Prescription Opioid Use Among Cancer Patients before and after the Onset of COVID-19: Evidence from Real-World Data

Objectives: Opioids play a significant role in the effective management of cancer-related pain. The COVID-19 lock down may have reduced access to opioids and caused a decline in the use of prescription of opioids among cancer survivors. This study compared opioid prescription rates among cancer survivors before and after the onset of COVID-19 pandemic using real-world electronic health records (EHR). Method(s): Cohort analyses of cancer patients using data from EHR database from the TriNetX, a global federated health research network across 76 healthcare organizations. We analyzed changes in prescription opioid use before (March 1, 2018, through March 1, 2019) and after onset of COVID-19 (April 01, 2020, through March 2021) among cancer survivors. The key outcome variable was any opioid prescription within 1 year of cancer diagnosis. One-to-one propensity score matching was used to balance the characteristics (age, sex, race, diagnoses including diabetes, hypertensive diseases, overweight, mood disorders, and visual disturbances) of the two cohorts. Data were analyzed using the TriNetX platform. Result(s): There were 1,502,143 cancer survivors before COVID-19 and 1,412,599 cancer survivors after the onset of COVID-19. The one-to-one propensity-score match yielded 1,382,561 cancer patients, mean age 64 at cancer diagnosis, and 73% were white. Percentage of opioid use among cancer patients declined from 35.6% before the COVID-19 to 35.1% after the onset of the pandemic (OR=0.976, 95% CI 0.971-0.981). Average number of opioid prescriptions within 1 year of cancer diagnosis declined from 5.7 before to 5.3 after the COVID-19 onset (p<0.001). Conclusion(s): Among cancer survivors, a small decline in prescription opioid use was observed after the onset of COVID-19 pandemic. Future studies are needed to distinguish the impact of revised guidelines, opioid prescription policy changes, and COVID-19 lock down on lower rates of prescription opioid use among cancer survivors.Copyright © 2023

The mediating effects of socio-behavioral factors on the needs for help among Asian American breast cancer survivors

Background: Breast cancer survivors often report their high needs for help during the transition to cancer survivorship. During the COVID-19 pandemic, technology-based programs are increasingly popular because of their high flexibility and accessibility in delivering information and coaching/support to address the current needs for help among cancer survivors. Yet, little is known about how socio-behavioral factors influence the effects of a technology-based intervention on the needs for help of racial/ethnic minority breast cancer survivors, especially Asian American breast cancer survivors. Purpose(s): The purpose of this secondary analysis was to examine the multiple socio-behavioral factors (including attitudes, self-efficacy, perceived barriers, and social influences related to breast cancer survivorship) mediated the effects of a technology-based intervention on the needs for help among Asian American breast cancer survivors. Method(s): This analysis was conducted with the data from 199 Asian American breast cancer survivor women who were recruited from January 2017 to June 2020 through online and offline communities/groups. The needs for help were measured using the Support Care Needs Survey-34 Short Form (SCNS) with five domains on psychological, information, physical, support, and communication needs. Mediation analysis was conducted using the PROCESS macro within SPSS. The analysis determined the mediating effects of four socio-behavioral mediators on the needs for help at pre-test [T0 ], post 1-month [T1 ], and post 3-months [T2 ] of a technology-based intervention. Result(s): Overall, all the mediators had statistically significant mediation effects on all types of needs for help (p < .05) at different points. Attitudes and social influence presented statistically significant mediation effects on the total needs for help score over 3 months (T0 , T1 , and T2 ). Perceived Barriers had mediation effects on all types of needs for help over 1 month (T0 , T1 ). Self-efficacy mediated the effects on all types of needs for help only at post 1 month (T1 ). Conclusion(s): The findings supported that all the socio-behavioral factors (attitudes, self-efficacy, perceived barriers, and social influences) mediated the effects of a technology-based intervention on the needs for help of Asian American breast cancer survivors. Future research and practice should consider socio-behavioral factors to reduce their needs for help during their survivorship process.

The relationship between inflammatory diet score and cancer-specific outcomes: Systematic review and meta-analysis

Cancer remains one of the most prevalent diseases in the United States and a leading cause of death. Large prospective studies have found significant correlations between dietary intake and cancer. Chronic inflammation promotes pro-cancer inflammatory environments and nutrition can influence inflammation, with the intake of certain food items increasing inflammatory biomarkers. The objective of this research was to explore the relationship between inflammatory diet score measured by the Dietary Inflammatory index and all-cause mortality, cancer-specific mortality, and cancer recurrence among cancer survivors. Web of Science, Medline, CINHAL, and PsycINFO databases were searched to collect potentially eligible sources that focus on dietary inflammation and cancer outcomes. All sources were uploaded to Covidence software and screened by two independent blinded reviewers. The quality of the sources was assessed using the Newcastle Ottawa scale and relevant data was extracted and transferred to the Comprehensive Meta Analysis software and a random effects model was used to perform meta-analysis. Of the 1444 studies imported into the Covidence software, 13 passed all the screening stages and were included in the final analysis. Eight studies reported on pre-diagnosis diet while five others reported on postdiagnosis diet. Five studies reported on colorectal cancer, four on breast cancer, two on ovarian cancer, one on endometrial cancer and one on prostate cancer. Meta-analysis of the studies found that being in the highest postdiagnosis DII score indicating pro-inflammatory diet significantly increased the risk of all-cause death among cancer survivors by 33.5% (HR = 1.335, 95% CI = 1.049, 1.698, n = 6). Analysis did not show a statistically significant association between DII score and cancer mortality or recurrence (HR = 1.097, 95% CI = 0.939, 1.281, n = 6). Analysis by cancer subtype found a significant correlation between postdiagnosis DII score and all-cause mortality among the breast cancer survivors (HR = 1.335, 95% CI = 1.041, 1.711, n = 3) though there were no significant associations between DII and the outcomes of interest from the other cancer types. The meta-analysis concludes that being in the highest postdiagnosis DII score group significantly increased the risk of all-cause death among cancer survivors. This suggests that risk of all-cause mortality could be reduced for cancer survivors by consuming more anti-inflammatory food components and reducing consumption of pro-inflammatory foods. These findings also warrant more research in this field to clarify the relationship between dietary inflammation as measured by the DII and cancer outcomes, particularly cancer-specific mortality.

