Routine Cancer Research Articles

The use of patient reported outcome measures in oncology clinical practice across Australia and New Zealand.

While there is increasing evidence on the benefits of PROMs in cancer care, the extent of routine collection and use of PROMs in clinical cancer practice across Australia and New Zealand (ANZ) is unknown. This study examined the prevalence and characteristics of PROMs use in routine clinical cancer care in ANZ. An online survey was designed and disseminated via professional societies and organisations using a snowball sampling approach to clinical and health administration professionals managing cancer care in ANZ. A poster advertising the study was also circulated on professional social media networks via LinkedIn and Twitter inviting health professionals from ANZ to participate if they were using or intending to use PROMs in clinical cancer practice. Responders opted into the survey via the survey link. From 132 survey views, 91(response rate, 69%) respondents from 56 clinical practices across ANZ agreed to participate in the survey, and of these 55 (n = 55/91, 60%) respondents reported collecting PROMs within their clinical practice. The majority of the respondents were from the State of New South Wales in Australia (n = 21/55, 38%), hospital (n = 35/55, 64%), and a public setting (n = 46/55, 83%). PROMs were collected in all cancer types (n = 21/36, 58%), in all stages of the disease (n = 31/36, 86%), in an adult population (n = 33/36, 92%), applied in English (n = 33/36, 92%), and used to facilitate communication with other reasons (27/36, 75%). A geospatial map analysis provided insights into the variation in PROMs uptake between the two countries and in certain jurisdictions within Australia. This study also highlights the limited resources for PROMs implementation, and a lack of systematic priority driven approach. PROM use across Australia and New Zealand seems variable and occurring predominantly in larger metropolitan centres with limited standardisation of approach and implementation. A greater focus on equitable adoption of PROMs in diverse cancer care settings is urgently needed.

Successful Routine Cervical Cancer Screening Facilitated by Pelvic Floor Physical Therapy for a Woman With Developmental Disability and a History of Trauma: Case Report

Background: Women with intellectual and developmental disabilities (I/DD) are not getting routine cervical cancer screens at the recommended frequency, limiting opportunities for early detection and treatment of cervical cancer. Pelvic floor physical therapy plans of care can be used to successfully address this health care disparity. Case Description: This is the case of a patient who had diagnoses of developmental delay, oppositional defiant disorder, attention-deficit disorder, unilateral hearing loss, and a history of trauma. The patient was referred by her primary care physician after a halted first pelvic examination due to tension of the patient's pelvic floor and her overall discomfort and dissociation from the session. Clinical findings revealed pelvic floor tension. Interventions were employed over the course of 18 sessions. Outcomes: Sessions focused on education, positioning, relaxation, and graded vaginal dilator insertion while keeping the patient engaged to prevent dissociation. The patient showed minimal clinically important differences on the Patient-Specific Functional Scale, met the short- and long-term goals including undergoing a pain-free pelvic examination, and had a significantly decreased pelvic floor resting tone. Discussion: For patients with I/DD, pelvic floor physical therapy can be a valuable tool to help them undergo a successful and pain-free routine cervical cancer screen. It may take longer than typical plans of care, but the outcomes justify the length of the intervention. Practices that promote self-determination are a key to success. Informed consent was obtained and signed by the patient's medical guardian. Video Abstract: Supplemental Digital Content available at: http://links.lww.com/JWHPT/A128

“Fear of raising the problem without a solution”: a qualitative study of patients’ and healthcare professionals’ views regarding the integration of routine support for physical activity within breast cancer care

