Quality Of Cancer Care Research Articles

Robotic Surgeries for Cancer in Low- and Middle-income Countries: Hope or Hype in Surgical Oncology?

Abstract Medical sciences and technology have grown exponentially over the past many decades. The doubling time of medical knowledge and technology has shortened from 50 years in the 1950s to just 73 days in 2020. The field of surgical oncology has progressed from open surgery to minimally invasive surgery (MIS). The revolutionary robotic technology has disrupted the space of MIS, with the added promise of better postoperative recovery and improved functional outcomes. This is largely due to reduced pain, fewer infections, lesser blood loss, shorter hospital stay, less scarring, and faster return to normal activities. It is noteworthy that better functional outcomes have been achieved without compromising the oncological principles, as endorsed by multiple studies that have demonstrated the safety, feasibility, and potential short-term advantages of the robotic platforms in surgical oncology. Although robotic surgeries are well established in high-income countries, their use in the low- and middle-income countries (LMICs) is scarce. Overwhelming issues pertaining to cancer care in the LMICs are advanced-stage presentation, barriers of affordability and access, and heterogeneity in the quality of cancer care, among others; hence, advancing the scope of robotics seems to be a low priority. Further, in LMICs, robotic surgeries are invariably offered to affluent populations, further perpetuating the vicious cycle of socioeconomic divide. There are several other challenges to implementing robotic platforms in the LMICs. We attempt to explore the potential solutions and strategies that can be adopted and adapted to overcome these challenges.

Deficient state-supported cancer care: A source of deep concern

Deficient state-supported cancer care: A source of deep concern

Patient Perceptions of the Impact of the COVID Pandemic on the Quality of Their Gastrointestinal Cancer Care.

We surveyed patients who had a received care for a gastrointestinal cancer between 03/2020 and 05/2021 to understand their perceptions of the impact of the Covid pandemic on cancer care delivery and quality of care. Three-hundred fifty-eight respondents provided evaluable responses (response rate: 17.3%). Approximately half of respondents (46.4%) perceived that they had experienced a pandemic-related cancer care modification; most changes were initiated by a clinician or the cancer center (44.6%). Relative to White patients those from Racialized Groups (OR: 1.91, 95% CI: 1.03-3.54) were more likely to report a cancer treatment change. Additionally, relative to patients in follow-up, those who were newly diagnosed (OR: 2.39; 95% CI: 1.21-4.71) were more likely to report a change. Compared to White patients, patients from Racialized Groups were approximately twice as likely to report perceiving that virtual visits during Covid negatively impacted the quality of their care (OR: 2.21; 95% CI: 0.96-5.08). These findings potentially reflect pre-existing systemic disparities in quality of and access to care, as well as differences in how care is experienced by patients from Racialized Groups.

Multidisciplinary approach to cancer care in Rwanda: the role of tumour board meetings.

Cancer treatment is complex and necessitates a multidisciplinary approach. Tumour Board Meetings (TBMs) provide a multidisciplinary platform for health care providers to communicate about treatment plans for patients. TBMs improve patient care, treatment outcomes and, ultimately, patient satisfaction by facilitating information exchange and regular communication among all parties involved in a patient's treatment. This study describes the current status of case conference meetings in Rwanda including their structure, process and outcomes. The study included four hospitals providing cancer care in Rwanda. Data gathered included patients' diagnosis, number of attendance and pre-TBM treatment plan, as well as changes made during TBMs, including diagnostic and management plan changes. From 128 meetings that took place at the time of the study, Rwanda Military Hospital hosted 45 (35%) meetings, King Faisal Hospital had 32 (25%), Butare University Teaching Hospital (CHUB) had 32 (25%) and Kigali University Teaching Hospital (CHUK) had 19 (15%). In all hospitals, General Surgery 69 (29%) was the leading speciality in presenting cases. The top three most presented disease site were head and neck 58 (24%), gastrointestinal 28 (16%) and cervix 28 (12%). Most (85% (202/239)) presented cases sought inputs from TBMs on management plan. On average, two oncologists, two general surgeons, one pathologist and one radiologist attended each meeting. TBMs in Rwanda are increasingly getting recognised by clinicians. To influence the quality of cancer care provided to Rwandans, it is crucial to build on this enthusiasm and enhance TBMs conduct and efficiency.

