Oncologists' perceived confidence and attitudes toward managing pre-existing chronic comorbidities during patients' active cancer treatment.

PURPOSE: To examine practicing oncologists' perceived confidence and attitudes toward management of pre-existing chronic conditions(PECC) during active cancer treatment(ACT). METHODS: In December 2018, oncologists in the National Cancer Institute's Community Oncology Research Program (NCORP) were invited to complete a was pilot-tested, IRB-approved online survey about their perceived confidence in managing PECC. Pearson chi-square test was used to identify oncologists' differences in perceived confidence to manage PECC and attitudes toward co-management of patients' PECC with non-oncologic care providers. Perceived confidence and attitudes were analyzed as a function of medical specialty while controlling demographic and medical practice variables. RESULTS: A total of 391 oncologists responded to the survey, 45.8% stated medical oncology as their primary specialty, 15.1% hematology oncology, 15.1% radiation oncology, 6.9% surgical oncology, and 17.1% other specialties such as gynecology oncology. Overall, 68.3% agreed (agree/strongly agree) that they were confident to manage PECC in the context of standard of care. However, only 46.6% and 19.7% remained confident when managing PECC previously managed by a primary care physician (PCP) and by a non-oncology subspecialist, respectively. Most oncologists (58.3%) agreed that patients' overall care was well coordinated, and 63.7% agreed that patients had optimal cancer and non-cancer care when PECC was co-managed with a non-oncology care provider. CONCLUSION: Most oncologists felt confident to manage all PECC during patients' ACT, but their perceived confidence decreased for PECC previously managed by PCPs or by non-oncology subspecialists. Additionally, they had positive attitudes toward co-management of PECC with non-oncologic care providers. These results indicate opportunities for greater collaboration between oncologists and non-oncology care providers to ensure comprehensive and coordinated care for cancer patients with PECC.

Exposing the Risks of Social Media Recruitment in Adolescents and Young Adults with Cancer: #Beware.

Enrolling adolescents and young adults (AYAs) in psychosocial research studies during cancer treatment is challenging. Successful AYA study recruitment not specific to oncology patients supports social media network advertising and recruitment strategies. However, this brief report describes several challenges to recruiting an appropriate and credible anonymous sample while conducting Institutional Review Board-approved research using social media recruitment. Namely, ethical oversight impeded access to AYAs with cancer and monetary remuneration allured many noneligible AYA participants who accessed the online survey. Lessons learned from this study provide caution for researchers interested in a similar approach and illustrate ways to determine credibility of findings.

Diabetes care management patterns before and after a cancer diagnosis: A SEER-Medicare matched cohort study.

BACKGROUND: Diabetes places patients with cancer at an increased risk of infections, hospitalizations, and mortality. The objective of the current study was to characterize diabetes care management patterns among patients with cancer in the year before and, separately, after cancer diagnosis. The authors hypothesized that diabetes care declines after a diagnosis of cancer. METHODS: The Surveillance, Epidemiology, and End Results (SEER) cancer registry linked to Medicare claims data was used. The authors included diabetic beneficiaries aged ≥65 years who were diagnosed with incident, nonmetastatic breast, prostate, or colorectal cancer between 2008 and 2013. Controls were diabetic Medicare beneficiaries in SEER regions who did not have cancer. Cases were matched to controls based on age, sex, Charlson Comorbidity Index, and diabetes severity. Primary outcomes were diabetes care received over 12 months: 1) hemoglobin A1c testing; 2) eye examination; and 3) low-density lipoprotein testing. Using a difference-in-difference (DID) approach, the authors examined use differences 12 months before to after diagnosis for patients with cancer and controls. To avoid capturing testing related to diagnosis and not diabetes management, the authors implemented a 90-day washout period (45 days before and/or after diagnosis). RESULTS: A total of 32,728 diabetic patients with cancer and 32,728 matched noncancer controls were included. After diagnosis, patients with cancer were found to have modest, but significantly lower, rates of diabetes care use compared with controls. Patients with cancer had greater declines in hemoglobin A1c testing (DID, 2.4%; 95% CI, 1.7%-3.0%), low-density lipoprotein testing (DID, 4.3%; 95% CI, 3.6%-5.0%), and receipt of all diabetes indicators (DID, 2.7%; 95% CI, 1.8%-3.5%) 12 months before to after diagnosis. CONCLUSIONS: Compared with controls, less diabetes care use was observed among patients with cancer in the year after diagnosis. Understanding and addressing the reasons for this may improve outcomes in this population.

Through our eyes: A photovoice intervention for adolescents on active cancer treatment.

