, and (e) family and peer support. Recommended changes, such as simple activities and guidance videos, were integrated into the HLaC Online prototype.ConclusionsInvolving end-users in the co-design process ensured the intervention’s relevance and specificity to the needs of cancer survivors. Next steps include feasibility testing the prototype, prior to commencing a national randomised control trial of HLaC Online.Implications for Cancer SurvivorsHLaC Online aims to support cancer survivors to improve their quality of life by making healthy lifestyle changes in their physical activity, healthy eating, weight management, mental health, and fatigue management.

Time to embed physical activity within usual care in cancer services: A qualitative study of cancer healthcare professionals’ views at a single centre in England

Purpose An increasing number of people affected by cancer (PABC) are living longer lives as treatment continues to advance. There is growing evidence for physical activity (PA) supporting health in this population before, during and after cancer treatment, but PA advice is not part of usual care. This study investigates views of frontline oncology healthcare professionals (HCPs) in one NHS teaching hospital in England to understand the role of PA advice across cancer services. Materials and methods This was a qualitative study interviewing HCPs and using thematic analysis. Results Four main themes were identified: 1. Awareness of the roles of PA in cancer; 2. Patient-specific factors in rehabilitation; 3. Cancer-specific factors in rehabilitation; 4. Barriers and opportunities to integrating PA within usual care. HCPs’ awareness of the role of PA in cancer rehabilitation was low overall and PA was found not to be embedded within rehabilitation. Contrastingly, there was awareness of PA’s potential to impact disease and treatment-related outcomes positively. Ideas for PA integration included training for staff and giving PA advice within consultations. Conclusions Low awareness of benefits of PA-based rehabilitation and lack of integration in usual care contrasted with HCPs’ interest in this area’s potential. Training HCPs to begin the conversation with patients affected by cancer in teachable moments may increase patient access. Implications for rehabilitation Integrating physical activity education and training for trainees and existing healthcare professionals workforce would help embed physical activity into routine clinical practice. Brief advice intervention training during every consultation, such as providing relevant individualised information and signposting, can be impactful. Physical activity within a broader cancer rehabilitation programme should be integrated as standard for every cancer patient. Individualised plans may include prehabilitation, restorative rehabilitation and palliative rehabilitation. Patient preferences and the patient experience should continue to shape service design. There is a need to ensure physical activity advice is consistent throughout healthcare settings and not fragmented between primary, secondary and tertiary care.

Impact of structural racism on inclusion and diversity in precision oncology: A scoping and critical review of the literature.

Inclusion and diversity in precision oncology are essential in reducing cancer disparities among racial and ethnic groups. However, present studies have favored the recruitment and participation of Whites, with limited applicability of their results to minority groups. Many reasons for their underrepresentation are downstream manifestations of structural racism. Therefore, this scoping review provides a precise mapping of recruitment and participation barriers for minorities in precision oncology that are associated with structural racism, including a critical appraisal of how disciplinary norms, paradigms, and tools used therein could inadvertently contribute to unforeseen inclusion and diversity challenges. Empirical and theoretical publications from Web of Science and PubMed were searched and analyzed to identify recruitment and participation barriers for minorities in precision oncology. In addition, using the public health critical race praxis (PHCRP) as guiding analytical framework, empirical studies were analyzed to identify unforeseen barriers resulting from simplification processes, assumptions, norms, paradigms, and tools used during the research process. One-hundred thirty-five barriers to recruitment and participation were identified or reported in included publications. They were subsequently categorized as being a manifestation of one of the following forms of racism, namely internalized, interpersonal, institutional, and structural racism. The PCHRP analysis revealed four additional factors to be considered in precision oncology studies in ensuring appropriate representation of their study populations. Future interventions aimed at reducing health disparities should focus predominantly on barriers associated with structural and institutional racism, which should then have ripple effects on other forms of racism. Importantly, the four factors identified through the PHCRP framework could further explain the lower participation rates of minorities in precision oncology and related activities. Therefore, they should be given due consideration by all stakeholders involved in the precision oncology ecosystem, from researchers and healthcare professionals to policy-makers, research ethics committees, and funders.

