ENRICH: Validating a multidimensional patient-reported financial toxicity measure.

153 Background: Financial toxicity is a patient-reported outcome reflecting burdens of cancer treatment costs. There is a need to assess financial toxicity in cancer care, as its unique domains—upstream factors like direct medical costs or downstream economic impact like bankruptcy—predict worse QOL, adherence, and mortality. Socioeconomically disadvantaged patients bear disparate financial toxicity burdens. We thus developed and report performance of a new measure, the Economic StraiN and Resilience in Cancer (ENRICh), to assess all financial toxicity domains in economically diverse patients. Methods: We studied 238 patients with Stage I-IV cancer from a tertiary academic comprehensive cancer center (MDA) and county safety-net hospital serving socioeconomically disadvantaged patients (LBJ). Financial toxicity domains and corresponding subscales were developed from qualitative/cognitive (n = 104) interviews. ENRICh and Comprehensive Score for Financial Toxicity (COST) questions were administered (n = 127; MDA = 71, LBJ = 56). To demonstrate known-group validity, we compared ENRICh scores between centers; for concurrent validity, we correlated ENRICh and COST; for reliability, we calculated Cronbach's coefficient α for ENRICh subscales (range 0, none, to 10, high burden). Results: There were 4 distinct, valid financial toxicity domains/subscales: 1) Burden of cost; 2) Disruption of financial stability; 3) Depletion of financial coping; 4) Depletion of instrumental coping. Patients from the 2 centers significantly differed in subscale and overall ENRICh scores. Socioeconomically disadvantaged patients had worse mean scores (4.9 vs 2.1, 95%CI -3.6,-2.1, effect size 1.4, P < .001). ENRICh significantly correlated with COST (r = -0.82, 95%CI -0.87,-0.77, P < .001). Subscales were reliable with excellent internal consistency (Cronbach α = 0.78 to 0.94). The 4 ENRICh domains collectively had synergistic impact on overall financial toxicity burden. Conclusions: ENRICh is valid, reliable, and identifies and 4 novel domains of financial toxicity. Future utility of this tool is to guide assessment/interventions targeting financial toxicity domains affecting diverse cancer patients, to mitigate disparities.

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ANALYSIS OF AN OVARIAN CANCER COHORT IN A HEALTH SYSTEM WITH A SAFETY-NET HOSPITAL AND A COMPREHENSIVE CANCER CENTER

10.26226/morressier.5770e29dd462b80290b4bfe0 ◽

2016 ◽

Author(s):

Sophia George

Keyword(s):

Ovarian Cancer ◽

Health System ◽

Safety Net ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Safety Net Hospital

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Successes with and barriers to patient-reported outcome deployment at a comprehensive cancer center.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.30_suppl.292 ◽

2018 ◽

Vol 36 (30_suppl) ◽

pp. 292-292

Author(s):

Nadine Jackson McCleary ◽

Deborah Schrag ◽

Neil E. Martin ◽

Sadiqa Mahmood ◽

Elizabeth Beyer ◽

...

Keyword(s):

Adverse Events ◽

Assessment Tool ◽

Treatment Plan ◽

Patient Reported Outcome ◽

Lessons Learned ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Patient Reported ◽

Oncology Practice ◽

Plan Modification

292 Background: Routine collection of patient reported outcomes (PROs) reduces hospitalizations and improves quality of life. In the absence of clear implementation guidelines and research guiding deployment, PROs may not have the desired impact on outcomes in routine oncology practice. We share lessons learned from PRO deployment at Dana-Farber Cancer Institute. Methods: We developed a symptom/toxicity assessment tool based on the PRO-CTCAE to capture 15 symptomatic adverse events with a 1-week recall: fatigue/ decreased appetite/insomnia/ shortness of breath/numbness and tingling/concentration, general pain/anxiety/sadness, rash, nausea/vomiting/fever, constipation, and diarrhea. Responses from eligible English-literate patients scheduled for a gastrointestinal cancer center or adult palliative care visit between January 18 to March 22, 2018 were transmitted directly from clinic tablet to the EMR. To evaluate the deployment, we sought qualitative feedback from clinic staff and three multidisciplinary working groups comprised of patients, nurses, pharmacists, operations leaders, quality/safety experts, and health services researchers to identify technical and workflow gaps in PRO Content, Implementation, and Analytics. Results: We noted a 38% response rate of the N = 4440 PROs assigned to N = 4440 scheduled visits for N = 2055 unique patients (36% were completed, 2% started but not completed); 62% were not started. Workflow enhancement requests include an updated summary view, a clinical documentation tool, a scoring algorithm to highlight severe responses, and a quality metric dashboard to evaluate the deployment. Ongoing analyses are studying the proportion of moderate-severe symptomatic adverse events reported and their association with provider action (i.e., supportive care referral, chemotherapy treatment plan modification, or unplanned ED/hospitalization in the subsequent 30 days). Conclusions: Refinement of the PRO deployment strategy is needed to guide implementation efforts and demonstrate meaningful impact in routine oncology practice.