ObjectiveThe benefits of physical activity across the cancer continuum for many adult cancers are well established. However, physical activity is yet to be routinely implemented into health services throughout the world. This study aims to explore patients’ and healthcare professionals’ views about integrating conversations and support for physical activity into routine care during treatment for breast cancer.MethodsHealthcare professionals and patients from across the UK living with or beyond breast cancer were invited to take part in semi-structured interviews that were conducted online. Recruitment for the study was advertised on social media, in cancer support groups and newsletters. Data were analysed using inductive thematic analysis.ResultsThree themes captured perceptions of integrating support for physical activity in routine breast cancer care among 12 health care professionals (who deliver breast cancer care) and 15 patients. Themes between healthcare professionals and patients overlapped, and therefore, combined themes are presented. These were: (1) current practice; (2) implementation in care and (3) training needs.ConclusionMany healthcare professionals who offer cancer care are reluctant to raise the topic of physical activity with patients, yet patients have suggested that they would like additional support to be physically active from their medical team. Providing healthcare professionals with education regarding the benefits of physical activity to reduce the risk of recurrence along with evidence based low-cost, remote interventions would allow them to integrate conversations about physical activity within routine cancer care for all patients.

Disproportionate preponderance of HPV genotypes associated with anogenital warts among HIV-positive MSM.

In this study, we characterized the HPV genotype distribution in a population of 489 adults already positive for HPV DNA. The study population was divided into two groups: 244 HIV-positive (HIV+) men who have sex with men (MSM) undergoing routine anal screening for sexually transmitted diseases (STDs) and 245 women undergoing routine cervical cancer screening. Acknowledging the fact that women and MSM represent two independent circles of sexual practices, which are-largely-exclusive of each other, we were interested in determining if particular genotypes of human papillomavirus (HPV) disproportionately predominate in one of these circles compared to the other. HIV+ MSM are significantly more likely to be infected with multiple genotypes at a time, with an odds ratio (OR) of 9.30 (95% confidence interval [CI]: 3.91-22.1) and a p-value of <0.001. In addition, multivariable-adjusted logistic regression analysis showed that anal swab samples were significantly more likely to harbor lrHPV infections, with an OR of 6.67 (95% CI: 2.42-18.4) and a p-value of <0.001, in particular, HPV 6, with an OR of 8.92 (95% CI: 3.84-20.7) compared to cervical samples of screening women. Given the significant impact of recurrent anogenital warts (AGWs) on quality of life and the accompanying predisposition to invasive anal cancer, our data underscore the critical need for HPV vaccination. This includes expanding vaccination eligibility to include both boys and adults within high-risk populations.

Development, acceptability and usability of culturally appropriate survivor narrative videos for breast cancer treatment in Botswana: a pilot study

ObjectivesNarrative communication has demonstrated effectiveness in promoting positive health behaviours, delivering support and coping with complex decision-making. Formal research evaluating this intervention for cancer treatment in Africa is lacking. We...

Psoriasis as a Risk Factor for Skin Cancer: An International, Propensity-Matched Retrospective Cohort Study

Psoriasis, a chronic immune-mediated skin disorder impacting millions globally, is increasingly recognized for its links to various disease processes. As our understanding of immune dysregulation in psoriasis progresses, acknowledging the pivotal role of dysregulated T-cells in the pathogenic development of the persistent inflammatory state becomes crucial. This immune dysregulation and the resulting prevalent inflammatory state have raised concerns about psoriasis potentially serving as a significant comorbidity in cancer development among patients. To contribute to this discussion, we conducted a global retrospective cohort study with propensity score matching (PSM) using the TriNetX Analytics platform. The study aimed to investigate whether patients diagnosed with psoriasis face an elevated risk in the development of cutaneous malignancies, encompassing both melanoma and non-melanoma skin cancers. Our findings confirmed a noteworthy concern, revealing a significantly increased risk of developing cutaneous neoplasms in individuals with psoriasis. In conclusion, our study underscores the importance of heightened awareness and the necessity for routine skin cancer screenings in this unique patient population. The observed association between psoriasis and an increased risk of cutaneous neoplasms highlights the need for proactive medical interventions and emphasizes the potential impact of psoriasis as a comorbidity in the context of cancer development.

Rural/Urban differences in uptake of preventive healthcare services: Variability in observed relationships across measures of rurality.