Smoking cessation for cancer patients through the lens of cancer specialists: challenges & solutions

Abstract Background The benefits of smoking cessation (SC) for cancer patients are widely recognised. However, there has been a limited emphasis on SC in this context and it continues to be a challenge for cancer patients. As part of a larger feasibility study aiming to develop a structured SC pathway for cancer patients in Ireland, this qualitative study explored the SC practices, experiences and opinions of oncology healthcare professionals (HCPs). Methods Semi-structured interviews were conducted with 18 HCPs from lung, breast, cervical, head and neck and general oncology, across 4 specialist adult cancer hospitals in Ireland. Interview transcripts were analysed using thematic analysis. Results Four key themes emerged: (1) Frequently ask and advise but infrequently assist: most HCPs ask about smoking and many advise about available supports, but few refer patients to SC services. Where offered, referrals were to hospital SC services and/or nicotine replacement therapy was prescribed; no HCP prescribed varenicline or bupropion. Barriers included lack of time, ill-defined referral pathways and lack of knowledge. (2) Increased willingness but differing ability to quit: most patients were interested in quitting post diagnosis and had varying support needs, linked to cancer stage, social circumstances and stress levels. (3) Need for an integrated or parallel service: all HCPs suggested that a structured and defined referral pathway will facilitate SC. (4) Motivational counselling and pharmacotherapy combination: many HCPs suggested face to face as the best mode of intervention initially, with regular follow ups and ongoing support virtually, started pre-treatment, with an empathetic and empowering approach with provision of both motivational counselling and SC pharmacotherapy. Conclusions Smoking post cancer diagnosis has serious implications for cancer treatment and prognosis but is frequently overlooked. These findings will inform the design of a SC pathway for cancer patients. Key messages • Despite increased willingness to quit, there is inadequate and inconsistent SC support provision for cancer patients. • Tailored SC support should be an integral part of comprehensive cancer care.

Stakeholders' perceptions of a community-based advanced nurse practitioner-led integrated oncology care model for adults receiving oral anti-cancer medication-A qualitative study.

The primary objective was to understand stakeholders' perceptions of a community-based advanced nurse practitioner (ANP)-led integrated OAM care model for adults. Qualitative data from interviews and focus groups were obtained from 33 individuals; either service users who attended ANP-led OAM clinics or stakeholders involved in OAM care. Data were subsequently analysed using thematic analysis. Four themes were identified and included reflection on pre-COVID-19 system, role of ANP in current OAM care, importance of robust communication and infrastructural requirements for transition to an integrated OAM care model. This study demonstrated that patients and HCPs perceived the proposal positively. They identified the ANP as the appropriate HCP to care for this cohort and the importance of communication and strategic planning for transitioning this model of care to the community setting. ISRCTN10401455.

Identification and management of cancer cachexia in patients: Assessment of healthcare providers' knowledge and practice gaps.

Cancer cachexia negatively impacts patient outcomes, quality of life and survival. Identification and management of cancer cachexia remains challenging to healthcare professionals (HCPs). The aim of this assessment was to identify current gaps in HCPs' knowledge and practice for identifying and managing adults with cancer-related cachexia. Results may guide development of new educational programmes to close identified gaps and improve outcomes of cancer patients. An international assessment was conducted using a mixed-methods approach including focus group interviews with subject matter experts and an electronic survey of practising HCP. The assessment was led by the Society on Sarcopenia, Cachexia and Wasting Disorders (SCWD) and was supported by in-country collaborating organizations. A quantitative survey of 58 multiple-choice questions was completed by physicians, nurses dietitians and other oncology HCP (N=2375). Of all respondents, 23.7% lacked confidence in their ability to provide care for patients with cancer cachexia. Patients with gastrointestinal, head and neck, pulmonary cancers and leukaemia/lymphoma were reported as those at highest risk for cachexia. Only 29.1% of respondents recognized a key criterion of cancer cachexia as >5% weight loss from baseline, but many (14.4%) did not utilize a standardized definition of cancer cachexia. Despite this, most clinicians (>84%) were able to identify causes of weight loss-reduced oral intake, progressive disease, side effects of therapy and disease-related inflammation. Of all respondents, 52.7% indicated newly diagnosed patients with cancer should be screened for weight loss. In practice, 61.9% reported that patient weight was systematically tracked over time, but only 1125 (47.4%) reported they weigh their cancer patients at each visit. Treatment of cachexia focused on increasing the patient's nutritional intake by oral nutritional supplements (64.2%), energy and protein fortified foods (60.3%) and counselling by a dietitian (57.1%). Whereas many respondents (37.3%) considered cachexia inevitable, most (79.2%) believed that an interprofessional team approach could improve care and that use of standardized tools is critical. Findings from this international assessment highlight the challenges associated with the care of patients with cancer cachexia, opportunities for interventions to improve patient outcomes and areas of variance in care that would benefit from further analysis.

Clinical uptake of precision medicine advances in NSCLC: A case study in RET fusions.

