Exercise improves outcomes for patients with cancer, yet implementation of exercise counseling and referral in oncology care remains inconsistent in Latin America. This study evaluated current practices, barriers, promoters, and provider/practice factors influencing exercise counseling. We conducted a cross-sectional survey in Spanish and Portuguese among oncology physicians in Latin America (December 2024-February 2025). Eligible participants included medical, surgical, radiation oncologists, and palliative care specialists providing direct patient care. A culturally adapted questionnaire assessed practices, barriers, promoters, and demographics. Analyses included descriptive statistics, Chi-square tests, and regression to examine predictors of counseling behaviors. A total of 454 physicians completed the survey (response rate: 29.5%). Although 62.5% routinely assessed physical activity, only 26.4% did so at every visit. Half regularly recommended exercise (50.7%), and 27.1% never referred patients to exercise programs. Barriers included patient factors (eg, fatigue, side effects, low motivation), provider insecurity/lack of knowledge (65.9%), and cultural norms favoring rest (76.7%). Promoters included prior training, personal exercise experience, and institutional support. Medical oncologists and hospital-based providers were more likely to assess, recommend, and refer (all P < .01). Regression showed prior training strongly predicted counseling behaviors (P < .001), while years in practice was negatively associated. Despite awareness of exercise benefits, counseling and referral remain suboptimal in Latin America. Barriers include structural, knowledge, and cultural factors, while provider training and institutional support improve practices. These findings support the need for targeted educational, system investments, and culturally adapted guidelines to enhance exercise integration in cancer care.
Biomarker testing, including immunohistochemistry (IHC) and next-generation sequencing, is the standard of care in advanced non-small cell lung cancer (NSCLC) for identifying actionable mutations such as EGFR, ALK, and KRAS. However, the rate of effective testing, defined as the availability of actionable results before treatment initiation, has not been examined in a US community oncology setting in a more contemporary patient sample. This study quantified effective testing rates and patient factors associated with testing. This retrospective study included patients with stage IIIB/IIIC/IV NSCLC treated within ONCare Alliance, a network of 30 US community oncology practices. Data collection consisted of patient demographics, disease characteristics, biomarker testing details (order date, test type, assays), and result availability at diagnosis and at the start of systemic therapy. Among 306 patients (median age 69 years; 51% female; 69.3% adenocarcinoma), 239 (78.1%) received systemic therapy. Overall biomarker testing rates were 93.1% (95% CI, 89.7 to 95.7) for all patients and 95.8% (95% CI, 92.4 to 98.0) for those treated systemically. Effective testing was significantly lower at 72.0% (95% CI, 65.8 to 77.6). Patients with adenocarcinoma (odds ratio [OR], 3.66 [95% CI, 1.41 to 9.5]; P = .008) or those scheduled to receive systemic therapy (OR, 4.00 [95% CI, 1.58 to 10.2]; P = .003) were more likely to undergo biomarker testing. Only 39.5% (95% CI, 34.0 to 45.3) was tested for all 13 National Comprehensive Cancer Network-recommended biomarkers. Although overall testing rates were high, more than 20% of patients lacked timely results to guide initial therapy. This critical gap may limit access to biomarker-directed treatment and highlights the need for streamlined diagnostic workflows and faster turnaround times to ensure optimal, evidence-based care in community oncology.
Regulatory approval of B-cell maturation antigen (BCMA)-CD3 bispecific antibodies (BsAbs) has revolutionized the treatment of patients with heavily pretreated relapsed or refractory multiple myeloma. Label-recommended premedications and step-up dose (SUD) regimens are used to mitigate the incidence and severity of serious adverse events such as cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome. Hospitalization of patients during the SUD regimen is also recommended by the manufacturers to facilitate the rapid therapeutic management of adverse events that may arise. Administering these therapies in an inpatient hospital setting increases the costs of delivering care, creates patient inconvenience, and most importantly, reduces overall access to this class of medication. Thus, the practice of administering BCMA-directed BsAb SUD regimens in an outpatient (OP) setting is being slowly adopted at some community practice sites; however, the development of robust OP administration models for these therapies requires more data on the feasibility and safety of doing so. Herein, we describe the OP BsAb program developed at our independent community oncology practice, New England Cancer Specialists (NECS). The program was designed with the intent to reduce health care resource utilization, improve patient experience, and expand treatment access for patients living in remote or underserved areas while preserving a coordinated care model. We outline the operational infrastructure and workflow implemented at NECS to administer BCMA-directed BsAb therapy in an OP setting to patients drawn from a vast rural geography. Finally, based on our clinical experiences, we discuss the potential to expand OP administration programs to BsAb therapies for other malignancies.
