Estimated Indirect Cost Savings of Using Telehealth Among Nonelderly Patients With Cancer

Husereau D., Drummond M., Augustovski F., de Bekker-Grob E., Briggs A.H., Carswell C., Caulley L., Chaiyakunapruk N., Greenberg D., Loder E., Mauskopf J., Mullins C.D., Petrou S., Pwu R., Staniszewska S.

Health economic evaluations are comparative analyses of alternative courses of action in terms of their costs and consequences. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement, published in 2013, was created to ensure health economic evaluations are identifiable, interpretable, and useful for decision making. It was intended as guidance to help authors report accurately which health interventions were being compared and in what context, how the evaluation was undertaken, what the findings were, and other details that may aid readers and reviewers in interpretation and use of the study. The new CHEERS 2022 statement replaces the previous CHEERS reporting guidance. It reflects the need for guidance that can be more easily applied to all types of health economic evaluation, new methods and developments in the field, and the increased role of stakeholder involvement including patients and the public. It is also broadly applicable to any form of intervention intended to improve the health of individuals or the population, whether simple or complex, and without regard to context (such as healthcare, public health, education, and social care). This Explanation and Elaboration Report presents the new CHEERS 2022 28-item checklist with recommendations and explanation and examples for each item. The CHEERS 2022 statement is primarily intended for researchers reporting economic evaluations for peer-reviewed journals and the peer reviewers and editors assessing them for publication. Nevertheless, we anticipate familiarity with reporting requirements will be useful for analysts when planning studies. It may also be useful for health technology assessment bodies seeking guidance on reporting, given that there is an increasing emphasis on transparency in decision making.

Turner K., Bobonis Babilonia M., Naso C., Nguyen O., Gonzalez B.D., Oswald L.B., Robinson E., Elston Lafata J., Ferguson R.J., Alishahi Tabriz A., Patel K.B., Hallanger-Johnson J., Aldawoodi N., Hong Y., Jim H.S., et. al.

Background Rapid implementation of telehealth for cancer care during COVID-19 required innovative and adaptive solutions among oncology health care providers and professionals (HPPs). Objective The aim of this qualitative study was to explore oncology HPPs’ experiences with telehealth implementation during the COVID-19 pandemic. Methods This study was conducted at Moffitt Cancer Center (Moffitt), an NCI (National Cancer Institute)-Designated Comprehensive Cancer Center. Prior to COVID-19, Moffitt piloted telehealth visits on a limited basis. After COVID-19, Moffitt rapidly expanded telehealth visits. Telehealth visits included real-time videoconferencing between HPPs and patients and virtual check-ins (ie, brief communication with an HPP by telephone only). We conducted semistructured interviews with 40 oncology HPPs who implemented telehealth during COVID-19. The interviews were recorded, transcribed verbatim, and analyzed for themes using Dedoose software (version 4.12). Results Approximately half of the 40 participants were physicians (n=22, 55%), and one-quarter of the participants were advanced practice providers (n=10, 25%). Other participants included social workers (n=3, 8%), psychologists (n=2, 5%), dieticians (n=2, 5%), and a pharmacist (n=1, 3%). Five key themes were identified: (1) establishing and maintaining patient-HPP relationships, (2) coordinating care with other HPPs and informal caregivers, (3) adapting in-person assessments for telehealth, (4) developing workflows and allocating resources, and (5) future recommendations. Participants described innovative strategies for implementing telehealth, such as coordinating interdisciplinary visits with multiple HPPs and inviting informal caregivers (eg, spouse) to participate in telehealth visits. Health care workers discussed key challenges, such as workflow integration, lack of physical exam and biometric data, and overcoming the digital divide (eg, telehealth accessibility among patients with communication-related disabilities). Participants recommended policy advocacy to support telehealth (eg, medical licensure policies) and monitoring how telehealth affects patient outcomes and health care delivery. Conclusions To support telehealth growth, implementation strategies are needed to ensure that HPPs and patients have the tools necessary to effectively engage in telehealth. At the same time, cancer care organizations will need to engage in advocacy to ensure that policies are supportive of oncology telehealth and develop systems to monitor the impact of telehealth on patient outcomes, health care quality, costs, and equity.