RESEARCH APPROACH: Photovoice, a participatory action research methodology, is a novel and promising intervention for adolescents with cancer. Photovoice was used as an intervention for eliciting and addressing the psychosocial needs of adolescents on active cancer treatment. PARTICIPANTS: Six adolescents, aged thirteen to seventeen years old, who were on active treatment or had completed treatment in the three months prior to recruitment participated in a seven-week photovoice group that took place from March to May 2017. Methodological Approach: Each of the seven sessions was recorded and later transcribed. A content analysis was used to identify themes that were analyzed using an integrated framework developed earlier. The framework broadly categorized the themes into six domains: (i) physical changes, (ii) psychosocial impacts, (iii) short-term social impacts, (iv) long-term social impacts, (v) impacts on holistic well-being, and (vi) informational needs. INTERPRETATION: Photovoice is an effective intervention for eliciting and addressing the psychosocial needs of adolescents on active cancer treatment.

Exploring Adolescents' Cancer Journey Through Photovoice: A Narrative Synthesis.

PURPOSE: Photovoice is a novel and promising intervention for working with youth in healthcare settings. Despite this, few studies have examined the efficacy of photovoice as a clinical tool for working with teenagers who are on their cancer journey. To better understand the needs of teenagers with cancer and the ways that photovoice can be utilized to address these needs, a systematic review of the literature was undertaken. METHODS: Keyword searches of six databases were completed, including MEDLINE, EMBASE, PsycINFO, Social Work Abstracts, Sociological Abstracts, and Health and Psychosocial Instruments. Searches were limited to articles focusing on the psychosocial needs of adolescents, aged 13-17, who were on active cancer treatment. RESULTS: Sixty-four articles were identified that discussed the psychosocial needs of teenagers on active cancer treatment. The needs of these teenagers can be understood as being influenced by the physical changes and symptoms, psychological impact of diagnosis and treatment, short- and long-term social impacts of cancer, impact on holistic well-being, and need for clear, age-appropriate communication. Among these articles, only four articles used photovoice as a methodology and none examined the impact of photovoice as an intervention for teenagers who were currently on active treatment. CONCLUSION: Photovoice is uniquely positioned among other psychosocial interventions to help address the needs of teenagers on their cancer journey. Despite this, few researchers have examined the efficacy of photovoice as a psychosocial intervention for teenagers who are currently on active treatment.

Risk factors for patients with stage IVB hepatocellular carcinoma and extension into the heart: prognostic and therapeutic implications.

PURPOSE: To evaluate the risk factors of hepatocellular carcinoma (HCC) extension into the right atrium (RA) and determine poor prognostic factors for HCC extension to the heart. MATERIALS AND METHODS: A total of 665 patients who were newly diagnosed with HCC were analyzed retrospectively from January 2004 to July 2012. The patients were divided into two groups: 33 patients with HCC extending into the RA and 632 HCC patients during the same period. The patients with HCC extending into the RA were subdivided into shorter survival group (<2 months) and longer survival group (≥2 months). RESULTS: The prevalence of HCC extending to the RA was 4.96%. In multivariate analysis, a modified Union Internationale Contre le Cancer (UICC) stage higher than IVA, hepatic vein invasion, concomitant inferior vena cava and portal vein invasion, and multinodular tumor type were risk factors for HCC extending to the RA. In multivariate analysis, Cancer of the Liver Italian Program (CLIP) score>3 (p=0.016, OR: 13.89) and active treatment (p=0.024, OR: 0.054) were associated with prognostic factors in patients HCC extending into the RA. Active treatment such as radiation (n=1), transcatheter arterial chemoembolization (TACE) (n=11), Sorafenib (n=1), and combined modalities (n=2) were performed. CONCLUSION: Modified UICC stage higher than IVA, vascular invasion and multinodular tumor type are independent risk factors for HCC extending to the RA. Active treatment may prolong survival in patients HCC extending into the RA.

Risk Factors for Patients with Stage IVB Hepatocellular Carcinoma and Extension into the Heart: Prognostic and Therapeutic Implications

PURPOSE: To evaluate the risk factors of hepatocellular carcinoma (HCC) extension into the right atrium (RA) and determine poor prognostic factors for HCC extension to the heart. MATERIALS AND METHODS: A total of 665 patients who were newly diagnosed with HCC were analyzed retrospectively from January 2004 to July 2012. The patients were divided into two groups: 33 patients with HCC extending into the RA and 632 HCC patients during the same period. The patients with HCC extending into the RA were subdivided into shorter survival group ( or =2 months). RESULTS: The prevalence of HCC extending to the RA was 4.96%. In multivariate analysis, a modified Union Internationale Contre le Cancer (UICC) stage higher than IVA, hepatic vein invasion, concomitant inferior vena cava and portal vein invasion, and multinodular tumor type were risk factors for HCC extending to the RA. In multivariate analysis, Cancer of the Liver Italian Program (CLIP) score >3 (p=0.016, OR: 13.89) and active treatment (p=0.024, OR: 0.054) were associated with prognostic factors in patients HCC extending into the RA. Active treatment such as radiation (n=1), transcatheter arterial chemoembolization (TACE) (n=11), Sorafenib (n=1), and combined modalities (n=2) were performed. CONCLUSION: Modified UICC stage higher than IVA, vascular invasion and multinodular tumor type are independent risk factors for HCC extending to the RA. Active treatment may prolong survival in patients HCC extending into the RA.