Rural residents are generally less likely to receive preventive healthcare than are urban residents, but variable measurement of rurality introduces inconsistency to these findings. We assessed the relationships between perceived and objective measures of rurality and uptake of preventive healthcare. In our sample, rural participants generally had equal or higher uptake of healthcare (i.e. private health insurance, check-up in the past year, being up-to-date on colorectal and cervical cancer screening) than urban participants. Importantly, the perceived measure of rurality performed similarly to the objective measures, suggesting that participant report could be a valid way to assess rurality in health studies. Significance for Public Health The ability to access routine preventive healthcare is a key component of public health. Comparing uptake of cancer screening in rural versus urban areas is one way to assess equity of healthcare access. Generally, rural areas have a higher burden of cancer than urban areas. The built environment, socioeconomic status, and patient perceptions can impact an individual's access to routine cancer screening. Preventive healthcare is of great importance to public health as a whole because screening can facilitate earlier diagnosis and more successful treatment for many preventable cancers, which may ultimately increase the quality and quantity of life.

Nephrotoxicity of targeted therapy used to treat lung cancer.

Lung cancer is the leading cause of cancer-related death worldwide, especially non-small cell lung cancer. Early diagnosis and better treatment choices have already provided a more promising prognosis for cancer patients. In targeted therapy, antagonists target specific genes supporting cancer growth, proliferation and metastasis. With the incorporation of targeted therapies in routine cancer therapy, it is imperative that the array of toxicities associated with these agents must be well-recognized and managed, especially since these toxicities are distinct from those seen with conventional cytotoxic agents. Drug-related nephrotoxicity has attracted attention when initiating cancer therapy. Our review aims to summarize the adverse renal effects caused by targeted therapy during lung cancer treatment, mainly focusing on EGFR and ALK tyrosine kinase inhibitors. Also, we discuss the possible mechanism of the side effect and provide managements to help improve the renal function in clinical practice.

A multimodal couple-coping intervention for enhancing sexual adjustment among breast cancer women: Study protocol for a randomised controlled trial.

To investigate the effects of a multimodal couple-based sexual health intervention for premenopausal women treated for breast cancer and their partners to provide personalised psychosexual care, and to understand participants' experience of, and adherence to, the intervention. This is an assessor-blinded, randomised controlled trial. Premenopausal women treated for breast cancer (N = 160) and their partners will be recruited. Dyads will be randomised into an intervention (n = 80) or attention control (n = 80) group. The intervention group will receive the multimodal couple-based sexual health intervention over eight weeks. The intervention comprises five face-to-face and virtual individual couple counselling sessions combined with online reading, a chat-based discussion forum, and telephone calls. The intervention is based on level I-II evidence and a robust theoretical framework. The attention control group will receive usual care plus telephone calls comprising general greetings and reminders to complete follow-up surveys. Sexual adjustment, relationship quality and quality of life will be measured at baseline, after completion of the intervention, three months and six months post-intervention. The project will adhere to the CONSORT-EHEALTH checklist. Qualitative interviews will explore the participants' experience of, and adherence to, the intervention. This study will provide the first pragmatic evidence of the effectiveness of a multimodal couple-coping intervention to support premenopausal women and their partners to improve sexuality, relationship quality and quality of life after treatment for breast cancer. Sexual health is a neglected area in clinical practice, for patients and partners. The ever-growing population of women treated for breast cancer at younger age has created a more pressing need for the development of tailored sexual health interventions. If effective, this intervention could be incorporated into routine cancer care to provide better support and care for this patient population to enhance sexual health, intimacy and overall well-being. ISRCTN35481498; prospectively registered on 08/05/2023.

