Search

PURPOSE: The COVID-19 pandemic led to rapid shifts in cancer survivorship care, including the widespread use of telehealth. Given the swift transition and limited data on preferences and experiences around telehealth, we surveyed oncology providers and post-treatment survivors to better understand experiences with the transition to telehealth. METHODS: We distributed provider (MD, PA or NP, nurse, navigator, and social worker) and survivor surveys through the American College of Surgeons Commission on Cancer in mid-October 2020. Survivor surveys were also disseminated through patient advocacy organizations. We included questions on demographics, experiences with telehealth, and preferences for future telehealth utilization. RESULTS: Among N = 607 providers and N = 539 cancer survivors, there was overwhelmingly more support from providers than from survivors for delivery of various types of survivorship care via telehealth and greater comfort with telehealth technologies. The only types of appointments deemed appropriate for survivorship care by both > 50% of providers and survivors were discussion of laboratory results or imaging, assessment and/or management of cancer treatment symptoms, nutrition counseling, and patient navigation support. Only a quarter of survivors reported increased access to health care services (25.5%), and 32.0% reported that they would use telehealth again. CONCLUSION: Although there have been drastic changes in technological capabilities and billing reimbursement structures for telehealth, there are still concerns around delivery of a broad range of survivorship care services via telehealth, particularly from the patient perspective. Still, offering telehealth services, where endorsed by providers and if available and acceptable to cancer survivors, may provide more efficient and accessible care following the COVID-19 pandemic.

Disclosure of sexual orientation and gender identity correlates with better outcomes, yet data may not be available in structured fields in electronic health record data. To gain greater insight into the care of sexual and gender-diverse patients in the Veterans Health Administration (VHA), we examined the documentation patterns of sexual orientation and gender identity through extraction and analyses of data contained in unstructured electronic health record clinical notes.Salient terms were identified through authoritative vocabularies, the research team's expertise, and frequencies, and the use of consistency in VHA clinical notes. Term frequencies were extracted from VHA clinical notes recorded from 2000 to 2018. Temporal analyses assessed usage changes in normalized frequencies as compared with nonclinical use, relative growth rates, and geographic variations.Over time most terms increased in use, similar to Google ngram data, especially after the repeal of the "Don't Ask Don't Tell" military policy in 2010. For most terms, the usage adoption consistency also increased by the study's end. Aggregated use of all terms increased throughout the United States.Term usage trends may provide a view of evolving care in a temporal continuum of changing policy. These findings may be useful for policies and interventions geared toward sexual and gender-diverse individuals. Despite the lack of structured data, the documentation of sexual orientation and gender identity terms is increasing in clinical notes.

Purpose Cancer research on sexual and gender minority (SGM) populations is gaining momentum. The purpose of this systematic review was to examine what is currently known in the research literature regarding patient-reported health outcomes after cancer treatment among SGM populations. Methods In March 2021, a medical librarian conducted a systematic keyword search on PubMed, Embase, Scopus, Web of Science, PsycINFO, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials. The primary inclusion criterion was assessment of at least one physical, psychosocial, emotional, or functional patient-reported health outcome related to the impacts of cancer diagnosis and/or treatment. Articles that met inclusion criteria were reviewed in their entirety, charted in a Word Table, and assessed for quality. Quality considerations included study design, sampling approach, diversity of sample, measures used, and analytic procedures. Studies were synthesized based on type of cancer study participants experienced. Results Sixty-four studies were included in the final analysis: most were quantitative, secondary analyses or cross-sectional studies with convenience samples, and focused on people with a history of breast or prostate cancer. Differences between sexual minority men and women in terms of coping and resilience were noted. Few studies reported on experiences of transgender persons and none reported on experiences of intersex persons. Conclusions A growing literature describes the patient-reported health outcomes of SGM people with a history of cancer. This study summarizes important between-group differences among SGM and heterosexual, cisgender counterparts that are critical for clinicians to consider when providing care. Implications for cancer survivors Sexual orientation and gender identity are relevant to cancer survivors’ health outcomes. Subgroups of SGM people have differential experiences and outcomes related to cancer and its impacts.

The Index of Attitudes toward Homosexuals (IAH) was published by Hudson and Ricketts in 1980 as a unidimensional index to measure affective responses to homosexuals. Siebert et al. identified two factors in a sample of predominantly female social science students: Cognitive/Social Distance (α = .91) and Affective/Attraction-Advances (α = .79). The present study sought to conduct a factor analysis to confirm the factor structure of the IAH in a national sample of oncology clinicians (n = 406). Exploratory factor analysis conducted on a random subset of 40% of survey respondents (n = 163) indicated three factors, termed: Avoidance (α = .92), Approach (α = .75) and Acceptance (α = .80). Confirmatory factor analysis conducted on the remaining 60% of respondents (n = 243) confirmed the three-factor structure (final Chi-square/DF = 1.988, RMSEA = 0.064, Bentler CFI = 0.949). Given the diversity, size, and strength of the sampling frame, future research using the IAH in clinical settings can obtain more precise findings by analyzing data according to these three factors.

The purpose of this pilot study was to test the efficacy of an online navigation training designed to improve trainee confidence in performing core patient navigation tasks among Nigerian nurses, patient advocates, and cancer survivors. The online training originally designed for US patient navigators was supplemented by a Nigerian health system interactive session. Nurses, advocates, and cancer survivors (n = 36) were recruited to take a patient navigation training from May–June 2020 that consisted of approximately 10 h of online content and a 2-h online session. Trainees enrolled in the no-cost training and completed all 20 lessons. Post-intervention interviews (n = 10) were conducted to garner feedback from trainees. Trainees reported statistically significant improvements in confidence in performing core competencies for cancer patient navigation across all lessons. Feedback was generally positive with trainees expressing satisfaction and appreciation for the training. Challenges included lack of free, broadband Internet access leading to data streaming costs on the part of trainees. Trainees who were oncology nurses indicated that funding, time, and staffing constraints could impede implementation of patient navigation in practice; but these trainees also expressed new ideas for patient support and advocacy to alleviate some barriers to care for their patients as a result of the training. This study provided preliminary data that supports the feasibility and utility of using the GW Cancer Center online patient navigation training in non-US settings. Small adaptations to training content and technological delivery could improve access to the training experience. Implementation science approaches are needed to inform sustainable patient navigation in low-resource settings.