Yabroff K.R., Mariotto A., Tangka F., Zhao J., Islami F., Sung H., Sherman R.L., Henley S.J., Jemal A., Ward E.M.

Abstract Background The American Cancer Society, National Cancer Institute, Centers for Disease Control and Prevention, and North American Association of Central Cancer Registries provide annual information about cancer occurrence and trends in the United States. Part 1 of this annual report focuses on national cancer statistics. This study is part 2, which quantifies patient economic burden associated with cancer care. Methods We used complementary data sources, linked Surveillance, Epidemiology, and End Results-Medicare, and the Medical Expenditure Panel Survey to develop comprehensive estimates of patient economic burden, including out-of-pocket and patient time costs, associated with cancer care. The 2000-2013 Surveillance, Epidemiology, and End Results-Medicare data were used to estimate net patient out-of-pocket costs among adults aged 65 years and older for the initial, continuing, and end-of-life phases of care for all cancer sites combined and separately for the 21 most common cancer sites. The 2008-2017 Medical Expenditure Panel Survey data were used to calculate out-of-pocket costs and time costs associated with cancer among adults aged 18-64 years and 65 years and older. Results Across all cancer sites, annualized net out-of-pocket costs for medical services and prescriptions drugs covered through a pharmacy benefit among adults aged 65 years and older were highest in the initial ($2200 and $243, respectively) and end-of-life phases ($3823 and $448, respectively) and lowest in the continuing phase ($466 and $127, respectively), with substantial variation by cancer site. Out-of-pocket costs were generally higher for patients diagnosed with later-stage disease. Net annual time costs associated with cancer were $304.3 (95% confidence interval = $257.9 to $350.9) and $279.1 (95% confidence interval = $215.1 to $343.3) for adults aged 18-64 years and ≥65 years, respectively, with higher time costs among more recently diagnosed survivors. National patient economic burden, including out-of-pocket and time costs, associated with cancer care was projected to be $21.1 billion in 2019. Conclusions This comprehensive study found that the patient economic burden associated with cancer care is substantial in the United States at the national and patient levels.

Novara G., Checcucci E., Crestani A., Abrate A., Esperto F., Pavan N., De Nunzio C., Galfano A., Giannarini G., Gregori A., Liguori G., Bartoletti R., Porpiglia F., Scarpa R.M., Simonato A., et. al.

Coronavirus disease 2019 (COVID-19) pandemic has caused increased interest in the application of telehealth to provide care without exposing patients and physicians to the risk of contagion. The urological literature on the topic is sparse.To perform a systematic review of the literature and evaluate all the available studies on urological applications of telehealth.After registration on PROSPERO, we searched PubMed and Scopus databases to collect any kind of studies evaluating any telehealth interventions in any urological conditions. The National Toxicology Program/Office of Health Assessment and Translation Risk of Bias Rating Tool for Human and Animal Studies was used to estimate the risk of bias. A narrative synthesis was performed.We identified 45 studies (11 concerning prostate cancer [PCa], three hematuria management, six urinary stones, 14 urinary incontinence [UI], five urinary tract infections [UTIs], and six other conditions), including 12 randomized controlled trials. The available literature indicates that telemedicine has been implemented successfully in several common clinical scenarios, including the decision-making process following a diagnosis of nonmetastatic PCa, follow-up care of patients with localized PCa after curative treatments, initial diagnosis of hematuria, management diagnosis and follow-up care of uncomplicated urinary stones and uncomplicated UTIs, and initial evaluation, behavioral therapies, and pelvic floor muscle training in UI patients, as well as follow-up care after surgical treatments of stress urinary incontinence or pelvic organ prolapse. The methodological quality of most of the reports was good.Telehealth has been implemented successfully in selected patients with PCa, UI, pelvic organ prolapse, uncomplicated urinary stones, and UTIs. Many urological conditions are suitable for telehealth, but more studies are needed on other highly prevalent urological malignant and benign conditions. Likely, the COVID-19 pandemic will give a significant boost to the use of telemedicine. More robust data on long-term efficacy, safety, and health economics are necessary.The diffusion of coronavirus disease 2019 (COVID-19) infections has recently increased the interest in telehealth, which is the adoption of telecommunication to deliver any health care activity. The available literature indicates that telemedicine has been adopted successfully in selected patients with several common clinical urological conditions, including prostate cancer, uncomplicated urinary stones, uncomplicated urinary infections, urinary incontinence, or pelvic organ prolapse. Likely, the COVID-19 pandemic will give a significant boost to the use of telemedicine, but more robust data on long-term efficacy, safety, and costs are necessary.