Lymphoid blood cancers, incidence and survival 2005-2023: A report from the UK’s Haematological Malignancy Research Network

BackgroundPopulation-based information on cancer incidence and outcome are required to inform clinical practice and research; but contemporary data are lacking for many lymphoid cancer subtypes. MethodsSet within a socio-demographically representative UK population of ∼4 million, data are from an established UK patient cohort (N = 22,414 diagnoses). Information on incidence (crude and age-standardised) and survival (overall and net) is presented for > 40 subtypes. ResultsThe median diagnostic age was 69.9 years (interquartile range 59.1–78.3), but unlike many other cancers, lymphoid malignancies can be diagnosed at any age; different subtypes dominating at different ages. Males were more likely to be diagnosed than females (age-standardised sex rate ratio: 1.55 (95% Confidence Interval: 1.50,1.59)), and most subtypes had a male predominance, some more than three-fold (e.g. Burkitt lymphoma 3.26 (2.42, 4.40)). Five-year net survival estimates varied hugely, ranging from 97.4% (95% CI: 56.5, 99.9) in patients with hairy cell leukaemia to 31.6% (95% CI: 2.5, 69.8) in those with T-cell prolymphocytic leukaemia. No significant sex difference in survival were observed for the majority of diagnoses; one exception being classical Hodgkin lymphoma, where males had a higher mortality (Excess Mortality Ratio: 1.44 (95% CI: 1.11, 1.87)). An improvement in survival over time was observed for some, but not all, of the major diagnostic groups. ConclusionsMarked incidence and survival variations by subtype, sex and age confirm the heterogeneity of lymphoid neoplasms and highlight the importance of accurately characterising disease entities. Despite recent improvements, routine cancer registration of lymphoid neoplasms remains challenging and new issues continue to emerge; including the lack of an international consensus on classification and the recording of progressions and transformations. Furthermore, the increasing need for additional molecular and genomic information required for accurate classification is likely to impact negatively on the quality of cancer registration data, especially in low income countries.

Perspectives of gynecologic oncology fellowship training and preparedness for practice

We aimed to examine the preparedness of recent gynecologic oncology fellowship graduates for independent practice.We conducted a web-based survey study using REDCap targeting Society of Gynecologic Oncology (SGO) members who graduated gynecologic oncology fellowship within the last six years. The survey included 52 items assessing fellowship training experiences, level of comfort in performing core gynecologic oncology surgical procedures and administering cancer-directed therapies. Questions also addressed factors driving participants’ selection of fellowship programs, educational experience, research and preparedness for independent practice. A total of 296 participants were invited to complete the survey. Response rate was 42% with n = 124 completed surveys included for analysis. The highest ranked factor for fellowship selection was fit with program 36% (n = 45). Upon completing fellowship, most were uncomfortable performing ureteral conduit formation 84% (n = 103), ureteroneocystostomy 77% (n = 94), exenteration 68% (n = 83), splenectomy 67% (n = 83) and lower anterior resection 41% (n = 51). Most were comfortable managing intraoperative complications 85% (n = 104) and standard cancer staging procedures (range: 61%–99%). Majority were comfortable providing cancer directed therapies with chemotherapy 99% (n = 123), immunotherapy 84% (n = 104), and poly ADP-ribose polymerase (PARP) inhibitors 97% (n = 120). Upon completing fellowship, 77% (n = 95) report having mentorship that met their expectations during fellowship and 94% (n = 116) felt they were ready for independent practice. Majority of fellowship graduates were prepared for independent practice and felt comfortable performing routine surgical procedures and cancer directed treatment. However, most are not comfortable with ultra-radical gynecologic oncology procedures. Maximizing surgical opportunities during fellowship training and acquiring early career mentorship may help.

Lymphedema Surveillance and Prevention.

Lymphedema is a chronic condition, which can impact a person's quality of life and function. Identifying lymphedema at an early stage is key to preventing a person from developing chronic lymphedema. Physiatry can play an important role in education, identification of risk factors, performing prospective lymphedema surveillance programs, and prevention/treatment of lymphedema. Incorporating lymphedema surveillance programs into routine cancer care provides physiatry with the opportunity to assess additional rehabilitation and functional needs of a cancer patient.

