Racial Background and Health Behaviors Among Adults With Cancer in Canada: Results of a National Survey

Background: This study was an assessment of the impact of racial background on health behaviors among Canadian adults with a concurrent or past history of a cancer diagnosis. Methods: The Canadian Community Health Survey datasets (2015–2018) were accessed, and adults (age ≥18 years) with cancer were reviewed. Information about the racial background, socioeconomic status, and different health behaviors was reviewed. Multivariable logistic regression analyses for factors associated with different health behaviors were conducted. Results: A total of 20,514 participants with a history of cancer were considered eligible and were included in the analysis. Compared with individuals who self-identified as White, those who self-identified as indigenous were less likely to have received an influenza vaccination in the past year (odds ratio [OR], 1.253; 95% CI, 1.084–1.448), less likely to have drunk alcohol in the past 12 months (OR, 0.641; 95% CI, 0.546–0.752), more likely to be current smokers (OR, 2.245; 95% CI, 1.917–2.630), and more likely to have used recreational drugs in the past 12 years (OR, 1.488; 95% CI, 1.076–2.057). Compared with individuals who self-identified as White, those who self-identified as non-White and nonindigenous were less likely to have received an influenza vaccination in the past year (OR, 1.207; 95% CI, 1.035–1.408), less likely to have drunk alcohol in the past 12 months (OR, 0.557; 95% CI, 0.463–0.671), and less likely to be current smokers (OR, 0.605; 95% CI, 0.476–0.769). Conclusions: Within the Canadian context, there is a considerable variability in the health behaviors of adults with cancer according to their racial background. There is a need to tailor the survivorship care planning of patients with cancer based on socioeconomic context.

Simplifying survivorship care planning: A randomized controlled trial comparing three care plan delivery approaches.

12024 Background: Survivorship care plans (“plans”) have been promoted to smooth the transition from active cancer treatment to survivorship. However, the time and resources involved in plan completion and delivery have been barriers to implementation. This randomized controlled trial aimed to identify the simplest, most effective approach for implementing survivorship care planning. Methods: Stage 1-3 breast, colorectal, and prostate cancer patients aged 21+ who were completing acute treatment were recruited from one urban-academic and one rural-community cancer center. Participants were randomized, stratified by recruitment site and cancer type, 1:1:1 to (a) mailed plan (“mail”), (b) plan delivered during one-time transition visit (“one-visit”), or (c) plan delivered during transition visit plus a 6-month follow-up visit (“two-visit”). Health service use (visits, tests/procedures, non-oral medications) was collected from participants and medical records for 18 months and compared to the plan recommendations. Logistic regression, adjusting for cancer type and recruitment site, was used to evaluate the primary outcome of adherence to recommendations for all health service use categories by intervention arm. Descriptive analyses compared care receipt for each health service use category separately (i.e., visits, tests/procedures, non-oral medications). Results: Of 378 participants randomized (n = 126 mail; n = 125 one-visit; n = 127 two-visit), 316 (84%) were analyzable for the primary outcome (n = 107 mail; n = 105 one-visit; n = 104 two-visit): 164 (52%) recruited from the urban-academic and 152 (48%) from the rural-community site; 137 (43%) breast, 112 (35%) prostate, 67 (21%) colorectal cancer; mean age 62 years. For the primary outcome, there was no difference across arms in the proportion of participants who received all plan-recommended care: 45.2% mail, 50.5% one-visit, 42.7% two-visit (p = 0.60). We did not find significant interactions by recruitment site or cancer type. There were also no differences in receipt of recommended care by category of health service use. The proportion of participants who had the recommended number of visits was 53.4% mail, 54.8% one-visit, 53.7% two-visit (p = 0.99). The proportion undergoing recommended tests/procedures was 78.8% mail, 77.2% one-visit, 73.0% two-visit (p = 0.62). The proportion receiving recommended non-oral medications was 66.7% mail, 75.0% one-visit, 73.7% two-visit (p = 0.87). Conclusions: This study found no significant difference in receipt of recommended follow-up care by plan delivery approach. Across study arms, survivors were more likely to receive recommended tests/procedures and non-oral medications but less likely to have the recommended number of visits. Feasibility and other factors may determine the best survivorship care planning approach. Clinical trial information: NCT03035773.

Implementing the Survivorship Care Plan

There are many challenges associated with ensuring quality care for cancer survivors. Cancer patients often require treatment by multiple specialists (surgeons, radiation oncologists, medical oncologists) due to the use of multimodal therapies. After treatment has ended, cancer patients may be at risk for serious long-term and late effects of their disease and treatment. Unfortunately, the oncology care system often fails to provide education and guidance to patients at the end of active cancer treatment, in contrast to the more standardized communication at the time of diagnosis and initial treatment planning. Delivering high-quality, coordinated care during the posttreatment phase is critical to ensure the best possible patient outcomes. One of the proposed first steps in accomplishing this is the widespread implementation of cancer treatment summaries and survivorship care planning, a key recommendation of the 2006 Institute of Medicine report, From Cancer Patient to Cancer Survivor: Lost in Transition. This has been embraced by a number of leading organizations, including the American Society of Clinical Oncology (ASCO) and the Commission on Cancer. Survivorship care has also become an international priority, with organizations such as the U.K. National Cancer Survivorship Initiative and Organization of European Cancer Institutes championing the importance of survivorship care. This chapter provides an overview of the development and use of treatment summaries and survivorship care planning and briefly reviews research on care plans and the health policy impact of survivorship care plans as they relate to quality improvement activities that are underway.

