Patients Receiving Cancer Treatment Research Articles

Travel Associated Carbon Emissions of Patients Receiving Cancer Treatment from an Urban Safety Net Hospital

BackgroundHealthcare transportation, particularly the transportation of patients to access healthcare services, is a significant source of carbon emissions. This study aims to estimate the carbon emissions of patient transportation among patients receiving cancer care at an urban community safety net hospital. Materials and MethodsWe conducted a retrospective study of patients seen at the oncology clinic of an urban community safety net hospital between July 1, 2022, and June 30, 2023. Patients with at least one in-person visit in one year, documented home addresses, and oncologic diagnoses were included in the study. The distance between each patient's home address and the hospital was calculated using the Google Map API key and a macro to calculate distance in meters. The total estimated carbon emissions were calculated using the E.P.A. equivalencies calculator. The primary outcome was carbon emissions from patients' round-trip travel from home to hospital. ResultsFrom July 1, 2022, to June 30, 2023, 13,970 visits were made to the oncology clinic. Of these, 8,235 visits made by 1,080 patients met the criteria for inclusion in the final analysis. Of the 8,235 visits recorded, 5,095 (61.8%) were follow-up/laboratory visits. The 1080 patients who attended the clinic had a mean age of 63.8 years; 700 (64.8%) were males, and 525 (48.6%) were Black or African American. Breast cancer was the most common diagnosis, accounting for 423 (39.2%) of cancer diagnoses. Each patient traveled 4.8 (0.3-149.3) miles for a one-way trip and 9.6 (0.7-298.6) miles round trip to receive cancer care. Approximately 1,520 (280-119,440) grams of carbon were emitted per patient visit. A total of 79,582 round trip miles was calculated for the 8,235 visits made by all patients within one year, which corresponds to 31,832 kg of CO2 emissions equivalent to 35,658 pounds of coal burned, 1,462 propane cylinders used for a home, or 3,872,250 smartphones charged. ConclusionTravel to receive cancer care is associated with significant carbon emissions and poses a climate and public health risk. Efforts to decrease the overall carbon footprint of cancer treatment are needed to minimize the contributions of cancer treatment to climate change.

Protective Role of Nanoceria-Infused Nanofibrous Scaffold toward Bone Tissue Regeneration with Senescent Cells.

The presence of oxidative stress in bone defects leads to delayed regeneration, especially in the aged population and patients receiving cancer treatment. This delay is attributed to the increased levels of reactive oxygen species (ROS) in these populations due to the accumulation of senescent cells. Tissue-engineered scaffolds are emerging as an alternative method to treat bone defects. In this study, we engineered tissue scaffolds tailored to modulate the adverse effects of oxidative stress and promote bone regeneration. We used polycaprolactone to fabricate nanofibrous mats by using electrospinning. We exploited the ROS-scavenging properties of cerium oxide nanoparticles to alleviate the high oxidative stress microenvironment caused by the presence of senescent cells. We characterized the nanofibers for their physical and mechanical properties and utilized an ionization-radiation-based model to induce senescence in bone cells. We demonstrate that the presence of ceria can modulate ROS levels, thereby reducing the level of senescence and promoting osteogenesis. Overall, this study demonstrates that ceria-infused nanofibrous scaffolds can be used for augmenting the osteogenic activity of senescent progenitor cells, which has important implications for engineering bone tissue scaffolds for patients with low regeneration capabilities.

Weighted Blanket: An Anxiety Reduction Tool in the Outpatient Oncology Infusion Setting.

Adults with cancer experience a significantly higher level of anxiety compared with the general population. Anxiety is reported at diagnosis and throughout the cancer trajectory, and it is particularly heightened at the initiation of infusion treatments. In 2020, the COVID-19 pandemic exacerbated anxiety levels in patients receiving cancer treatments. This evidence-based practice project evaluated the feasibility and effectiveness of using medical-grade weighted blankets to reduce anxiety in patients with cancer receiving the first two infusion treatments in the ambulatory setting. Patients completed a modified version of the Visual Analog Scale for Anxiety to self-report anxiety pre- and postimplementation. Patients and nurses completed feasibility surveys. Patients reported reduced anxiety after using a weighted blanket and described weighted blankets as comforting and soothing. More than 90% of surveyed patients agreed or strongly agreed that the blanket was comfortable, not too heavy, and easy to put on, and did not interfere with nursing care or their own activities. Nurses valued the ease of use and adherence to infection control standards.

