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Snyder C, Smith KC, Leisenring WM, Stratton KL, Boyd CM, Choi Y, Dean LT, Hudson MM, Chow EJ, Oeffinger KC, Park ER, McDonald AJ, Armstrong GT, Nathan PC. Continuity and coordination of care for childhood cancer survivors with multiple chronic conditions: Results from the Childhood Cancer Survivor Study. Cancer 2024. [PMID: 39154228 DOI: 10.1002/cncr.35522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 07/11/2024] [Accepted: 07/16/2024] [Indexed: 08/19/2024]
Abstract
INTRODUCTION Continuity and coordination-of-care for childhood cancer survivors with multiple chronic conditions are understudied but critical for appropriate follow-up care. METHODS From April through June 2022, 800 Childhood Cancer Survivor Study participants with two or more chronic conditions (one or more severe/life-threatening/disabling) were emailed the "Patient Perceived Continuity-of-Care from Multiple Clinicians" survey. The survey asked about survivors' main (takes care of most health care) and coordinating (ensures follow-up) provider, produced three care-coordination summary scores (main provider, across multiple providers, patient-provider partnership), and included six discontinuity indicators (e.g., having to organize own care). Discontinuity (yes/no) was defined as poor care on one or more discontinuity item. Chi-square tests assessed associations between discontinuity and sociodemographics. Modified Poisson regression models estimated prevalence ratios (PRs) for discontinuity risk associated with the specialty and number of years seeing the main and coordinating provider, and PRs associated with better scores on the three care-coordination summary measures. Inverse probability weights adjusted for survey non-participation. RESULTS A total of 377 (47%) survivors responded (mean age 48 years, 68% female, 89% non-Hispanic White, 78% privately insured, 74% ≥college graduate); 147/373 (39%) reported discontinuity. Younger survivors were more likely to report discontinuity (chi-square p = .02). Seeing the main provider ≤3 years was associated with more prevalent discontinuity (PR; 95%CI) (1.17; 1.02-1.34 vs ≥ 10 years). Cancer specialist main providers were associated with less prevalent discontinuity (0.81; 0.66-0.99 vs. primary care). Better scores on all three care-coordination summary measures were associated with less prevalent discontinuity: main provider (0.73; 0.64-0.83), across multiple providers (0.81; 0.78-0.83), patient-provider partnership (0.85; 0.80-0.89). CONCLUSIONS Care discontinuity among childhood cancer survivors is prevalent and requires intervention.
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Affiliation(s)
- Claire Snyder
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland, USA
| | - Katherine C Smith
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland, USA
| | | | | | - Cynthia M Boyd
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Youngjee Choi
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Lorraine T Dean
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland, USA
| | | | - Eric J Chow
- Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | | | - Elyse R Park
- Harvard Medical School, Boston, Massachusetts, USA
| | | | | | - Paul C Nathan
- Hospital for Sick Children, Toronto, Ontario, Canada
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Wolfson JA, Davis ES, Saha A, Martinez I, McCall D, Kothari P, Brackett J, Dickens DS, Kahn AR, Schwalm C, Sharma A, Richman J, Cuglievan B, Bhatia S, Dai C, Levine JM, Johnston EE. Adolescents and young adults with cancer: the clinical course of COVID-19 infections. J Natl Cancer Inst 2024; 116:1366-1373. [PMID: 38627241 DOI: 10.1093/jnci/djae085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/20/2023] [Accepted: 04/05/2024] [Indexed: 08/09/2024] Open
Abstract
Adolescents and young adults (ie, individuals aged 15-39 years, known as AYAs) with cancer face unique vulnerabilities yet remain underrepresented in clinical trials, including adult registries of COVID-19 in cancer (AYAs: 8%-12%). We used the Pediatric Oncology COVID-19 Case Report to examine the clinical course of COVID-19 among AYAs with cancer. The Pediatric Oncology COVID-19 Case Report collects deidentified clinical and sociodemographic data regarding individuals aged from birth to 39 years with cancer (37%) and COVID-19 from more than 100 institutions. Between April 1, 2020, and November 28, 2023, 191 older AYAs (individuals 22-39 years of age) and 640 younger AYAs (individuals 15-21 years of age) were captured. Older AYAs were less often hospitalized (P < .001), admitted to the intensive care unit (P = .02), and required respiratory support (P = .057). In multivariable analyses, older AYAs faced 80% lower odds of intensive care unit admission but 2.3-times greater odds of changes to cancer-directed therapy. Unvaccinated patients had 5.4-times higher odds of intensive care unit admission. Among AYAs with cancer, the COVID-19 course varies by age. These findings can inform oncology teams directing COVID-19 management and prevention in AYA patients with cancer.