PURPOSE OF REVIEW: Until recently, sexual and gender minority (SGM) people have been largely invisible in health care and health services research. However, understanding the needs and experiences of SGM cancer patients is critical to providing high-quality care, including needs and experiences related to sexual health. In this narrative review, we highlight that the literature on sexual health for SGM people with cancer is lacking, summarize existing literature on disparities affecting SGM patients with cancer, and discuss factors associated with these disparities. We conclude with recommendations and suggestions for future research in this area. RECENT FINDINGS: Emerging evidence suggests that SGM people are at a higher risk for breast, cervical, endometrial, HPV-related, and lung cancers, as well as poor cancer outcomes, due to behavioral risk factors and health care system factors (e.g. lower access to health care insurance, discrimination in non-affirming care settings, negative health care interactions with providers). Additional research suggests that lack of clear guidelines for cancer screening in SGM patients, particularly for transgender and gender diverse patients, negatively impacts cancer screening uptake among SGM people. A growing number of studies have suggested greater sexual challenges following cancer treatment for sexual minority men with prostate cancer, while other studies highlight positive outcomes for sexual minority women following cancer treatment, such as benefit finding and resilience. Research on transgender and gender diverse patients is lacking. SUMMARY: Collection of sexual orientation and gender identity data across clinical enterprises and population-based surveys, mandatory health care provider training on cultural and clinical competency with SGM patients, and additional research inclusive of and focused on SGM cancer patients are key strategies to advance evidence-based clinical cancer care for diverse SGM populations.

Oncology social workers rarely receive training on the health care needs of lesbian, gay, bisexual, transgender, queer, and intersex (LGBTQI) cancer patients. This study examined the efficacy of an intensive workshop that aimed to increase the knowledge, confidence, and clinical preparedness of social workers supporting LGBTQI cancer patients.A workshop consisting of didactic and interactive content was provided to an opt-in sample of social workers (Results showed statistically significant changes in two of three learning objectives (Oncology social workers can benefit from opportunities for learning specific to LGBTQI health.

Tobacco-related health disparities (TRHDs) have a significant impact on population health in the USA. Effectively preventing and controlling TRHDs among young adult populations require multiple prevention and cessation points, including within college/university contexts. This commentary addresses current campus tobacco control policies and cessation interventions for U.S. college students, with an emphasis on TRHDs and opportunities for research and research translation to reduce these disparities. This commentary is informed by literature published between 2010 and 2020 regarding (a) prevalence and impact of campus tobacco control policies; and/or (b) behavioral outcomes from cessation interventions for young adults attending colleges. Despite a doubling of college campuses adopting tobacco-free policies from 2012 to 2017, roughly two-thirds continue to operate without such policies. Few policies address alternative tobacco products (e.g., e-cigarettes, cigars/cigarillos, and hookah), and communication about and enforcement of existing policies is extremely limited. A broad range of cessation intervention strategies have targeted individuals in this age group, but with little focus on TRHDs and limited intervention dissemination. Importantly, college students representing populations at risk for TRHDs (e.g., racial/ethnic/sexual/gender minorities, low socioeconomic status) are less likely to be exposed to strong tobacco control policies or supports for cessation. There are untapped opportunities for behavioral medicine approaches to reduce TRHDs in college settings. Research findings regarding multilevel (policy, community-level, and individual-level) interventions must be translated to policy/practice in order to address tobacco use, particularly among vulnerable college student populations.

This study explored cancer survivors’ experiences with and priorities for cancer survivorship care to describe a patient-centered approach to quality survivorship care. We conducted 22 focus groups with 170 adult survivors of breast, prostate, and colorectal cancer from six cities across the country and online. We used thematic analysis to identify participants’ principles and priorities for quality survivorship care. Based on our analysis of a limited group of cancer survivors, we identified two core principles that underlie participants’ expectations for survivorship care and 11 practice priorities that reflect opportunities to improve patient-centeredness at the individual, interpersonal, and organizational levels. The principles reflect participants’ desire to be better prepared for and equipped to accept and manage their chronic care needs post-cancer treatment. The priorities reflect practices that patients, providers, and cancer centers can engage in to ensure survivors’ goals for post-treatment care are met. Results from the study suggest the need to expand conceptualization of high-quality survivorship care. The survivor principles and practice priorities identified in this study challenge the field to organize a more patient-centered survivorship care system that empowers and respects patients and provides a holistic approach to survivors’ chronic and long-term needs. Quality cancer survivorship care must reflect patients’ priorities. The findings from this study can be used to develop a patient-centered framework for survivorship care that can be used in conjunction with quality guidelines to ensure survivorship care is organized to achieve both clinical and patient-centered outcomes.

Purpose: This study examined the relationship between clinician recommendation and receipt of cancer screenings among a transgender and gender-nonconforming (TGNC) sample (n=58). Methods: Respondents self-identified as TGNC, age 40+ years, and residents of the Washington, D.C. area. Odds ratios were calculated to compare provider-recommended with received screenings. An open-text question asked for recommendations to improve screening experiences. Results: Provider recommendations were associated with screenings for breast, colorectal, prostate, lung, and anal cancer. Respondents cited interpersonal skills, affirming language, and clear information as important health care provider characteristics. Discussion: Participants reported being more likely to be screened if a provider recommended one regardless of evidence from current published guidelines. Conclusion: Gender identity, anatomy, and hormone exposure are critical elements that should be collected in future cancer screening research to build a stronger evidence base for provider recommendations based on population-level and individual-level risks of TGNC people.

