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Background: Hepatocellular carcinoma (HCC) surveillance is underutilized, with Methods: We conducted a retrospective cohort study of individuals with cirrhosis using claims data from Medicare, Medicaid, and private insurance plans in North Carolina. We included individuals ≥ 18 years with a first occurrence of an ICD-9/10 code for cirrhosis between January 1, 2010, and June 30, 2018. The outcome was HCC surveillance by abdominal ultrasound, CT, or MRI. We estimated 1- and 2-year cumulative incidences for HCC surveillance and assessed longitudinal adherence to surveillance by computing the proportion of time covered (PTC). Results: Among 46,052 individuals, 71% were enrolled through Medicare, 15% through Medicaid, and 14% through private insurance. The overall 1-year cumulative incidence of HCC surveillance was 49% and the 2-year cumulative incidence was 55%. For those with an initial screen in the first 6 months of their cirrhosis diagnosis, the median 2-year PTC was 67% (Q1, 38%; Q3, 100%). Conclusions: HCC surveillance initiation after cirrhosis diagnosis remains low, though it has improved slightly over time, particularly among individuals with Medicaid. Impact: This study provides insight into recent trends in HCC surveillance and highlights areas to target for future interventions, particularly among patients with nonviral etiologies.

Background: The pharmacy reference database, Micromedex, lists concomitant hydrochlorothiazide and cyclophosphamide use as a potential, major drug–drug interaction (DDI), although only one small, single-center study supports this claim. Our objective was to estimate associations between this potential DDI and two adverse chemotherapy-related events, neutropenia-related hospitalizations and treatment regimen discontinuation, among a cohort of women with breast cancer initiating adjuvant chemotherapy containing cyclophosphamide. Methods: Using linked Surveillance, Epidemiology, and End Results Program (SEER)-Medicare data, we included women 66 years and older with breast cancer diagnosis between 2007 and 2011, who initiated a regimen containing cyclophosphamide. Risk ratios (RR) and 95% confidence intervals for adverse outcomes comparing women exposed versus unexposed to the potential DDI were assessed using modified multivariable Poisson regression adjusting for potential confounders. Results: In total, 27% of women receiving cyclophosphamide treatment were exposed to concomitant hydrochlorothiazide, of which 11% experienced a neutropenia-related hospitalization and 21% discontinued their chemotherapy regimen prior to completion. Adjusted risks of both adverse events were similar between those exposed and unexposed to the potential DDI [neutropenia-related hospitalization: adjusted RR (aRR) = 0.92 (0.70–1.21); treatment discontinuation: aRR = 1.00 (0.96–1.05)]. Conclusions: Our results do not support an association between concomitant hydrochlorothiazide use and two clinically relevant adverse chemotherapy-related events. Impact: Our results support reassessing and potentially lowering severity of this potential interaction in drug reference databases.

Background: Black patients with cancer report worse symptom burden and management relative to Whites. Use of electronic patient-reported outcomes (ePROs) have been linked to improved cancer-related symptom management, with potential to address inequities in symptom management. Visualization of ePRO symptom data is a critical component of ePRO development; however, engagement of diverse patient and family stakeholders in the visualization of ePRO data has been limited. As part of the Symptom and Healthcare Access Reporting and Evaluation (SHARE) study, we engaged diverse stakeholders in the development of an ePRO tool. Herein, we describe our stakeholder engagement process, as well as feedback and recommendations for optimizing visualization of ePRO data with an equity prioritization lens. Methods: We leveraged a multi-step, mixed-methods, community-engaged research approach to solicit input from diverse patients in active treatment (n= 30 Black; n=49 White) and members of cancer-focused community advisory boards (n=1 Asian; n=8 White). Stakeholders provided feedback on two versions of the ePRO symptom report (Prototype 1[original version] and Prototype 2 [modified version based on initial stakeholder feedback]) through an iterative process. Feedback was obtained via surveys, individual interviews, and group meetings. Results: Compared with White patients, Blacks reported more challenges in using and understanding Prototype 1 of the symptom report. Community advisory board members shared similar concerns regarding ease of use of Prototype 1. In particular, patients and members noted that graphical legends and axes were difficult to interpret, making it difficult to identify which symptoms were worsening or improving. Prototype 2 of the ePRO symptom report incorporated feedback, such as increasing font and graph sizes, combining related symptoms (e.g., nausea and vomiting) into a single graph, and inclusion of color-graded graph schemes corresponding to symptom severity (e.g., green=no symptom; orange=moderate severity), which facilitated ease of use for patients with limited graphical literacy. In comparing Prototype 1 to Prototype 2, community advisory board members reported that Prototype 2 was more visually appealing and easier to use and understand. Conclusions: Overall, feedback from diverse patients and community stakeholder groups resulted in the development of a more usable and patient-centered ePRO symptom summary report. Our work highlights the importance and value of engaging diverse stakeholders in the development of ePRO systems, including the visualization of ePRO data, in order to optimize the in the use of ePRO tools for everyone. Citation Format: Wendi L. Elkins, Neda R. Padilla, Dani Cutts, Mattias Jonsson, Michelle Johnson, Giselle Corbie-Smith, Samuel Cykert, Bryce B. Reeve, Antonia V. Bennett, Donald L. Rosenstein, Hanna Sanoff, Cleo A. Samuel. Engaging diverse patients and families in the visualization of cancer-related patient-reported outcomes [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-042.