Revisiting the Association of ECOG Performance Status With Clinical Outcomes in Diverse Patients With Cancer.

The ECOG performance status (PS) scale was developed to support national clinical trials, but the degree to which ECOG PS predicts clinical outcomes in patient subgroups outside of clinical trials is relatively unknown. This study examined associations between ECOG PS and adverse outcomes in a diverse community oncology population. In this retrospective cohort study, demographic and clinical characteristics, including the most recent ECOG PS between January 1, 2017, and December 31, 2019, were examined for patients receiving cancer treatment within Kaiser Permanente Northern California (KPNC). Proportional hazard models were used to evaluate the effect of ECOG PS on adverse outcomes. A total of 21,730 patients were identified. Overall, most patients had an ECOG PS of 0 (42.5%) or 1 (42.5%). In multivariable analysis, an ECOG PS of 3 or 4 was associated with higher risk of 30-day emergency department visits (adjusted hazard ratio [aHR], 3.85; 95% CI, 3.47-4.26), 30-day hospitalizations (aHR, 4.70; 95% CI, 4.12-5.36), and 6-month mortality (aHR, 7.34; 95% CI, 6.64-8.11) compared with an ECOG PS of 0. Additionally, we found that upper gastrointestinal and stage IV cancers were associated with a higher risk of adverse outcomes compared with breast and stage I cancers, respectively. When adjusted for ECOG PS, African American race, Asian race, and female sex were associated with a lower risk of mortality than White race and male sex. An ECOG PS of 3 or 4 was more predictive of mortality in younger patients and those with breast cancer (P<.001). ECOG PS and upper gastrointestinal and stage IV cancers were independently associated with increased risk of emergency department visits, hospitalizations, and mortality, whereas African American and Asian race and female sex were associated with decreased risk of mortality. An ECOG PS of 3 or 4 was more predictive of an increased risk of mortality in younger patients and patients with breast cancer. These findings can enhance the use of ECOG PS for clinical decision-making and defining eligibility for clinical trials.

Travel-associated carbon emissions of patients receiving cancer treatment from an urban safety net hospital.

e13812 Background: Climate change is one of the grand challenges of the 21st century. The U.S. currently emits 11% of the annual global greenhouse gases, and 8-10% of its emissions result from the healthcare industry. Studies on the contribution of patients' commute for cancer treatment to healthcare-associated CO2 emissions remain limited. This study aims to determine the CO2 emissions of patients’ commute for cancer treatment among patients with malignancies at an urban safety net hospital. Methods: We conducted a retrospective study of patients seen at an oncology clinic from July 1, 2022 - June 30, 2023. Demographic data, data on visit diagnosis and indication (e.g., laboratory, infusion, or follow-up visits), and patients' home addresses were collected from the EMR. Distance between patients’ homes and the hospital was calculated using a Google Map API and a macro for distance. Total CO2 emissions from patients’ travel in miles were estimated at 400 grams of CO2 per mile based on the Environmental Protection Agency’s estimate of the average CO2 emissions for a passenger vehicle. The primary outcome was CO2 emissions from patients’ round-trip travel. The total estimated CO2 emissions were converted to equivalents of coal burned, smartphones charged, and gallons of gasoline used based on the EPA equivalencies calculator. Results: Of the 8,235 visits, 5,095 (61.8%) were follow-up/laboratory visits, and 3,137 (38.1%) were chemotherapy infusion visits. Of the 1,080 patients who attended the clinic, the mean age was 63.8 years, 700 (64.8%) were males, 379 (35.1%) were females, 525 (48.6%) were black or African American, 139 (12.9%) were whites. Breast cancer was the most common diagnosis, with 423 (39.2%) of patients. Each patient traveled an average of 9.6 miles round trip (Range = 0.7-298.6 miles) to receive cancer care. An estimated 1,520 grams of CO2 was emitted for each patient’s visit. A total of 79,582 round trip miles was made in 8,235 visits, which corresponds to 31,832 kg of CO2 emissions, equivalent to 35,658 pounds of coal burned, 1,462 propane cylinders used for a home, or 3,872,250 smartphones charged. Conclusions: Cancer care is associated with significant CO2 emissions. Efforts to decrease the overall carbon footprint of cancer treatment through adoption of telemedicine and alternative treatment schedules, are needed to reduce the effect of cancer treatment on the climate. [Table: see text]

