ABSTRACT
Background: Patients with cancer, especially minority and low-income individuals, are at increased risk of financial toxicity and food insecurity. The COVID-19 pandemic has added dire economic challenges to vulnerable populations leading to a global increase in food insecurity. We sought to evaluate the severity and predictors of food insecurity among low-income patients with cancer. Methods: We conducted a cross-sectional multi-lingual survey (i.e., English, Spanish, and Chinese) on a convenience sample of patients with cancer who receive oncologic care at a safety-net hospital. Food insecurity and financial toxicity were measured using validated scales [i.e., US Department of Agriculture Household Food Security Survey and the Comprehensive Score for Financial Toxicity (COST)]. The primary outcome was food insecurity during COVID-19 and predictors of interest included sex, financial toxicity, insurance change, and degree of acculturation. Data was summarized using descriptive statistics and we explored associations between food insecurity and predictors of interest using bivariate regression. Results: A total of 140 patients participated in the study, of whom 56% were male and 47% were 50-64 years old. The most common cancer diagnoses were breast cancer (33%), followed by prostate (13%) and lung cancer (12%). The diverse study participants self-reported being 42% Hispanic/Latinx, 33% Asian, 18% Black or African American, and 14% White. Over half (52%) reported an annual household income ≤$24,999 and 50% experienced a decrease in income during the COVID-19 pandemic. The median COST score was 24 (IQR: 19-31) with 41% experiencing financial toxicity (COST < 26). Most participants experienced food insecurity, including 42% with low food security and an additional 19% with very low food security. In bivariate analysis, increasing financial toxicity (i.e., lower COST score) was associated with a 21% increased risk of very low or low food security (95% CI: 1.11-1.32) and 13% increased risk of low food security (95% CI: 1.05-1.21). Male sex was associated with 312% increased risk of very low food insecurity when compared to female sex (95% CI: 1.02-9.55). Acculturation and changes in insurance coverage were not associated with increased risk of food insecurity. Conclusions: Food insecurity was highly prevalent in this multi-ethnic cohort of low-income patients with cancer. Interestingly, male sex was significantly associated with increased risk of very low food insecurity. Further analyses should explore this potentially at-risk population, their access to nutrition-related support, and the impact of food insecurity in cancer outcomes.
ABSTRACT
Background: The well-being of oncology providers (OP) is in jeopardy with increasing workload, limited resources, and personal challenges that result from the COVID-19 pandemic. We aim to evaluate the impact of COVID-19 on work-related (WR) satisfaction and fatigue among OP in Latin America. Methods:We conducted an international cross-sectional online survey of OP practicing in Latin America. The survey was administered in English, Spanish, and Portuguese. Data was analyzed using descriptive statistics and Chi-square tests. Results: In August 2020, 704 OP from 20 Latin American countries completed the survey (77% of 913 who started the survey). Table outlines baseline characteristics. Higher frequency of WR fatigue (67% vs. 58%, p=0.010) and exhaustion (81% vs. 70%, p=0.001) were reported by OP who cared for patients with COVID-19, compared to OP who cared for patients without COVID-19. Providers that observed delays in referrals to radiation (p=0.002) and surgery (p=0.04) reported WR fatigue at higher rates than their counterparts. Higher exhaustion (p=0.016) and dissatisfaction (p=0.046) were reported by OP who lacked access to supportive services, as social work. A significantly higher proportion of women reported WR fatigue (72% vs. 56%, p=0.003) and exhaustion (86% vs. 68%, p=0.001), when compared to men. Women were more likely than men to endorse higher current levels of fatigue when compared to pre-COVID-19 (61% vs. 46%, p=0.0001). To reduce stress, women were more likely than men to cut the time spent watching the news (p=0.002). Both genders declined research collaborations and speaking opportunities. Conclusions: Fatigue and dissatisfaction with work-life were prevalent among OP in Latin America. Higher rates of WR fatigue were seen in women, OP caring for patients with COVID-19, and OP with patients who experienced cancer care delays. Our data imply that OP may be a prime target for psychosocial support, particularly as current challenges will continue for the foreseen future. Baseline characteristics (N=704).