Use of Digital Health Technology Among Older Adults With Cancer in the United States: Findings From a National Longitudinal Cohort Study (2015-2021).

BACKGROUND: Despite the benefits of digital health technology use, older adults with cancer (ie, aged 65 years) have reported challenges to technology adoption. However, there has been a lack of a good understanding of their digital health technology use patterns and the associated influential factors in the past few years. OBJECTIVE: This study aimed to examine the trends in and factors associated with digital health technology use among older adults with cancer. METHODS: The National Health and Aging Trends Study (NHATS) data set is a national longitudinal cohort study with annual survey waves of Medicare beneficiaries 65 years and older. Participants were community-dwelling older adults who self-reported previous or current cancer diagnoses in each round. The study sample size of each round ranged from 1996 (2015) to 1131 (2021). Digital health technology use was defined as using the internet or online in the last month to order or refill prescriptions, contact medical providers, handle Medicare or other insurance matters, or get information about their health conditions. The association of sociodemographics, clinical factors (self-rated health, chronic conditions, difficulties in activities of daily living, dementia, anxiety, and depression), and physical function (Short Physical Performance Battery and grip strength) with digital health technology use was examined using design-based logistic regression. All statistical analyses accounted for the complex sample design. RESULTS: The prevalence of any digital health technology use increased from 36% in 2015 to 45% in 2019. In 2020-2021, which was amid the COVID-19 pandemic, it ranged from 51% to 52%. In terms of each digital health technology use behavior, in 2015, overall, 28% of older cancer survivors used digital health technology to obtain health information, followed by contacting clinicians (19%), filling prescriptions (14%), and handling insurance (11%). Greater use of digital health technology was associated with younger age, being White, having a college or higher education, having a higher income, having more comorbidities, nondementia, and having a higher gait speed. CONCLUSIONS: Digital health technology use in older adults with cancer has gradually increased, particularly during the COVID-19 pandemic. However, socioeconomic and racial disparities have remained in older cancer survivors. Additionally, older adults with cancer may have some unique features associated with digital health technology use; for example, their use of digital health may be increased by their comorbidities (ie, health care needs) and reduced by their frailty.

Impact of comorbidities on people with and without cancer early in the COVID-19 pandemic: An observational study.

BACKGROUND: The present study sought to investigate how comorbidity burden influences cancer survivors' quality of life (QoL) and the challenges/adaptations during the coronavirus disease 2019 (COVID) pandemic, and to examine how appraisal processes are related to this impact. METHODS: This cross-sectional study, administered in spring/summer 2020, compared cancer survivors to a general-population comparison sample. QoL was assessed with standardized tools. COVID-specific questions included selected items compiled by the US National Institutes of Health, and cognitive appraisal processes were assessed using the QoL Appraisal Profilev2 Short-Form. Principal components analysis reduced the number of comparisons. Multivariate analysis of covariance investigated group differences in QoL, COVID-specific variables, and cognitive-appraisal processes. Linear regression investigated group differences in COVID-specific variables as a function of cognitive-appraisal processes, QoL, demographic covariates, and their interactions. RESULTS: Cancer survivors fared substantially better than non-cancer participants in QoL and cognitive functioning when they had no other comorbidities, but substantially worse on QoL when they had three or more comorbidities. Cancer survivors with no comorbidities were less likely to feel worried about COVID, less likely to engage in self-protection, and prioritized engaging in problem-focused and prosocial actions compared to non-cancer participants. Conversely, cancer survivors confronted with multiple comorbidities exhibited more proactive self-protection and experienced more anxiety about the pandemic. CONCLUSION: The impact of having multiple comorbidities in the context of cancer is associated with notable differences in social determinants of health, QoL outcomes, COVID-specific challenges/adaptations, and appraisal of QoL. These findings provide an empirical basis for implementing appraisal-based coping interventions.

Validity of the 2-Minute-Step Test Administered Virtually

PURPOSE/HYPOTHESIS: The 2-minute-step test (2MST) is a face-to-face (F2F) measure used to clinically evaluate aerobic capacity in adults. With the onset of the COVID-19 pandemic, the need to assess cardiovascular health in a virtual environment became evident. The 2MST is amenable to being performed in a virtual environment due to low space requirements, simple instructions, and the ability to visually count step performance through a remote visual setup. The purpose of this study is to determine if there is a difference in performance on the 2MST when administered virtually compared with F2F. NUMBER OF SUBJECTS: 28 healthy adults aged 18-35 were recruited. Subjects were screened to determine eligibility and scheduled for a practice session in both test environments. Exclusion criterion included balance impairments, cardiopulmonary conditions, and pain/recent surgeries that would adversely impact stepping performance. MATERIALS AND METHODS: Subjects performed the 2MST virtually via Zoom platform and F2F on two separate days within 1 week of each other in a counterbalanced order. The primary outcome measure was total number of steps with the right leg to the marked height in both testing sessions. Heart rate was measured prior to performance and immediately upon test completion on both days. Group differences were analyzed using twotailed paired t-tests. RESULT(S): 25 adults (mean age = 24.0 years, 9males, 16 females) completed both sessions. Three subjects were not able to complete both tests and were excluded from analysis. There is no significant difference in mean number of steps performed F2F (M=108.6, SD=11.5) and virtual (M=109.2, SD=15.1);t(24)= .359, p = .7227. The average of the difference in steps between F2F and the virtual environment was <1 step (0.6). Change in heart rate (bpm) was not significantly different in the second test (M=50.4, SD=24.8) compared with the first test (M=46.7, SD=23.6) suggesting similar exertion in both test environments;t(23)=1.0288, p= .3143. CONCLUSION(S): Our findings indicate 2MST performance in healthy adults aged 18-35 is not significantly different when administered via Zoom compared with F2F. This suggests the 2MST may be an effective tool, if a visual virtual option such as Zoom or Facetime, is available when assessing aerobic capacity remotely. Limitations of the study include generalizability to other age groups is currently unknown and the ability of subjects to independently set up the test remotely was not assessed. As in all virtual assessments, clinical reasoning guides which patients are appropriate to perform outcome measures safely, if skilled assistance in not available. CLINICAL RELEVANCE: A valid tool to assess aerobic capacity in a virtual environment can improve patient care, improve access to physical activity interventions and improve health outcomes. Vulnerable populations, such as cancer survivors, who need virtual options for ongoing care will benefit from assessment tools that are adaptable and valid in virtual settings.

