Geographic Accessibility and Completion of Initial Low-Dose CT-Based Lung Cancer Screening in an Urban Safety-Net Population.

Background: Recent modifications to low-dose CT (LDCT)-based lung cancer screening guidelines increase the number of eligible individuals, particularly among racial and ethnic minorities. Because these populations disproportionately live in metropolitan areas, we analyzed the association between travel time and initial LDCT completion within an integrated, urban safety-net health care system.

Methods: Using Esri's StreetMap Premium, OpenStreetMap, and the r5r package in R, we determined projected private vehicle and public transportation travel times between patient residence and the screening facility for LDCT ordered in March 2017 through December 2022 at Parkland Memorial Hospital in Dallas, Texas.

Assessing Barriers and Facilitators to Lung Cancer Screening: Initial Findings from a Patient Navigation Intervention.

Low-dose computed tomography-based lung cancer screening represents a complex clinical undertaking that could require multiple referrals, appointments, and time-intensive procedures. These steps may pose difficulties and raise concerns among patients, particularly minority, under-, and uninsured populations. The authors implemented patient navigation to identify and address these challenges.

Hospital Surgical Volume Is Poorly Correlated With Delivery of Multimodal Treatment for Localized Pancreatic Cancer: A National Retrospective Cohort Study.

Unlabelled: Using Donabedian's quality of care model, this study assessed process (hospital multimodal treatment) and structure (hospital surgical case volume) measures to evaluate localized pancreatic cancer outcomes.

Background: Treatment at high surgical volume hospitals has been shown to improve short-term outcomes. However, multimodal treatment-surgery and chemotherapy-is the standard of care yet only received by 35% of US patients and has not been examined at the hospital level.

Enhancing access to and diversity in cancer clinical trials through a financial reimbursement program: Protocol to evaluate a novel program.

As clinical trials have become more complex, with increasing numbers of required procedures and clinic visits, gaining access to promising new treatments has become even more challenging for many individuals. To address these barriers, we implemented a financial reimbursement and outreach program designed to increase the number and diversity of participants in cancer clinical trials at centers in Dallas, Houston, and Philadelphia. As endorsed by U.

Colorectal Cancer Incidence, Inequalities, and Prevention Priorities in Urban Texas: Surveillance Study With the "surveil" Software Package.

Background: Monitoring disease incidence rates over time with population surveillance data is fundamental to public health research and practice. Bayesian disease monitoring methods provide advantages over conventional methods including greater flexibility in model specification and the ability to conduct formal inference on model-derived quantities of interest. However, software platforms for Bayesian inference are often inaccessible to nonspecialists.

Long-term Mammography Adherence among Uninsured Women Enrolled in the Breast Screening and Patient Navigation (BSPAN) Program.

Background: The Breast Screening and Patient Navigation (BSPAN) Program provides access to no-cost breast cancer screening services to uninsured women in North Texas. Using data from the longitudinal BSPAN program (2012-2019), we assessed prevalence and correlates of (i) baseline adherence and (ii) longitudinal adherence to screening mammograms.

Methods: Outcomes were baseline adherence (adherent if women received second mammogram 9-30 months after the index mammogram) and longitudinal adherence (assessed among baseline adherent women and defined as being adherent 39 months from the index mammogram).

Longitudinal Experience With and Impressions of COVID-19-Related Clinical Research Changes.

Purpose: The COVID-19 pandemic has led to profound changes in clinical research, including remote consent, telehealth, off-site procedures, shipment of therapy, and remote study monitoring. We assessed longitudinal perceptions of these adjustments among clinical research professionals.

Methods: We distributed an anonymous survey assessing experiences, perceptions, and recommendations regarding COVID-19-related clinical research adjustments to cancer clinical research office personnel in May 2020 and again in November 2020.

Electronic Health Records-Based Cardio-Oncology Registry for Care Gap Identification and Pragmatic Research: Procedure and Observational Study.

Background: Professional society guidelines are emerging for cardiovascular care in cancer patients. However, it is not yet clear how effectively the cancer survivor population is screened and treated for cardiomyopathy in contemporary clinical practice. As electronic health records (EHRs) are now widely used in clinical practice, we tested the hypothesis that an EHR-based cardio-oncology registry can address these questions.

Reimbursement Matters: Overcoming Barriers to Clinical Trial Accrual.

Background: Accrual to cancer clinical trials is suboptimal. Few data exist regarding whether financial reimbursement might increase accruals.