Purpose This study examined whether higher levels of self-reported cultural competency training were associated with less anti-gay bias among a cancer healthcare provider sample (n = 404) recruited in January 2017. Methods A factorial analysis of variance (ANOVA) was performed to examine anti-gay bias across professional role, sex and level of cultural competency training using the Index of Attitudes on Homosexuality (IAH). Results Females, F(1, 396) = 8.861, p = 0.003, ηp2 = 0.022, and those who reported higher levels of cultural training, F(1, 396) = 6.136, p = 0.014, ηp2 = 0.015 had lower mean IAH composite scores than men or those with lower levels of training, respectively. Females reported statistically significantly lower mean scores than males for Avoidance, F(1, 396) = 14.105, p Conclusion Findings suggest that cultural competency training may moderate some aspects of anti-gay bias. Practice implications Cultural competency training may be one important strategy to improve care for sexual minority patients.

Over a decade ago, the National Academy of Medicine (NAM) recommended that states develop, implement, and evaluate plans that include consideration of survivorship care. The purpose of this study was to review comprehensive cancer control plans in the USA, specifically to identify the inclusion of cancer survivorship-focused goals and objectives and examine alignment of survivorship-focused objectives with the NAM recommendations. Plans from 50 states, 7 territories, 5 tribal organizations, and the District of Columbia were reviewed to assess inclusion of survivorship goals and objectives. One territory plan was excluded because it did not include a survivorship-focused goal or objective (final n = 62). Objectives were assigned to domains based on NAM survivorship recommendations. Plans included between 1 and 19 survivorship-related objectives. Of the 345 survivorship objectives extracted and analyzed, the most prevalent domains addressed were raising awareness, survivorship care plans, healthcare professional capacity, and models of coordinated care. Employment-related concerns, developing and implementing quality measures, and investments in research were not frequently included in objectives. Comprehensive cancer control plans represent an important strategy that may reduce the impact of cancer and its treatment. State, territorial, and tribal coalitions can use these results to systematically focus future survivorship efforts on areas relevant to their region and population. The growing number of survivors requires broad-ranging policy strategies. Future efforts are needed to assess the implementation and impact of plan strategies to improve the overall wellness of cancer survivors.

More than 5 percent of the U.S. population identifies as lesbian, gay, bisexual, transgender, queer, or intersex (LGBTQI).1-3 Inclusively termed “sexual and gender minorities,” LGBTQI people have u...

PURPOSE: Patient navigation (PN) is an increasingly recognized element of high-quality, patient-centered cancer care, yet PN in many cancer programs is absent or limited, often because of concerns of extra cost without tangible financial benefits. METHODS: Five real-world examples of PN programs are used to demonstrate that in the pure fee-for-service and the alternative payment model worlds of reimbursement, strong cases can be made to support the benefits of PN. RESULTS: In three large programs, PN resulted in increased patient retention and increased physician loyalty within the cancer programs, leading to increased revenue. In addition, in two programs, PN was associated with a reduction in unnecessary resource utilization, such as emergency department visits and hospitalizations. PN also reduces burdens on oncology providers, potentially reducing burnout, errors, and costly staff turnover. CONCLUSION: PN has resulted in improved patient outcomes and patient satisfaction and has important financial benefits for cancer programs in the fee-for-service and the alternative payment model worlds, lending support for more robust staffing of PN programs.

The purpose of this study was to provide a snapshot of U.S. oncology provider perspectives on caring for diverse patients, including self-rated awareness, comfort, skills, practices, challenges, facilitators, and barriers.An online survey was administered to a convenience sample of multidisciplinary oncology providers. Descriptive statistics and bivariate analyses were computed for Likert-style items to investigate differences by level of past diversity training. Qualitative content analysis was conducted on open-response questions.Roughly one-third (36.7%) of the 406 survey respondents reported receiving high levels of past diversity training, with statistically significant differences by training amount for self-rated skills and select awareness and practice items (p 0.05). Key challenges qualitatively described included language barriers (n = 143) and alternative health beliefs (n = 52). Knowledge and training (n = 62), interpretation services (n = 53), and staff attitudes (n = 46) were the most frequently mentioned factors affecting culturally sensitive care.Fifteen years after the publication of Unequal Treatment, the National Academies' landmark report on healthcare disparities, oncology healthcare providers have ongoing challenges caring for diverse patients and opportunities to implement recommendations from the report.Content of diversity trainings should focus on identified gaps and practical challenges. Multi-level supports are needed, including resources and training for oncology providers.

Lesbian, gay, bisexual, transgender, queer, and intersex people have unique health and health care needs that are inadequately met. An eight-hour symposium was developed at the George Washington University (GW) to better prepare health professional students and faculty to care for sexual and gender minority patients. This study compared surveyed learner knowledge, attitudes, and clinical preparedness, as well as perceived value of interprofessional learning, before and after the symposium. Learners at post-test were compared to an interprofessional group who did not attend the symposium. Results indicated statistically significant improvements for confidence in all learning objectives (