Competitive cause of death in elderly breast cancer survivors

Background: Breats cancer is a major health problem in elderly ( >= 70 years) women. Increase incidence with age and the progressive increase in life expectancy mean that the numbers in elderly breast cancer diagnosis are increasing. These patients do not always receive the proper treatment and despite this the survival of this population is not always depends on cancer, there are other competing causes of death typical of the aging population. Method(s): A retrospective observational analysis of women >= age 70 diagnosed with breast carcinoma in HUPHM between 2014 and 2020 was made. Clinical, pathological data and stages at diagnosis were analyzed. We checked our patients with the national death center (official national registry) thus obtaining an exact date of death and the cause of death. Data updated in January 2023 , ensuring a minimum follow-up of 24 months. We excluded deaths from Covid or of unknown cause to avoid bias. Result(s): A total of 421 patients were analyzed, mean age of 78.6 years and median follow-up of 48 months. 28% of patients had died at the time of analysis, 11% due to cancer and 17% from other causes. If we analyze the population deceased by cancer, no deaths are detected in patients diagnosed with carcinoma in situ (4% of the population), in stage I (30% of the population) the cumulative incidence of cancer death at 5 years is 3%, 7% In stage II (30% of the population), 15% in stage III (16%) and 70% in stage IV (12%). Death by other causes are more frequent in early breast cancer, the cumulative incidence at 5 years are 10% in stage I, 22% in stage II, 44% in satge III and just 10% in stage IV. The most frequent causes of death in this population were caridovascular events and infections. There are no differences in 5-year mortality according to histological subtypes 20%, 12%, 25% and 12% for triple negative, Rh+/HER2-, RH+/her2+ and RH-/HER2+ respectively. Conclusion(s): Although elderly patients do not receive optical treatments, mortality from cancer in early stages is incidental at 5 years, a different scenario is seen in metastatic disease in which the patient's prognosis depends mainly on the oncological disease, Therefore, an effort should be made in the treatment of these patients with metastatic breast cancer since adequate treatments can have a clearly positive impact on the survival of patients. Legal entity responsible for the study: The authors. Funding(s): Has not received any funding. Disclosure: All authors have declared no conflicts of interest.Copyright © 2023

Annual advances of acupuncture research in 2022

This article reviews the major advances in acupuncture research in 2022, including clinical reports, basic research, and reviews. In terms of the type of literature, most of them are systematic reviews and clinical trials, while high-quality basic studies can also be found. The innovative inventions and researches in this field are of increasing quality and in a wide range of fields, acupuncture is attracting more and more attention in the international arena. In particular, some acupuncture combined sensors such as H2 -EC/SD co-therapy, precise positioning, and vivo monitoring of neurotransmitter has been used for oncological diseases and neuropathic pain. Acupuncture has been shown to be beneficial in the treatment of pain, stroke, psychiatric disorders, cancer, COVID-19 and others. Most of the studies show that acupuncture can play a positive role in various diseases and provide evidence for clinical applications and mechanism research.Copyright © 2023 By Author(s). Published by TMR Publishing Group Limited.

"Disconnected from the World:" Exploring How the COVID- 19 Pandemic Shaped Adolescent and Young Adult (AYA) Cancer Survivors' Daily Lives

Background/Purpose: Adolescent and young adult (AYA) cancer survivors experience acute and long-term challenges, including disruptions to developmental milestones, altered relationships, and difficulty managing follow-up care. The COVID-19 pandemic likely exacerbated these challenges, but, to date, we know little about young survivors' day-to-day lives during this time. Here, we qualitatively assessed AYA cancer survivors' pandemic-related experiences. Method(s): Thirty-five AYA cancer survivors (85% female, Mage = 32.7 years, 71% White, September 2020-March 2021) wrote factual details about their day-to-day lives (e.g., "what is a typical day like?") as part of a larger randomized controlled trial. Participants were, on average, 5.9 years post-diagnosis;the majority were diagnosed with lymphoma (25.7%) or thyroid cancer (17.1%). Data were analyzed using constant comparative method. Result(s): Five themes emerged: (1) job changes (e.g., inability to work due to immunosuppression, fear career would become less viable);(2) limited interactions/relational depth (e.g., feeling "left out" due to immunosuppression, inability to date, risky family behaviors limit meaningful connection);(3) varying reactions to virtual communication (e.g., gratitude for online schooling, exercise, and social media, withdrawing from friendships due to "zoom burn out," not attending therapy due to lack of engagement);(4) difficulty engaging in health-promoting behaviors and attending/interacting in medical appointments (e.g., problems maintaining nutrition and exercise routines, postponing surveillance appointments, missing family member presence in medical appointments), and (5) disruptions/ delays to post-treatment milestones/plans (e.g., delaying vocational changes, wedding and family planning, and celebratory travel). Notably, no themes associated with positive adjustment emerged. Conclusions and Implications: Goals within multiple domains were obstructed and unmet needs were identified, namely, assistance navigating isolation, relationship disruptions, career/financial barriers, and access to medical care. Results are limited due to the methodology, as this was not a structured interview. Nonetheless, individual counsel with AYA cancer survivors is recommended to provide resources and address pandemic-induced barriers to health and well-being.

