Trends in Patient Volume by Hospital Type and the Association of These Trends With Time to Cancer Treatment Initiation

Frosch, Zachary A K; Illenberger, Nicholas; Mitra, Nandita; Boffa, Daniel J.; Facktor, Matthew A.; Palis, Bryan E.; Bekelman, Justin E.; Shulman, Lawrence N.; Takvorian, Samuel U

doi:10.1001/jamanetworkopen.2021.15675

Cited by 19 publications

(16 citation statements)

References 55 publications

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“…While academic facilities are associated with better oncologic and long-term outcomes, recent evidence suggests that academic facilities experienced greater patient volume growth than did community hospitals. 13 – 17 These trends in greater patient volume may exacerbate racial/ethnic disparities in treatment delays. It is unclear whether academic facilities are aware of these disparities and the extent to which systemic barriers may be leading to treatment delays among disadvantaged populations.…”

Section: Discussionmentioning

confidence: 99%

Factors Mediating Racial/Ethnic Disparities in Delayed Treatment of Breast Cancer

et al. 2022

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Background Despite improvements, disparities in breast cancer care have led to an inequitable distribution of treatment delays and worse outcomes among patients with breast cancer. This study aimed to quantify the contribution of mediators that may explain racial/ethnic disparities in breast cancer treatment delays. Patients and Methods We conducted a retrospective analysis of patients from the National Cancer Database with stage I–III breast cancer who underwent surgical resection. Mediation analyses estimated the extent to which racial/ethnic disparities in the distribution of patient characteristics account for racial/ethnic disparities in delayed treatment. Results Of the 1,349,715 patients with breast cancer included, 10%, 5%, and 4% were Black, Hispanic, and other non-white race/ethnicity, respectively. Multivariable models showed that patients in these racial/ethnic groups had 73%, 81%, and 24% increased odds of having a treatment delay relative to white patients. Mediation analyses suggested that 15%, 19%, and 15% of the treatment delays among Black, Hispanic, and other non-white race/ethnicity patients, respectively, are explained by disparities in education, comorbidities, insurance, and facility type. Therefore, if these mediators had been distributed equally among all races/ethnicities, a reduction of 15–19% in the delayed treatment disparities experienced by minority patients would have been observed. Academic facility type was the factor that could yield the largest reduction in time to treatment disparities, contributing to 8–13% of racial/ethnic disparities. Conclusions Patients with breast cancer who identified as Black, Hispanic, and other non-white races/ethnicities are exposed to longer treatment delays relative to white patients. Efforts to equalize mediators could remove substantial portions of racial/ethnic disparities in delayed treatment.

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Section: Discussionmentioning

confidence: 99%

Factors Mediating Racial/Ethnic Disparities in Delayed Treatment of Breast Cancer

et al. 2022

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“…Adoption of NGS testing in the community is critical because most patients with cancer in the United States are treated in community practices rather than in academic medical centers. 9 Our cancer center leadership determined that increased adoption of PMed was a goal and this decision led to the formation of our program.…”

Section: Discussionmentioning

confidence: 99%

Programmatic Efforts Increase Adoption of Genomic Precision Medicine in Cancer Care in a Community Cancer Center

Darabi

Braxton

Homer

et al. 2022

JCO Precision Oncology

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PURPOSE The adoption of precision medicine (PMed) depends on the critical curation of data and interpretation of genomic results. Herein, we sought to study the effect of a coordinated multidisciplinary program to assess results in a community cancer center clinic. METHODS In a retrospective review from July 2018 to July 2021, we analyzed the implementation of a multidisciplinary PMed program in a tertiary referral community cancer center. Germline genetics test results have been reviewed since 2017. RESULTS A total of 3,131 tumor samples were analyzed by large panel somatic genomic testing through commercial laboratories during the study period. The number of reviewed cases rose from 661 in the first year to 1,532 in year 3. Additional recommendations beyond what was reported by the commercial laboratory were made in 42.9% of cases. Referrals to the hereditary cancer program for germline testing increased by 32% from the 2017 baseline. Process improvement efforts reduced the rate of DNA quantity nonsufficient for testing to 3.3% compared with a national average of 4.89%. The average time from receipt of orders to issuing of a report of the somatic panel was 15.5 days, compared with 19.1 days for other institutions using the same laboratory. The PMed team has been critical in support of clinical research by assisting in trial procurement and feasibility assessment to the identification of patients for clinical trials. Conclusion The use of somatic genomic testing is increasing at our cancer center. Education and in-depth analysis of the data are valued by cancer physicians. The development and implementation of a PMed program has demonstrated improved physicians' understanding of molecular testing, resulting in improved outcomes for patients.

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“…Diffusion of rehabilitation services in these community settings has been limited [ 14 ]. Indeed, cancer survivorship and rehabilitation programs are clustered in specialty care centers where fewer than half of the people with cancer receive treatment [ 15 ]. Access to rehabilitation services may be further exacerbated for cancer survivors with known disabilities because physical, cognitive, and emotional impairments can make care coordination, scheduling, and travel to and from appointments particularly onerous [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Developing an mHealth App for Empowering Cancer Survivors With Disabilities: Co-design Study

Adler¹,

Morales²,

Sotelo³

et al. 2022

JMIR Form Res

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Background The transition from active treatment to long-term cancer survivorship leaves the needs of many cancer survivors unaddressed as they struggle with physical, cognitive, psychological, and social consequences of cancer and its treatment. The lack of guidance after treatment has forced cancer survivors to manage long-term effects on their own, which has an impact on their overall health, quality of life, and social participation. Mobile health (mHealth) interventions can be used to promote self-management and evidence-informed education. Objective This study aims to design an mHealth app for cancer survivors with disabilities that will offer interventions to improve their quality of life and increase their self-efficacy to manage cancer as a chronic condition. Methods We organized 3 co-design workshops with cancer survivors (n=5). These workshops included persona development based on data from 25 interviews with cancer survivors with disabilities; prototype ideation, where we sketched ideas for the prototype; and prototype development, where participants critiqued, and suggested improvements for, the wireframes. Results These workshops helped us to define the challenges that cancer survivors with disabilities face as well as important considerations when designing an mHealth app for cancer survivors with disabilities, such as the need for including flexibility, engagement, socialization, and a minimalistic design. We also outline guidelines for other researchers to follow when planning their own co-design workshops, which include allowing more time for discussion among participants, having small participant groups, keeping workshops engaging and inclusive, and letting participants dream big. Conclusions Using a co-design process aided us in developing a prototype of an mHealth app for cancer survivors with disabilities as well as a list of guidelines that other researchers can use to develop their own co-design workshops and design their app. Furthermore, working together with cancer survivors ensured that the design team had a deeper sense of empathy toward the target users and kept the focus on our ultimate goal: creating something that cancer survivors would want to use and benefit from. Future work will include usability testing of a high-fidelity prototype based on the results of these workshops.

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Trends in Patient Volume by Hospital Type and the Association of These Trends With Time to Cancer Treatment Initiation

Cited by 19 publications

References 55 publications

Factors Mediating Racial/Ethnic Disparities in Delayed Treatment of Breast Cancer

Factors Mediating Racial/Ethnic Disparities in Delayed Treatment of Breast Cancer

Programmatic Efforts Increase Adoption of Genomic Precision Medicine in Cancer Care in a Community Cancer Center

Developing an mHealth App for Empowering Cancer Survivors With Disabilities: Co-design Study

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