Purpose The purposes of this study are to describe oncology patient navigation (PN) program perspectives on: (1) use of information systems and processes, (2) uses of program data, and (3) desired information system characteristics. Methods We conducted multi-phase data collection to inform development of the Patient Navigation Barriers and Outcomes Tool™ (PN-BOT™), a new information management and reporting tool for oncology PN programs. Phase I was a national online survey of PN staff (n = 343) about data practices. Phase II was a pilot test of a PN-BOT™ prototype with nine PN programs. Survey results were tabulated. Qualitative analysis identified emergent themes from open-response fields from the Phase I survey and open-response survey and interview data from Phase II pilot testers. Results PN program information management practices and systems were diverse and often leveraged a patchwork of untailored platforms. Navigators used data to inform navigation tasks, service improvement, research, and reporting. Respondents desired a streamlined, integrated, affordable data system able to minimize data entry burden, meet needs of diverse stakeholders, facilitate navigation work, readily generate reports, and share information among healthcare team members. Conclusions Although oncology navigation programs explore diverse solutions, programs struggle to find health information technologies that sufficiently meet their needs. Information systems designed for oncology PN programs should perform a wide range of functions: be customizable, affordable, interoperable, and have low data entry burden. Organizations exploring solutions should invite PN input in decisions. PN-BOT™ was developed as a free Excel-based tool for PN programs responsive to reported needs.

BACKGROUND To assess the impact of COVID-19 on cancer survivors, we fielded a survey promoted via email and social media in winter 2020. Examination of the data showed suspicious patterns that warranted serious review. OBJECTIVE The aim of this paper is to review the methods used to identify and prevent fraudulent survey responses. METHODS As precautions, we included a Completely Automated Public Turing test to tell Computers and Humans Apart (CAPTCHA), a hidden question, and instructions for respondents to type a specific word. To identify likely fraudulent data, we defined a priori indicators that warranted elimination or suspicion. If a survey contained two or more suspicious indicators, the survey was eliminated. We examined differences between the retained and eliminated data sets. RESULTS Of the total responses (N=1977), nearly three-fourths (n=1408) were dropped and one-fourth (n=569) were retained after data quality checking. Comparisons of the two data sets showed statistically significant differences across almost all demographic characteristics. CONCLUSIONS Numerous precautions beyond the inclusion of a CAPTCHA are needed when fielding web-based surveys, particularly if a financial incentive is offered.

Most medical students receive inadequate preparation to care for sexual and gender minority (SGM) patients. A review of one urban medical school’s pre-clinical curriculum was conducted to assess coverage of appropriate SGM health content. Curricula that fully or partially addressed American Association of Medical Colleges (AAMC) core competencies for SGM health were categorized in an Excel spreadsheet. For partially met competencies, content that addressed the competency along with what was needed to fully address the competency were documented. AAMC SGM competencies that were not addressed at all were also noted. As a secondary source for triangulation, curricular topics were compared to SGM health content prioritized by Vanderbilt, a leader in championing inclusion of SGM content in medical curricula. Of the 30 AAMC competencies, 10 competencies were addressed, 11 were partially addressed, and 9 were not addressed. Gaps were noted in the AAMC domains of professionalism, systems-based practice, interprofessional collaboration, and personal/professional development. Among Vanderbilt topics, the George Washington University (GW) curriculum lacked content in intersex health, sexually transmitted infections (STIs) in lesbians, vaginitis in lesbians, efficacy of anal microbicides, anal Pap smears, and anal cancer risk and treatment for men who have sex with men (MSM). Despite these weaknesses, GW clocked greater than the national average at 7.5 hours of SGM content. This study provides a roadmap for curricular enhancements needed at GW as well as a prototype for other institutions to audit and improve curricular coverage on SGM health.

OBJECTIVE: Sexual and gender minority people have unique, unaddressed health care needs following prostate cancer. The research team along with a group of established subject matter experts developed a training and companion materials for health care professionals to address this need. METHODS: Post-assessment evaluation was reported in frequencies and percentages by combining results from learners who attended an original, live web-based training and learners who completed the same training on-demand via a Learning Management System. RESULTS: Learners from both the live and archived training reported that the training increased their knowledge to effectively work with sexual and gender minority prostate cancer survivors. Learners also reported gaining new resources and strategies they could apply to their work. CONCLUSION: Results indicate the training fills an educational gap for health care professionals and supports the need for additional training of health care professionals focused on the healthcare needs of SGM cancer survivors.

Purpose: Cancer research on sexual and gender minority (SGM) populations is gaining momentum. However, literature on patient-reported health outcomes for SGM people with a history of cancer is limited. The purpose of this review was to examine the nature and extent of research regarding patient-reported health outcomes after cancer treatment among SGM populations. Methods: A systematic search of key words, titles, abstracts, and/or major subjects was conducted in PubMed, Scopus, and CINAHL in September 2019 and in EMBASE in February 2020. Included studies investigated at least one physical, psychosocial, emotional, or functional patient-reported outcome related to cancer diagnosis and/or treatment. Articles that met inclusion criteria were reviewed in their entirety, charted in a Word Table, assessed for quality, and trends within and across studies were reported in addition to each study’s results. Results: Fifty-two studies were included in the final analysis; most were quantitative and focused on people with a history of breast and prostate cancer. Most studies were secondary analyses or cross-sectional studies of convenience samples, limiting generalizability. Conclusions: A growing literature describes the patient-reported health outcomes of SGM people with a history of cancer. This study summarizes important between-group differences among SGM and heterosexual, cisgender counterparts that are critical for clinicians to consider when providing care. Implications for cancer survivors: Sexual orientation and gender identity are relevant to cancer survivors’ health outcomes. Clinicians and researchers can build an evidence base to inform care improvements by collecting data on anatomy, sexual orientation, and gender identity in Electronic Health Records and population-based surveys.