Abstracts from the American Psychosocial Oncology Society 20th Annual Conference

The proceedings contain 208 papers. The topics discussed include: social media use in young adult cancer survivors: a phenomenological approach to understand young adult cancer survivors' experience;creative coping programs to reduce symptoms of psychological distress and build feelings of connection among young adult cancer patients and survivors;engaging AYAs by meeting them where they are: development of an annual AYA Cancer Summit;reconnection in a post-covid world: leveraging social and peer support for young adults with cancer;social isolation and social support among young adult vs. older adult cancer survivors during one year of the COVID-19 pandemic: a propensity score matched analysis;financial concerns in parents who lost a child to cancer;caregivers' reactions to emerging stress biomarkers: a potentially innovative approach to increasing engagement with support;and closure is a myth: the importance of recognizing and managing grief in psycho-oncologists.

Social Isolation and Social Support Among Young Adult Vs. Older Adult Cancer Survivors during One Year of the COVID-19 Pandemic: A Propensity Score Matched Analysis

Background/Purpose: Social isolation is associated with worse outcomes among cancer survivors, whereas social support is protective. Social factors are particularly important to evaluate among young adult (YA) cancer survivors aged 18-39 given the rapid social development that occurs during young adulthood, and social isolation may have been exacerbated during the COVID-19 pandemic. We examined differences in social isolation and social support among YA vs. older adult cancer survivors (aged >=40) across one year of the COVID-19 pandemic. Method(s): Participants were recruited to a large cohort study from 11/2020 to 02/2021. PROMIS short forms were used to assess social isolation at enrollment, 2-months, 6-months, and 10-months, and social support (i.e., emotional, instrumental, and informational support and companionship) at 2-months, 4-months, 6-months, 8-months, and 12-months. Propensity score matching to nearest neighbor was used to match YAs with older adult cancer survivors based on demographic and clinical characteristics. Multilevel models were used to evaluate the effects of age (YA vs. older adult), time (month), and the interaction of age and time on social isolation and social support. Result(s): In total, 504 participants were included (252 matched pairs). Most were female (70%), White (81%), and non-Hispanic (83%). YAs were M = 33.6 years (SD = 4.5) and older adults were M = 58.8 years (SD = 10.4). Across age groups and time, average scores for social isolation and social support were within normal ranges. YAs reported more social isolation than older adults (Mpooled = 48.7 and 45.8, respectively;Beta = 2.50, p < 0.01), and social isolation and companionship decreased similarly for YAs and older adults (Beta = -0.12, p = 0.04 and Beta = -0.12, p = 0.02, respectively). No other associations were observed. Conclusions and Implications: YA cancer survivors reported more social isolation than older adults during the COVID-19 pandemic, though differences were small and not clinically meaningful. Future studies should identify patient characteristics associated with high social isolation and low social support to identify subgroups that may benefit from intervention.

Acceptability of an Adapted Resiliency Program for Adolescent and Young Adult Cancer Survivors (AYA)

Background/Purpose: Receiving a cancer diagnosis during adolescence and young adulthood (AYA;15-39) coincides with a period of pivotal developmental milestones. Coping with the stress of cancer diagnosis exacerbates risk for distress and feelings of isolation among AYAs. Mind-body resiliency programs may offer a compassionate approach for tackling these negative post-treatment psychosocial experiences. The present mixed methods study explores the acceptability of an 8-week, synchronous, virtual group Relaxation Response Resiliency Program (3RP) adapted to address the unique challenges facing AYAs (3RP-AYA). Method(s): Recruitment occurred at an academic hospital in Boston, MA from 03/2019 to 09/2020. Participants (N = 72, Mage = 23.8, female = 73.6%, non-Hispanic White = 59.7%, Hispanic/Latino = 20.8%, 1.6 years post-treatment) were randomized to receive 3RP-AYA immediately (intervention group;n = 35) or after 3 months (waitlist control;n = 37) via Zoom. Electronic surveys were collected before and after participants completed treatment;we report post-treatment survey data measuring acceptability across five domains (enjoyability, helpfulness, convenience, future use, and satisfaction) using 4-point Likert scales (1 = not at all to 4 = very). Qualitative post-treatment interviews further queried program acceptability. Result(s): Program acceptability responses indicated program satisfaction: enjoyability (M = 3.62, SD = 0.69), helpfulness (M = 3.45, SD = 0.75), and convenience (M = 3.67, SD = 0.71). More specifically, 76.7% of participants found the virtual delivery to be very convenient, and 71.7% rated the sessions as very enjoyable. 91.7% of participants reported they were likely/very likely to use learned skills in the future and 91.7% reported the intervention as helpful/very helpful. Additionally, 96.6% reported satisfaction with the overall content. Exit interviews highlighted session intergroup connectivity as a particular strength. Conclusions and Implications: Across multiple domains, the 3RPAYA was deemed acceptable by AYAs. Participants valued the opportunity to learn mind-body skills and connect with other young survivors. The synchronous virtual study platform showed promise for being a convenient and helpful tool to deliver mind-body programs to AYA survivors during the Covid-19 pandemic.