Roberts E.T., Mehrotra A.

This cross-sectional study uses data from the 2018 American Community Survey to assess disparities in digital access among Medicare beneficiaries by demographic and socioeconomic characteristics.

Lee A., Shah K., Chino F.

This cross-sectional study reports parking fees at National Cancer Institute–designated cancer treatment centers to assess parking costs for the treatment duration of certain cancers.

Wolfe M.K., McDonald N.C., Holmes G.M.

Objectives. To quantify the number of people in the US who delay medical care annually because of lack of available transportation and to examine the differential prevalence of this barrier for adults across sociodemographic characteristics and patient populations. Methods. We used data from the National Health Interview Survey (1997–2017) to examine this barrier over time and across groups. We used joinpoint regression analysis to identify significant changes in trends and multivariate analysis to examine correlates of this barrier for the year 2017. Results. In 2017, 5.8 million persons in the United States (1.8%) delayed medical care because they did not have transportation. The proportion reporting transportation barriers increased between 2003 and 2009 with no significant trends before or after this window within our study period. We found that Hispanic people, those living below the poverty threshold, Medicaid recipients, and people with a functional limitation had greater odds of reporting a transportation barrier after we controlled for other sociodemographic and health characteristics. Conclusions. Transportation barriers to health care have a disproportionate impact on individuals who are poor and who have chronic conditions. Our study documents a significant problem in access to health care during a time of rapidly changing transportation technology.

Witte J., Mehlis K., Surmann B., Lingnau R., Damm O., Greiner W., Winkler E.C.

Patients experiencing financial distress as a side-effect of cancer are not only reported in the United States, but also in third-party payer healthcare systems in Europe. Since validated survey instruments are a prerequisite for robust and comparable results, we aimed to compile and classify available instruments to enable both a better understanding of the underlying construct of financial toxicity and to facilitate further studies that are adjustable to various healthcare systems. We did a systematic literature search on studies that provide data on perceived cancer-related financial distress experienced by adult patients using PubMed, CINAHL and Web of Science databases up to 2018. We analyzed all detected instruments, items domains and questions with regard to their wording, scales and the domains of financial distress covered. Among 3298 records screened, 41 publications based on 40 studies matched our inclusion criteria. Based on the analysis of 352 different questions we identified 6 relevant subdomains that represent perceptions of and reactions to experienced financial distress: (i) active financial spending, (ii) use of passive financial resources, (iii) psychosocial responses, (iv) support seeking, (v) coping with care or (vi) coping with ones' lifestyle. We found an inconsistent coverage and use of these domains that makes it difficult to compare and quantify the prevalence of financial distress. Moreover, some existing instruments do not reflect relevant domains for patients in third-party payer systems. There is neither a consistent understanding of the construct of financial burden nor do available instruments cover all relevant aspects of a patients' distress perception. We encourage using the identified six domains to further develop survey instruments and adjust them to different health systems.

Diaz A., Schoenbrunner A., Pawlik T.M.

