A latent class assessment of healthcare access factors and disparities in breast cancer care timeliness.

Background: Delays in breast cancer diagnosis and treatment lead to worse survival and quality of life. Racial disparities in care timeliness have been reported, but few studies have examined access at multiple points along the care continuum (diagnosis, treatment initiation, treatment duration, and genomic testing).

Methods And Findings: The Carolina Breast Cancer Study (CBCS) Phase 3 is a population-based, case-only cohort (n = 2,998, 50% black) of patients with invasive breast cancer diagnoses (2008 to 2013).

Telephone Survey-Reported Perceptions of Telehealth Visits Among Black and Non-Black Patients Diagnosed With Cancer.

Purpose: Empirical evidence underscores both benefits of telehealth visits and persistent disparities in use for Black adults. Guided by the Technology Acceptance Model, we evaluated perceptions regarding telehealth visits among Black and Non-Black adults receiving cancer care from two academic health systems.

Methods: Between April 2022 and October 2023, a survey was conducted among adult patients treated for cancer in the past 3 years.

Variability in Causal Effects and Noncompliance in a Multisite Trial: A Bivariate Hierarchical Generalized Random Coefficients Model for a Binary Outcome.

Within each of 170 physicians, patients were randomized to access e-assist, an online program that aimed to increase colorectal cancer screening (CRCS), or control. Compliance was partial: of the experimental patients accessed e-assist while no controls were provided the access. Of interest are the average causal effect of assignment to treatment and the complier average causal effect as well as the variation of these causal effects across physicians.

Pharmacist-facilitated Patient Reported Outcome Measure (PROM) monitoring: developing an EHR SmartForm© to monitor side effects of oral oncolytics during routine telehealth encounters.

Purpose: Patient reported outcome measures (PROMs) are increasingly used in oncology care, but pharmacists providing direct patient care have been overlooked. We engaged pharmacists and adults receiving oral oncolytics (chemotherapy medication taken by mouth) to develop a SmartForm© in the electronic health record (EHR) for PROM monitoring. Pharmacists verbally ask the patient side effect questions during routine telehealth encounters and enter responses in real time.

Trust of social media content and risk of making misinformed decisions: Survey of people affected by cancer and their caregivers.

Background: This study explores social media (SM) usage and trust in information among cancer patients and their caregivers. We compare socio-demographic characteristics to identify groups more likely to rely on social media for treatment decisions and those less inclined to validate social media information with their provider.

Methods: A national survey of people diagnosed with cancer and those who were caregivers to people diagnosed with cancer was conducted via online survey in November-December 2021.

The feasibility and equity of text messaging to determine patient eligibility for lung cancer screening.

Objectives: Text messaging could be effective for determining patient eligibility for lung cancer screening (LCS). We explored people's willingness to share their tobacco use history via text message among diverse groups.

Study Design: Cross-sectional survey.

Assessing the Validity of the Centers for Medicare & Medicaid Services Measure in Identifying Potentially Preventable Emergency Department Visits by Patients With Cancer.

Purpose: The Centers for Medicare & Medicaid Services (CMS) implemented chemotherapy measures (OP-35) to reduce potentially preventable emergency department visits (PPEDVs) and hospitalizations. This study evaluated the validity of the OP-35 measure in identifying PPEDVs among patients with cancer.

Methods: This is a cross-sectional study, which used data from the 2012-2022 National Hospital Ambulatory Medical Care Survey.

Self-Collection for HPV Testing: Potential Issues Related to Performance Measures and Quality Improvement Among Federally Qualified Health Centers.

Context: Most incident cases of cervical cancer in the United States are attributable to inadequate screening. Federally qualified health centers (FQHCs) serve a large proportion of women who are low-income, have no insurance, and are underserved-risk factors for insufficient cervical cancer screening. FQHCs must maintain quality measures to preserve their accreditation, address financial reimbursements, and provide quality care.

Predicting the Future by Studying the Past for Patients With Cancer Diagnosed in the Emergency Department.