COVID-19 and the Psychosocial Impact of Breast Health Delays

INTRODUCTION: Reallocation of resources during the COVID-19 pandemic resulted in delays for breast health care. Data are sparse regarding the impact of these delays on psychosocial outcomes. METHOD(S): Women seeking breast health care across a multi-site breast program in a large metropolitan area were assessed for psychosocial outcomes including depression, stress, and anxiety as it related to delays in care. Psychosocial outcomes were evaluated utilizing validated instruments (PROMIS, PHQ-9). Outcomes were stratified by treatment group (healthy, breast cancer, survivor) and Kaplan-Meier curves created for breast cancer patients to evaluate the relationship of time to treatment stratified by dichotomous psychosocial outcomes. Demographic and clinical data was ed from the electronic medical record. RESULT(S): 85 women enrolled in the study including 30 (35%) breast cancer patients, 24 (28%) healthy women, and 31 (36%) breast cancer survivors. Overall, 58% reported a delay in breast health care including surgery, radiation, chemotherapy, medical oncology treatments, clinical appointments, breast imaging and/or biopsies, survivorship follow-up, support groups, and/or screening. Compared to women in the no delay group, a greater proportion of women reporting a delay had high anxiety (78% vs. 58%;p = 0.06), high perceived stress (45% vs. 28%;p = 0.17), high loneliness (67% vs. 32%;p = 0.003), moderate or higher depression (16% vs. 8.3%;p = 0.34), and no or low emotional support (58% vs. 28%;p = 0.008). Among breast cancer patients, the first treatment modality was surgery in 73% and the median time to treatment was 33 days. The median time to treatment was 40 days for breast cancer patients reporting a delay compared to 28 days for patients reporting no delay. Longer time to treatment was observed among breast cancer patients with high versus low anxiety, perceived stress, loneliness, and depression and for patients with low versus high emotional support. CONCLUSION(S): Women with and without breast cancer reporting a delay had worse measures for anxiety, depression, perceived stress, loneliness, and emotional support. Longer time to treatment was experienced by breast cancer patients with worse psychosocial measures. Risk stratification of women seeking breast health care during the COVID-19 pandemic is needed to identify and support those at risk for adverse psychosocial outcomes. (Table Presented).

Factors Associated With Online Patient-Provider Communications Among Cancer Survivors in the United States During COVID-19: Cross-sectional Study.

BACKGROUND: Online patient-provider communication (OPPC) is crucial in enhancing access to health information, self-care, and related health outcomes among cancer survivors. The necessity of OPPC increased during SARS-CoV-2/COVID-19, yet investigations in vulnerable subgroups have been limited. OBJECTIVE: This study aims to assess the prevalence of OPPC and sociodemographic and clinical characteristics associated with OPPC among cancer survivors and adults without a history of cancer during COVID-19 versus pre-COVID-19. METHODS: Nationally representative cross-sectional survey data (Health Information National Trends Survey 5, 2017-2020) were used among cancer survivors (N=1900) and adults without a history of cancer (N=13,292). COVID-19 data included data from February to June 2020. We calculated the prevalence of 3 types of OPPC, defined as using the email/internet, tablet/smartphone, or electronic health record (EHR) for patient-provider communication, in the past 12 months. To investigate the associations of sociodemographic and clinical factors with OPPC, multivariable-adjusted weighted logistic regression was performed to obtain odds ratios (ORs) and 95% CIs. RESULTS: The average prevalence of OPPC increased from pre-COVID to COVID among cancer survivors (39.7% vs 49.7%, email/internet; 32.2% vs 37.9%, tablet/smartphone; 19.0% vs 30.0%, EHR). Cancer survivors (OR 1.32, 95% CI 1.06-1.63) were slightly more likely to use email/internet communications than adults without a history of cancer prior to COVID-19. Among cancer survivors, the email/internet (OR 1.61, 95% CI 1.08-2.40) and EHRs (OR 1.92, 95% CI 1.22-3.02) were more likely to be used during COVID-19 than pre-COVID-19. During COVID-19, subgroups of cancer survivors, including Hispanics (OR 0.26, 95% CI 0.09-0.71 vs non-Hispanic Whites) or those with the lowest income (US $50,000-

Modeling a public-private grant initiative to address breast cancer care disparities at the community level

Background: Breast cancer disparities between Black and White women have persisted in the US, with breast cancer death rates 40% higher in Black women compared to White women (American Cancer Society Cancer Facts & Figures for African American/Black People 2022-2024). Education and interventions at the community level can potentially reduce racial gaps, particularly in curbing late-stage diagnoses that disproportionately affect Black women with breast cancer. Together, the American Cancer Society (ACS) and Pfizer Global Medical Grants (Pfizer) developed a collaborative model to support health systems in engaging communities to reduce breast cancer disparities between Black and White women. This collaboration aimed to identify novel interventions and provide foundational support for these communities to advance their work in bridging the gap in breast cancer disparities. Method(s): This collaborative grant program divided project responsibilities, in which Pfizer provided funding and ACS provided project oversight and technical support. An advisory committee provided input on the areas of most need, impact and project direction. Funding applicants were required to partner with local organizations to implement evidence-based initiatives for education and/or quality improvement within the respected community. The grant award selection committee comprised of experts in the field, including breast cancer survivors and individuals from racial/ethnic minority groups. In response to a Request for Proposals, over 100 applications were systematically reviewed based on the National Cancer Institute grant selection process. The committee selected 9 grantees with innovative proposals addressing breast cancer disparities for Black women along the cancer-care continuum. Bi-annual progress reports were used to measure progress, with a final report to mark projects' impact and reach. The COVID-19 pandemic presented numerous obstacles during the project period and the ability to convene with partners virtually through web-based sessions helped to foster opportunities for collaboration and knowledge sharing among leaders in cancer disparities research. Result(s): The projects occurred from January 2020 to June 2022, with no-cost extensions given to accommodate COVID-19 pandemic delays. During this period grantees successfully completed project goals in one of three areas: screening, identifying areas of need and education. Approximately 10,000 patients and 200 healthcare professions were impacted among three projects focused on increasing mammography efforts in Black women during the project period. Three projects incorporated surveys and focus groups to identify novel areas for intervention/need and interviewed over 350 patients and over 60 health care professionals. The remaining three grantee projects that focused on education successfully implemented advertisement campaigns and lecture series to target patients and healthcare professionals. The projects selected under this model independently completed their goals within the project period while also laying a foundation to continue work in reducing disparities along the cancer care continuum with their enhanced community partner relations. Additionally, the project period also provided opportunities for external collaborations and discussion among all grantees through 8 ACS-coordinated online sessions and 3 summits. Conclusion(s): Projects selected by the public-private grant initiative model can enhance community relationships and provide infrastructure to continue work along the cancer care continuum. We believe this collaborative competitive grant program can be used for future efforts to address breast cancer and other health disparities at the community level. Similar collaborative funding projects related to prostate and pan-tumor disparities have been launched and are currently ongoing.