ABSTRACT
Background: The COVID-19 pandemic has led to unprecedented restrictions to travel and in-person activities that limit hematology/oncology (HO) fellowship programs' (FP) recruitment activities. Prospective applicants rely on websites and social media (SOME) to guide their decisions of applying or ranking a FP. We aim to evaluate HO FP's digital footprint in order to identify informational gaps. Methods: The AMA Fellowship and Residency Electronic Interactive Database (FREIDA) was queried for all HO programs. We searched Google, Twitter, Instagram, Facebook, and YouTube for HO FP pages. Content was evaluated using published criteria. Qualitative content analysis of SOME posts is planned. Results: Our analysis includes 176 FP that actively recruited during the 2020 match season. Over half (57%, n = 100) were universitybased and the median number of fellow positions per year was 4 per FP (range 0-16). Most FP had websites (95%, n = 167) with varying information (Table) for prospective applicants. Twenty percent (n = 33) included a diversity statement. While 63% (n = 106) of FP provided application information, only 51% discussed visa requirements. Few FP websites included key information such as why fellows chose a particular FP (7%, n = 12), accolades of fellows (3%, n = 5), or employment location of alumni (25%, n = 44). Only 42% (n = 69) provided city, and 5% (n = 8) showed fellows socializing. Thirty-four FP (19%) have informational videos (range 1-10) in YouTube (length range: 1:37-18:15min). Most (82%;n = 28) were published since May 2020 in alignment with the FP recruitment season. Twitter was the second most common SOME platform, used by 19% (n = 32) of FP. 56% (n = 18) joined Twitter since May 2020 correlating with the current recruitment season. The number of Twitter followers (median 119, range: 0-1408) and posts (median 47, range: 0- 687) varied across FP. Only 4% used Facebook and 6% Instagram. Conclusions: Our analysis of FP's digital footprint revealed that applicants participating in the 1st virtual HO recruitment season were provided limited online information. Programs can use online content to provide information on resources, research opportunities, and achievements of faculty and fellows that can guide applicant decision making. In the era of COVID-19, highlighting the diversity and breath of each FP, hospital, and city are vital to attract a diverse and talented pool of trainees.
ABSTRACT
Background: The severe acute respiratory syndrome 2 (SARS-cov-2) virus causing COVID19 has brought great challenges to global health services affecting cancer care delivery, outcomes, and increasing the burden in oncology providers (OP). Our study aimed to describe the challenges that OP faced while delivering cancer care in Latin America. Methods: We conducted an international crosssectional study using an anonymous online survey in Spanish, Portuguese, and English. The questionnaire included 43 multiple choice questions. The sample was stratified by OP who have treated patients with COVID-19 versus those who have not treated patients with COVID-19. Data was analyzed with descriptive statistics and Chi-square tests. Results: A total of 704 OP from 20 Latin American countries completed the survey (77% of 913 who started the survey). Oncologists represented 46% of respondents, followed by 25% surgicaloncologists. Of the respondents, 56% treated patients with COVID-19. A significant proportion of OP reported newly adopting telemedicine during COVID-19 (14% vs 72%, p=0.001). More than half (58%) of OP reported making changes to the treatments they offered to patients with cancer. As shown in the table, caring for patients with COVID-19 significantly influenced practice patterns of OP. Access to specialty services and procedures was significantly reduced: 40% noted significantly decreased or no access to imaging, 20% significantly decreased or no access to biopsies, 65% reported delays in surgical oncology referrals, and 49% in radiation oncology referrals. A vast majority (82%) reported oncologic surgeries were delayed or cancelled, which was heightened among those treating patients with COVID-19 (87% vs 77%, p=0.001). Conclusions: The COVID-19 pandemic has significantly affected the way cancer care is delivered in globally. Although changes to healthcare delivery are necessary as a response to this global crisis, our study highlights the significant disruption and possible undertreatment of patients with cancer in Latin America that results from COVID-19.
ABSTRACT
Background: Accurate performance status (PS) documentation is essential as poor PS is a strong predictor of treatment-related toxicity. At our institution, a baseline chart review revealed missing PS documentation in 28% of Fellow-seen new patient visits (NPV);PS documentation as unstructured text comprised the remainder. The lack of structured PS documentation represents a missed opportunity for accurate data in registries, trial registration, and supportive care referrals. Methods: To improve standardized documentation of PS for NPV, we designed a Fellowled quality improvement (QI) initiative over the course of 2 PDSA cycles. Specifically, we developed and implemented a structured PS smart data element tool (SDET) into our electronic medical record (EMR). PDSA cycle 1 (7/2019-11/2019) included SDET implementation and publicity using flyers & emails. PDSA cycle 2 (12/2019-4/2020) incorporated individualized feedback to Fellows, biweekly email reminders, and outreach to attendings regarding our SDET. We calculated cumulative usage of our SDET for PS documentation during the 2019-2020 academic year among NPV seen by Fellows. Our aim was to assess and document PS in at least 50% of NPV seen in person. Results: During PDSA cycle 1, cumulative structured PS documentation increased from 8% to 31% (Table). Focus groups revealed that Fellows were not consistently incorporating our SDET into their note templates or were relying on attendingwritten templates. Over PDSA cycle 2, the cumulative structured PS documentation rate increased from 24% to 54%. Overall our cumulative documentation rate is 40%, in large part driven by cycle 1 because of a drop in NPVs and the transition to telehealth during the COVID-19 pandemic. Conclusions: Our Fellow-led QI intervention improved cumulative structured PS documentation from 8% to 40% using two rapid PDSA cycles. Our intervention highlights the importance of real-time data review and stakeholder feedback to identify ongoing challenges. Our third PDSA cycle will include expansion to all clinic providers (Fellows, attendings, and advancedpractice providers), as well as the incorporation of telehealth encounters and follow-up visits. We also hope to align our QI initiative with broader steps toward data interoperability via the ASCO-sponsored mCODE initiative.