OBJECTIVE The aim of this study was to define trends in the geographic distribution of surgical services in the United States to assess possible geographic barriers and disparities in access to surgical care. SUMMARY BACKGROUND DATA Despite the increased need and utilization of surgical procedures, Americans often face challenges in gaining access to health care that may be exacerbated by the closure and consolidation of hospitals. Although access to surgical care has been evaluated relative to the role of insurance, race, and health literacy/education, the relationship of geography and travel distance to access has not been well studied. METHODS The 2005 and 2015 American Hospital Association annual survey was used to identify hospitals with surgical capacity; the data were merged with 2010 Census Bureau data to identify the distribution of the US population relative to hospital location, and geospatial analysis tools were used to examine a service area of real driving time surrounding each hospital. RESULTS Although the number of hospitals that provided surgical services slightly decreased over the time periods examined (2005, n = 3791; 2015, n = 3391; P

Nipp R.D., Lee H., Gorton E., Lichtenstein M., Kuchukhidze S., Park E., Chabner B.A., Moy B.

Abstract Background The financial burden experienced by patients with cancer represents a barrier to clinical trial participation, and interventions targeting patients’ financial concerns are needed. We sought to assess the impact of an equity intervention on clinical trial patients’ financial burden. Materials and Methods We developed an equity intervention to reimburse nonclinical expenses related to trials (e.g., travel and lodging). From July 2015 to July 2017, we surveyed intervention and comparison patients matched by age, sex, cancer type, specific trial, and trial phase. We longitudinally assessed financial burden (e.g., trial-related travel and lodging cost concerns, financial wellbeing [FWB] with the COmprehensive Score for financial Toxicity [COST] measure) at baseline, day 45, and day 90. We used longitudinal models to assess intervention effects over time. Results Among 260 participants, intervention patients were more likely than comparison patients to have incomes under $60,000 (52% vs. 24%, p < .001) and to report travel-related (41.0% vs. 6.8%, p < 0.001) and lodging-related (32.5% vs. 2.0%, p < .001) cost concerns at baseline. Intervention patients were more likely to report travel to appointments as their most significant financial concern (24.0% vs. 7.0%, p = .001), and they had worse FWB than comparison patients (COST score: 15.32 vs. 23.88, p < .001). Over time, intervention patients experienced greater improvements in their travel-related (−10.0% vs. +1.2%, p = .010) and lodging-related (−3.9% vs. +4.0%, p = .003) cost concerns. Improvements in patients reporting travel to appointments as their most significant financial concern and COST scores were not statistically significant. Conclusion Cancer clinical trial participants may experience substantial financial issues, and this equity intervention demonstrates encouraging results for addressing these patients’ longitudinal financial burden.

Yabroff K.R., Zhao J., Zheng Z., Rai A., Han X.

Abstract Rising costs of cancer care have led to increased concerns about medical financial hardship for cancer survivors and their families in the United States. In this commentary, we provide an overview of research describing medical financial hardship and introduce a conceptual framework for identifying risk factors and research gaps at the patient and family, provider and care team, health care system, employer, and state and national policy levels. We then use this framework to highlight measurement and data infrastructure gaps related to hardship, summarize existing interventions to minimize hardship, and identify opportunities for future intervention efforts.

Tuckson R.V., Edmunds M., Hodgkins M.L.

Sanders G.D., Neumann P.J., Basu A., Brock D.W., Feeny D., Krahn M., Kuntz K.M., Meltzer D.O., Owens D.K., Prosser L.A., Salomon J.A., Sculpher M.J., Trikalinos T.A., Russell L.B., Siegel J.E., et. al.