Support for patients with MBC

Over the last decade we have witnessed rapid advances in the treatment of patients with metastatic breast cancer (MBC) with seminal discoveries in cancer biology, correlative biomarkers and clinical trials leading to multiple new drug approvals. While these milestones have improved survival, the science of survivorship in this population is just beginning. The diagnosis of MBC is life-changing and requires individualized and multidisciplinary support. The NCI defined the areas of epidemiology and surveillance, symptom management, psychosocial research, health-care delivery, and health behaviors as necessary fields to advance the state of the science in advanced cancer survivors. A multifaceted program addressing these domains is needed to assess MBC patients and their unique and ever-changing needs. With input from patients and providers, program components should include: therapeutic clinical trials, multidisciplinary specialty care, individualized patient navigation, peer support, continuing education, and patient reported outcome (PRO) collection to support patients living with MBC. Input for a program for MBC patients can be guided by a multidisciplinary steering committee in which patient advocates are a major voice. Patients can provide insight into what works for them, and what they are facing may be very different from the experience of an early-stage breast cancer patient. Clinical trials designed to advance the current scientific knowledge of breast cancer treatment are essential to patients living longer, more fulfilled lives with MBC. Clinical trials may include systemic therapy, local therapies such as surgery and radiation for MBC patients, side-effect management and quality of life (may put elsewhere). A comprehensive systemic therapy portfolio should include all biological subtypes as well as recommended treatment options (hormonal therapy, targeted therapy, chemotherapy, and immunotherapy). Multidisciplinary care is necessary to diagnose and treat any condition the MBC patient may encounter and is essential in providing quality care. Comorbidities and debilitating side effects arising from cancer treatment are known to be associated with inferior outcomes. MBC patients may experience lack of familiarity of some providers with novel MBC cancer treatment, side effects, and interactions of their cancer treatment with non-cancer conditions and treatment. With the increasing life expectancy of MBC patients, it is important to manage the medical comorbidities in coordination with the MBC patient's cancer treatment. Integrative Medicine helps support the quality of life of patients through providing clinical modalities such as stress management, yoga, meditation, acupuncture, massage and lifestyle counseling. Supportive care helps support cancer related fatigue and sleep challanges, geriatrics and hospice and palliative care for advanced cancer patients. The role of navigation for MBC patients is unique and should be designed to support the patient's many individual needs. Navigation requires assessment of individual knowledge deficit, coordination of care challenges, internal resource utilization, cultural requests, and emotional health. Navigation should also address the patient's financial and disability questions, medication assistance, symptom management, advanced care planning and goals of care discussions. Additional items to be discussed during navigation visits include primary care provider utilization, COVID-19 vaccination, illness and medication questions, and other patient questions as they arise. A comprehensive registry of MBC patient's medical records and histories will assist researchers in designing future therapeutic and quality of life clinical trials. The categories of patient demographics, clinical variables, pathological variables, treatment variables, outcomes of MBC, and PROs will create a robust registry. A comprehensive patient registry can create a rich database which can guide and inspire future innovative research. Peer support through support groups and peer-to-peer matching s pivotal to MBC patients finding and utilizing their patient voice, emotionally supporting each other and learning from other's similar experiences. Connection between patients and the creation of a community of survivors can empower patients to positively impact their care through self-advocacy and self-efficacy. Continuing patient education is also essential to providing quality cancer care. The format of a weekly virtual education webinars are helpful in creating an engaged patient community and a platform to disseminate educational resources in a reoccurring digestible format. Frequent educational webinars covering a wide variety of topics can positively influence patient interactions with their healthcare providers and influence how patients living with MBC view their own cancer experience. Educational webinars provide opportunities for patients to connect with subject matter experts, other patients like themselves, and share information with their family and friends. Informed patients can discuss and ask questions more confidently with their health care providers about information and services presented during the educational webinars. The symptom profile of patients living with MBC are impacted by numerous variables such as disease burden, treatment plan, comorbidities, supportive regimen etc. The collection of PROs has been shown to improve patient satisfaction with his/her care, improve quality of life, decrease emergency room visits and hospitalizations, and increased overall survival. The routine measurement and management of MBC patients' symptoms has been found to be integral in providing comprehensive cancer treatment. The collection of PROs improves patient and provider communication and elicits the outcome to symptoms that matter most to each patient. Patients diagnosed with MBC are living longer because of the recent advancements in therapeutic treatments. A multifaceted and comprehensive program consisting of therapeutic clinical trials, multidisciplinary specialty care, individualized patient navigation, peer support, continuing education, and PROs collection is integral to fully support patients living with MBC.