32 Background: Precision medicine has revolutionized cancer care in advanced NSCLC and new actionable biomarkers and targeted therapies are emerging at an unprecedented pace, creating myriad opportunities to improve care and mitigate the often-dire sequelae of traditional cancer therapy. Delays in uptake of testing and biomarker-guided treatment for patients with NSCLC and EGFR activating mutations or ALK fusions are well documented despite clear evidence-based practice, guidelines, and expert recommendations. In this study, we analyze healthcare professionals (HCPs) awareness and application of RET fusion testing and integration of recently approved selective RET inhibitors into practice for appropriate patients with advanced NSCLC. Methods: From 1/2020-6/2022, multiple educational activities were developed to provide HCPs with evidence-based expert and guideline recommendations on assessment of and therapy selection for RET fusion–positive NSCLC. The activities comprised live symposia associated with 4 major oncology and pathology conferences (AMP, USCAP, ASCO, AACR), 3 regional live workshop series across the US, 3 live webinars, and 2 on-demand videos. Baseline polling questions designed to assess key aspects of HCP knowledge and practice patterns were repeated at each activity. Results: Across all activities at baseline, on average only 38% of responding HCPs correctly identified RNA NGS as the most sensitive testing assay for detection of RET fusions and 36% accurately selected the appropriate targeted therapy for patient case with a KIF5B-RET gene fusion. From 2020 through 2022, with each new group of learners across different scopes of practice, we found suboptimal awareness of optimal RET fusion testing methodology and choice of therapy for patients with RET fusion–positive NSCLC (table). Optimal responses were slightly higher among learners attending conference-associated symposia vs live workshop series and online education. Conclusions: The use of optimal testing assays for RET alterations across patients with NSCLC remains low and many HCPs continue to lack awareness of appropriate targeted therapy for patients with RET–fusion positive NSCLC > 2 years after the first approved indication for this biomarker. These results underscore a lag in adoption of optimal precision medicine approaches for NSCLC among oncology HCPs and the need for expert guidance and educational activities to optimize individualized, biomarker-driven treatment approaches. An analysis of patterns by HCP role (MD, NP/PA, RN, Pharmacist) will be presented.[Table: see text]

CN39 Development of a reference model for patient and public involvement in oncology research in French-speaking Switzerland

Patient and public involvement (PPI) in research is increasingly encouraged as a means of improving its validity and relevance. Although gaining momentum, the implementation of PPI in research in Switzerland remains recent. Our aim was to establish a PPI model for cancer research adapted to the local context that will assist researchers to apply PPI approaches within their projects. Two semi-directed focus groups were conducted with 10 local key informants including patient representatives (2), oncology healthcare professionals (3), PPI experts (2), experts in patient-reported measures (2), and health managers (1). A deductive thematic approach was used to identify benefits, limitations and facilitators of establishing a PPI model in cancer research in the local context. In addition, we identified established frameworks in research and/or cancer research to analyze the main concepts and elements to be considered. Consensus was reached on the benefits of involving patients in research, allowing for more specific, relevant, and comprehensive studies. Participants also identified limiting factors such as the lack of PPI culture in healthcare research or the need for a paradigm shift at different levels. Among facilitators for the success and long-term sustainability of PPI were awareness of the resources, capacities of the research organization and capabilities of the patients, the need for PPI training for both researchers and patients, and the recognition of patient’s contributions. Nine different frameworks from seven countries were retained for further analysis. Main elements identified related to the goals to be achieved (why?), the knowledge that patients can contribute (what?), and the types and degree of patients' involvement (who & how?). The resulting SCCL-PPI model is multidimensional, comprising the stages of research, different levels and types of involvement, capabilities required from patients and capacities of the research group/organization. It is important for researchers to make a careful assessment of each of these dimensions. We chose to depict it using the Rubik’s cube to reflect the importance of adaptability of a PPI approach to each individual research project.

International Survey on Frailty Assessment in Patients with Cancer.