In the article that accompanies this editorial, Kapadia et al. developed a digital quality measure to identify emergency presentations of incident cancers, a measure they found to associated with both antecedent missed opportunities for diagnosis and subsequent 1-year all-cause mortality. Their work highlights the need for a cancer control continuum that includes, not only improved early detection, but also improved symptom recognition, expedited diagnostic work-up, and increased downstream support, including multilevel interventions focused on care continuity and symptom management for these patients with emergency presentations of cancer to improve cancer outcomes.

Key Performance Indicators and Metrics for the Implementation of an Oral Chemotherapy Adherence Program.

Background: Oral anticancer agents (OAAs) transformed cancer care for patients, extending survival and delaying progression in certain cases. There are multiple pharmacy-driven models to improve patient knowledge and adherence to OAAs. However, a lack of measurable key performance indicators (KPIs) has limited the adoption, implementation, and maintenance of these models.

Understanding mechanisms of racial disparities in breast cancer: an assessment of screening and regular care in the Carolina Breast Cancer Study.

Purpose: Screening history influences stage at detection, but regular preventive care may also influence breast tumor diagnostic characteristics. Few studies have evaluated healthcare utilization (both screening and primary care) in racially diverse screening-eligible populations.

Methods: This analysis included 2,058 women age 45-74 (49% Black) from the Carolina Breast Cancer Study, a population-based cohort of women diagnosed with invasive breast cancer between 2008 and 2013.

Rates of Downstream Procedures and Complications Associated With Lung Cancer Screening in Routine Clinical Practice : A Retrospective Cohort Study.

Background: Lung cancer screening (LCS) using low-dose computed tomography (LDCT) reduces lung cancer mortality but can lead to downstream procedures, complications, and other potential harms. Estimates of these events outside NLST (National Lung Screening Trial) have been variable and lacked evaluation by screening result, which allows more direct comparison with trials.

Objective: To identify rates of downstream procedures and complications associated with LCS.

Self-Collection for Primary HPV Testing: Perspectives on Implementation From Federally Qualified Health Centers.

Introduction: Primary testing for high-risk human papillomavirus (HPV) by self-collection could result in higher rates of cervical cancer screening. Federally qualified health centers (FQHCs) in the US serve a large proportion of women who have low income and no health insurance and are medically underserved - risk factors for being insufficiently screened for cervical cancer. Although the implementation of self-collection for HPV testing is not yet widespread, health care entities need to prepare for its eventual approval by the US Food and Drug Administration.

Uptake of Lung Cancer Screening CT After a Provider Order for Screening in the PROSPR-Lung Consortium.

Background: Uptake of lung cancer screening (LCS) has been slow with less than 20% of eligible people who currently or formerly smoked reported to have undergone a screening CT.

Objective: To determine individual-, health system-, and neighborhood-level factors associated with LCS uptake after a provider order for screening.

Design And Subjects: We conducted an observational cohort study of screening-eligible patients within the Population-based Research to Optimize the Screening Process (PROSPR)-Lung Consortium who received a radiology referral/order for a baseline low-dose screening CT (LDCT) from a healthcare provider between January 1, 2015, and June 30, 2019.

The Perceived Usability of Virtual Visits Among Black Adults' Receiving Oncology Care: A Qualitative Analysis.

Background: With the COVID-19 pandemic came rapid uptake in virtual oncology care. During this, sociodemographic inequities in access to virtual visits (VVs) have become apparent. To better understand these issues, we conducted a qualitative study to describe the perceived usability and acceptability of VVs among Black adults diagnosed with cancer.

Barriers and facilitators associated with implementing interventions to support oral anticancer agent adherence in academic and community cancer center settings.

Purpose: The goal of this study is to determine barriers and facilitators to the implementation of medication adherence interventions to support cancer patients taking novel, targeted oral anticancer agents (OAAs).