Artificial intelligence (AI) has been rapidly evolving in medicine. While there are existing data about the perceptions and concerns of health care workers regarding AI, those of the hematology and oncology (HemOnc) workforce remain unknown. We assessed opinions of physicians (faculty and fellows), advanced practice providers (APPs), and nurses in HemOnc on integrating AI in medical education (MedEd) and clinical practice (CP). Group-specific electronic surveys were developed. The HemOnc workforce from the three Mayo Clinic sites was invited to participate. Participation was anonymous, with data collection between November 7, 2024, and January 20, 2025. Results were reported as proportions, with 95% binomial CI when appropriate. A total of 344 participants responded, 118 physicians (77 faculty, 41 fellows), 49 APPs, and 177 nurses. Most had used AI although less than half felt very or moderately knowledgeable about it. A total of 95% of fellows, 97% of faculty physicians, 96% of APP, and 92% of nurses believe that AI will be integrated in MedEd. A total of 94% of physicians and 88% of nonphysicians believe that this integration would be beneficial. In CP, 98% of fellows, 96% of faculty physicians, 100% of APPs, and 92% of nurses believe in AI's integration. However, 51% of physicians and 68% of nonphysicians had some concerns, including technology time, medical costs, and burnout. Nonetheless, 85% of fellows, 94% of faculty physicians, 98% of APPs, and 86% of nurses would embrace AI. The majority of this single health system HemOnc's workforce endorsed AI integration into MedEd and CP but highlighted relevant concerns. Proper education, effective partnership among all stakeholders, and well-organized integration are essential for optimizing AI's incorporation into HemOnc's MedEd and CP and ensuring that it fully supports the mission of providing high-quality patient care.
Measuring clinical practice guideline (CPG)-consistent care through electronic health record (EHR) queries provides a scalable and efficient approach to evaluating quality of care. Template care pathways are used to operationalize CPGs. Goals were to (1) identify care pathway actions for supportive care in pediatric oncology that are amenable to EHR-based evaluation, (2) prioritize five care pathway actions for further assessment, (3) develop EHR queries to identify patients who received care pathway-consistent care, and (4) describe the proportion of pediatric patients with cancer who received care pathway-consistent care. Within established template care pathways for pediatric cancer supportive care, we identified actions amenable to measurement using structured EHR data. Prioritization was performed by six pediatric oncology clinicians, resulting in five care pathway actions for further evaluation. We created EHR-based queries for each action at one site and applied them to a second site. Once queries were validated at both sites, we described care pathway-consistent care. The five high-value care pathway actions focused on (1) management of highly emetogenic chemotherapy, (2) chest computed tomography for prolonged fever and neutropenia investigation, (3) antifungal prophylaxis in AML, (4) treatment of Clostridioides difficile infection, and (5) cisplatin ototoxicity prevention. Queries created at one institution were successfully executed at the second institution. Care pathway-consistent proportions ranged from 16% for sodium thiosulfate administration in patients with nonmetastatic hepatoblastoma to 91% for antifungal prophylaxis in patients with AML. We successfully used the EHR to benchmark care pathway-consistent care. The prevalence of care pathway-consistent care was variable and low for some actions.