Since publication of the report by the Panel on Cost-Effectiveness in Health and Medicine in 1996, researchers have advanced the methods of cost-effectiveness analysis, and policy makers have experimented with its application. The need to deliver health care efficiently and the importance of using analytic techniques to understand the clinical and economic consequences of strategies to improve health have increased in recent years.To review the state of the field and provide recommendations to improve the quality of cost-effectiveness analyses. The intended audiences include researchers, government policy makers, public health officials, health care administrators, payers, businesses, clinicians, patients, and consumers.In 2012, the Second Panel on Cost-Effectiveness in Health and Medicine was formed and included 2 co-chairs, 13 members, and 3 additional members of a leadership group. These members were selected on the basis of their experience in the field to provide broad expertise in the design, conduct, and use of cost-effectiveness analyses. Over the next 3.5 years, the panel developed recommendations by consensus. These recommendations were then reviewed by invited external reviewers and through a public posting process.The concept of a "reference case" and a set of standard methodological practices that all cost-effectiveness analyses should follow to improve quality and comparability are recommended. All cost-effectiveness analyses should report 2 reference case analyses: one based on a health care sector perspective and another based on a societal perspective. The use of an "impact inventory," which is a structured table that contains consequences (both inside and outside the formal health care sector), intended to clarify the scope and boundaries of the 2 reference case analyses is also recommended. This special communication reviews these recommendations and others concerning the estimation of the consequences of interventions, the valuation of health outcomes, and the reporting of cost-effectiveness analyses.The Second Panel reviewed the current status of the field of cost-effectiveness analysis and developed a new set of recommendations. Major changes include the recommendation to perform analyses from 2 reference case perspectives and to provide an impact inventory to clarify included consequences.

Ambroggi M., Biasini C., Del Giovane C., Fornari F., Cavanna L.

Abstract The burden of travel from a patient's residence to health care providers is an important issue that can influence access to diagnosis and treatment of cancer. Although several studies have shown that the travel burden can result in delays in diagnosis and treatment of many common cancers, its role appears underestimated in the treatment of patients in clinical practice. Therefore, we performed a review of the published data on the role of travel burden influencing four items: delay of diagnosis, adequate treatment of cancer, outcome, and quality of life of cancer patients. Forty-seven studies published up to December 2014 were initially identified. Twenty studies were excluded because they did not regard specifically the four items of our review. Twenty-seven studies formed the basis of our study and involved 716,153 patients. The associations between travel burden and (a) cancer stage at diagnosis (12 studies), (b) appropriate treatment (8 studies), (c) outcome (4 studies), and (d) quality of life (1 study) are reported. In addition, in two studies, the relation between travel burden and compliance with treatment was examined. The results of our review show that increasing travel requirements are associated with more advanced disease at diagnosis, inappropriate treatment, a worse prognosis, and a worse quality of life. These results suggest that clinical oncologists should remember the specific travel burden problem for cancer patients, who often need health care services every week or every month for many years.

Yabroff K.R., Guy G.P., Ekwueme D.U., McNeel T., Rozjabek H.M., Dowling E., Li C., Virgo K.S.

Although patient time costs are recommended for inclusion in cost-effectiveness analyses, these data are not routinely collected. We used nationally representative data and a medical service-based approach to estimate the annual patient time costs among cancer survivors.We identified adult 6699 cancer survivors and 86,412 individuals without a cancer history ages 18 years or more from 2008-2011 Medical Expenditure Panel Survey (MEPS). Service use was categorized as hospitalizations, emergency room use, provider visits, ambulatory surgery, chemotherapy, and radiation therapy. Service time estimates were applied to frequencies for each service category and the US median wage rate in 2011 was used to value time. We evaluated the association between cancer survivorship and service use frequencies and patient time costs with multivariable regression models, stratified by age group (18-64 and 65+ y). Sensitivity analyses evaluated different approaches for valuing time.Cancer survivors were more likely to have hospitalizations, emergency room visits, ambulatory surgeries, and provider visits in the past year than individuals without a cancer history in adjusted analyses (P

Boddy A.

Byun M., Baek H., Kim T., Jung J., Lee H., Lee Y., Kim S., Lee W., Choi S.H., Lee S., Kim J.S.