DIVAS - DC Pink Divas Intervening Virtually to Advance Saving Lives: Assessing the impact of digital behavioral health breast cancer education program for Black women

Breast cancer is now the most common cancer. Thirty years of increased awareness, early diagnosis, and treatment access contributed to a 40% decline in breast cancer deaths. Yet, in 2021, more than 281,550 new cases of invasive and 49,290 new cases of non-invasive breast cancer will be diagnosed in U.S. women. Black women are 40% more likely to die of breast cancer - the highest breast cancer death rate across racial and ethnic groups. Today, the Black-white breast cancer mortality gap persists, and Black metastatic breast cancer (MBC) patients have a poorer prognosis. The pandemic exacerbated breast cancer disparities. In 2020, delays and avoidance contributed to an 85% breast cancer screening drop while MBC patients' risk of severe illness and death from COVID-19 elevated. Therapy interruptions and abandonment increased, and conversely, clinical trial enrollment decreased. COVID-19 has accelerated the digital platform shift to telemedicine, online psychosocial support programs, virtual patient navigation, and digital engagement across the oncology care continuum. DC Pink Divas Intervening Virtually to Advance Saving Lives (DIVAS) is an award-winning evidence-based training, outreach, and patient navigation program developed to address the educational needs of Black early-stage, MBC breast cancer patients, survivors, and caretakers and provide strategies to educate, empower and impact women by increasing breast health knowledge, decreasing gaps in screenings and access, increasing awareness of MBC to ensure that where a woman lives, will not determine if she lives through a 1-year commitment of attendance in 8 cohort-based education modules where Black breast cancer mortality is highest. The DIVAS Health Behavioral Change Model adapts the Precaution Adoption Process Model, Health Behavior Model, and Social-Ecological Model. DIVAS implements innovative virtual outreach programs, training, and intervention strategies to empower Advocates to educate peers, providers, and policymakers. 3 Cohorts of Black women impacted by breast cancer trained as Lay Breast Health Advocates from 2011, 2020, and 2021 (N = 57;77.5 % 45 years or younger;36.7% early-stage 0-II, 50% late stage III-IV, 10.3% caretakers) self-reported their lifestyle behaviors, breast cancer diagnosis, breast health education, social media use, and interest in a digital-based lifestyle intervention. Participants completed pre-and post-surveys, interviews, and journaling over 10.5+ hours of education modules to understand their breast health, provider-related challenges, and community-related resources. Findings provide evidence that cohort-tailored education is a successful method of supporting Black women in a behavioral-health intervention. The provision of printed culturally attuned information along with the digital-based instruction from a Black woman health care provider or public health expert is effective in helping Black breast cancer survivors transition into patient empowerment, improve QOL and contribute to better patient outcomes. After the intervention and completion of breast health modules, participants reported increased: self-efficacy in communicating with providers (70%) and self-efficacy in making treatment decisions (70%) self-confidence (85%), and a decrease in lifestyle risk factors (87%). Patient-centric behavioral health interventions in breast cancer education must be advanced digitally to address the pandemic's compounded crisis. DC Pink Divas provides insights to combat rising disparities by educating, empowering, and mobilizing Black lay breast health advocates to improve outcomes. Collaborative digital interventions across the care continuum to improve awareness, access, adherence, infrastructure, culturally attuned training, and support are evidencebased methods for navigating the cancer care transformation accelerated by COVID-19 to advance breast health equity. (Table Presented).

Racial Disparities in the Quality of Life and Vaccination of Breast Cancer Survivors during COVID-19: A Longitudinal Study

Background: Older adults with pre-existing health conditions such as cancer are at higher risks of COVID-related morbidity and mortality. Moreover, the pandemic has triggered new sources of anxiety and stress impairing their quality of life (QoL), such as fear of infection, financial challenges, and social isolation. The goal of this study is to evaluate the changes in QoL of breast cancer patients and survivors during the pandemic and assess whether racial/ethnic minority patients were disproportionately affected. As the COVID-19 vaccines become available, another goal of the study is to examine the vaccination rate and symptoms after vaccination among patients of different racial/ethnic groups. Method(s): Two waves of surveys were sent out to the breast cancer patients registered in the Chicago Multiethnic Epidemiologic Breast Cancer Cohort (ChiMEC) via RedCap in the summers of 2020 and 2021 with response rates of > 48%. To measure anxiety and stress, we calculated an overall score (ranging from 0-44) using 11 questions on a 5-point Likert scale, with lower score representing better QoL. The questions were adopted from existing item banks, and the items showed good internal consistency (Cronbach's alpha = 0.84). The second survey also contained questions on vaccination status, concerns, and symptoms after vaccination. Result(s): In the first wave of survey in 2020, no significant racial differences were found in the anxiety/stress scores among the 1300 breast cancer patients. In the second wave of survey in 2021, 1348 patients responded, with 66% of them also respondents of the previous survey. Compared to 2020, the average anxiety/stress score in 2021 decreased from 13.2 to 12.2 for White patients, while increased from 12.8 to 13.6 for Black patients. Mixed effects models showed that the scores worsened significantly for Black patients while improved significantly for White patients. Compared to Whites, Black patients were significantly less confident to find medical help and keep up with work/home responsibilities, while significantly more likely to feel isolated and overwhelmed, and more frequently worried about being sick and going to hospitals. The racial differences in the anxiety/stress scores became insignificant after adjusting for annual household income in multivariate linear mixed effect models. In terms of Covid-19 vaccination, 92.2% of the respondents got vaccinated, with no significant racial/ethnic difference. However, there were more Black patients who had not decided yet or did not respond to this question (Table). The major concerns for patients were the long-term and short-term side effects of the vaccines. In terms of symptoms after vaccination, the most reported symptoms were pain at injection site (62.0%), tiredness (50.2%) and muscle or body aches (30.8%). Conclusion(s): Through a longitudinal study, we found that although the anxiety/stress scores of our patients remained moderate, White patients were having improved QoL while Black patients were doing worse. A third wave of survey is planned in the summer of 2022 to further examine this trend. In our study, the vaccination rates were very high among all racial/ethnic groups and the symptoms after vaccination were similar to the ones demonstrated in the general population. We hope that this information can proactively address some patients' concerns about getting vaccinated.