Objective: The objective of this study was to assess perceptions about reimbursement to overcome barriers to trial accrual.

Clinician Variation in Ordering and Completion of Low-Dose Computed Tomography for Lung Cancer Screening in a Safety-Net Medical System.

Background: Less than 5% of eligible individuals in the United States undergo lung cancer screening. Variation in clinicians' participation in lung cancer screening has not been determined.

Patients And Methods: We studied medical providers who ordered ≥ 1 low-dose computed tomography (LDCT) for lung cancer screening from February 2017 through February 2019 in an integrated safety-net healthcare system.

Assessment of patient and provider attitudes towards therapeutic drug monitoring to improve medication adherence in low-income patients with hypertension: a qualitative study.

Objectives: Previous studies have implicated therapeutic drug monitoring (TDM), by measuring serum or urine drug levels, as a highly reliable technique for detecting medication non-adherence but the attitudes of patients and physicians toward TDM have not been evaluated previously. Accordingly, we solicited input from patients with uncontrolled hypertension and their physicians about their views on TDM.

Design: Prospective analysis of responses to a set of questions during semistructured interviews.

Experience, Perceptions, and Recommendations Concerning COVID-19-Related Clinical Research Adjustments.

Background: During the COVID-19 public health emergency, the FDA and NIH altered clinical trial requirements to protect participants and manage study conduct. Given their detailed knowledge of research protocols and regular contact with patients, clinicians, and sponsors, clinical research professionals offer important perspectives on these changes.

Methods: We developed and distributed an anonymous survey assessing COVID-19-related clinical trial adjustment experiences, perceptions, and recommendations to Clinical Research Office personnel at the Harold C.

Stakeholder engagement to initiate lung cancer screening in an urban safety-net health system.

• Health systems, especially those caring for medically underserved populations, should consider a multi-level approach to patient and stakeholder engagement to advance adoption of population screening as guideline-based care. • Iterative engagement should inform design and activation of an electronic order set to (1) capture socio-demographic data to establish screening eligibility, and (2) provide CMS-mandated documentation of patient counseling, while minimizing order burden for referring clinicians. • Patients who most stand to benefit from guideline-based lung cancer screening may also be those least likely to complete the multi-step processes of screening.

Patient and provider perspectives on delivery of oral cancer therapies.

Objective: The introduction of oral cancer therapies presents new challenges to delivery of quality cancer care. Little is known about how patients and providers address and overcome these challenges. We conducted a qualitative study exploring the range of patient and provider perspectives on oral cancer therapies.

Impact of a Cancer Urgent Care Clinic on Regional Emergency Department Visits.

Purpose: Did the creation of an urgent care clinic specifically for patients with cancer affect emergency department visits among adults newly diagnosed with cancer?

Patients And Methods: We applied an interrupted time series analysis to adjusted monthly emergency department visits made by adults age 18 years or older who were diagnosed with cancer between 2009 and 2016 at a comprehensive cancer center. Cancer registry patients were linked to a longitudinal regional database of emergency department and hospital visits. Because the urgent care clinic was closed on weekends, we took advantage of the natural experiment by comparing weekend visits as a control group.

Mobile Device Applications for Electronic Patient Portals in Oncology.

Purpose: Mobile devices provide individuals with rapid and frequent access to electronic patient portals. We investigated how oncology patients use this technology to review test results and communicate with providers.

Patients And Methods: We performed a retrospective study of patients enrolled in the MyChart electronic health portal associated with the Epic electronic medical record at the Harold C.

Care coordination for complex cancer survivors in an integrated safety-net system: a study protocol.

Background: The growing numbers of cancer survivors challenge delivery of high-quality survivorship care by healthcare systems. Innovative ways to improve care coordination for patients with cancer and multiple chronic conditions ("complex cancer survivors") are needed to achieve better care outcomes, improve patient experience of care, and lower cost. Our study, Project CONNECT, will adapt and implement three evidence-based care coordination strategies, shown to be effective for primary care conditions, among complex cancer survivors.

Polypharmacy and patterns of prescription medication use among cancer survivors.

Background: The population of cancer survivors is rapidly growing in the United States. Long-term and late effects of cancer, combined with the ongoing management of other chronic conditions, make survivors particularly vulnerable to polypharmacy and its adverse effects. In the current study, the authors examined patterns of prescription medication use and polypharmacy in a population-based sample of cancer survivors.