Barriers and facilitators to adherence to Optimal Care Pathways for diagnosis and treatment of cancer for Aboriginal and Torres Strait Islander people.

The Optimal Care Pathways (OCP) are a framework to promote high-quality and integrated cancer care for all Australians, from prevention through to end-of-life-care. Aboriginal and Torres Strait Islander people experience disproportionate cancer incidence and mortality, but little research has addressed whether cancer care for Aboriginal people meets the standards prescribed by the OCPs. This study aims to consider barriers and facilitators to quality cancer care for Aboriginal people. Semi-structured interviews were conducted with 30 health professionals who deliver care to Aboriginal people with cancer in primary care and hospital settings in New South Wales, Australia. Health professionals included Aboriginal Health Workers, nurses, general practitioners, and community workers. Interviews were conducted in 2019-2020 and explored participant perspectives of barriers and facilitators of optimal cancer care, particularly related to prevention, early detection, diagnosis, and treatment for Aboriginal people. Data were qualitatively analysed using framework analysis. In general, participants perceived Aboriginal patients to have good access to preventive care. In terms of early detection and diagnosis, access to primary care, pathology, radiology, and some specialists (e.g. respiratory physicians) was seen as optimal. However, access to hospital-based gastroenterologists for colonoscopy was perceived to be poor due to long wait times. Access to optimal care for cancer treatment was perceived to be hindered due to the lack of bulk-billing for bowel cancer, breast cancer, and cardiothoracic surgery. Other barriers to care identified by participants included unclear referral pathways, poor communication between patient and the treating team, and a lack of timely provision of discharge summaries. Facilitators of optimal care during treatment and survivorship included: the Integrated Team Care and Close the Gap programs, and presence of key health workers to help patients navigate the health system. The major barriers to quality cancer care for Aboriginal people appeared to be to specialist and procedural access, demonstrating that the 'Inverse Care' law applied in reducing access for populations at higher risk of cancer.

Abstract A057: Determining community priorities for a cancer health equity dashboard for quality monitoring

Abstract Background: Quality measures for accreditation, reimbursement and care monitoring have long focused on the delivery of effective care within health care institutions. As calls for greater health equity have emerged alongside understandings of the limited role that health care plays in health outcomes, researchers and practitioners seek quality measures that reflect critical components of health quality while also helping to address inequities in resources, access and risks that present with diverse patient populations. Our research sought to identify quality measures of importance to people living in the catchment area of our comprehensive cancer center and to determine community priorities for the development of a cancer health equity dashboard. Methodology: In-depth interviews were conducted with 15 community members and/or patients as part of a mixed methods project. A modified rapid analysis framework was used to review, analyze, categorize, and reduce data from interview transcripts. The research team also met with health care leadership whose responsibilities entailed quality measurement or reporting. Proxy member verification, through use of the hospital’s Patient and Family Advisory Council, helped refine reporting priorities. Results: Although most participants appreciated the health care quality and health equity definitions used by the hospital, thematic analysis revealed nine concepts that community members believed were missing from the definitions as well as perceived misalignments in the operationalization of definitions when aiming to provide quality cancer care. Community members believed more attention should be paid to communications (i.e. provider-patient/family and health system-community), costs (i.e. affordability, transparency, insurance navigation) and patient context (i.e. home life, work conditions, history with health care systems). Workforce diversity was also frequently identified as an important quality-related metric that could be reported and monitored over time. Finally, participants suggested using the cancer care continuum as a comprehensible way to organize quality monitoring efforts. Most respondents had difficulty recalling cancer center efforts focused on cancer prevention and early detection yet believed there were educational and prevention interventions that could help create more equitable conditions for future cancer patients. Conclusion: Demonstrating and addressing differences in quality perspectives among community members and health systems may improve perceptions of shared interest among catchment area stakeholders while also highlighting paths to address cancer disparities. Qualitative findings will be combined with quantitative data to create a roadmap for design of a cancer health equity dashboard to facilitate quality monitoring for different audiences. Grouped by implementation difficulty, researchers hope this roadmap will highlight opportunities for cancer leadership to better incorporate equity into existing measurement and operations demands. Citation Format: Sakinah C. Suttiratana, Katherine A. Nash, Robert Rock, Carol R. Oladele, Sujana Nelakanti, Erin Singleton, Maurice Williams, Karen H. Wang. Determining community priorities for a cancer health equity dashboard for quality monitoring [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A057.

