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69 Background: Clinical trials are part of standard cancer care. Yet, a quarter of oncology fellows in a 2023 survey reported feeling underprepared to conduct research after training and nearly half did not identify research as important to their practice. In a 2024 survey, we explore the impact of exposure to research activities in fellowship on intentions to conduct research post-training. Methods: Fellows who took the 2024 ASCO Medical Oncology In-Training Exam (ITE) were invited to an optional IRB-exempted post-exam survey to measure (1) research exposure during training and (2) anticipated research participation once in practice. Responses of moderate and great amount are combined as frequent (vs. never, rarely, occasionally as not frequent). Rates of frequent research engagement in future practice are compared by frequent/not frequent research exposure during fellowship, expected practice setting, and program year using chi-squared analysis. Results: Of the 1884 US medical oncology fellows taking the ITE, 1491 (79%) participated in this study, 33% 1st year, 37% 2nd year, 39% 3rd year. 891 (60%) expect their first post-training role to be in academics, 527 (35%) in a non-academic practice, and 67 (5%) in other settings. Anticipated engagement in enrollment and management of participants on clinical trials post-training was associated with exposure to those activities in fellowship and with expected practice setting. Overall, 827 (63%) anticipate frequent participation in research once in practice. 531 (76%) of 701 with frequent exposure in training compared to 296 (37%) of 790 with not frequent exposure anticipate frequent participation in practice (p<0.001). 610 (78%) of fellows expecting to practice in an academic setting vs. 192 (40%) in a non-academic setting anticipate frequent future participation in practice (p<0.001). For research leadership activities (writing clinical research protocols, applying for clinical research grants, serving as principal investigator), 622 (49%) anticipate frequent participation once in practice. 390 (79%) of 519 with frequent vs. 229 (29%) of 855 with not frequent exposure to leadership activities during fellowship anticipate frequent future engagement (p<0.001). 523 (67%) of fellows expecting to practice in an academic setting vs. 76 (16%) in a non-academic setting anticipate frequent leadership engagement after training (p<0.001). Anticipated future participation did not vary by program year for either type of research activity. Conclusions: Findings show an urgent need to increase exposure to research during fellowship training to improve participation in clinical trials by practicing oncologists. This is a critical component of improving patient access to research. [ABSTRACT FROM AUTHOR]

43 Background: The Supreme Court decision in Dobbs v. Jackson Women's Health Organization (2022) allows states to ban or limit abortion without health exceptions for pregnant persons. Notably, about 1 out of every 1000 pregnant persons has cancer and abortion is utilized in up to 28% of pregnant patients with cancer. To investigate the impact of this court decision on oncology practice, we studied perceptions among oncology fellows of the effect of abortion restrictions on quality care and whether they anticipate care implications to influence their decisions on future practice location. Methods: Fellows who took the 2024 ASCO Medical Oncology In-Training Exam (ITE) were invited to take an optional post-ITE survey assessing perceived (1) effect of abortion policies on ability to provide 9 key aspects of quality cancer care, including care access and delays, trust, and professional well-being and (2) impact of abortion restrictions on quality care in decisions of future practice location. Agreement (Agree, Strongly Agree) and impact on future practice location (Somewhat likely, Very likely) were compared by respondent gender and abortion policies (banned/under legal contention vs legal) in their own or neighboring state using chi-squared analysis. Results: Of 1884 US medical oncology fellows who took the ITE, 1254 (67%, inc. 49% male, 46% female) participated in this survey; 34% trained in states with bans, 44% in states adjacent to states with bans, and 22% in and adjacent to states where abortion is legal. Overall, 33% of fellows report that abortion restrictions affected their ability to deliver at least one aspect of quality care, including 22% reporting limited availability/delays of drugs and 28% reporting poorer job satisfaction. For all 9 aspect of quality care, agreement was strongly associated with local abortion status (p<0.001). For example, 37% of fellows in abortion-restricted states report reduced patient trust and relationship quality vs. 20% among those in states adjacent to bans vs. 18% among those in and adjacent to legal states (p<0.001). Over half (51%) of fellows report that they are likely to consider the impact of local abortion policies on quality care when deciding future practice location (28% were neutral, 21% unlikely to consider). More fellows training in states where abortion is legal report being likely to consider the impact of local abortion policies on care in future practice location decisions (55%) than those training in abortion-restricted states (45%) (p<0.001). More women (58%) than men (45%) report being likely to consider the impact of local abortion policies on quality care in future practice location (p<0.001). Conclusions: Findings provide early insights into the impact of abortion restrictions both on key aspects of quality care as well as the geographic distribution of future oncologists. [ABSTRACT FROM AUTHOR]

The article presents the "State of Cancer Care in America, 2016," the third annual report published by the American Society of Clinical Oncology (ASCO). Topics discussed include the report describing both challenges and opportunities facing the U.S. cancer care system. Also mentioned are cancer care access and affordability under the Affordable Care Act (ACA), the 2016 ASCO Census and ASCO Practice Trends surveys and ASCO policy recommendations for U.S. Congress and professional organizations.