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Patient-reported financial toxicity following management of localized prostate cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e17053 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e17053-e17053

Author(s):

Brandon S. Imber ◽

Amy L. Tin ◽

Andrew Vickers ◽

James Andrew Eastham ◽

Michael J. Zelefsky ◽

...

Keyword(s):

Prostate Cancer ◽

Decision Making ◽

Treatment Decision ◽

Additive Models ◽

Localized Prostate Cancer ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Financial Toxicity ◽

Treatment Type ◽

Patient Reported

e17053 Background: Cancer patients’ potential for severe financial toxicity (FT) is well-established, however there is limited data on the magnitude of this challenge associated with treatment of localized prostate cancer (PC). The extent to which men consider potential financial implications prior to selection of a treatment strategy remains poorly understood. Methods: Between 5/2020-10/2020, 1233 insured PC patients treated at a comprehensive cancer center completed a one-time FT survey which included the COmprehensive Score for financial Toxicity (COST) instrument, impressions of PC costs and financial coping strategies. Inclusion criteria was localized disease and treatment with either radical prostatectomy (RP) or definitive radiotherapy (RT) in the previous 4-26 months (mo) or at least 6mo of active surveillance (AS) prior to survey. To assess possible temporal differences in FT, responses were grouped into 6, 12, 18 and 24 months after treatment start, and we plotted COST against time, using generalized additive models to allow for non-linearity. Results: Overall, 988 men were eligible for analysis: 347 (35%) underwent RP, 384 (39%) underwent RT, and 257 (26%) were on AS. The median age at survey completion was 67 years (quartiles 62, 72). Men were predominantly white (89%), English-speakers (99%) and married (84%). The median (quartiles) COST score for all patients was 33 (26, 38) with possible range of 0-44 with lower scores indicating greater FT; median values were identical with similar quartiles (+/- 1 point) when stratified by treatment type. There were no significant changes in median COST between men surveyed at the four time points for any treatment subgroup. In total, 66 men (7.1%) reported spending > 20% of annual income on treatment and 10% felt that PC has created at least somewhat of a financial hardship for their family. Top drivers of burdensome cost included medical bills (37%) and transportation costs (21%). Most (83%) reported giving little or no consideration to possible costs prior to making a PC treatment decision, yet the majority (77%) felt that out of pocket costs should be communicated to a patient prior to decision making. Most believed patients should definitely (46%) or possibly (33%) have the opportunity to discuss financial concerns with the radiation oncologist or urologist. Conclusions: Our study is the first reported use of the COST instrument to assess subjective financial distress in localized PC patients. Our results demonstrate that the overall degree of FT in this cohort of insured patients treated at a specialized cancer center is low. While potential financial burden does not strongly influence treatment decision making in this cohort, most want this information and an opportunity to discuss financial concerns with their oncologist. Next steps include identification of predictors for high FT risk and extension of our survey to hospital systems with differing demographic profiles.

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Psychosocial concerns and needs of cancer survivors treated at a comprehensive cancer center and a community safety net hospital

Supportive Care in Cancer ◽

10.1007/s00520-016-3479-5 ◽

2016 ◽

Vol 25 (3) ◽

pp. 895-904 ◽

Cited By ~ 1

Author(s):

Rebecca Selove ◽

Maya Foster ◽

Debra Wujcik ◽

Maureen Sanderson ◽

Pamela C. Hull ◽

...

Keyword(s):

Cancer Survivors ◽

Safety Net ◽

Community Safety ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Psychosocial Concerns ◽

Safety Net Hospital

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Inclusion of spiritual pain in patient reported outcome assessments as part of an integrative medicine physician consultation.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.31_suppl.190 ◽

2017 ◽

Vol 35 (31_suppl) ◽

pp. 190-190

Author(s):

Gabriel Lopez ◽

Wenli Liu ◽

Minxing Chen ◽

Yisheng Li ◽

Alejandro Chaoul ◽

...