BackgroundFrailty negatively affects the outcomes of patients with cancer, and its assessment might vary widely in the real world. The objective of this study was to explore awareness and use of frailty screening tools among the ONCOassist healthcare professionals (HCPs) users.Materials and MethodsWe sent 2 emails with a cross-sectional 15-item survey in a 3-week interval between April and May 2021. Differences in the awareness and use of tools according to respondents’ continents, country income, and job types were investigated.ResultsSeven hundred thirty-seven HCPs from 91 countries (81% physicians, 13% nurses, and 5% other HCPs) completed the survey. Three hundred and eighty-five (52%) reported assessing all or the majority of their patients; 518 (70%) at baseline and before starting a new treatment. Three hundred and four (43%) HCPs were aware of performance status (PS) scores only, 309 (42%) age/frailty/comorbidity (AFC) screening, and 102 (14%) chemotoxicity predictive tools. Five hundred and thirty-seven (73%) reported using tools; 423 (57%) just PS, 237 (32%) AFC, and 60 (8%) chemotoxicity ones. Reasons for tools non-use (485 responders) were awareness (70%), time constraints (28%), and uselessness (2%). There were significant differences in awareness and use of screening tools among different continents, country income, job types, and medical specialties (P < .001 for all comparisons).ConclusionAmong selected oncology HCPs, there is still a worldwide lack of knowledge and usage of frailty screening tools, which may differ according to their geography, country income, and education. Targeted initiatives to raise awareness and education are needed to implement frailty assessment in managing patients with cancer.

Psychological Impact of COVID-19 on Oncology Patients: Perceptions of Oncology Health Care Providers.

The COVID-19 pandemic profoundly impacted psychological well-being worldwide. Oncology health care professionals' (OHCPs') perceptions of psychological effects of COVID-19 among people in active cancer treatment were explored. Semi-structured interviews with a purposive sample of OHCPs actively providing care were conducted. Interviews were audio-recorded, transcribed, and coded using Atlas.ti v8 and thematic analysis. In total, 30 OHCPs participated. Most were registered nurses (70%), worked in outpatient setting (56.7%) and were in their current position 1-5 years (53.3%). Overarching themes are as follows: (a) cancer treatment disrupted due to patients' fear of exposure to COVID-19; (b) social distancing restrictions caused discontinued social support and supportive services that exacerbated psychological distress; (c) pandemic-related stressors led to overwhelmed coping skills; and (d) OHCPs played a vital role in providing emotional support and connecting patients with family/friends through technology. Behavioral health interventions should focus within the "new world of COVID-19" of reduced face-to-face support and increased online support for patients.

Practice-Based Evidence to Support Return to Work in Cancer Patients.

BackgroundInternational research emphasizes the importance of providing early, hospital-based support in return to work (RTW) for cancer patients. Even though oncology health professionals are aware of the scientific evidence, it remains unclear whether they implement this knowledge in current practice. This paper presents the knowledge and viewpoints of health care professionals (HCPs) on their potential role in their patients' RTW process.MethodsSemi-structured interviews with oncology HCPs were used to describe current practice. Results of these interviews served as input for focus group discussions with managers in oncology hospitals, which led to an agreement on of best practice.ResultsThis research had the participation of 75% of Belgian institutions involved in oncology health care services. Five themes were identified that influence care providers and staff to implement scientific evidence on RTW in cancer patients: (1) Opinions on the role that care institutions can take in RTW support; (2) Current content of RTW support during oncology care; (3) Scientific bases; (4) Barriers and success factors; and (5) Legislation and regulations. The key elements of the best practice included a generic approach adapted to the needs of the cancer patient supported by a RTW coordinator.ConclusionsHealth care providers include RTW support in their current care, but in very varied ways. They follow a process that starts with setting the indication (meaning the identification of patients for whom the provision of work-related care would be useful) and ends with a clear objective agreed upon by HCPs and the patient. We recommend that specific points of interest be included in regulation at both the patient and hospital levels.

Knowing to Ask and Feeling Safe to Tell - Understanding the Influences of HCP-Patient Interactions in Cancer Care for LGBTQ+ Children and Young People.

BackgroundLesbian, gay, bisexual, transgender, queer or questioning (LGBTQ+) people experience healthcare inequalities in cancer care. Previous studies have focused on knowledge, attitudes and behaviours of healthcare professionals (HCPs) treating adults with cancer and how these contribute to inequalities. To date, no research has focused on HCPs treating LGBTQ+ children and adolescents with cancer in the UK. This is important given that this group may be at a critical time for exploring their gender identity and sexual orientation, whilst also facing a cancer diagnosis. We aimed to explore the knowledge, attitudes and behaviours of paediatric, teenage and young adult oncology HCPs treating LGBTQ+ patients in the UK.MethodsWe carried out semi-structured interviews with 8 HCPs in paediatric, teenage and young adult (TYA) oncology from the Royal Marsden NHS Foundation Trust. Eight questions were asked, which centred around participants’ knowledge, attitudes and behaviours regarding management of LGBTQ+ patients in oncology. Interview transcripts were analysed by inductive thematic analysis.ResultsWe identified 10 themes, including novel themes (how HCPs acquire knowledge and expectations of a ‘third party’ to be the expert) which may underlie previously observed trends in knowledge, attitudes and behaviours of HCPs. We highlight other themes and HCP concerns specific to care of LGBTQ+ patients in paediatrics (influence of the parental-carer dynamic, concerns around patient age and development as a barrier to disclosure) which require further research. We found evidence of the interrelatedness of HCP knowledge, attitudes and behaviours and the ability of these elements to positively influence each other. We mapped our themes across these elements to form a new suggested framework for improving HCP-patient interactions in LGBTQ+ Cancer Care. We found a need both for individual HCP education and organisational change, with creation of a culture of psychological safety to improve patient care.ConclusionKnowledge, attitudes and behaviours of HCPs are closely interdependent when providing care to young LGBTQ+ patients with cancer. The authors suggest that future efforts to improve care of these patients address this complexity by spanning the domains of our suggested framework. Whilst HCP education is essential, change must also occur at an organisational level.