Background: Lesbian, gay, bisexual, transgender, queer and intersex people comprise approximately 5% of the U.S. population, yet health care professional student education on sexual and gender minority (SGM) health is sparse. This study explored the degree to which sociodemographic factors and student affiliation with SGM people explained self-reported competence in caring for SGM patients. Methods: This study sought to define Reduced Models from an eight-variable Full Model that explained a meaningful amount (≥ 0.15) of total variance across a sample of health care professional students in terms of six criterion variables: Basic Knowledge, Attitudinal Awareness and Clinical Preparedness (subscales of the Lesbian, Gay, Bisexual, Transgender Development of Clinical Skills Scale); Attitudes Toward LGBT People Scale (ATLPS); and Beliefs and Behaviors (subscales of the Gay Affirming Practice Scale). Results: Political affiliation, religiosity, and SGM affiliation were predictor variables in half of the Reduced Models. SGM-specific health training hours were included in Reduced Models for Clinical Preparedness and affirming Behaviors. Conclusion: Sociodemographic factors, lived experiences, and amount of training in SGM-specific health matter when it comes to health care professional students’ sense of preparedness in caring for SGM patients.

In order to celebrate the accomplishments of the Centers for Disease Control and Prevention's (CDC) National Comprehensive Cancer Control Program (NCCCP), the Comprehensive Cancer Control National Partners (CCCNP) developed this Special Issue on Cancer Causes and Control. This, the third Special Issue on Comprehensive Cancer Control (CCC), is a reflection of 20 years of building successful partnerships to prevent and control cancer; planning and implementing strategic cancer control; collaborating to address national cancer prevention and control priorities; evaluating efforts; sharing successes; and, in later years, serving as a model for global cancer control planning and implementation. The CDC currently supports cancer control planning and implementation in all 50 states, the District of Columbia, eight tribes or tribal organizations, and seven Pacific Island Jurisdictions and U.S. territories through the NCCCP. CCC is an approach that brings together multi-sector partners to address the cancer burden in a community collectively by leveraging existing resources and identifying and addressing cancer related issues and needs. The Comprehensive Cancer Control National Partnership (CCCNP), a partnership of national organizations, has been committed to supporting comprehensive cancer control efforts since 1999. We summarize the efforts described in this Special Issue. We also describe opportunities and critical elements to continue the momentum for comprehensive cancer control well into the future.

PURPOSE: As of 2016, an estimated 15.5 million cancer survivors were living in the United States and the number of cancer survivors is expected to increase to 20.3 million by 2026. Numerous clinical studies have shown that comorbidities, such as obesity and diabetes, and unhealthy lifestyle choices, such as physical inactivity and heavy smoking, negatively influence overall quality of life and long-term survival of cancer survivors. Accordingly, survivorship programs seek to focus on overall wellness, including symptom management, monitoring for late effects of treatment, monitoring for recurrence, helping patients adapt healthy behaviors, and quality of life. This paper provides a broad overview of public health efforts to address the needs of cancer survivors. METHODS: To describe a range of examples of survivorship initiatives in comprehensive cancer control, we analyzed documents from comprehensive cancer control programs and coalitions and solicited detailed examples from several national partners. RESULTS: Comprehensive cancer control programs, coalitions, and partners are undertaking myriad initiatives to address cancer survivorship and building upon evidence-based interventions to promote healthy behaviors for cancer survivors across the country. CONCLUSION: A coordinated public health approach to caring for the growing population of cancer survivors can help address the long-term physical, psychosocial, and economic effects of cancer treatment on cancer survivors and their families.

There is a growing number of post-treatment cancer survivors in the USA. Cancer survivors can have a variety of care needs and health care professionals must be prepared to meet these needs. The American Cancer Society (ACS) and the George Washington University (GW) Cancer Center developed The Cancer Survivorship E-Learning Series for Primary Care Providers (E-Learning Series) to address the need for cancer survivorship training and education among health care professionals with a focus on primary care. The GW Cancer Center analyzed evaluation data from 1341 learners who voluntarily completed a module pre- and post-assessment between April 15, 2013, and December 31, 2017, to assess differences in self-rated confidence, on a five-point Likert scale, to meet learning objectives. Descriptive statistics characterize the sample and paired samples t tests were used to assess any statistically significant differences from pre to post (p

OBJECTIVES: To evaluate the online Executive Training on Navigation and Survivorship developed by the George Washington University Cancer Center, which provides guidance on building and sustaining oncology patient navigation and survivorship programs. SAMPLE AND SETTING: Volunteer sample (n=499) of U.S. healthcare professionals, including nurses, patient navigators, and others. METHODS AND VARIABLES: Learners completed questionnaires before and after each module and at the end of the training. Descriptive statistics were calculated. Paired t-tests were used to assess pre- to posttest learning confidence gains for each module. Sub-analyses were conducted for learners indicating a nursing profession. Qualitative learner feedback was summarized. RESULTS. All groups demonstrated statistically significant (p

Survivorship care plans (SCPs)—documents intended to improve care for cancer survivors who have completed active treatment—are required, yet implementation is poor. We sought to understand SCP implementation in cancer programs in the USA with the objective of identifying opportunities for improvement. We recruited cancer care providers in the USA via several cancer care networks to participate in a survey regarding SCP implementation. We used descriptive statistics to analyze the data. Three hundred ninety-five providers from diverse cancer programs in 47 states and Washington, DC responded to the survey. The timing of SCP implementation varied across and within cancer programs, with approximately 40% of respondents reporting developing SCPs more than 3 months after primary treatment or adjuvant therapy completion. Nurse navigators were responsible for 48–58% of each stage of SCP implementation. Processes that could have been automated often occurred in-person or via phone and vice versa. Respondents reported spending more than 2 h per SCP to complete all stages of implementation, of which less than a third was reimbursed by third-party payers. We identified several opportunities for improving SCP implementation, including broadening the base of responsibility, optimizing modes of communication, decreasing the time required and increasing the funding available, and limiting variation in SCP implementation across and within cancer programs. Future work should assess the influence of approaches to SCP implementation on desired outcomes.