Changes in hospital mortality in patients with cancer during the COVID-19 pandemic (ISARIC-CCP-UK): a prospective, multicentre cohort study

Patients with cancer are at greater risk of dying from COVID-19 than many other patient groups. However, how this risk evolved during the pandemic remains unclear. We aimed to determine, on the basis of the UK national pandemic protocol, how factors influencing hospital mortality from COVID-19 could differentially affect patients undergoing cancer treatment. We also examined changes in hospital mortality and escalation of care in patients on cancer treatment during the first 2 years of the COVID-19 pandemic in the UK. We conducted a prospective cohort study of patients aged older than 19 years and admitted to 306 health-care facilities in the UK with confirmed SARS-CoV-2 infection, who were enrolled in the International Severe Acute Respiratory and emerging Infections Consortium (ISARIC) WHO Clinical Characterisation Protocol (CCP) across the UK from April 23, 2020, to Feb 28, 2022; this analysis included all patients in the complete dataset when the study closed. The primary outcome was 30-day in-hospital mortality, comparing patients on cancer treatment and those without cancer. The study was approved by the South Central-Oxford C Research Ethics Committee in England (Ref: 13/SC/0149) and the Scotland A Research Ethics Committee (Ref 20/SS/0028), and is registered on the ISRCTN Registry (ISRCTN66726260). 177 871 eligible adult patients either with no history of cancer (n=171 303) or on cancer treatment (n=6568) were enrolled; 93 205 (52·4%) were male, 84 418 (47·5%) were female, and in 248 (13·9%) sex or gender details were not specified or data were missing. Patients were followed up for a median of 13 (IQR 6-21) days. Of the 6568 patients receiving cancer treatment, 2080 (31·7%) died at 30 days, compared with 30 901 (18·0%) of 171 303 patients without cancer. Patients aged younger than 50 years on cancer treatment had the highest age-adjusted relative risk (hazard ratio [HR] 5·2 [95% CI 4·0-6·6], p<0·0001; vs 50-69 years 2·4 [2·2-2·6], p<0·0001; 70-79 years 1·8 [1·6-2·0], p<0·0001; and >80 years 1·5 [1·3-1·6], p<0·0001) but a lower absolute risk (51 [6·7%] of 763 patients <50 years died compared with 459 [30·2%] of 1522 patients aged >80 years). In-hospital mortality decreased for all patients during the pandemic but was higher for patients on cancer treatment than for those without cancer throughout the study period. People with cancer have a higher risk of mortality from COVID-19 than those without cancer. Patients younger than 50 years with cancer treatment have the highest relative risk of death. Continued action is needed to mitigate the poor outcomes in patients with cancer, such as through optimising vaccination, long-acting passive immunisation, and early access to therapeutics. These findings underscore the importance of the ISARIC-WHO pandemic preparedness initiative. National Institute for Health Research and the Medical Research Council.

Survival Status and Predictors Among Women with Advanced Stage of Cervical Cancer.

Cervical cancer is one of the leading causes of cancer death in women, even though it is a preventable disease. Most deaths occur in low- and middle-income countries. In addition to early detection and receipt of standard treatments, survivorship is an important component of high quality of care across the cancer continuum. To assess the survival status of advanced-stage cervical cancer patients after cancer treatment has started. A one-year prospective cohort study was employed to assess the survival status of women with advanced stages of cervical cancer. A total of 180 cervical cancer patients were recruited, and the study was conducted from January 10, 2022, to September 20, 2023. Data entry and analysis were done in the SPSS 29 version. Descriptive statistics were used to examine participant characteristics. The Kaplan-Meier procedure and log rank test were used to estimate the duration of survival. Bivariate and multivariate Cox regression analyses were computed for predictor variables with survival status. Patients receiving cancer treatment at FIGO stages IVA and IVB had survived by 56% and 24%, respectively, whereas patients receiving treatment at stages IIB and IIIA had survived by 100%. The estimated mean survival time at one-year follow-up was 5.706 months (95% CI: 3.785-7.627) for patients with FIGO stage IVB, but 11.537 months (95% CI: 11.199-11.887) for those with stages II and III (P < 0.001). Women over 60 years old had a 1.5-fold higher risk of death than those under 60 (HR: 1.482, P = 0.040). The one-year cumulative survival rate among advanced-stage cervical cancer patients was 77%. Major factors associated with survival were age, cancer stage, the presence of anemia, and waiting time for treatment.