Catalyzing Navigation for Breast Cancer Survivorship (CaNBCS) in Safety-Net Settings: A Mixed Methods Study

Purpose The current number of breast cancer survivors (BCS) in the United States is approximately 3.8 million, and this number is further expected to increase with improvement in treatments. Survivorship care plans (SCPs) are patient-centered tools that are designed to meet cancer survivors' informational needs about their treatment history, recommended health care, and health maintenance. However, the data on SCP benefits remain uncertain, especially in low-income and racial and ethnic minority cancer survivors. Patient navigation is an effective intervention to improve patient adherence and experience of interdisciplinary breast cancer treatment. Objectives This study sought to understand the role of lay patient navigators (LPN) in survivorship care planning for BCS in safety-net settings. Methods This study is a mixed methods pilot randomized clinical trial to understand the role of patient navigation in cancer survivorship care planning in a public hospital. We invited BCS who had completed active breast cancer treatment within 5 years. LPNs discussed survivorship care planning and survivorship care-related issues with BCS in the intervention arm over a 6-month intervention period and accompanied patients to their primary care appointment. LPNs also encouraged survivors to discuss health care issues with oncology and primary care providers. The primary objective was to assess BCS’ health-related quality of life (HRQOL). The secondary objectives were self-efficacy and implementation. We assessed implementation with 45–60-min semi-structured interviews with 15 BCS recruited from the intervention arm and 60-min focus groups with the oncologists and separately with LPNs. Results We enrolled 40 patients, 20 randomized to usual care and 20 randomized to LPN navigation. We did not find a statistically significant difference between the two arms in HRQOL. There was also no difference in self-efficacy between the two arms. Qualitative analysis identified implementation barriers to intervention that may have contributed to less effective intervention. Implications for Cancer Survivors Future survivorship care planning interventions need to consider: Cancer survivors’ needs and preferences, the need for dedicated resources, and the role of electronic health records in survivorship care plan delivery.

Chronic Comorbidities Among Survivors of Adolescent and Young Adult Cancer

PURPOSE To describe the incidence, relative risk, and risk factors for chronic comorbidities in survivors of adolescent and young adult (AYA) cancer. METHODS This retrospective cohort study included 2-year survivors of AYA cancer diagnosed between age 15 and 39 years at Kaiser Permanente Southern California from 2000 to 2012. A comparison cohort without cancer was individually matched (13:1) to survivors of cancer on age, sex, and calendar year. Using electronic medical records, all participants were followed through December 31, 2014, for chronic comorbidity diagnoses. Poisson regression was used to evaluate the association between cancer survivor status and risk of developing each comorbidity. The associations between cumulative exposure to chemotherapy and radiation therapy and selected comorbidities were examined for survivors of cancer. RESULTS The cohort included 6,778 survivors of AYA cancer and 87,737 persons without a history of cancer. The incidence rate ratio (IRR) for survivors of cancer was significantly increased for nearly all comorbidities examined. IRR ranged from 1.3 (95% CI, 1.2 to 1.4) for dyslipidemia to 8.3 (95% CI, 4.6 to 14.9) for avascular necrosis. Survivors of AYA cancer had a 2- to 3-fold increased risk for cardiomyopathy, stroke, premature ovarian failure, chronic liver disease, and renal failure. Among survivors of cancer, significant associations between chemotherapy and radiation therapy exposures and late effects of cardiomyopathy, hearing loss, stroke, thyroid disorders, and diabetes were observed from the multivariable analyses. Forty percent of survivors of AYA cancer had multiple (≥ 2) comorbidities at 10 years after index date, compared with 20% of those without cancer. CONCLUSION Risk of developing comorbidities is increased in survivors of AYA cancer compared with the general population. Specific cancer treatment exposures were associated with risk of developing different comorbidities. These findings have important implications for survivorship care planning and patient education.

Prostate specific antigen testing as disease surveillance and monitoring five years after definitive therapy for localized prostate cancer.

e17602 Background: The National Comprehensive Cancer Network, in 2007, recommends prostate specific antigen (PSA) testing every 6-12 months for the first 5 years following definitive treatment for localized prostate cancer. We compared guideline-concordant PSA testing, as disease surveillance and monitoring, in African-American (AA) and Caucasian (CA) men 5-years after definitive therapy. Methods: A total of 19,377 CA and 1,995 AA men from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database diagnosed with prostate cancer and received definitive treatments from 2007 through 2016 were included. Multivariate log-binomial regression model were used to examine the effect of demographic and clinical characteristics on the likelihood of not receiving at least one PSA surveillance test annually for the first 5 years following definitive treatment. Results: Overall, receipt of surveillance testing and monitoring was high, with 97% of CA men and 94% of AA men receiving at least one test the first year after treatment and approximately 81% of CA men and 77% of AA men receiving at least one test in the fifth year after treatment. Risk of not receiving a test in AA men declined with time compared to CA men, in the first year (Relative Risk [RR], 1.68, 95% CI, 1.37-2.07) and the fifth year (RR, 1.07, 95% CI, 0.98-1.18) since treatment. Further, non-married men and men with intermediate risk had a higher risk of not receiving a surveillance test. Conclusions: Most men received guideline-concordant PSA testing 5-years after definitive therapy. The decline in PSA surveillance overtime reflects the need for continued long-term survivorship care planning and coordination. [Table: see text]