6520 Background: Most oncology practices do not collect patients’ sexual orientation (SO) or gender identity (GI) (SOGI), prohibiting assessment of sexual and gender minority (SGM) patients’ cancer disparities and identification of such patients in cancer care or research. Studies report that 90% of SGM patients would disclose their SOGI, while 78% of clinicians believe that patients would not. Preliminary evidence indicates that SOGI disclosure improves health outcomes. Organizations, including ASCO and NIH, have called for routine SOGI data collection, but institutional barriers, e.g. lack of SOGI fields in EMRs, hinder progress. This study aimed to delineate institutional and individual-level factors related to SOGI data collection in oncology. Methods: From Oct to Nov 2020, an anonymous 54 item online survey was distributed to ASCO members via direct outreach, listservs and social media. The survey assessed whether respondents’ institutions collect SOGI data, factors related to SOGI data collection, respondents’ attitudes about SOGI data and SGM patients, and demographics. Simple and multiple logistic regression modeling determined factors associated with respondents’ reports of SOGI data collection at their institutions. Results: Nearly half of 257 respondents reported their institutions collect SO and GI data (42%, 48%, respectively); over a third reported their institutions did not collect SO or GI data (36%, 34%, respectively); and a fifth were unsure (22%, 18%, respectively). Collection of both SO and GI was associated in unadjusted models with leadership support and having resources for SOGI data collection. SO collection was also associated with type of institution, having an SGM family member, and belief that knowing SO is important for providing quality care. GI collection was associated with the respondent’s role, SO, political leaning, past SGM training, and belief that knowing GI is important for providing care. Odds ratios (OR) from adjusted models with 95% confidence intervals (CI) comparing respondents who reported SO or GI collection as “Yes” vs. “No” are reported (comparisons to “Unsure” not presented). Most respondents (79%) felt it was important to know both SO and GI to provide quality care, while 14% felt neither was important. Conclusions: Whether or not institutions collect SOGI data is related to many factors. Despite limited statistical power, the same three factors emerged as drivers of data collection: leadership support, resources and individuals’ attitudes. These are critical and possibly self-reinforcing elements for collecting SOGI data.[Table: see text]

e18520 Background: Lack of sexual orientation and gender identity (SOGI) data collection is a barrier to inclusion of sexual and gender minority (SGM) patients in oncology. ASCO, NIH, and other groups have called for collection of SOGI data and documentation of SGM health disparities as a priority for clinical care and research. However, SOGI data are not routinely collected in most cancer care settings. The purpose of this study was to examine perceived barriers and facilitators to SOGI data collection among oncology professionals and researchers. Methods: An anonymous 54-item web-based survey was distributed to ASCO members which included two opened-ended items on barriers and facilitators to SOGI data collection. The survey was also promoted on listservs (Association of Community Cancer Centers, Association of Oncology Social Workers) and social media (e.g., Twitter, LinkedIn, Facebook professional groups). Responses to the open–ended items (n = 152) were coded by three coders using content analysis and constant comparison methods. Inter-rater reliability was 0.95. Results: The majority of respondents noted individual and organizational barriers to collecting SOGI data, including Culture (no support, expressed value or awareness of need from institution); Electronic Health Record (no location for SOGI or workflow challenges); Provider Discomfort (lack of knowledge on how/why to collect SOGI data, concerns about expressed bias); Patient Discomfort (privacy concerns, mistrust, refusal); Lack of Training or Resources; and Time (insufficient time to collect). Facilitators included a need for Protocols (intake process, patient-initiated disclosure); Training (how to collect and what to do with data); Culture change (institutional and/or provider priority); and improving Community Trust (patient trust, particularly in conservative areas of the country). A few respondents were concerned about patient safety in disclosure and some respondents noted culture change would require more representation of SGM staff and “safe spaces” in oncology settings. Three respondents made negatively biased comments about SGM patients. Conclusions: Overall, specific feedback from oncology providers identified barriers to SOGI data collection and suggested facilitators to resolve them, although not all respondents expressed value for SOGI data collection. Conservative culture and lack of leadership prioritization were cultural barriers; culture change (organizational and social) was noted as a potential facilitator for SOGI data collection. While workflow challenges and lack of a place to document SOGI in the EHR were barriers, protocols for documentation and patient-led disclosure were suggested facilitators. The study supports the need for leadership, processes, structured data fields, implicit bias and cultural humility training, and reduction of stigma to respond to the ASCO and NIH call to action.

Introduction Approximately 1.4 million transgender and gender diverse (TGD) adults in the United States have unique health and health care needs, including anatomy-driven cancer screening. This study explored the general healthcare experiences of TGD people in the Washington, DC area, and cancer screening experiences in particular. Methods Twenty-one TGD people were recruited through word of mouth and Lesbian Gay Bisexual Transgender Queer (LGBTQ)-specific community events. Participant interviews were conducted and recorded via WebEx (n = 20; one interview failed to record). Interviews were transcribed using Rev.com. Two coders conducted line-by-line coding for emergent themes in NVivo 12, developed a codebook by consensus, and refined the codebook throughout the coding process. Member checking was conducted to ensure credibility of findings. Results Three major themes served as parent nodes: health-care seeking behaviors, quality care, and TGD-specific health care experiences. Within these parent nodes there were 14 child nodes and 4 grand-child nodes. Subthemes for health care seeking behaviors included coverage and costs of care, convenience, trust/mistrust of provider, and provider recommendations for screening. Subthemes for quality of care included professionalism, clinical competence in transgender care, care coordination, provider communication, and patient self-advocacy. Overall, transgender men were less satisfied with care than transgender women. Conclusions Results suggest a need for improved provider communication skills, including clear explanations of procedures and recommendations for appropriate screenings to TGD patients. Results also suggest a need for improved clinical knowledge and cultural competency. Respondents also wanted better care coordination and insurance navigation. Overall, these findings can inform health care improvements for TGD people.