Germline pathogenic variants associated with triple-negative breast cancer in US Hispanic and Guatemalan women using hospital and community-based recruitment strategies

PurposeRecruit and sequence breast cancer subjects in Guatemalan and US Hispanic populations. Identify optimum strategies to recruit Latin American and Hispanic women into genetic studies of breast cancer.MethodsWe used targeted gene sequencing to identify pathogenic variants in 19 familial breast cancer susceptibility genes in DNA from unselected Hispanic breast cancer cases in the US and Guatemala.Recruitment across the US was achieved through community-based strategies. In addition, we obtained patients receiving cancer treatment at major hospitals in Texas and Guatemala.ResultsWe recruited 287 Hispanic US women, 38 (13%) from community-based and 249 (87%) from hospital-based strategies. In addition, we ascertained 801 Guatemalan women using hospital-based recruitment. In our experience, a hospital-based approach was more efficient than community-based recruitment. In this study, we sequenced 103 US and 137 Guatemalan women and found 11 and 10 pathogenic variants, respectively. The most frequently mutated genes were BRCA1, BRCA2, CHEK2, and ATM. In addition, an analysis of 287 US Hispanic patients with pathology reports showed a significantly higher percentage of triple-negative disease in patients with pathogenic variants (41% vs. 15%). Finally, an analysis of mammography usage in 801 Guatemalan patients found reduced screening in women with a lower socioeconomic status (p < 0.001).ConclusionGuatemalan and US Hispanic women have rates of hereditary breast cancer pathogenic variants similar to other populations and are more likely to have early age at diagnosis, a family history, and a more aggressive disease. Patient recruitment was higher using hospital-based versus community enrollment. This data supports genetic testing in breast cancer patients to reduce breast cancer mortality in Hispanic women.

Effects on Quality of Life of a Telemonitoring Platform amongst Patients with Cancer (EQUALITE): A Randomized Trial Protocol.

Cancer, a pervasive global health challenge, necessitates chemotherapy or radiotherapy treatments for many prevalent forms. However, traditional follow-up approaches encounter limitations, exacerbated by the recent COVID-19 pandemic. Consequently, telemonitoring has emerged as a promising solution, although its clinical implementation lacks comprehensive evidence. This report depicts the methodology of a randomized trial which aims to investigate whether leveraging a smartphone app called Contigo for disease monitoring enhances self-reported quality of life among patients with various solid cancers compared to standard care. Secondary objectives encompass evaluating the app's impact on depressive symptoms and assessing adherence to in-person appointments. Randomization will be performed independently using an allocation sequence that will be kept concealed from clinical investigators. Contigo offers two primary functions: monitoring cancer patients' progress and providing educational content to assist patients in managing common clinical situations related to their disease. The study will assess outcomes such as quality of life changes and depressive symptom development using validated scales, and adherence to in-person appointments. Specific scales include the EuroQol Group's EQ-5D questionnaire and the Patient Health Questionnaire (PHQ-9). We hypothesize that the use of Contigo will assist and empower patients receiving cancer treatment, which will translate to better quality of life scores and a reduced incidence of depressive symptoms. All analyses will be undertaken with the intention-to-treat principle by a statistician unaware of treatment allocation. This trial is registered in ClinicalTrials under the registration number NCT06086990.

Survey of community and hospital pharmacist involvement in outpatient chemotherapy using Japanese health information data.

In this study, information on injectable anticancer drug use and additional fee for enhanced collaboration (AEC) and additional fee for specific drug management guidance 2 (ASD2) claims from the NDB Open Data Japan (NODJ) dataset and the number of patients with cancer according to sex and age from the National Cancer Registry (NCR) dataset were integrated and evaluated to determine the current status and challenges in pharmacist interventions for patients receiving cancer treatment. The NODJ data, including receipt data billed from 2020 to 2021, were obtained from the Ministry of Health, Labour and Welfare website. The use of injectable anticancer drugs decreased relative to the number of cancer patients aged ≥ 75 years compared to those aged < 75 years. Regarding injectable anticancer drug use, the number of AEC claims was similar between men and women, but the number of ASD2 claims was lower in men than in women. The number of times community pharmacists claimed their ASD2 was approximately 5% of the number of times hospital pharmacists claimed their AEC. This study revealed that several patients did not receive sufficient guidance from community pharmacists compared to hospital pharmacists, suggesting a potential insufficiency in the collaboration between the two groups.