With the rise in patients traveling worldwide for medical treatment in recent years, the importance of patient care continuum has become increasingly evident. We aimed to analyze the role of video consultations in facilitating medical care for patients traveling internationally for medical care in South Korea. In this retrospective study, data were gathered on video consultations for international medical travelers conducted between January 2021 and December 2023 at a single tertiary hospital. We analyzed information on patient demographics, the content of video consultation, and how these factors were associated with the patient’s decision to travel for treatment. A total of 16.5% of international medical travel patients who underwent video consultation subsequently traveled for treatment. Patients who engaged directly with the institution were more likely (aOR 5.74, [95% CI 1.20–27.33]) to travel for treatment compared to those who relied on domestic or international travel services. Additionally, patients who participated in follow-up video consultations were more likely (aOR 4.06, [95% CI 1.04–15.92]) to travel compared to those who underwent their first video consultation. International medical travel patients utilized video consultations for a range of medical conditions, with the likelihood of subsequent treatment travel being associated with both the medium through which consultations were initiated and prior experience with the institution.

Kass J.D., Arpey N.C., Conway D.J., Gibbs C.P., Scarborough M.T., Spiguel A.R.

Introduction: Asynchronous telemedicine has emerged as a promising tool for increasing access to care and triaging patients for evaluation in clinic. However, the role of asynchronous telemedicine in the delivery of orthopaedic oncologic care has yet to be determined. The purpose of this study was to evaluate response time for these electronic consults and characterize their triage outcomes. Methods: Two hundred sixty-eight patients whose clinical data were reviewed using asynchronous telemedicine by an orthopaedic oncologist at a tertiary academic medical center from May 2020 to August 2023 were retrospectively identified. Demographic and clinical information, response time to consult, and triage outcome were collected and reported with descriptive statistics. Response time to asynchronous consults was compared with wait time for patients referred directly for a synchronous telehealth appointment using the Mann-Whitney U test. Results: Most patients (71.6%) live more than 100 miles from the clinic. After initial asynchronous review, 131 patients (48.9%) were invited to schedule an in-person appointment, 42 (15.7%) of whom eventually underwent biopsy or surgery. Nonsurgical follow-up with repeat imaging in the future was recommended for 72 patients (26.9%). As-needed follow-up was suggested for 65 patients (24.2%). The average response time to asynchronous consult was 6.9 days (median 4.0, SD 7.9 days) compared with wait time of 17.0 days (median 13.0, SD 17.9 days) for synchronous telehealth visit (P < 0.01). Conclusion: Asynchronous telemedicine can expedite triage of orthopaedic oncology patients and reduce unnecessary in-person visits, which may be particularly beneficial for those seeking care from far distances. Additional studies are needed to assess clinical outcomes and patient satisfaction with this approach to care delivery.

Caston N.E., Deng L., Williams C.P., Levitan E.B., Azuero A., Griffin R., Smith K.L., Wolff A.C., Melisko M.E., Shinn E.H., Gallagher K., Angove R., Wheeler S.B., Rocque G.B.

PURPOSE Over the course of the COVID-19 pandemic, the Food and Drug Administration allowed cancer clinical trials to make modifications. As policymakers consider sustaining these modifications, understanding patient perspectives on impact is critical. METHODS This cross-sectional study used survey data collected between August 2021 and September 2021 by the Translational Breast Cancer Research Consortium and December 2022 by Patient Advocate Foundation among female breast cancer survivors. Respondents reported how changes to location, telemedicine, convenience, and opting out of certain procedures would affect their willingness to participate in a trial. Respondents' county-level vulnerability was determined using five-digit Federal Information Processing Standard codes to link to the Social Vulnerability Index (SVI) overall theme (range, 0-1). According to the SVI, the most vulnerable counties are those in the upper 10% of the overall theme. Model-estimated odds ratios (ORs) and 95% CIs were estimated using multinomial logistic regression models to explore the association between county-level social vulnerability and willingness to participate. RESULTS Overall, 573 women were included, 12% lived in the most vulnerable counties, and 18% had previous trial participation. Over half (53%) reported that they would be very willing to participate in a trial that offered medication delivery to the home. When compared with all other counties, respondents in most vulnerable counties did not have increased willingness to participate in a trial using telemedicine (OR, 0.21 [95% CI, 0.07 to 0.63]). Results were similar for all other trial modifications, though not statistically significant. CONCLUSION Our sample of breast cancer survivors viewed trial modifications favorably. However, respondents in the most vulnerable counties were less likely to be influenced by these modifications. Research is needed to understand if additional modifications would influence participation of this vulnerable population.