Comparative Analysis of First-Line FOLFOX Treatment With and Without Anti-VEGF Therapy in Metastatic Colorectal Carcinoma: A Real-World Data Study.

FOLFOX (leucovorin calcium [folinic acid], fluorouracil, and oxaliplatin) combined with or without anti-VEGF therapy represents one of the primary first-line treatment options for metastatic colorectal carcinoma (mCRC). However, there is limited comparative data on the impact of anti-VEGF therapy on treatment effectiveness, survival outcomes, and tumor location. This retrospective, comparative study utilized data from the AIM Cancer Care Quality Program and commercially insured patients treated at medical oncology clinics in the US. We analyzed 1652 mCRC patients who received FOLFOX, of which 1015 (61.4%) were also treated with anti-VEGF therapy (VEGF cohort). Patients in the VEGF cohort exhibited a higher frequency of lung (33% vs 23%; P < .001) and liver metastases (74% vs 62%; P < .001), underwent fewer liver surgeries prior to treatment (1.2% vs 3.6%; P = .002), and had a higher proportion of right-sided tumors (27% vs 18%; P = .001). Adjusted analysis revealed no significant difference in overall survival (OS) between patients treated with and without anti-VEGF (median survival: 25.4 vs 26.0 months; P = .4). FOLFOX-only treated patients experienced higher rates of post-treatment hospitalizations (22% vs 15%; P < .001). Notably, left-sided tumors treated with anti-VEGF showed a trend toward decreased OS (median survival: 26.8 vs 33months; P = .09). Our real-world data analysis suggests that the addition of anti-VEGF to FOLFOX offers limited and short-lived benefits in the context of mCRC and may provide differential survival benefit based on tumor sidedness.

Primary caregivers of children with cancer, Sri Lanka; A journey through their Psychological distress, Psychosocial needs, and Knowledge on caregiving

Identifying and addressing the psychosocial needs and psychological distress of primary caregivers of children and adolescents with cancers is emerging globally as a component that should be incorporated into quality cancer care. The objective of this study was to describe the psychosocial needs, psychological distress, knowledge of caregiving, and associated factors among the primary caregivers of children and adolescents with cancers attending the leading cancer treatment center in Sri Lanka. A descriptive cross-sectional study was conducted among childhood cancer caregivers in the early post-diagnosis stage using a needs and knowledge assessment questionnaire and General Health Questionnaire-30. Associations were sought between variables by bivariate analysis and further multivariate analysis. Consecutively, emotional needs, financial needs, informational needs, practical needs, and need for family and social support were at the top of the unmet needs list. All study participants had at least one item of unmet psychosocial needs. A lower education level was significantly associated with higher unmet psychosocial needs (OR=4.990; CI=1.96-12.72). Almost all the primary caregivers were psychologically distressed (97.6 %; CI = 95.3% - 99.9%) during the early post-diagnosis period. Only 18% of caregivers had a good overall knowledge of childhood cancer caregiving. Good overall knowledge of childhood cancer caregiving was associated with low distress levels (OR =2.46; 95% CI= 1.04 – 5.83). Almost all primary caregivers of children and adolescents with cancers at the early stages of diagnosis were highly distressed and had multiple unmet psychosocial needs with poor awareness of caregiving.