Clinical pharmacy services in cancer patients with hypertension

Abstract Clinical pharmacy services aim to ensure the rational use of drugs and resolve disease/health conditions with a multidisciplinary approach. Pharmaceutical care plans need to be created to effectively provide clinical pharmacy services in the treatment of hypertension which is one of the common chronic diseases in cancer patients. In this mini-review, we examine which drugs can cause or worsen hypertension in patients receiving cancer treatment, potential drug-drug interactions between drugs used in cancer treatment and antihypertensive drugs, pharmacological and clinical studies for the treatment of hypertension in patients with hypertension before cancer diagnosis or newly diagnosed hypertension due to cancer treatment. Non-pharmacological treatment approaches are presented. We think that our study will be a resource that can be used to solve possible drug-related problems in the practice.

Treatment-emergent antidrug antibodies related to PD-1, PD-L1, or CTLA-4 inhibitors across tumor types: a systematic review

BackgroundIncreased understanding of how the immune system regulates tumor growth has innovated the use of immunotherapeutics to treat various cancers. The impact of such therapies, including programmed cell death protein...

The Functional Assessment of Cancer Therapy Scale: Development and Validation of the General Measure.

We developed and validated a brief, yet sensitive, 33-item general cancer quality-of-life (QL) measure for evaluating patients receiving cancer treatment, called the Functional Assessment of Cancer Therapy (FACT) scale. The five-phase validation process involved 854 patients with cancer and 15 oncology specialists. The initial pool of 370 overlapping items for breast, lung, and colorectal cancer was generated by open-ended interview with patients experienced with the symptoms of cancer and oncology professionals. Using preselected criteria, items were reduced to a 38-item general version. Factor and scaling analyses of these 38 items on 545 patients with mixed cancer diagnoses resulted in the 28-item FACT-general (FACT-G, version 2). In addition to a total score, this version produces subscale scores for physical, functional, social, and emotional well-being, as well as satisfaction with the treatment relationship. Coefficients of reliability and validity were uniformly high. The scale's ability to discriminate patients on the basis of stage of disease, performance status rating (PSR), and hospitalization status supports its sensitivity. It has also demonstrated sensitivity to change over time. Finally, the validity of measuring separate areas, or dimensions, of QL was supported by the differential responsiveness of subscales when applied to groups known to differ along the dimensions of physical, functional, social, and emotional well-being. The FACT-G meets or exceeds all requirements for use in oncology clinical trials, including ease of administration, brevity, reliability, validity, and responsiveness to clinical change. Selecting it for a clinical trial adds the capability to assess the relative weight of various aspects of QL from the patient's perspective.

Detection of Maternal Malignancy after Abnormal Noninvasive Prenatal Testing (NIPT)