Optimized whole-genome sequencing workflow for tumor diagnostics in routine pathology practice.

Two decades after the genomics revolution, oncology is rapidly transforming into a genome-driven discipline, yet routine cancer diagnostics is still mainly microscopy based, except for tumor type-specific predictive molecular tests. Pathology laboratories struggle to quickly validate and adopt biomarkers identified by genomics studies of new targeted therapies. Consequently, clinical implementation of newly approved biomarkers suffers substantial delays, leading to unequal patient access to these therapies. Whole-genome sequencing (WGS) can successfully address these challenges by providing a stable molecular diagnostic platform that allows detection of a multitude of genomic alterations in a single cost-efficient assay and facilitating rapid implementation, as well as by the development of new genomic biomarkers. Recently, the Whole-genome sequencing Implementation in standard Diagnostics for Every cancer patient (WIDE) study demonstrated that WGS is a feasible and clinically valid technique in routine clinical practice with a turnaround time of 11 workdays. As a result, WGS was successfully implemented at the Netherlands Cancer Institute as part of routine diagnostics in January 2021. The success of implementing WGS has relied on adhering to a comprehensive protocol including recording patient information, sample collection, shipment and storage logistics, sequencing data interpretation and reporting, integration into clinical decision-making and data usage. This protocol describes the use of fresh-frozen samples that are necessary for WGS but can be challenging to implement in pathology laboratories accustomed to using formalin-fixed paraffin-embedded samples. In addition, the protocol outlines key considerations to guide uptake of WGS in routine clinical care in hospitals worldwide.

Implementing a nurse-led screening clinic for symptom distress with community-based referral for cancer survivors: A feasibility study.

This prospective, single-arm, pragmatic implementation study evaluated the feasibility of a nurse-led symptom-screening program embedded in routine oncology post-treatment outpatient clinics by assessing (1) the acceptance rate for symptom distress screening (SDS), (2) the prevalence of SDS cases, (3) the acceptance rate for community-based psychosocial support services, and (4) the effect of referred psychosocial support services on reducing symptom distress. Using the modified Edmonton Symptom Assessment System (ESAS-r), we screened patients who recently completed cancer treatment. Patients screening positive for moderate-to-severe symptom distress were referred to a nurse-led community-based symptom-management program involving stepped-care symptom/psychosocial management interventions using a pre-defined triage system. Reassessments were conducted at 3-months and 9-months thereafter. The primary outcomes included SDS acceptance rate, SDS case prevalence, intervention acceptance rate, and ESAS-r score change over time. Overall, 2988/3742(80%) eligible patients consented to SDS, with 970(32%) reporting ≥1 ESAS-r symptom as moderate-to-severe (caseness). All cases received psychoeducational material, 673/970(69%) accepted psychosocial support service referrals. Among 328 patients completing both reassessments, ESAS-r scores improved significantly over time (p<0.0001); 101(30.8%) of patients remained ESAS cases throughout the study, 112(34.1%) recovered at 3-month post-baseline, an additional 72(22%) recovered at 9-month post-baseline, while 43(12.2%) had resumed ESAS caseness at 9-month post-baseline. Nurse-led SDS programs with well-structured referral pathways to community-based services and continued monitoring are feasible and acceptable in cancer patients and may help in reducing symptom distress. We intend next to develop optimal strategies for SDS implementation and referral within routine cancer care services.