The Importance of Culturally Relevant Breast Clinic Navigation in Improving Breast Cancer Care in Africa.

Cultural norms, community-specific cultural or religious beliefs, and resultant patient health-belief models are known to pose a significant but imperceptible barrier to breast cancer care. However, there is a paucity of data addressing the need for culturally relevant breast clinic navigation in the context of culturally diverse regions. Thus, this study aimed to assess the benefit of culturally similar breast clinic navigators in facilitating treatment adherence and improving overall care in patients. This study was a retrospective qualitative study. It included breast cancer patients who attended our clinic from January, 2017 to December, 2017 and whose management plan included neoadjuvant chemotherapy. These patients were assigned culturally similar breast clinic navigators who counselled them from diagnosis, to treatment, to survivorship. Additionally, navigation concerns were grouped into the following: Navigating the neighbourhood, navigating hostile hospital environments, and navigating medical consultations. Through counselling sessions and regular telephone follow-up, breast clinic navigators were able to address navigation concerns, provide support for the patient as well as inform the multidisciplinary team (MDT) on the patient's thought process and potential barriers for care. Thus, treatment plans were personalised, resulting in improved, holistic care. The role of culturally relevant patient navigators within the MDT is not well-described in the current literature. However, this role is useful where a gap exists between medical professionals and patients from varied backgrounds. Thus, navigators from the same/similar backgrounds help improve the healthcare worker's understanding of the patient's thought process, ensuring good quality and holistic breast cancer care.

Cancer diagnosis in areas of conflict.

To date, many Arab countries within the Middle East are facing political, financial, and social instability from war and conflicts. These conflicts have led to severe resources shortages and sometimes complete breakdowns in cancer care and diagnosis. Cancer diagnosis at early stages is the most vital step in achieving optimal cancer care and outcomes. Shortages in cancer diagnostic services have meant that many people within areas of conflict are ultimately deprived of these services in their own countries. Therefore, many of these cancer sufferers must bear travel expenses to neighboring countries in order to seek these services. A lack of prevention, screening, and diagnostic services for this population is known to deepen the cancer care deficit within these areas. Additionally, the financial burden of traveling abroad alongside the need to secure childcare and time off work can be overwhelming. As a result, patients within areas of conflict are frequently diagnosed at later stages and are less likely to receive optimal management plans. Though conflict-affected regions encounter many similar challenges in delivering quality cancer care, pronounced region-specific differences do exist. Therefore, it is important to build a roadmap that can provide tailored solutions to deficits in instruments, manpower, and facilities for each and every region involved. Keeping in mind the importance of collaboration and coordination on national and international levels to address the ground disparity in cancer diagnostic services, the main objective of this review article is to examine the significant problems, shortages, and difficulties in providing cancer diagnosis with a focus on imaging to conflict-affected populations in the Middle East (mainly Iraq, Syria, Yemen, and Sudan). Finally, we discuss how access to cancer diagnostic imaging services has been impacted by these conflicts.

Exploring cancer care needs for Latinx adults: a qualitative evaluation

Latinx adults with cancer, as compared with non-Latinx White adults, are diagnosed with more advanced stages and experience worse quality of life. Identifying barriers in cancer care among low-income Latinx adults is crucial to designing and implementing culturally appropriate interventions. The objective of this study was to explore the specific barriers encountered by Latinx adults after a cancer diagnosis and perspectives on the use of community health workers (CHWs) to address these barriers. We conducted semi-structured qualitative interviews with low-income Latinx adults with a past or current history of cancer and/or their caregivers in a community oncology clinic located in an agricultural community in California. Analysis was based in grounded theory and performed using the constant comparative method. Sixteen interviews were conducted with patients alone (n = 11), a caregiver alone (n = 1), and patient-caregiver pairs (n = 4 patients; n = 4 caregivers). Four major themes emerged: (1) low cancer health literacy including cancer diagnosis and treatment, cancer fatalism, navigating next steps after diagnosis, advance directives, and precision medicine; (2) challenges in communicating and receiving supportive services due to language barriers; (3) stress and anxiety regarding financial hardships related to job loss, insurance barriers, and the COVID-19 pandemic; (4) the need for supportive, bilingual, and bicultural personnel to assist in overcoming these challenges. Low-income Latinx adults with cancer and their caregivers experience health literacy, communication, and financial barriers that impede quality cancer care delivery. Embedding CHWs in the care team could be one way to address these barriers to culturally concordant, accessible care.