Investigating young adult cancer survivors' perspectives on the future and interpersonal relationships

For many young adults (YA, aged 18-39) who have recently survived cancer, planning and working towards goals for the future is a fraught process. Prior research consistently identifies the challenges of survivorship, including: rebuilding personal identity, accepting the impact of cancer-related interruptions on personal goals, navigating new roles in significant close relationships, and initiating new relationships as a survivor. However, there is limited research describing the mechanisms underlying these persistent challenges, which poses difficulties when tailoring evidence-based psychological intervention. The present study consolidates both established and newly hypothesized survivorship challenges into a novel conceptual model, hypothesizing that they are interrelated, and mutually reinforcing, to perpetuate social isolation and avoidance of the future in young survivors.This dissertation study elucidated what YA survivors experience as they envision their lives in the future, with a focus on goals, such as family-building, which may be shared with a close other. We hypothesized that YA may struggle to plan for the future because they experience interfering emotions and thoughts related to their health, often regarding recurrence of cancer or late effects of treatment. Many of these struggles may be difficult to share with a partner. In particular, self-conscious emotions, such as embarrassment, shame, guilt, or pride associated with being a cancer survivor, may explain how relating to others without cancer can be challenging. This qualitative study utilized a semi-structured interview to prompt YA survivors to imagine significant future events in their close relationships, identifying future-oriented thoughts, beliefs, coping strategies, and emotions as they arose. Participants included 35 YAs treated for cancer within the past five years. Interviews were conducted remotely over a secure video platform and professionally transcribed. Analysis software was used to test deductive codes based on a priori research questions, and inductive codes based on bottom-up consensus coding of transcripts. Quantitative data regarding demographics and mental health were used to augment analyses and interpretation. The process of thematic text analysis was used to identify significant themes and subthemes in the data. Findings indicated good support for the hypothesized conceptual model, including the impact of health anxiety and social isolation on close relationships and psychosocial well-being. In some cases, social isolation was worsened by the impacts of COVID-19. In addition to deductive findings regarding the interfering nature of cancer-related worry in planning for the future, inductive themes gleaned from analyses included the prominence of grief (e.g. loss of fertility due to treatment, death of peers). Participants overwhelmingly requested tailored and ongoing mental health support in survivorship, and the majority of participants had attended peer support groups. This study provides a strong foundation for broader quantitative study confirming the themes hypothesized by the conceptual model presented here. It also provides a preliminary basis for clinical intervention to improve future planning based on mitigating social isolation and addressing the short- and long-term impacts of decisional avoidance in the context of health anxiety. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Optimizing Precision Medicine Cancer Clinical Trials

With the advent of precision medicine, getting the right treatment for the right patient at the right time has illuminated a variety of challenges and opportunities for innovation in trial design and conduct. Although there is no onesize- fits-all approach to precision medicine, a number of approaches, particularly basket and umbrella trial platforms that permit simultaneous evaluation of multiple treatments in multiple patient cohorts, have evolved to improve trial efficiency. The novel coronavirus pandemic has illuminated the need for, and feasibility of, conducting trials with fewer requirements, greater flexibility, and more decentralization. Through the lens of precision medicine cancer clinical trials, successes and challenges will be discussed to share practical solutions of how to improve evidence generation in the era of precision medicine. Through discussion of precision medicine cancer clinical trials within the United States, this session will provide an overview of how best to optimize these clinical trials. This session comprises the following three main topic areas: matching treatments to patients, including the use of novel patient identification strategies, genomic matching rules, molecular tumor boards (MTBs), decision-support tools, incorporating precision medicine trials into a research portfolio, and how to overcome challenges;accelerating evidence development, including the use of adaptive trial designs, cohort management strategies and data sharing plans;and improving diversity of trial participants and increasing generalizability of study results through expanded eligibility criteria and site selection strategies. This topic will be explored through 90 min of invited talks and a panel discussion with Q&A. Moderator and session chair, Richard L Schilsky, MD, FACP, FSCT, FASCO, will introduce the session and speakers and provide an introduction on the basics of precision oncology. Timothy Cannon, MD, a medical oncologist and clinical trial researcher, will present a case study of two patients with the same alteration and discuss how the care for each differed based on access to a precision medicine cancer clinical trial. Dr. Cannon will also discuss how to implement precision medicine trials within a research portfolio and how to identify patients at a site. Christine Walko, PharmD, BCOP, FCCP, a pharmacist and researcher, will then discuss the basics of matching therapies to genomics, how to use decision support tools, the role of an MTB, and identifying therapeutic options for patients. Edward S Kim, MD, MBA, FACP, FASCO, a medical oncologist, will talk about MTBs from a clinician perspective and precision medicine cancer clinical trials from a community practice perspective. Dr. Kim will also speak about how to extend the research team to create an adequate community research portfolio and about using broader eligibility criteria that might facilitate enrollment of diverse populations. Jane Perlmutter, PhD, MBA, FASCO, a cancer survivor and patient advocate, will discuss what pragmatic trials are, how they increase the opportunity for diversity and generalizability, and patient perspectives regarding pragmatic and precision cancer clinical trials. Susan Halabi, PhD, FASCO, FSCT, a researcher and professor of biostatistics and bioinformatics, will talk about the best ways to design an adaptive trial, especially its role in real-world settings, how these types of designs can be used for efficient signal finding in rare populations, and how these trials can create opportunities for data sharing and collaboration. Pam K Mangat, MS, a research scientist and the Director of Clinical Research for American Society of Clinical Oncology's (ASCO) Targeted Agent and Profiling Utilization Registry (TAPUR) Study, will discuss the operations behind a precision medicine study, advantages and disadvantages of a pragmatic trial, cohort closing and collapsing rules to help with management of large numbers of small cohorts, and contributing knowledge to other trials. The session will conclude with a panel di cussion moderated by session chair, Richard L Schilsky, MD, FACP, FSCT, FASCO, for approximately 10 min, with 5 min for a Q&A session.