Actualités en anatomie et cytologie pathologiques dans le cancer du sein

AbstractBreast cancer (BC) is highly heterogeneous in clinical, morphological and biological terms. Even if certain tumors present the same phenotype, their biological characteristics and response to treatment may differ. High-throughput molecular analyses have enabled us to better understand the biology of these cancers and identify molecular subclasses. Morphological classification of SCs remains paramount in constant evolution, and we will cite some changes in the new 2019 WHO classification (5th edition) including new entities and updates to the diagnostic criteria for certain tumor types. We will also see the introduction of biological parameters in patient stratification, biomarkers that are known but are experiencing renewed interest such as HER2 and newly introduced in breast pathology such as PD-L1, which are of interest for their impact on therapeutic decision. We will conclude with a brief overview of emerging technologies, including artificial intelligence, which could prove invaluable in routine breast cancer assessment or the prediction of the recurrence risk in the near future. All these advances contribute to personalized care for patients with BC.

Abstract C131: Disparities in breast cancer screening resumption among health plan enrollees in the US following the COVID-19 pandemic: Are all groups back on track?

Abstract Purpose: The COVID-19 pandemic disproportionately impacted racial/ethnic minority and low-income individuals and resulted in significant disruptions in preventive care for all groups. While severe declines in routine cancer screening were observed during pandemic shutdown periods, it is unclear whether return-to-screening rates following healthcare reopening are consistent across all groups. In this study we examine rates of breast cancer screening pre- and post- pandemic shutdown periods across race/ethnicity, age, and income among health plan enrollees in the United States (US) to inform screening catch-up strategies after COVID-19 disruptions. Methods: We conducted a retrospective analysis of breast cancer screening claims (including codes for mammography, breast MRI, digital breast tomography, and breast imaging) from Optum Clinformatics Data Mart among female enrollees from 2019-2021. Eligible enrollees included women, ages 40-75 with continuous enrollment 12 months prior to screening index month. Screening volume was calculated each calendar month during the three-year period, with January 2019-February 2020 as the pre-pandemic period, March 2020 through June 2020 as the pandemic closure period, and July 2020-December 2021 as the post-closure (reopening) pandemic period. We conducted an event study to calculate group-level monthly predicted probabilities of screening using a linear probability model with group interactions by month, controlling for demographic variables and comorbidities. Additionally, we used difference-in-difference (DD) regressions including group interacted with a post-closure pandemic dummy. The pandemic closure period months were excluded from our DD analysis. Results: Our study included 8,378,296 health plan enrolled women. Overall mammography screening decreased significantly during the pandemic closure phase (March-June 2020) but rebounded to higher levels in the post-closure period relative to baseline (3.76% to 3.96%). Screening rates were highest among non-Hispanic White women in the pre-pandemic period compared to other racial-ethnic groups. Our DD model suggests that White-Asian disparities increased in the post-pandemic period while other race/ethnic disparities remained constant. Additionally, disparities in screening by age changed during the pandemic. Although the oldest age group (65-75) had the highest screening rates in the pre-closure phase, they were slower to return to pre-pandemic levels of screening compared to younger age groups. Implications: Return to breast cancer screening among health plan enrollees in the US was robust. However, disparities in screening rates between groups in the pre-pandemic period were again observed in the reopening period, signaling lost opportunities to revamp structural inequities in care delivery following the pandemic. Further monitoring of return-to-screening disparities, particularly among more medically underserved groups, will be critical in informing interventions to address the long-term consequences resulting from the disruption of COVID-19 on cancer care. Citation Format: Jennifer Tsui, Sarah Axeen, John Thacker, Sonali Saluja, Laura Solano, Willow Pastard, Chun Nok Lam, Todd Schneberk, Cameron Kaplan. Disparities in breast cancer screening resumption among health plan enrollees in the US following the COVID-19 pandemic: Are all groups back on track? [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C131.