CANCER CARE IN ELDERLY: CHALLENGES AND REQUIREMENTS OF INFORMAL CAREGIVERS

Abstract The affect of Covid -19 and changes in healthcare has shifted most of cancer care of elderly to home settings. Calcutta Metropolitan Institute of Gerontology (CMIG), Regional Resource and Training Centre in Ageing studied the daily tasks, requirements and emotional burden of caregivers in West Bengal, India. Caregivers of lung cancer, liver cancer and colorectal cancer patients (n=500) completed questionnaires provided by CMIG. The mean age of cancer patients was 72.5 years. CMIG found that 47% of the caregivers were the spouses of elderly patients, 33% were their adult children and 20% were other family members. Forty six percent of the caregivers were found to care for patients with metastatic disease, 33% cared for co morbidities, 63% cared for those undergoing chemotherapy or radiotherapy. Ninety eight percent of the caregivers provided assistance with Activities of Daily Living, 75% in administering medicine, 47% helped in pain management, 39% helped in hospital visits or deciding to call doctor. Twenty one percent of the caregivers reported poor health and 16% were not confident of the quality of care they provided. Sixty six percent reported suffering from stress and perceived cancer as a family disease, 45% thought they lacked social support. Of the adult children who provided care, 78% resported they needed more training to provide quality cancer care and transitioning to formal care would improve results.This study will help influence State policies for allocation of resources for training for cancer caregivers, build support groups for stress management and create cancer care helplines.

Stakeholders' Experiences and Perspectives Regarding Care Quality for Women With Breast Cancer: A Systematic Review.

The considerable growth in the number of patients with breast cancer leads to substantial pressure on healthcare services; however, the main measures that will evaluate what is important to the key stakeholders in improving the quality of breast cancer care are not well defined. This study aimed to synthesize providers' and patients' experiences and perspectives regarding barriers and quality breast cancer care in health services. PubMed, Scopus, MEDLINE, Web of Knowledge, and the Cochrane Library databases were searched, and articles published in English up to August 2020 were screened. Two reviewers independently screened all articles. Data were obtained directly from different stakeholder groups including patients, health providers, and professionals. The search strategy identified 21 eligible articles that met inclusion criteria and reported perspectives of 847 health providers and 24 601 patients regarding healthcare quality. Health providers and patients with breast cancer noted information needs, psychosocial support, responsibility for care, and coordination of care as important quality improvement characteristics of the healthcare system. Shifting to high-quality breast cancer care would likely be a complicated process, and there is a need for the cancer care services to consider important characteristics of quality cancer care as a care priority, that is, to be responsive. Breast cancer survivorship care programs and interventions may need to consider the barriers or common challenges to care noted in this review, especially regarding information sharing and the need for social support and care cooperation.

Disparities in the Diagnosis and Treatment of Bile Duct Cancer in People with Disabilities: A National Cohort Study in South Korea.