Spiritual care is recognized by the WHO and consensus frameworks as integral to whole-person oncology care, yet its integration into practice remains limited. Global data on clinician beliefs, practices, and barriers are limited. The aim was to characterize oncology and palliative care clinicians' attitudes, practices, and barriers regarding spiritual care and to examine variation by characteristics such as role, region, age, sex, years of experience, setting, and place of clinical practice. This was an international cross-sectional online survey (December 23, 2024-February 7, 2025) disseminated through oncology, hematology, and palliative care societies across 55 countries. Eligible participants were health care professionals involved in cancer care (N = 670). Attitudes toward spiritual care, perceived role, frequency of screening and history-taking, preparedness and training, and barriers were examined. Logistic regression models examined associations by discipline and region. Among 670 respondents (mean age, 47.8 years; 432 [64%] women), 380 (57%) practiced in Europe, and 228 (34%) in North America. Most endorsed spiritual care as essential (587 [90%]) and agreed that spiritual distress impairs outcomes (599 [92%]). Yet, only 87 (13%) always conducted screening and 56 (9%) always took a history. Nearly half of oncologists never did either. Compared with palliative care physicians, oncologists had lower odds of endorsing spiritual care as their role (adjusted odds ratio [aOR], 0.27 [95% CI, 0.12 to 0.59]) and performing screening (aOR, 0.44 [95% CI, 0.21 to 0.95]). Training preparedness was lowest among oncologists (mean, 2.7/10) although 86% sought further training. Key barriers were the lack of time (49%) and role ambiguity (46%). Clinicians worldwide affirm the importance of spiritual care, yet systematic provision is limited. Embedding role-appropriate competencies and integrating screening into routine workflows are needed to advance whole-person cancer care.
Limited access to high-speed internet (broadband [BB]) may pose challenges to video telehealth visit (VTV) utilization. This study explored barriers, facilitators, and attitudes toward VTV adoption in patients with cancer residing in low-BB settings. We examined a cohort of patients with cancer receiving longitudinal care at Mayo Clinic Cancer Practice in the Upper Midwest. Eligible patients had ≥6 in-person visits during July 2020-October 2022, received oncology care at Mayo Clinic sites, were alive at sampling, and resided in low-BB areas defined by Federal Communications Commission data as 0 or 1 internet service provider offering <25 Mbps. We enrolled 24 participants stratified into two groups: (1) Transitioned users (TUs): adopted VTVs postpandemic (November 2022-December 2023); (2) persistent nonusers (PNUs): received exclusively in-person visits. Semistructured telephone interviews were conducted in June 2024 and thematically analyzed. The average age of participants was 71.3 years (range, 42-88), 50% was female, and all identified as White. Three themes emerged: (1) Structural and clinical constraints-physical examinations, laboratory testing, and chemotherapy administration were viewed as requiring in-person care, whereas VTVs were perceived acceptable for routine follow-ups; (2) Skills and experience-digital literacy was generally adequate, but confidence and direct exposure to VTV distinguished TU from PNU; (3) Motivations-both groups preferred in-person care for cancer-related emotional reassurance. TU cited weather, travel burden, and proactive provider offering as adoption triggers, whereas PNU reported that VTV was rarely offered. TU focused on system-level solutions, whereas PNUs preferred individual-level resources. Differential VTV adoption in low-BB settings reflected exposure, provider offering, and situational necessity rather than BB access alone. Oncology practices should consider normalizing the hybrid care model combining in-person and video appointment visits and provide tailored supports to advance equitable telemedicine. Expanding video care in oncology requires more than digital access and depends on patient experience, care context, and human connection inherent in oncology care.
Clinical research coordinators (CRCs) are essential for the conduct of oncology clinical trials. They work under demanding conditions and face unique emotional stressors that may lead to burnout and high turnover. Yet, little research has examined factors influencing burnout in this population. We used validated, structured questionnaires to investigate personal factors associated with burnout among oncology CRCs in Israel. Specifically, we tested a moderated mediation model linking job engagement and role overload to burnout via job satisfaction, with empathy as a moderator. An online survey was completed by 140 CRCs; after excluding cases with excessive missing data, 121 responses were analyzed. In bivariate analyses, job engagement was positively correlated with job satisfaction (r = 0.56, P < .001), role overload was negatively correlated with job satisfaction (r = -0.29, P < .05), and job satisfaction was negatively correlated with burnout (r = -0.58, P < .001). Empathy showed moderate, significant correlations with job engagement and job satisfaction. In the integrative moderated mediation model, higher empathy strengthened the indirect effects of both role overload and job engagement on burnout via job satisfaction (job engagement → job satisfaction → burnout: indirect effect at low empathy = -0.46 [95% CI, -0.77 to -0.18], moderate = -0.66 [-0.95 to -0.41], high = -0.83 [-1.24 to -0.46]; role overload → job satisfaction → burnout: indirect effect at low = 0.15 [0.06 to .26], moderate = 0.22 [0.12 to 0.33], high = 0.27 [0.13 to 0.43]). Findings are discussed in the context of the Conservation of Resources theory. This study adds to the literature on CRC burnout by highlighting empathy's moderating role and its potential implications for CRC workforce well-being, retention, and organizational practices (eg, incorporating empathy screening into recruitment, training to enhance empathic skills, and interventions to increase job engagement and reduce role overload).