Introduction: Noninvasive prenatal testing (NIPT) is routinely used to screen for fetal aneuploidies in chromosomes 13, 18 and 21. NIPT uses NGS based methods to detect fetal cfDNA in maternal circulation. In 2016, the American College of Obstetricians and Gynecologists recommended offering NIPT testing for all pregnant patients regardless of maternal age. Reports of maternal malignancy detected by NIPT have been increasing since its wide adoption into clinical practice, but subsequent management has not been standardized. We therefore report the outcomes of patients with abnormal NIPT evaluated and managed at a single institution. Methods: A case series ofpatients referred to Dana-Farber Cancer Institute between 2014 and 2022 for evaluation following an abnormal NIPT or for treatment of a cancer identified through NIPT. Results: Fourteen cases were included in this series. The median age at NIPT was 34 (range 29-42). Most patients (79%) had multiple chromosomal aneuploidy while 3 patients had ≤2 chromosomal abnormalities reported on their NIPT. Twelve patients (86%) underwent subsequent invasive prenatal testing: results were normal in all but one whose trisomy 12 finding led to early termination. Eleven patients (79%) underwent a whole-body MRI (WBMRI), 6 (55%) of which identified a suspicious finding that required biopsy. Of the 6 patients biopsied for a finding on WBMRI, 5 (83%) were found to have a malignancy. All patients who had a negative WBMRI did not have an identified malignancy. Of the total 14 cases, 10 (71%) underwent biopsies for abnormal findings and 8 (80%) of biopsies led to diagnosis of malignancy (or 57% of overall cohort). This was found to be Hodgkin lymphoma in 4 (29%), primary mediastinal large B cell lymphoma in 2 (14%) and triple negative breast cancer in 2 (14%) of the patients. Other causes of abnormal NIPT were uterine fibroids in 3 (21%), hepatic adenoma in 1 (7%), ovarian dermoid cyst in 1 (7%) and no abnormal findings in 1 (7%). Half of the patients received cancer treatment during pregnancy and the other half after pregnancy. Treatment included chemotherapy 6 (75%), chemotherapy/radiation 1 (12.5%) and surgery/chemotherapy 1 (12.5%). Post treatment, 6/8 (75%) patients achieved a complete metabolic response (CMR), one patient is still undergoing treatment and one patient (breast cancer) is deceased. Overall, there were 12 (86%) live births, one pregnancy termination and one patient with missing data. The median birthweight was 7.2 lbs (6.1-8.5 lbs). Two patients had NIPT with previous pregnancies. One patient had a normal NIPT and the other had an abnormal NIPT that was similar in two pregnancies, but she had a hepatic adenoma. Two patients with PMBCL had subsequent pregnancies and repeat NIPT after treatment were both normal . Conclusions: Specific abnormal NIPT results may be caused by maternal malignancy, especially where there is discordance with the fetal karyotype. A WBMRI without contrast is a safe and feasible initial approach for diagnosis and staging in these patients. Most tumors are lymphomas, for which treatment during and soon after pregnancy is possible with favorable maternal and fetal outcomes.

Emergency department visits among patients receiving systemic cancer treatment in the ambulatory setting

BackgroundMost patients receive systemic cancer treatment in the ambulatory setting. However, during their treatment journey, patients experience complications that necessitate emergency department (ED) visits. Few studies evaluated the burden of such visits and their characteristics. This study aimed to evaluate the incidence and characteristics of ED visits among adult cancer patients receiving systemic cancer treatment in the ambulatory setting.MethodsA retrospective observational study was conducted at a comprehensive cancer center in Jordan. Utilizing the medical records database, we identified all patients treated in the chemotherapy infusion units, between January and December 2021. Patients who received only supportive therapy were excluded. The proportion of patients who required ED visits, their characteristics, types of cancer treatments received, and reasons for ED visits were recorded.ResultsOver the study period, 4985 patients received 38,803 treatment cycles in the infusion units. Among those, 2773 (55.6%) patients had 10,061 ED visits. Patients who presented to the ED had a mean age of 53.7 ± 13.8 (SD) years and 1763 (63.6%) were females. The most common types of malignancies were breast (39.5%) and gastrointestinal (20%). The most common cancer treatments associated with ED visits were platinum-based (24.8%), immune-mediated/targeted therapy (15.3%), and hormonal (12.3%). The most common admission diagnoses were neuromuscular/skeletal symptoms (34.8%) and gastrointestinal symptoms (20.2%).ConclusionsIn a large cohort of cancer patients receiving cancer treatment in the ambulatory setting, over half of them required at least one ED visit. Most visits were for neuromuscular/skeletal and gastrointestinal symptoms. Future studies should identify measures to reduce ED visits to enhance the patients’ quality of life and outcomes and optimize resources.

Economic evaluation of a non-medical financial assistance program on missed treatment appointments among adults with cancer.