We aimed to evaluate the impacts of disability on the diagnosis, treatment, and prognosis of bile duct cancer (BDC) according to the severity and type of disability. Patients diagnosed with BDC were selected from an age- and sex-matched population (1:3 ratio) with or without disabilities from the National Disability Database, the Korean Central Cancer Registry, and the Korean National Health Insurance claims database. The cohort included 15,065 patients with BDC, with a significantly lower rate in those with severe disabilities than in people without or with mild disabilities (110.6 vs. 136.5 vs. 147.6 per 105 persons, respectively). People with severe disabilities were diagnosed with BDC at an earlier age but were less likely to undergo surgery (adjusted odds ratio (aOR) = 0.52, 95% confidence interval (CI): 0.45-0.61) or chemotherapy (aOR = 0.76, 95% CI: 0.61-0.95) compared to those without disabilities. This trend was more evident in patients with mental disabilities. The overall and cancer-specific mortality rates were higher in patients (especially women) with disabilities than in those without. There needs systemic approach to ensure equal access to quality cancer care for people with disabilities.

Consensus Quality Measures and Dose Constraints for Prostate Cancer From the Veterans Affairs Radiation Oncology Quality Surveillance Program and American Society for Radiation Oncology Expert Panel

PurposeThere are no agreed upon measures to comprehensively determine the quality of radiation oncology (RO) care delivered for prostate cancer. Consequently, it is difficult to assess the implementation of scientific advances and adherence to best practices in routine clinical practice. To address this need, the US Department of Veterans Affairs (VA) National Radiation Oncology Program established the VA Radiation Oncology Quality Surveillance (VA ROQS) Program to develop clinical quality measures to assess the quality of RO care delivered to Veterans with cancer. This article reports the prostate cancer consensus measures. Methods and MaterialsThe VA ROQS Program contracted with the American Society for Radiation Oncology to commission a Blue Ribbon Panel of prostate cancer experts to develop a set of evidence-based measures and performance expectations. From February to June 2021, the panel developed quality, aspirational, and surveillance measures for (1) initial consultation and workup, (2) simulation, treatment planning, and delivery, and (3) follow-up. Dose-volume histogram (DVH) constraints to be used as quality measures for definitive and post-prostatectomy radiation therapy were selected. The panel also identified the optimal Common Terminology Criteria for Adverse Events, version 5.0 (CTCAE V5.0), toxicity terms to assess in follow-up. ResultsEighteen prostate-specific measures were developed (13 quality, 2 aspirational, and 3 surveillance). DVH metrics tailored to conventional, moderately hypofractionated, and ultrahypofractionated regimens were identified. Decision trees to determine performance for each measure were developed. Eighteen CTCAE V5.0 terms were selected in the sexual, urinary, and gastrointestinal domains as highest priority for assessment during follow-up. ConclusionsThis set of measures and DVH constraints serves as a tool for assessing the comprehensive quality of RO care for prostate cancer. These measures will be used for ongoing quality surveillance and improvement among veterans receiving care across VA and community sites. These measures can also be applied to clinical settings outside of those serving veterans.

The importance of the system of obligatory medical insurance in improving the availability and quality of cancer care in the Chelyabinsk region

Reducing mortality from major chronic non-communicable diseases is a priority direction for the development of the healthcare system. At the state level, the task has been set to combat oncological diseases as one of the main causes of mortality of the population. Rational and sufficient financial provision of oncological care at the expense of mandatory medical insurance largely determines the use of modern medicines, effective treatment regimens and compliance with the established deadlines for providing medical care to patients.The purpose of the work is to this study analyzes the volume and quality of cancer care and its financing in the Chelyabinsk region on the basis of information from the regional foundation of obligatory medical insurance.Materials and methods: personalized accounting of insured persons, analytical reports, tables, databases, financial and methodological documents in the field of obligatory medical insurance. In the course of the research, the following scientific methods were used: system analysis, comparing, generalization.The results of the study show that the modernization of the approach to financial provision of oncological care in the Chelyabinsk region has increased its availability and quality for the population. The development of medical science in the field of oncology follows the path of targeting therapy, which makes it possible to successfully treat patients for whom standard treatment methods are ineffective, and allows finding ways to correct the identified pathology.Сonclusion: the development of the pharmaceutical market leads to the emergence of new, often expensive, medicines. In this regard, we can only expect a further increase in the need for chemotherapeutic drugs and, as a result, an increase in costs. In this regard, the improvement of the drug supply system, including obligatory medical insurance, is one of the priority areas in ensuring the availability and quality of medical care.