The traditional combined hematology and oncology fellowship model is increasingly strained by accelerating subspecialization and therapeutic complexity. This commentary focuses on structural reforms within fellowship training to better align education with contemporary clinical practice and evolving workforce demands. We propose standardized, career-aligned tracks, earlier subspecialty focus within fellowship, and redesigned continuity clinic models that preserve foundational breadth while enabling depth of expertise. We further highlight how emerging assessment reforms and educational tools can support these structural changes. By aligning fellowship training with both real-world clinical demands and established educational science, we can ensure a more sustainable and effective pathway for preparing future hematologists and oncologists.
Despite strong evidence and guidelines supporting prophylactic anticoagulation for ambulatory patients with cancer starting systemic cancer-directed therapy who are at high risk of venous thromboembolism (VTE), uptake in practice is limited. We evaluated the real-world impact of prophylactic anticoagulation in such patients receiving guideline-based care. We conducted an observational cohort study of patients assessed as part of a multidisciplinary VTE prevention program (the Vermont model) from 2016 to 2021. For this study, we included outpatients at high risk of VTE based on a Khorana risk score or Protecht risk score of ≥3. Based on the individualized decision making, patients either received or did not receive prophylactic anticoagulation. The primary outcome was VTE at 6 months after risk assessment. The secondary outcome was all-cause mortality at 6 months. Of 573 high-risk patients assessed during the study period, 340 (59%) received thromboprophylaxis and 233 (41%) did not. Eleven (3.2%) on thromboprophylaxis developed a VTE within 6 months, compared with 18 (7.7%) not on thromboprophylaxis. After adjusting for age, sex, BMI, cancer stage, chemotherapy, immunotherapy, distance from center, and history of VTE, thromboprophylaxis reduced VTE (adjusted odds ratio [OR], 0.36 [95% CI, 0.16 to 0.80]) compared with no thromboprophylaxis. Of deaths within 6 months, 57 (16.8%) occurred in the thromboprophylaxis group versus 73 (31.3%) in the no thromboprophylaxis group (adjusted OR, 0.46 [95% CI, 0.30 to 0.71]). Ambulatory patients with cancer at high risk of VTE who received prophylactic anticoagulation had improved clinical outcomes with fewer VTE events and less mortality. Our real-world data support available clinical trial data and underscore the importance of the provision of guideline-directed care in the cancer outpatient setting.
Phase II trials are intended to identify promising treatment paradigms for definitive phase III testing, but how effectively they serve this role in radiation oncology is unknown. We evaluated whether phase II cooperative group studies of radiation therapy function as effective gateways to phase III testing and identified factors associated with downstream progression. Using ClinicalTrials.gov, we identified completed phase II radiation therapy trials conducted through the National Clinical Trials Network cooperative groups. We assessed whether trials met their prespecified primary end point and whether successful trials progressed to phase III evaluation. Logistic regression evaluated associations between trial characteristics and phase III transition. Decision concordance between phase II outcomes and subsequent development decisions was examined. Among 92 completed phase II trials (2003-2019), 54% met their primary end point, yet only 17% progressed to phase III testing. Among trials that met their end point, fewer than one third advanced, with 71% representing discordant successes (positive phase II trial without phase III progression). Toxicity-based end points most frequently met phase II criteria (67%) but were least likely to translate to phase III (8% of successful trials). Larger enrollment number (odds ratio [OR], 1.68 per 50 patients [95% CI, 1.21 to 2.31]) and longer duration (OR, 1.20 per year [95% CI, 1.00 to 1.44]) were associated with phase III transition. Trials that advanced to phase III were not completed more rapidly (median duration 132 v 108 months). Most phase II radiation oncology trials that meet prespecified end points do not progress to definitive phase III testing. This phenomenon appears driven less by statistical futility than by structural and decisional barriers. Greater prespecification of advancement intent and selection of decision-relevant end points may improve the efficiency and impact of radiotherapy cooperative group trials.