Desenzi Ciaralo P.P., Guerreiro Cardoso P.F., Minamoto H., Bibas B.J., Ribeiro de Carvalho C.R., Pego-Fernandes P.M.

Baek S., Choi J., Noh J., Jeong H.

Background/Objectives: Access to healthcare in medically underserved areas remains a significant challenge in South Korea due to the concentration of healthcare resources in metropolitan regions. Telemedicine offers a promising approach to mitigating this issue, yet its cost-effectiveness in these settings remains underexplored. This study aims to conduct a cost-minimization analysis comparing teleconsultation and in-person care for chronic diseases, dementia, and rehabilitation in medically underserved areas. Methods: In accordance with CHEERS 2022 guidelines, this study evaluates both direct and indirect costs from a societal perspective, while accounting for costs borne by various societal stakeholders. It provides evidence to guide policy decisions in regions with significant healthcare access disparities. Results: Using data from South Korea’s 2018 teleconsultation pilot program involving 1232 patients, the analysis revealed that teleconsultation reduced societal costs per consultation by USD 7.92 for chronic diseases, USD 27.30 for dementia care, and USD 9.61 for rehabilitation. These savings were primarily attributed to reductions in productivity losses and transportation expenses. Furthermore, the analysis identified a shift in financial burden from patients and caregivers to government and public expenditures. Conclusions: The findings highlight teleconsultation’s effectiveness in reducing healthcare costs while consistently benefiting diverse patient groups, underscoring the necessity of integrating telemedicine into mainstream healthcare systems to improve access and alleviate financial strain on patients and their families.

Dunn M.R., Fridman I., Kinlaw A.C., Neslund‐Dudas C., Tam S., Elston Lafata J.

ABSTRACTObjectiveTo evaluate patient‐ and area‐level factors in relation to telehealth visit use in cancer care.Study Setting and DesignWe surveyed a cohort of adults with an upcoming healthcare visit related to their cancer treatment at two academic medical centers (one in central North Carolina and one in southeast Michigan) and their community affiliates. Black adults and those with a scheduled telehealth visit were purposively oversampled during recruitment. We linked respondent residential addresses to area‐level measures, including broadband access. The two patient‐reported outcomes of interest were (1) whether a choice in visit type (virtual or in‐person) was offered and (2) scheduled visit type.Data Sources and Analytic SampleWe assembled a cohort of 773 adults (response rate = 15%). After excluding nonrecall for being offered a choice, the analytic sample was 725 adults.Principal FindingsThe sample was 46% aged < 65 years, 42% Black, and 67% women. Black respondents were less likely than non‐Black respondents to be offered a choice, 15% versus 23%, prevalence difference (PD) and 95% CI = (−8.7%, CI: −14.4, −3.0) and if offered a choice, less likely to accept a telehealth visit (20% vs. 67%; PD = −47.0%, CI: −62.0, −32.0). Compared to men, women had a lower frequency of visit choice (16% vs. 27%; PD = −10.9%. CI: −17.4, −4.4) and accepted telehealth visits (42% vs. 63%; PD = −20.8%, CI: −36.8, −4.7). Respondents who expressed technology‐related worries were less likely to accept a telehealth visit. Lower area‐level technology access (e.g., broadband ownership) and higher poverty were nonsignificantly associated with less offering and less scheduling of telehealth visits.ConclusionsInterventions to improve access to telehealth in cancer care and mitigate structural inequities (namely racism and sexism) should consider patient‐ and area‐level barriers to being offered a choice in visit type and the ability to accept a telehealth visit.

Bange E.M., Coughlin K.Q., Li W., Brown T.J., Ragusano D., Balar E., Arasappan D., Nnaji M., Kim E., Alban C., Uppuluri S., Moriarty E., Bange T., Zinck L., Smith D., et. al.

de Laffolie J.