Understanding the Impact of Medicaid-Serving Primary Care Team Functioning and Clinical Context on Cancer Care Treatment Quality: Implications for Addressing Structural Inequities.

Primary care factors related to Medicaid enrollees' receipt of guideline concordant cancer treatment is understudied; however, team structure and processes likely affect care disparities. We explore Medicaid-serving primary care teams functioning within multiteam systems to understand performance variations in quality of breast and colorectal cancer care. We conducted a comparative case study, using critical case sampling of primary care clinics in New Jersey, to provide maximum variation on clinic-level care performance rates (Medicaid enrollees' receipt of guideline-concordant treatment). Site evaluations, conducted from 2019 to 2020, included observation (2-3 days) and interviews. Using a multistep analytic process, we explored contextual factors within primary care that may contribute to cancer care performance variations. We identified performance variations stemming from adaptations of multiteam system inputs and processes on the basis of contextual factors (ie, business model, clinic culture). Team 1 (average performer), part of a multisite safety-net clinic system, mainly teamed outside their organization, relying on designated roles, protocol-based care, and quality improvement informed by within-team metrics. Team 2 (high performer), part of a for-profit health system, remained mission-driven to improve urban health, teamed exclusively with internal teams through electronically enabled information exchange and health system-wide quality improvement efforts. Team 3 (low performer), a physician-owned private practice with minimal teaming, accepted Medicaid enrollees to diversify their payer mix and relied on referral-based care with limited consideration of social barriers. Primary care team structures and processes variations may (in part) explain performance variations. Future research aiming to improve care quality for Medicaid populations should consider primary care teams' capacity and context in relation to composite teams to support care quality improvements in subsequent prospective trials.

Partnering to Strengthen Health Systems and Improve Access to Quality Cancer Care.

Partnering to Strengthen Health Systems and Improve Access to Quality Cancer Care.

2022 Canadian Surgery Forum Sept. 15–17, 202201. Operative classification of ventral abdominal hernias: new and practical classification02. Watchful waiting for large primary splenic cysts03. Transversus abdominis plane (TAP) blocks with and without dexamethasone in colorectal surgery04. What factors determine publication of resident research day projects?05. Characterization of near-infrared imaging and indocyanine green use amongst general surgeons06. Variation in opioid prescribing

# 01. Operative classification of ventral abdominal hernias: new and practical classification {#article-title-2} Ventral hernias of the abdomen are defined as a noninguinal, nonhiatal defect in the fascia of the abdominal wall. Unfortunately, there is not currently a universal classification system

Breast Cancer Disparities and the Digital Divide.

Socioeconomically disadvantaged populations and minority groups suffer from high breast cancer mortality, a disparity caused by decreased access to specialty care, lower treatment adherence, co-morbidities, and genetic predisposition for biologically aggressive breast tumor subtypes. Telehealth has the potential to mitigate breast cancer disparities by increasing access to specialty care and health information. However, unequal access to high-speed/broadband internet service and telehealth itself magnifies breast cancer disparities in vulnerable populations. This review evaluates the impact of the digital divide on breast cancer outcomes, as well as strategies for leveraging telehealth to reduce breast cancer disparities. There is a paucity of research specific to employing telehealth to address breast cancer disparities. Previous studies provide examples of telehealth utilization for increasing screening mammography, in addition to improving access to breast cancer care, including breast cancer specialist, nurse navigators, and clinical trials. Telehealth can also be used as an approach to risk reduction, with strategies to support weight management and genetic testing. Eliminating the digital divide holds enormous potential for mitigating breast cancer disparities through an intentional focus on improving access to telehealth. With increased accessibility, resource allocation, and improved digital infrastructure, telehealth can be used to address disparities in early detection, quality of breast cancer care, treatment adherence, and risk assessment. Further research is essential to elucidate best practices in breast cancer telehealth approaches in underserved communities.