The field of cancer rehabilitation and prehabilitation has grown significantly over the past decade. Advancements in early detection and treatment have resulted in a growing number of cancer survivors in the United States (US), expected to reach 26 million by 2040.(1) Health care professional graduate education is trying to catch up with anticipated clinical demand by increasing the number of cancer rehabilitation fellowship training programs and introducing rehabilitation/prehabilitation concepts earlier in training. Numerous national organizations have issued guidelines for cancer rehabilitation research and posttreatment cancer health care. As treatment modalities evolve, so too must research on side-effects and multisystem management over the continuum of care. Current research strategies address different cancer types with a broad focus on timing of interventions, cost effectiveness, efficacy of rehabilitation, and improving screening and assessment tools. A collaborative, interdisciplinary research model is paramount to deepen impact and broaden reach. Policy supports could advance cancer survivorship and rehabilitative care. Funding to advance evidence-based practices for distress screening, psychosocial support, survivorship care planning, and rehabilitation services remains critical. Current social policies and health care access protections must be expanded to best serve the growing number of cancer survivors in the US. Equitable health care access, health care experience and health care outcomes remain a critical area for research and policy supports. The cost of cancer treatment requires significant reform to ensure access to all. Rehabilitation services are elements of standards of care for many neurological, cardiovascular and orthopedic diagnoses, but currently are not standard for actual or potential dysfunctions among cancer survivors. Both the disease process and the variety of therapeutic modalities increase risks of dysfunction, impairments, poor survival, and diminished quality of life. Rehabilitation focuses on optimizing quality of life and maximizing function throughout the continuum of cancer care. Health care professionals are urged to integrate high quality interdisciplinary care to promote collaboration and dissemination of knowledge which will yield better care for cancer survivors. Prehabilitation has the potential to play key roles in reducing or eliminating many cancer-related impairments and disabilities.

Cancer causes significant death and disability globally. However, costs of more personalized cancer care continue to climb, while access to basic cancer screening and treatment is not available to much of the world. This chapter provides an overview of the status of patient-reported outcomes (PROs) in cancer clinical care and research. PROs are valuable for health care and health economic decision-making at institutional, regional, national, and international levels. PRO data should be considered along with cost and survival data when approving new therapies. PRO data can also be helpful when assessing existing treatment options for patients, particularly for drugs with minor outcome and toxicity differences. Finally, PROs can be useful in reimbursement algorithms to ensure delivery of quality cancer care in value-based financing environments. The authors advocate for reframing the concept of health value, aligning PRO measures with societal values, and broadening the definition of society to extend beyond national boundaries.

PURPOSE: Recent advances in cancer treatment have resulted in greatly improved survival, and yet many patients in the USA have not benefited due to poor access to healthcare and difficulty accessing timely care across the cancer care continuum. Recognizing these issues and the need to facilitate discussions on how to improve navigation services for patients with cancer, the National Cancer Policy Forum of the National Academies of Sciences, Engineering, and Medicine (NASEM) held a workshop entitled, “Establishing Effective Patient Navigation Programs in Oncology.” The purpose of this manuscript is to disseminate the conclusions of this workshop while providing a clinically relevant review of patient navigation in oncology. DESIGN: Narrative literature review and summary of workshop discussions RESULTS: Patient navigation has been shown to be effective at improving outcomes throughout the spectrum of cancer care. Work remains to develop consensus on scope of practice and evaluation criteria and to align payment incentives and policy. CONCLUSION: Patient navigation plays an essential role in overcoming patient- and system-level barriers to improve access to cancer care and outcomes for those most in need.

Answer questions and earn CME/CNE The American Cancer Society Head and Neck Cancer Survivorship Care Guideline was developed to assist primary care clinicians and other health practitioners with the care of head and neck cancer survivors, including monitoring for recurrence, screening for second primary cancers, assessment and management of long-term and late effects, health promotion, and care coordination. A systematic review of the literature was conducted using PubMed through April 2015, and a multidisciplinary expert workgroup with expertise in primary care, dentistry, surgical oncology, medical oncology, radiation oncology, clinical psychology, speech-language pathology, physical medicine and rehabilitation, the patient perspective, and nursing was assembled. While the guideline is based on a systematic review of the current literature, most evidence is not sufficient to warrant a strong recommendation. Therefore, recommendations should be viewed as consensus-based management strategies for assisting patients with physical and psychosocial effects of head and neck cancer and its treatment. CA Cancer J Clin 2016;66:203-239. © 2016 American Cancer Society.

Answer questions and earn CME/CNE The purpose of the American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline is to provide recommendations to assist primary care and other clinicians in the care of female adult survivors of breast cancer. A systematic review of the literature was conducted using PubMed through April 2015. A multidisciplinary expert workgroup with expertise in primary care, gynecology, surgical oncology, medical oncology, radiation oncology, and nursing was formed and tasked with drafting the Breast Cancer Survivorship Care Guideline. A total of 1073 articles met inclusion criteria; and, after full text review, 237 were included as the evidence base. Patients should undergo regular surveillance for breast cancer recurrence, including evaluation with a cancer-related history and physical examination, and should be screened for new primary breast cancer. Data do not support performing routine laboratory tests or imaging tests in asymptomatic patients to evaluate for breast cancer recurrence. Primary care clinicians should counsel patients about the importance of maintaining a healthy lifestyle, monitor for post-treatment symptoms that can adversely affect quality of life, and monitor for adherence to endocrine therapy. Recommendations provided in this guideline are based on current evidence in the literature and expert consensus opinion. Most of the evidence is not sufficient to warrant a strong evidence-based recommendation. Recommendations on surveillance for breast cancer recurrence, screening for second primary cancers, assessment and management of physical and psychosocial long-term and late effects of breast cancer and its treatment, health promotion, and care coordination/practice implications are made.