The impact of the COVID-19 pandemic on routine HIV care and cervical cancer screening in North-Central Nigeria

IntroductionCervical cancer is the fourth most diagnosed cancer among women globally, with much of the burden being carried by women in limited-resource settings often worsened by the high prevalence of HIV. Furthermore, the COVID-19 pandemic disrupted organized screening efforts and HIV management regimens worldwide, and the impact of these disruptions have not been examined in these settings. The purpose of this paper is to describe whether uptake of cervical cancer screening and HIV management changed before, during, and since the COVID-19 pandemic in North-Central Nigeria.MethodsLongitudinal healthcare administration data for women who obtained care between January 2018 and December 2021 were abstracted from the AIDS Prevention Initiative Nigeria (APIN) clinic at Jos University Teaching Hospital. Patient demographics, pap smear outcomes, and HIV management indicators such as viral load and treatment regimen were abstracted and assessed using descriptive and regression analyses. All analyses were conducted comparing two years prior to the COVID-19 pandemic, the four quarters in 2020, and the year following COVID-19 restrictions.ResultsWe included 2304 women in the study, most of whom were between 44 and 47 years of age, were married, and had completed secondary education. About 85% of women were treated with first line highly active retroviral therapy (HAART). Additionally, 84% of women screened using pap smear had normal results. The average age of women who sought care at APIN was significantly lower in Quarter 3, 2020 (p = 0.015) compared to the other periods examined in this study. Conversely, the average viral load for women who sought care during that period was significantly higher in adjusted models (p < 0.0001). Finally, we determined that the average viral load at each clinic visit was significantly associated with the period in which women sought care.ConclusionsOverall, we found that COVID-19 pandemic mitigation efforts significantly influenced women’s ability to obtain cervical cancer screening and routine HIV management at APIN clinic. This study buttresses the challenges in accessing routine and preventive care during the COVID-19 pandemic, especially in low-resource settings. Further research is needed to determine how these disruptions to care may influence long-term health in this and similar at-risk populations.

Assessing Patient-Reported Outcomes in Routine Cancer Clinical Care Using Electronic Administration and Telehealth Technologies: Realist Synthesis of Potential Mechanisms for Improving Health Outcomes.

The routine measurement of patient-reported outcomes in cancer clinical care using electronic patient-reported outcome measures (ePROMs) is gaining momentum worldwide. However, a deep understanding of the mechanisms underpinning ePROM interventions that could inform their optimal design to improve health outcomes is needed. This study aims to identify the implicit mechanisms that underpin the effectiveness of ePROM interventions and develop program theories about how and when ePROM interventions improve health outcomes. A realist synthesis of the literature about ePROM interventions in cancer clinical care was performed. A conceptual framework of ePROM interventions was constructed to define the scope of the review and frame the initial program theories. Literature searches of Ovid MEDLINE, Ovid Embase, Scopus, and CINAHL, supplemented by citation tracking, were performed to identify relevant literature to develop, refine, and test program theories. Quality appraisal of relevant studies was performed using the Mixed Methods Appraisal Tool. Overall, 61 studies were included in the realist synthesis: 15 (25%) mixed methods studies, 9 (15%) qualitative studies, 13 (21%) descriptive studies, 21 (34%) randomized controlled trials, and 3 (5%) quasi-experimental studies. In total, 3 initial program theories were developed regarding the salient components of ePROM interventions-remote self-reporting, real-time feedback to clinicians, and clinician-patient telecommunication. The refined theories posit that remote self-reporting enables patients to recognize and report symptoms accurately and empowers them to communicate these to clinicians, real-time feedback prompts clinicians to manage symptoms proactively, and clinician-patient telephone interactions and e-interactions between clinic encounters improve symptom management by reshaping how clinicians and patients communicate. However, the intervention may not achieve the intended benefit if ePROMs become a reminder to patients of their illness and are not meaningful to them and when real-time feedback to clinicians lacks relevance and increases the workload. The key to improving health outcomes through ePROM interventions is enabling better symptom reporting and communication through remote symptom self-reporting, promoting proactive management of symptoms through real-time clinician feedback, and facilitating clinician-patient interactions. Patient engagement with self-reporting and clinician engagement in responding to feedback are vital and may reinforce each other in improving outcomes. Effective ePROM interventions might fundamentally alter how clinicians and patients interact between clinic encounters.