Abstract 5965: The effectiveness of health care professional training on the legal issues impacting individuals diagnosed with cancer to improve patient quality of life

Abstract A cancer diagnosis may carry with it a variety of legal issues, including navigating insurance, government benefits, employment, and consumer rights. These legal issues can cause people unnecessary worry, confusion, and stress, and can be overwhelming. The Insurance and Finance Intensive provides health care professionals tools to proactively identify the presence of cancer-related legal, insurance, and financial issues facing their patients. Additionally, the training helps health care professionals to offer referrals to appropriate legal and related resources, once those issues are identified. Oncology health care professionals participated in an eight-hour comprehensive training. Attendees were provided with substantive information about cancer-related legal issues, such as identifying health insurance options, navigating taking time off work and accessing disability insurance, and managing finances. A follow-up survey was sent to past 2020 and 2021 Intensive attendees (n=126), to measure the effectiveness of the training and to address additional questions and difficult case studies. Ninety-four percent of survey respondents indicated that they changed their behavior or practice based on what they learned at the training. Ninety-four percent of survey respondents strongly agreed or agreed that the information provided by the training helped reduce the financial burden that their patients and families experience after a cancer diagnosis. Ninety-seven percent of respondents strongly agreed or agreed that the information provided by the training improved the quality of life of their patients and families. The Insurance &amp; Finance Intensive successfully provided health care professionals with valuable information on the practical and legal issues that impact individuals diagnosed with cancer. It is recommended that more health care professionals participate in this training to mitigate the financial burden of a diagnosis and improve the quality of life of their patients. Citation Format: Madison McMahon Ward, Joanna Fawzy Morales, Monica Fawzy Bryant. The effectiveness of health care professional training on the legal issues impacting individuals diagnosed with cancer to improve patient quality of life [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5965.

Development, Testing, and Implementation of the Belgian Patient Reported Experience Measure for Pancreatic Cancer Care (PREPARE) Project: Protocol for a Multi-Method Research Project.

BackgroundPatients with pancreatic cancer do not feel involved in the development of their treatment and care plans. In Belgium, these plans are decided on during multidisciplinary team meetings. However, limited time is spent on the discussion of the preferences of the patient during these meetings. This research project aims to develop a patient-reported experience measure (PREM) for pancreatic cancer and assess if its use can support collaborative treatment decision-making.ObjectiveThis paper aims to outline the protocol for a multi-method research project to improve person-centered pancreatic cancer care in Belgium. Three subobjectives are pursued: (1) to develop a PREM to assess the experiences of care-related aspects in pancreatic cancer care, (2) to validate the PREM, and (3) to develop and evaluate an educational intervention to support the use of the PREM’s results.MethodsFor the development of the PREM, an exploratory mixed methods study design will be used. The study will start with a survey followed by a telephone interview involving patients with pancreatic cancer and digestive oncology health care professionals. Study two is the testing of the content and construct validity of the PREM. Study three involves the implementation study according to the Medical Research Council framework of a complex intervention introducing the PREM in practice. The effectiveness of the intervention will be investigated using a pragmatic randomized controlled trial study design.ResultsThe protocol presents the entire structure of the research project. Ethics approval to conduct the exploratory mixed methods study (objective 1) has been obtained, and recruitment has started since January 2022.ConclusionsThe poor prognosis of patients with pancreatic cancer should not be considered a hurdle to not study this patient population group. Involving patients in the research and decision-making processes early on is key. This project aims to realize a scientifically sound research process providing research outputs that can easily and timely be implemented in the care trajectory of patients with pancreatic cancer. This research project will also lead to recommendations on how to involve patients with pancreatic cancer and how the methodology of this research project can be translated to other patient groups.International Registered Report Identifier (IRRID)PRR1-10.2196/29004