Methods: We conducted qualitative interviews using a semi-structured guide from the Consolidated Framework for Implementation Research (CFIR). We used purposive sampling to identify clinicians (physicians, pharmacists, nurse practitioners, nurses) and administrators (leadership from medicine, pharmacy, and nursing) who delivered care and/or oversee care delivery for patients with chronic leukemia prescribed an OAA.

Health Information and Misinformation: A Framework to Guide Research and Practice.

When facing a health decision, people tend to seek and access web-based information and other resources. Unfortunately, this exposes them to a substantial volume of misinformation. Misinformation, when combined with growing public distrust of science and trust in alternative medicine, may motivate people to make suboptimal choices that lead to harmful health outcomes and threaten public safety.

Preferences for Electronic Modes of Communication Among Older Primary Care Patients: Cross-sectional Survey.

Background: Health information delivered via daily modes of communication such as email, text, or telephone reportedly supports improved health behavior and outcomes. While different modes of communication beyond clinical visits have proven successful for patient outcomes, preferences for communication modes have not been comprehensively studied among older primary care patients. We addressed this gap by assessing patient preferences for receiving cancer screening and other information from their doctors' offices.

Predicting Acute Care Events Among Patients Initiating Chemotherapy: A Practice-Based Validation and Adaptation of the PROACCT Model.

Purpose: Acute care events (ACEs), comprising emergency department visits and hospitalizations, are a priority area for reduction in oncology. Prognostic models are a compelling strategy to identify high-risk patients and target preventive services, but have yet to be broadly implemented, partly because of challenges with electronic health record (EHR) integration. To facilitate EHR integration, we adapted and validated the previously published PRediction Of Acute Care use during Cancer Treatment (PROACCT) model to identify patients at highest risk for ACEs after systemic anticancer treatment.

Associations With Virtual Visit Use Among Patients Receiving Radiation Therapy.

Purpose: The objective of this study was to test for patient characteristics associated with virtual versus office visits among radiation oncology patients.

Methods And Materials: Using the electronic health record, we extracted encounter data and corresponding patient information for the 6 months before and 6 months of COVID-19-enabled virtual visits (October 1, 2019, to March 22, 2020 vs March 23, 2020, to September 1, 2020) at a National Cancer Institute-Designated Cancer Center. Encounters during COVID-19 were categorized as in-person or virtual visits.

Exploring the Acceptability of Text Messages to Inform and Support Shared Decision-making for Colorectal Cancer Screening: Online Panel Survey.

Background: While online portals may be helpful to engage patients in shared decision-making at the time of cancer screening, because of known disparities in patient portal use, sole reliance on portals to support cancer screening decision-making could exacerbate well-known disparities in this health care area. Innovative approaches are needed to engage patients in health care decision-making and to support equitable shared decision-making.

Objective: We assessed the acceptability of text messages to engage sociodemographically diverse individuals in colorectal cancer (CRC) screening decisions and support shared decision-making in practice.

Automatic speech recognition performance for digital scribes: a performance comparison between general-purpose and specialized models tuned for patient-clinician conversations.

One promising solution to address physician data entry needs is through the development of so-called "digital scribes," or tools which aim to automate clinical documentation via automatic speech recognition (ASR) of patient-clinician conversations. Evaluation of specialized ASR models in this domain, useful for understanding feasibility and development opportunities, has been difficult because most models have been under development. Following the commercial release of such models, we report an independent evaluation of four models, two general-purpose, and two for medical conversation with a corpus of 36 primary care conversations.

Test performance metrics for breast, cervical, colon, and lung cancer screening: a systematic review.

Background: Multiple quality metrics have been recommended to ensure consistent, high-quality execution of screening tests for breast, cervical, colorectal, and lung cancers. However, minimal data exist evaluating the evidence base supporting these recommendations and the consistency of definitions and concepts included within and between cancer types.

Methods: We performed a systematic review for each cancer type using MEDLINE, Embase, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) from 2010 to April 2020 to identify guidelines from screening programs or professional organizations containing quality metrics for tests used in breast, cervical, colorectal, and lung cancer screening.