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To understand from patients, care partners (P/CPs), and physicians the ideal timing of specialty palliative care (SPC) involvement. Using a framework of phenomenology and care ethics, we analyzed interviews through a thematic analysis approach. Two investigators independently coded transcripts of recorded interviews. P/CPs were recruited from a single hospital clinic from multiple different oncologists. Physicians were recruited via purposeful snowball sampling based on their knowledge and expertise. Thirty-one participants were recruited: 14 (45%) P/CPs and 17 (55%) clinicians. The mean age of P/CP was 49 years, whereas clinicians' mean age was 44 years. Half of P/CPs were female, and a similar portion of clinicians (53%) were female. More than half of patients had gliomas (57%), and all clinicians were physicians who had practiced neuro-oncology for a mean of 12 years. We identified four themes: (1) Participants felt patients would have benefited from earlier SPC, but there were slight differences in timing based on brain tumor type and grade; (2) neuro-oncology patients have unique supportive care needs compared to other cancers; (3) specialty knowledge of neuro-oncology is important to P/CP for advance care planning, prognostication, and anticipatory guidance; and (4) the broadly intensive role played by care partners in neuro-oncology means they have equally heavy supportive needs. This is one of the first studies to explore timing of SPC for patients with CNS tumors. P/CPs and clinicians agreed that early, time-based SPC is beneficial for management of high-grade tumors. Increasing knowledge of neuro-oncology among SPC clinicians working with this population is an area for further study.
Approximately three quarters of patients with sarcoma report financial toxicity, defined as the psychosocial and economic burden of cancer care. The Comprehensive Score for Financial Toxicity (COST) is a screening questionnaire validated in patients with cancer. However, its use is not widespread in sarcoma care, likely in part due to its complexity. This study aimed to characterize financial toxicity in patients with sarcoma and evaluate whether shorter screening tools can identify high-risk patients. We conducted a survey and retrospective cohort study of patients treated for sarcoma at a large, academic sarcoma center in 2016-2024. Patients completed the COST questionnaire (11 graded questions, each scored on a five-point Likert scale from 0 to 4) and the shorter, four-question Worry about Affording Healthcare Scale (WAHS). We obtained clinical information from the electronic health record. We used descriptive statistics to summarize responses to COST, Pearson's correlation coefficient to assess the association between WAHS and COST, and stepwise Spearman correlations to evaluate whether an abbreviated (1-4 question) version of COST correlated highly with total COST score. Among 205 participants, the mean COST score was 20/44 (standard deviation = 6; lower scores indicate greater financial toxicity). Respondents worried most about job loss (mean COST: 0.99) and family finances (mean COST: 1.11). WAHS was weakly correlated with COST (r = 0.47, P < .01). A four-item abbreviated COST tool was strongly correlated with the total COST (ρ = 0.906, P < .0001) and demonstrated high sensitivity (96%) and moderate specificity (75%). An abbreviated four-item COST tool could act as a clinically feasible, accurate screening tool after external validation. Routine financial toxicity screening could facilitate timely detection and referral to essential financial navigation resources.
Noncommunicable diseases disproportionately affect low- and middle-income countries, which are projected to account for 75% of global cancer deaths by 2030. Latin America faces unique challenges, including fragmented health systems, limited infrastructure, and significant inequities in access to screening and innovative therapies. This special series in JCO Global Oncology highlights context-specific research from Latin American experts designed to bridge evidence gaps and strengthen regional oncology practice. Key Themes and Findings: Digital Innovation: Studies explore telehealth to expand supportive care in remote areas and online platforms to address the shortage of geriatric oncology specialists. Precision Medicine: Research emphasizes the need for region-specific genomic data, noting that hereditary cancer patterns in Latin America differ from those in the Global North. While molecular profiling (eg, for "EGFR" and "ALK" in lung cancer) significantly improves survival, access to testing remains a major barrier. Health Economics: A budget impact analysis suggests that prioritizing cost-effective surgical castration over medical alternatives could save over $600 million US dollars, allowing for reinvestment in advanced therapies. Real-World Evidence: Data on genitourinary cancers and rare soft tissue sarcomas reveal persistent disparities in treatment patterns and emphasize the necessity of multidisciplinary care. Moving forward, the region must transition from retrospective data to prospective, interventional studies. Addressing the "implementation gap"-where diagnostics exist without matching treatment access-is vital. Sustained progress requires locally adapted guidelines, improved registries, and increased research funding to ensure equitable, high-quality cancer care across Latin America.