Zegarra-López M., Aranda-Gutierrez A., Muñoz Lozano J.F., Villarreal-Garza C.

PURPOSE Limited information exists about medical oncology fellowship programs in Latin America. Our study aimed to clarify unknowns, with the goal of identifying areas for improvement and potential expansion of fellowships. MATERIALS AND METHODS Sixteen medical oncologists, each from a different Latin American country, were surveyed using an online questionnaire. Descriptive statistics were used to summarize the collected variables. RESULTS In total, 232 fellowship programs exist in the surveyed nations, of which 444 medical oncologists graduate every year. Only Argentina, Brazil, Chile, Mexico, and Peru have more than five active fellowship programs. Honduras and Nicaragua did not report any fellowship programs. These nations—along with Colombia, Ecuador, El Salvador, Guatemala, and Peru—depend on foreign education for the training of their medical oncologists. Only one of every 50 medical graduates pursues a career path in medical oncology, and a mere 2.2% of internal medicine residents transition into the field. Nearly half of the data were collected through word of mouth, as many countries lack official, publicly accessible sources for some of the variables studied. CONCLUSION This study serves as a pioneering effort that future research groups can build upon. We believe that addressing the shortage of medical oncologists in Latin America by increasing the number of locally trained fellows is the most effective way to swiftly and sustainably improve cancer outcomes.

Requier R., Demoor-Goldschmidt C., Bertrand A., Dumas A.

Smith I.D., Leverenz D.L., Bolster M.B.

Lapen K., Chino F., Noble A., Jin J.O., Levit L.A., Kirkwood K., Schenkel C., Subbiah I.M.

Burnout in oncologists has been increasing, especially after the COVID-19 pandemic. This is concerning because burnout can have both personal and professional repercussions, as well as a negative impact on patients and organizational financial health. Drawing on information and ideas discussed at an ASCO Town Hall session at the 2023 Annual Meeting developed by the State of Cancer Care in America Editorial Board, this study reviews key organizational strategies for improving professional well-being and argues for the importance of measuring and researching the well-being of the oncology workforce to ensure healthy work environments. Although both individual- and organizational-level interventions to mitigate burnout are valuable, organizational interventions have been shown to be the most effective. Thus, strategies to ensure professional wellness should focus on developing organizational policies, cultures, and best practices that create healthy work environments. Specific policies and best practices for organizations to prioritize include the following: (1) Eliminating low-value work, including processes related to electronic health record systems. (2) Restructuring teams to efficiently complete work. (3) Promoting clinician work-life integration. (4) Promoting psychological safety in the workplace to prevent workplace discrimination. (5) Identifying individual practice stressors. (6) Fostering community within the organization.

Gergelis K.R., Huston A., O’Sullivan C.C., Laack N.N., Corbin K.S.

Suresh U., Ancker J., Salmi L., Diamond L., Rosenbloom T., Steitz B.

Patient portal use among patients with cancer has increased significantly in recent years. This state-of-the-art review seeks to address and analyse literature involving patient portal use by patients with cancer and their care partners. In this review, we queried articles from PubMed published between January 2018 and April 2024 that describe recent trends and the current presence of portals in cancer care for patients, proxy users and/or care partners. We searched for articles addressing three overarching themes: (1) trends and disparities in portal adoption and use among patients with cancer, (2) use of specific portal components and functions in cancer care and (3) associations between portal use and cancer-related outcomes. Our search identified 278 unique studies, of which 82 were relevant empiric studies that met inclusion criteria and were included in this review. These papers aligned with 12 subthemes, including disparities in patient portal access, growing use of telemedicine via patient portal and patient access to immediately available to electronic health information. Our findings indicate that patient portals play an increasingly important role in helping patients manage their cancer care, despite few disparities that contribute to inequitable use. However, despite consistent growth in use over recent years, there are many areas for improvement in how portals support patients with cancer and a demand for functionality to continually evolve with patient needs.