Church interventions can reduce obesity disparities by empowering participants with knowledge and skills within an established community. The purpose of this study was to evaluate the Biomedical/Obesity Reduction Trial (BMORe) and investigate changes in health beliefs among obese adult participants. Ten pre-/post-intervention focus groups applying the Health Belief Model conducted in two African-American churches in Tennessee (n = 20) and South Carolina (n = 20), and one rural Appalachian church in Kentucky (n = 21). Two independent coders using NVivo analyzed transcribed audio data and notes. Participants' health status of being overweight/obese and having comorbidities of diabetes and high blood pressure motivated enrollment in BMORe. Initially participants voiced low self-efficacy in cooking healthy and reading food labels. BMORe made participants feel "empowered" after 12 weeks compared to initially feeling "out of control" with their weight. Participants reported improvements in emotional health, quality of life, and fewer medications. During post-intervention focus groups, participants reported increased self-efficacy through family support, sharing healthy eating strategies, and having accountability partners. Solidarity and common understanding among BMORe participants led focus group attendees to comment how their peers motivated them to stay in the program for 12 weeks. Long-term barriers include keeping the weight off by maintaining habits of exercise and healthy eating. Implementation of pre-/post-intervention focus groups is an innovative approach to evaluate an obesity intervention and track how changes in health beliefs facilitated behavior change. This novel approach shows promise for behavioral interventions that rely on participant engagement for sustained effectiveness.

Colorectal cancer (CRC) is the third most common cancer and third leading cause of cancer death in both men and women and second leading cause of cancer death when men and women are combined in the United States (US). Almost two-thirds of CRC survivors are living 5 years after diagnosis. Considering the recent decline in both incidence and mortality, the prevalence of CRC survivors is likely to increase dramatically over the coming decades with the increase in rates of CRC screening, further advances in early detection and treatment and the aging and growth of the US population. Survivors are at risk for a CRC recurrence, a new primary CRC, other cancers, as well as both short-term and long-term adverse effects of the CRC and the modalities used to treat it. CRC survivors may also have psychological, reproductive, genetic, social, and employment concerns after treatment. Communication and coordination of care between the treating oncologist and the primary care clinician is critical to effectively and efficiently manage the long-term care of CRC survivors. The guidelines in this article are intended to assist primary care clinicians in delivering risk-based health care for CRC survivors who have completed active therapy.

Purpose Patient navigation has emerged as a promising strategy in reducing disparities among diverse cancer patients. However, little is known about navigators’ own perspectives on their roles in providing culturally competent care. The purpose of the present study is to describe these self-identified roles. Methods Data were collected from an online survey with a convenience sample of cancer patient navigators. Using NVivo 10, qualitative content analysis was conducted on free text responses to the question: “In your opinion, what is the role of a patient navigator or nurse navigator in the provision of culturally sensitive care to patients?” Frequencies of each navigator-identified role mentioned were tabulated. Results Of 294 respondents, 50.7% (n = 149) provided a response to the question of interest. Respondents described the following 11 interrelated navigator roles in the provision of culturally competent care: (1) assess and understand patient needs, (2) tailor care to patient, (3) build rapport/open communication, (4) facilitate communication between patient and health care team, (5) educate/provide resources to the patient, (6) advocate, (7) self-motivated learning, (8) address barriers to care, (9) involve/meet the needs of family or support people, (10) educate/support health care team, and (11) support patient empowerment in care. Conclusions Patient navigators are uniquely well-positioned to improve cultural competence of cancer care given their role as liaison to patients and providers. Cancer care settings should use navigators with direct knowledge of patient culture whenever possible; however, communication and cultural competence training is highly recommended for all navigators given the diversity of patient needs.

Background: Sexual and gender minorities experience health care access barriers, discrimination, and denial of care that result in poorer health outcomes. This is the first study to examine oncology provider anti-gay bias in a national sample in any country. Methods: U.S. cancer care professionals (n=404) were surveyed to determine whether level of cultural training had an impact on degree of anti-gay bias as measured through the Index of Attitudes on Homosexuality (IAH). Based on statistically significant independent variables, a 2x3 factorial between-groups ANOVA was conducted to examine mean differences between sex assigned at birth (male v. female) and level of cultural training (low v. medium v. high) on IAH composite and component (Avoidance, Approach, Acceptance) scores. Post-hoc tests examined all pairwise comparisons. Interaction effects were examined prior to main effects. Findings: Females reported less anti-gay bias than males as measured by IAH composite scores (F(1, 398)=25·256, p

Patient navigation has arisen quickly as a new health profession with great heterogeneity of background, training, roles, and practices. This chapter provides an overview of key tools and resources available to new and experienced navigators of various types, including core competencies, training, certificate and certification options, guides and toolkits, and evaluation support.

Building a patient navigation program is a multistep process. Most of the processes are comparable whether the program is based in a clinical or community setting. For any program to succeed, it needs planning, administrative support, adequate resources, and policies and procedures that utilize evidence-based methods. Important to the process of planning is comprehensive needs assessment, program design, identification of program champions, and ongoing quality improvement. Questions to consider and sample tools for assessment are included. An extended case example of the evolution of an American Indian patient navigation program is provided.

The cancer care system suffers from unevenly distributed resources, variability in practice, workforce constraints, and misaligned financial incentives. A quality cancer care system is equitable, patient-centered, safe, effective, and timely. Attaining this vision of quality care depends on a collaborative commitment to equity, transparency, and information sharing for ongoing quality improvement. This chapter focuses primarily on quality cancer care in the USA with implications for global expansion and attention to the navigator role in quality cancer care.

(2014). Catalyzing Patient-Centered Care: Start Where You are and Share What You Know. Oncology Issues: Vol. 29, No. 1, pp. 30-39.