With the growing number of cancer survivors and projected shortages of oncology providers, understanding who delivers survivorship care has important implications for care quality. We examined follow-up provider patterns among lung cancer survivors in the Veterans Health Administration (VHA) system and assessed variation in receipt of guideline-concordant computed tomography (CT) imaging. We conducted a retrospective cohort study of 20,532 Veterans with stage I to III non-small cell lung cancer who received definitive treatment between 2008 and 2016. The primary exposure was the lung cancer survivor's follow-up provider specialty, defined as the specialty with whom the patient received the most post-treatment follow-up visits. We evaluated associations between treatment type and follow-up provider specialty and compared receipt of guideline-concordant surveillance imaging, defined as chest CT performed 120-270 days after treatment, across specialties using multivariable logistic regression, adjusted for demographic, clinical, and facility characteristics. Follow-up care frequently shifted to specialties different from those delivering definitive treatment. Among patients treated with surgery alone, most patients, 61% transitioned to primary care for follow-up, while 27% remained with surgery. Patients followed by medical oncology had the highest rates of guideline-concordant chest CT (72.8% v 66.2% in primary care, adjusted odds ratio, 1.42 [95% CI, 1.31 to 1.53]; P < .001). Chest radiography was used in 26% of cases, most often in primary care and surgical clinics. Survivorship follow-up for lung cancer in the VHA often shifted to primary care, where adherence to guideline-concordant chest CT was lower than in medical oncology. These shifts in care may have further implications for post-treatment outcomes and survivorship care, highlighting the opportunity to support nononcology providers in delivering guideline-concordant care as survivorship workforce demands grow.
Tumor-agnostic therapies represent a transformative shift in oncology, targeting molecular alterations irrespective of cancer histology. These therapies offer new hope for patients with rare and difficult-to-treat malignancies, yet their integration into clinical practice remains inconsistent because of the absence of guidelines. Traditional organ-based classifications hinder timely access to precision treatments, despite evidence supporting molecular-driven approaches. Living guidelines, continuously updated frameworks based on emerging data, are essential to bridge this gap. They enable just-in-time incorporation of new therapies, streamline biomarker-driven care, and address the unique needs of rare and ultrarare cancers. Regulatory approvals for tumor-agnostic agents, such as NTRK inhibitors and immunotherapies for microsatellite instability-high/mismatch repair-deficient tumors, underscore the urgency for unified guidance. Trials like TAPUR, TRACK, and NCI-MATCH demonstrate the feasibility and benefit of molecular profiling across diverse cancer types. Tools like ESMO's ETAC-S provide structured criteria for evaluating tumor-agnostic potential, yet real-world implementation lags. Living guidelines can harmonize testing practices, improve access, and educate clinicians on cross-tumor applicability. They also facilitate proactive biomarker testing, reduce treatment delays, and enhance patient safety through tailored toxicity management. As oncology evolves toward molecular precision, living tumor-agnostic guidelines are critical for ensuring equitable, evidence-informed care for all patients, particularly those with rare cancers. National organizations must prioritize their development to fully realize the promise of precision medicine.