Keyword(s):

Integrative Medicine ◽

Psychological Health ◽

Psychological Needs ◽

Physical Symptoms ◽

Patient Reported Outcome ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Medicine Physician ◽

Patient Reported ◽

Edmonton Symptom Assessment Scale

190 Background: Complementary and integrative health services are increasingly available to patients at cancer centers to help address physical and psychological needs. We review inclusion of spiritual pain (SP) as part of patient reported outcome (PRO) assessments in patients presenting for an outpatient integrative medicine consultation at a comprehensive cancer center. Methods: PRO data were collected as part of outpatient physician consultations at an integrative medicine clinic; we reviewed data between January 2013 and April 2017. Patients completed the Edmonton Symptom Assessment Scale (ESAS-FS, 12 symptoms, scale 0-10, 10 worst possible) immediately prior to the clinical encounter. ESAS distress subscales analyzed included psychological, physical, and global. Statistical analyses included summary statistics, two sample t-tests, correlations, and logistic regression. Results: We analyzed data from 4348 unique participants. Demographics included 65% women, average age 55.5, 78% Caucasian, 72% married or with significant other, majority Christian non-Catholic (49%) followed by non-specified (23%), and Catholic (20%). Overall, 41% of patients reported SP at baseline. Patients reporting a SP score of ≥ 1 (n = 1549) reported significantly higher levels of global, physical, and psychological distress than patients with SP scores of 0 (n = 2275) (all p’s < 0.001). Older patients and men were less likely to report SP. SP clustered with psychological symptoms of depression and anxiety (reliability coefficient 0.76). Conclusions: A significant number of cancer patients presenting for integrative medicine consultations reported having SP, with SP clustering with psychological versus physical symptoms. More research is needed to better understand how routine screening for SP contributes to assessments of overall psychological health.

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Enhancing Patient-Provider Communication With the Electronic Self-Report Assessment for Cancer: A Randomized Trial

Journal of Clinical Oncology ◽

10.1200/jco.2010.30.3909 ◽

2011 ◽

Vol 29 (8) ◽

pp. 1029-1035 ◽

Cited By ~ 204

Author(s):

Donna L. Berry ◽

Brent A. Blumenstein ◽

Barbara Halpenny ◽

Seth Wolpin ◽

Jesse R. Fann ◽

...

Keyword(s):

Controlled Trial ◽

Clinic Visit ◽

Self Report ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Control Group ◽

Cancer Symptoms ◽

Patient Reported ◽

Life Issues ◽

Clinic Visits

Purpose Although patient-reported cancer symptoms and quality-of-life issues (SQLIs) have been promoted as essential to a comprehensive assessment, efficient and efficacious methods have not been widely tested in clinical settings. The purpose of this trial was to determine the effect of the Electronic Self-Report Assessment–Cancer (ESRA-C) on the likelihood of SQLIs discussed between clinicians and patients with cancer in ambulatory clinic visits. Secondary objectives included comparison of visit duration between groups and usefulness of the ESRA-C as reported by clinicians. Patients and Methods This randomized controlled trial was conducted in 660 patients with various cancer diagnoses and stages at two institutions of a comprehensive cancer center. Patient-reported SQLIs were automatically displayed on a graphical summary and provided to the clinical team before an on-treatment visit (n = 327); in the control group, no summary was provided (n = 333). SQLIs were scored for level of severity or distress. One on-treatment clinic visit was audio recorded for each participant and then scored for discussion of each SQLI. We hypothesized that problematic SQLIs would be discussed more often when the intervention was delivered to the clinicians. Results The likelihood of SQLIs being discussed differed by randomized group and depended on whether an SQLI was first reported as problematic (P = .032). Clinic visits were similar with regard to duration between groups, and clinicians reported the summary as useful. Conclusion The ESRA-C is the first electronic self-report application to increase discussion of SQLIs in a US randomized clinical trial.

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Changes in fatigue, barriers, and predictors towards physical activity in advanced cancer patients over a period of 12 months—a comparative study

Supportive Care in Cancer ◽

10.1007/s00520-021-06020-3 ◽

2021 ◽

Author(s):

J. Frikkel ◽

M. Beckmann ◽

N. De Lazzari ◽

M. Götte ◽

S. Kasper ◽

...