282 Background: Addressing patients’ cancer-related financial needs is critical to ensuring equitable cancer care delivery. Although many cancer centers report having financial support programs available to meet patients' medical and non-medical financial needs, formal evaluation of these programs has been limited. We retrospectively evaluated the impact of a program providing non-medical financial assistance on missed treatment appointments among patients receiving cancer treatment at a large, Southeastern public hospital system. Methods: We used patient electronic health records, program records, and cancer registry data to examine the impact of the program on rates of missed (or “no-show”) radiation therapy and infusion chemotherapy/immunotherapy appointments in the six months following treatment initiation. We employed propensity weighting to estimate the average treatment effect on those exposed to the program, stratified by treatment appointment type (radiation therapy, infusion chemotherapy/immunotherapy). We developed a decision tree-based economic model to assess the program’s cost-effectiveness from the health system perspective in a hypothetical cohort over a six-month time horizon. Results: Of 1,347 patients receiving radiation therapy between 2015 and 2019, 53% (N=715) had ≥1 no-shows, and 28% (N=378) received program assistance. Receipt of any assistance was associated with a 2.1 percentage point (95% CI: 0.6 – 3.5) decrease in the proportion of no-shows, corresponding to a 51% decrease in the overall mean no-show proportion. Under the current funding model, the program is estimated to save the health system $153 per missed appointment averted, relative to not providing non-medical financial assistance. Of the 1,641 patients receiving infusion chemotherapy/immunotherapy, 33% (N=541) received program assistance, and only 14% (N=223) had ≥1 no-shows. The financial assistance program did not have a significant effect on no-show proportions among infusion visits. Conclusions: This study employed a novel approach to retrospectively evaluate a non-medical financial assistance program for patients undergoing active cancer treatment. Findings support investment in programs that address patients’ non-medical financial needs, particularly for those undergoing intensive radiation therapy.

Optimizing GCSF prophylaxis: Artificial intelligence (AI) models to predict chemotherapy-induced FN in patients with cancer.

547 Background: NCCN guidelines recommend primary prophylaxis with granulocyte-colony stimulating factors (GCSF) for select risk classifications; however, the recommendations for a patient at &lt;20% risk of FN are not as explicit. This study builds on previously developed FN risk models and aims to use AI modeling techniques to predict individual risk of neutropenic complications in patients receiving cancer treatment. Methods: An AI-based FN risk modeling study was conducted using retrospective administrative claims of adult commercial and Medicare Advantage patients treated for non-myeloid malignancies from Jan 01 2009 to March 31 2020. Exclusions were myeloid malignancy, pregnancy, clinical trial participation, HIV positive status, hematopoietic cell transplantation, baseline GCSF, surgery or radiation in the first six days of the first chemotherapy cycle. Model features included baseline patient clinical and demographic characteristics, baseline HCRU, chemotherapy treatment patterns, FN risk factors, and use of primary GCSF prophylaxis. The models were developed with an 80/20 train/test split and compared using standard measures of goodness of fit. Various traditional and AI techniques, such as logistic and lasso regressions, TensorFlow Keras, and XGBoost, were trained to predict FN events in this sample. Based on performance, XGBoost was selected for analysis (ROC of 0.86). Results: The sample comprised of (mean age 68 years, 50% female). Among 17,233 patients (20% test set), 2,773 patients (all risk categories) received primary GCSF prophylaxis; 14,460 patients did not receive primary GCSF prophylaxis. The top 20% risk score threshold was deemed optimal to identify high-risk patients. Model outcomes were bifurcated and analyzed based on NCCN guided risk levels; for the high risk chemo regimen, intermediate risk regimen, and remaining patients without primary GCSF prophylaxis, model sensitivity was 74%, 88%, and 56% respectively. Model specifications for the overall top 20% of the test cohort without primary GCSF prophylaxis are described in the table as overall, high risk, intermediate risk, and other risk subsets. Conclusions: While the XGBoost model provided the best fit, the logistic regression model is a strong candidate to identify characteristics associated with higher odds of an FN event. Through identification of these characteristics, the rate of FN in this population can be better addressed and optimize utilization of GCSFs for primary prophylaxis.[Table: see text]

Multi-Institutional Analysis of Cancer Patient Exposure, Perceptions, and Trust in Information Sources Regarding Complementary and Alternative Medicine.

Complementary and alternative medicine (CAM) use during cancer treatment is controversial. We aim to evaluate contemporary CAM use, patient perceptions and attitudes, and trust in various sources of information regarding CAM. A multi-institutional questionnaire was distributed to patients receiving cancer treatment. Collected information included respondents' clinical and demographic characteristics, rates of CAM exposure/use, information sources regarding CAM, and trust in each information source. Comparisons between CAM users and nonusers were performed with chi-squared tests and one-way analysis of variance. Multivariable logistic regression models for trust in physician and nonphysician sources of information regarding CAM were evaluated. Among 749 respondents, the most common goals of CAM use were management of symptoms (42.2%) and treatment of cancer (30.4%). Most CAM users learned of CAM from nonphysician sources. Of CAM users, 27% reported not discussing CAM with their treating oncologists. Overall trust in physicians was high in both CAM users and nonusers. The only predictor of trust in physician sources of information was income >$100,000 in US dollars per year. Likelihood of trust in nonphysician sources of information was higher in females and lower in those with graduate degrees. A large proportion of patients with cancer are using CAM, some with the goal of treating their cancer. Although patients are primarily exposed to CAM through nonphysician sources of information, trust in physicians remains high. More research is needed to improve patient-clinician communication regarding CAM use.