Cancer care involves a host of multidisciplinary teams that can often result in fragmented care, creating delays and increasing patient stress. Navigation programs have demonstrated benefits in screening adherence, timely follow-up, and patient satisfaction, but most remain confined to single or only few specialties. We describe the design, implementation, and early outcomes of a comprehensive, system-wide nurse navigation program spanning multiple oncology service lines. Northwell Health, a 26-hospital system serving approximately 13 million people, launched its first navigation pilot in 2022. Nurse navigators were paired with patients at diagnosis and coordinated all subsequent care steps including specialty referrals, appointments, ancillary services, and psychosocial support. Referrals occurred through electronic pathology alerts, provider or self-referrals, and imaging or emergency department findings. Outcomes included time to initial oncology appointment (TTA) and patient-reported satisfaction. From 2023 to 2024, 7,010 patients entered navigation, including 5,329 with confirmed malignancy. In breast oncology, TTA decreased from 22.8 days prenavigation (2022) to 6.8 days postimplementation. Gynecologic, colorectal, and hepatobiliary/GI services saw similar reductions (7-8 days v 12-14 days prior). High satisfaction was generally observed during the postdiagnosis period, with potential areas of improvement including ease of communication (median, 4.5; IQR, 2) and program explanation (median, 4; IQR, 2). Patient satisfaction remained high throughout care, with median scores of 5 (IQR, 1) across both peritreatment and post-treatment surveys. Greater variability in satisfaction was observed during the immediate postdiagnosis period, particularly regarding communication and program explanation. Implementation of a centralized, system-wide cancer navigation program was feasible and associated with improved access to oncology care and consistently high patient satisfaction across multiple cancer service lines. These findings support comprehensive navigation infrastructure as a scalable strategy to enhance care delivery in large health systems.
To examine whether Medicare Advantage (MA) enrollment is associated with differences in the timeliness of novel hormonal therapy (NHT) initiation, including abiraterone, enzalutamide, apalutamide, and darolutamide, for metastatic hormone-sensitive prostate cancer (mHSPC), compared with Traditional Medicare (TM), and to explore disparities by race, socioeconomic status (SES), and care setting. We conducted a retrospective cohort study using the Flatiron Health Research Database, including 3,215 patients age ≥65 years diagnosed with mHSPC between 2018 and 2023. Timely NHT initiation was defined as receipt within 45 days of diagnosis. Multivariable logistic regression models were adjusted for age, race/ethnicity, year of diagnosis, de novo metastatic status, Eastern Cooperative Oncology Group performance status, SES, and practice type, using inverse probability of treatment weighting to balance baseline characteristics between MA and TM groups. Among the 3,215 patients, 2,011 (63%) were enrolled in TM and 1,204 (37%) in MA. Overall, 25% initiated NHT within 45 days of diagnosis. Compared with TM beneficiaries, MA enrollees was associated with lower odds of timely NHT initiation (adjusted odds ratio [aOR], 0.82 [95% CI, 0.70 to 0.95]; P = .01). Differences were more pronounced among racial and ethnic minority patients (aOR, 0.54 [95% CI, 0.37 to 0.77]), individuals from lower-SES areas (aOR, 0.75 [95% CI, 0.58 to 0.98]), and patients receiving care in community settings (aOR, 0.80 [95% CI, 0.67 to 0.95]). MA enrollment was associated with lower odds of timely NHT initiation compared with TM. These associations were particularly evident among underserved groups, highlighting the need to evaluate how MA program structures may influence equitable access to evidence-based cancer care.
This study assessed the feasibility of developing the University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center (UMGCCC)-Medicare-linked database infrastructure by integrating tumor registry, electronic health records (EHRs), and Medicare administrative claims data. The database was designed to support research identifying determinants of differences in cancer outcomes among patient populations commonly under-represented in clinical trials (based on the US population with the disease) including older adults. Patients 65 years and older who were diagnosed and/or received their first course of treatment for a primary tumor at UMGCCC from 2018 to 2021 were included in the database. A two-stage data linkage process was used to merge cancer center tumor registry data with EHR and Medicare claims data. We performed data quality and linkage quality checks. Summary statistics were calculated for patient and tumor characteristics. Of the 3,322 patients identified from the tumor registry, 3,119 patients (94%) were included in the UMGCCC-Medicare database (mean age 73.1 years, 56% male, 31% Black). Lung cancers were the most common (15%) followed by oral cancers (12%) and non-Hodgkin lymphoma (6%). The development of the UMGCCC-Medicare database serves as proof of concept for linking real-world data from different sources. The database is a valuable resource for research requiring detailed patient-level data and follow-up that may generate real-world evidence for older adults living in the United States and treated in routine oncology practice.