Keyword(s):

Physical Activity ◽

Cancer Patients ◽

Advanced Cancer ◽

Physical Functioning ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Advanced Cancer Patients ◽

Psychological Conditions ◽

Patient Reported

Abstract Purpose Physical activity (PA) is recommended to improve advanced cancer patients’ (ACP) physical functioning, fatigue, and quality of life. Yet, little is known about ACPs’ attitude towards PA and its influence on fatigue and depressiveness over a longer period. This prospective, non-interventional cohort study examined ACPs’ fatigue, depression, motivation, and barriers towards PA before and after 12 months of treatment among ACP Methods Outpatients with incurable cancer receiving treatment at a German Comprehensive Cancer Center reporting moderate/severe weakness/tiredness during self-assessment via MIDOS II were enrolled. Fatigue (FACT-F), depression (PHQ-8), cancer-related parameters, self-assessed PA behavior, motivation for and barriers against PA were evaluated (T0). Follow-up data was acquired after 12 months (T1) using the same questionnaire. Results At follow-up, fatigue (p=0.017) and depressiveness (p=0.015) had increased in clinical relevant extent. Physically active ACP did not show significant progress of FACT-F (p=0.836) or PHQ-8 (p=0.799). Patient-reported barriers towards PA remained stable. Logistic regression analyses identified motivation as a positive predictor for PA at both time points (T0, β=2.152, p=0.017; T1, β =2.264, p=0.009). Clinically relevant depression was a negative predictor for PA at T0 and T1 (T0, β=−3.187, p=0.044; T1, β=−3.521, p=0.041). Conclusion Our findings emphasize the importance of psychological conditions in physical activity behavior of ACP. Since psychological conditions seem to worsen over time, early integration of treatment is necessary. By combining therapy approaches of cognitive behavioral therapy and exercise in interdisciplinary care programs, the two treatment options might reinforce each other and sustainably improve ACPs’ fatigue, physical functioning, and QoL. Trial registration German Register of Clinical Trials, DRKS00012514, registration date: 30.05.2017

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Integrative Oncology Physician Consultations at a Comprehensive Cancer Center: Analysis of Demographic, Clinical and Patient Reported Outcomes

Journal of Cancer ◽

10.7150/jca.17506 ◽

2017 ◽

Vol 8 (3) ◽

pp. 395-402 ◽

Cited By ~ 14

Author(s):

Gabriel Lopez ◽

Jennifer McQuade ◽

Lorenzo Cohen ◽

Jane T Williams ◽

Amy R Spelman ◽

...

Keyword(s):

Patient Reported Outcomes ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Integrative Oncology ◽

Patient Reported

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Chronic Myeloid Leukemia: What Every Practitioner Needs to Know in 2017

American Society of Clinical Oncology Educational Book ◽

10.1200/edbk_175712 ◽

2017 ◽

pp. 468-479

Author(s):

Hanna Jean Khoury ◽

Loretta A. Williams ◽

Ehab Atallah ◽

Rüdiger Hehlmann

Keyword(s):

Chronic Myeloid Leukemia ◽

Myeloid Leukemia ◽

Kinase Inhibitors ◽

Quantitative Polymerase Chain Reaction ◽

Chronic Phase ◽

Safety Net ◽

Patient Reported Outcome ◽

Patient Reported ◽

Treatment Free Remission ◽

Pro Tools

The prognosis of chronic phase chronic myeloid leukemia (CML) has improved so that life expectancy for patients responding to tyrosine kinase inhibitors (TKIs) is now equivalent to age-matched controls. Attention should be paid to comorbidities that impact survival. The success of TKI therapy can be easily and reliably assessed at well-accepted time points using quantitative polymerase chain reaction (PCR) standardized to the international scale. Patient-reported outcome (PRO) tools are readily available for use in the clinic and provide complementary information on the tolerance of TKIs. Effectively managing adverse events of TKIs can improve compliance and quality of life. Discontinuation of TKIs is the next frontier in CML. In select patients with sustained deep molecular remission, a discontinuation of TKI is associated with a durable treatment-free remission in approximately 50%. Patient engagement in their discontinuation can be achieved through a provider multi-team coaching, is complementary to the available guidelines, and may provide an additional safety net so that these discontinuations remain safe when applied in general practices.

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