Sexual Behaviors and Intimate Relationships of Sexual Partners of Young Patients with Early-Stage Cervical Cancer: A Qualitative Study.

This study aimed to explore the sexual behaviors and intimate relationships of sexual partners of young patients with cervical cancer. This study employed a descriptive phenomenological research design, which falls within the realm of qualitative research methods. Qualitative research typically utilizes interview techniques for gathering participants' experiences, perceptions, and behaviors. This study conduct face-to-face semi-structured interviews with the sexual partners of 15 young cervical cancer patients receiving cancer treatment to collect their experiences and perspectives on intimate relationships and sexual behavior with cervical cancer patients, and use the Colaizzi method for data analysis. Four themes were identified through the interview analysis: (1) reduction or absence of sexual behavior, (2) unpleasant sexual experiences, (3) adjustment of intimate relationships, and (4) lack of sexual health education. The sexual partners of young cervical cancer patients have experienced significant shifts in their perspectives on sexual behavior and intimate relationships. These changes include reduction or absence of sexual behavior, unpleasant sexual experiences, adjustment of intimate relationships, and lack of sexual health education. Hospitals should pay more attention to the sexual behavior and intimate relationships of patients with cervical cancer and their sexual partners, and social support systems and psychological and emotional counselling services should be established for providing relevant knowledge and guidance.

Assessing oncology patient interest in using telehealth for routine cancer care and clinical trials.

525 Background: Since the onset of COVID-19, oncology practices across the U.S. have integrated telemedicine (TM) and remote patient monitoring (RPM) into cancer care. However, the future role of telehealth in oncology remains unknown. We conducted a survey among a diverse group of oncology patients to assess their access to technology and interest in using TM/RPM as part of routine cancer care and clinical trials. Methods: Between March 27 and June 21, 2023, we administered in person surveys to oncology patients receiving cancer treatment at an academic cancer center in New York City. We collected respondent demographic and clinical data, as well as information about their access to technology and interest in using TM/RPM as part of cancer care. Results: There were 50 respondents with a mean age of 60 (SD 16). 62% identified as female, 22% were Hispanic of any race, 16% were non-Hispanic Black, and 48% were non-Hispanic White. 52% had a yearly income below $70,000 and 40% had less education than a bachelor’s degree. 34% had Medicare, 24% had Medicaid only, and 42% had commercial insurance. Regarding travel, 28% of respondents lived over an hour from the cancer center, and 39% paid &gt;$20 for travel each visit. The majority owned an electronic communication device (93%) and had internet access at home (98%). 80% had internet fast enough for video visits and 86% identified as comfortable using the internet. Prior to the survey, 66% of respondents had participated in a video visit and 59% had participated in a telephone visit with their oncologist. Of these patients, more than 95% were somewhat or very satisfied with their remote visit. If provided with internet, more than half of respondents were willing to participate in video visits (57%) and telephone visits (61%) as part of regular care. Convenience and eliminating travel were the most commonly cited reasons for preferring remote care. Regarding trial participation, 52% had previously enrolled in a cancer clinical trial and 67% reported openness to trial participation. If the risks and benefits of a trial were explained over the phone or in a video visit as opposed to in person, 73% of respondents reported they would be equally or more likely to enroll. If the risks and benefits had already been explained in person, 77% would be willing to sign consent electronically. A large majority (91%) would be equally or more likely to enroll in a clinical trial that reduced travel time by providing the option of remote visits. Similarly, 78% would be willing to use wearable technology and 80% would be willing to use a health app as part of a clinical trial. Conclusions: In this diverse and underprivileged group, patients have access to technology and are willing to use it for both routine cancer care and clinical trial enrollment and participation. In the future, oncology practices should incorporate remote technology into cancer care, including trials, to reduce travel time and enhance convenience.