Patient Willingness to Use a Pharmacy-Based Colorectal Cancer Screening Service: A National Survey of U.S. Adults.

We aimed to understand U.S. adults' willingness to use a pharmacy-based fecal immunochemical test (FIT) distribution service for routine colorectal cancer screening called PharmFIT using Diffusion of Innovation Theory, evaluating patient's appraisals of the program's relative advantage, compatibility, and complexity. From March to April 2021, we conducted a national online survey of 1,045 U.S. adults ages 45 to 75. We identified correlates of patient willingness to use PharmFIT using structural equation modeling. Most respondents (72%) were willing to get a FIT from their pharmacy for their regular colorectal cancer screening. Respondents were more willing to participate in PharmFIT if they perceived higher relative advantage ($\hat{\beta}$= 0.184; confidence interval, CI95%: 0.055-0.325) and perceived higher compatibility ($\hat{\beta}$ = 0.422; CI95%: 0.253-0.599) to get screened in a pharmacy, had longer travel times to their primary health care provider ($\hat{\beta}$ = 0.007; CI95%: 0.004-0.010). Respondents were less willing to participate in PharmFIT if they were 65 years or older ($\hat{\beta}$ = -0.220; CI95%: -0.362 to -0.070). Most U.S. adults would be willing to participate in PharmFIT for their routine colorectal cancer screening. Patient perceptions of the relative advantage and compatibility of PharmFIT were strongly associated with their willingness to use PharmFIT. Pharmacies should account for patient preferences for these two traits of PharmFIT to increase adoption and use. Pharmacy-based colorectal cancer screening may be a viable public health strategy to significantly increase equitable access to screening for U.S. residents.

“A double-edged sword”: Influence of the 21st Century Cures Act on the childhood cancer care experience.

360 Background: The 21st Century Cures Act allows patients to immediately access their electronic health record (EHR) via an online portal. For pediatric patients with cancer and their families, this federal mandate has profound implications. We sought to explore perspectives of key stakeholders on how the Cures Act influences the childhood cancer care experience, receipt of results, and communication with the oncology team. Methods: In a multi-center qualitative study at three National Cancer Institute-designated comprehensive cancer centers, we conducted semi-structured interviews with adolescent and young adult patients with cancer (n=26), parents of children with cancer (n=32), and interdisciplinary clinicians in pediatric oncology (n=23). Interviews were audio-recorded, transcribed verbatim, coded, and thematically analyzed. Results: Across 81 participants, 73% self-identified as women, 69% as White race, and 17% as Hispanic/Latinx ethnicity. Most patients and parents perceived the EHR portal to be a convenient, centralized record-keeping tool that enables them to prepare for appointments, track treatment progress, and assume greater agency in their cancer care. Many patients and parents preferred the immediacy of the portal to bypass wait times and facilitate real-time decision-making. Access to notes and results on the portal was widely perceived to enhance communication and appeared to engender greater trust in the oncology team. Simultaneously, patients and parents acknowledged that instant access to results laden with medical jargon can heighten confusion, worry, and anger, particularly upon receipt of concerning results (i.e., pathology or radiology results revealing a new diagnosis of cancer or relapse) before meeting with a clinician. Clinicians generally favored the EHR portal and reported adapting their practices to provide greater anticipatory guidance, occasionally altering language in clinical notes to avoid upsetting patients or families. However, several clinicians expressed concern about situations in which high-stakes results are instantly available to patients and the responsible clinician has not yet had an opportunity to interpret and discuss. Clinicians spoke of shifting expectations regarding prompt communication of results. Many clinicians would prefer a system in which a time delay is built into the release of particularly sensitive results. Overall, clinicians reported that the EHR portal may increase administrative burden and interfere with clinical workflow. Conclusions: While key stakeholders recognize that the Cures Act offers important patient-centered innovations, many participants identified challenges that impede on optimal implementation. This study underscores the need to establish best practices for integrating use of the EHR portal into routine childhood cancer care.