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Affiliation(s)
- Julie A Wolfson
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elizabeth S Davis
- Department of Surgery, Boston University/Boston Medical Center, Boston, MA, USA
| | - Aniket Saha
- Pediatric Hematology-Oncology, Prisma Health Upstate, Bi-Lo Charities Children's Cancer Center, and Greenville Health System, Greenville, SC, USA
| | - Isaac Martinez
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David McCall
- Department of Pediatrics, MD Anderson Cancer Center, Houston, TX, USA
| | - Prachi Kothari
- Pediatric Hematology-Oncology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Julienne Brackett
- Pediatric Hematology-Oncology, Department of Pediatrics, Texas Children's Hospital, Houston, TX, USA
| | - David S Dickens
- Pediatric Hematology-Oncology, Department of Pediatrics, University of Iowa, Iowa City, IA, USA
| | - Alissa R Kahn
- Pediatric Hematology/Oncology, Department of Pediatrics, St Joseph's University Medical Center, Paterson, NJ, USA
| | - Carla Schwalm
- Pediatric Hematology-Oncology, Department of Pediatrics, Bronson Methodist Hospital, Kalamazoo, MI, USA
| | - Archana Sharma
- Pediatric Hematology-Oncology, Department of Pediatrics, Rutgers Cancer Institute, New Brunswick, NJ, USA
| | - Joshua Richman
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
- Center for Cancer and Blood Disorders, Children's National Medical Center, Washington, DC, USA
| | - Branko Cuglievan
- Department of Pediatrics, MD Anderson Cancer Center, Houston, TX, USA
| | - Smita Bhatia
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Chen Dai
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jennifer M Levine
- Center for Cancer and Blood Disorders, Children's National Medical Center, Washington, DC, USA
| | - Emily E Johnston
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA
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Shear DZ, Eary RL, Rodriguez SA, Dunker AM, McDuffee PR, Taghavi SE, Hall BC. Advancing the call towards implementing AYA screening of needs in adult oncology settings. Support Care Cancer 2024; 32:477. [PMID: 38954063 DOI: 10.1007/s00520-024-08668-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 06/18/2024] [Indexed: 07/04/2024]
Affiliation(s)
- Deborah Z Shear
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA.
- Fort Worth Adolescent and Young Adult Oncology Coalition, Fort Worth, TX, USA.
- University of Texas Southwestern Medical Center, Moncrief Cancer Institute, Fort Worth, TX, USA.
| | - Rebecca L Eary
- Department of Family and Community Medicine, UT Southwestern Medical Center, Dallas, TX, USA
| | - Serena A Rodriguez
- Department of Health Promotion & Behavioral Sciences, The University of Texas Health Science Center (UTHealth) at Houston, School of Public Health, Dallas, TX, USA
- Center for Health Promotion & Prevention Research, UTHealth Houston, School of Public Health, Houston, TX, USA
- Institute for Implementation Science, UTHealth Houston, Houston, TX, USA
| | - Alexandra M Dunker
- University of Texas Southwestern Medical Center, Moncrief Cancer Institute, Fort Worth, TX, USA
| | - Peyton R McDuffee
- University of Texas Southwestern Medical Center, Moncrief Cancer Institute, Fort Worth, TX, USA
| | - Sarah E Taghavi
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
- Fort Worth Adolescent and Young Adult Oncology Coalition, Fort Worth, TX, USA
- University of Texas Southwestern Medical Center, Moncrief Cancer Institute, Fort Worth, TX, USA
| | - Brittany C Hall
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA
- Fort Worth Adolescent and Young Adult Oncology Coalition, Fort Worth, TX, USA
- University of Texas Southwestern Medical Center, Moncrief Cancer Institute, Fort Worth, TX, USA
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Scott I, Oberoi S. Developing an Adolescent and Young Adult Oncology Program in a Medium-Sized Canadian Centre: Lessons Learned. Curr Oncol 2024; 31:2420-2426. [PMID: 38785462 PMCID: PMC11119119 DOI: 10.3390/curroncol31050181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/17/2024] [Accepted: 04/24/2024] [Indexed: 05/25/2024] Open
Abstract
The Adolescent and Young Adult (AYA) Program at CancerCare Manitoba (CCMB) has experienced tremendous growth since its inception. This report provides an overview of how the AYA program at CCMB was established and the crucial factors that led to its early accomplishments and continued expansion. These factors included actions and decisions made at the individual and organizational level that helped lay a strong foundation for the program's sustained success. We hope that some of these lessons learned can be adapted and implemented by other oncology agencies to improve the care outcomes and experiences of AYAs living with cancer.
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Affiliation(s)
- Ian Scott
- Department of Psychosocial Oncology, CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada;
| | - Sapna Oberoi
- Paul Albrechtsen Research Institute, CancerCare Manitoba, Winnipeg, MB R2H 2A6, Canada
- Department of Pediatrics and Child Health, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB R3A 1S1, Canada
- Department of Pediatric Hematology-Oncology, CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada
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Hettmer S, Lindner LH. The AYA gap for rhabdomyosarcoma. Pediatr Blood Cancer 2024; 71:e30905. [PMID: 38311774 DOI: 10.1002/pbc.30905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/06/2024]
Affiliation(s)
- Simone Hettmer
- Division of Pediatric Hematology and Oncology, Department of Pediatric and Adolescent Medicine, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Lars H Lindner
- Department of Medicine III, LMU University Hospital, LMU Munich, Munich, Germany
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Beauchemin MP, Solomon S, Michaels CL, McHenry K, Turi E, Khurana R, Sanabria G. Toward identification and intervention to address financial toxicity and unmet health-related social needs among adolescents and emerging adults with cancer and their caregivers: A cross-cultural perspective. Cancer Med 2024; 13:e7197. [PMID: 38659403 PMCID: PMC11043682 DOI: 10.1002/cam4.7197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 03/30/2024] [Accepted: 04/04/2024] [Indexed: 04/26/2024] Open
Abstract
PURPOSE We qualitatively explored the unique needs and preferences for financial toxicity screening and interventions to address financial toxicity among adolescents and emerging adults (younger AYAs: 15-25 years) with cancer and their caregivers. METHODS We recruited English- or Spanish-speaking younger AYAs who were treated for cancer within the past 2 years and their caregivers. Semi-structured interviews were conducted to explore preferences for screening and interventional study development to address financial toxicity. The data were coded using conventional content analysis. Codes were reviewed with the study team, and interviews continued until saturation was reached; codes were consolidated into categories and themes during consensus discussions. RESULTS We interviewed 17 participants; nine were younger AYAs. Seven of the 17 preferred to speak Spanish. We identified three cross-cutting themes: burden, support, and routine, consistent, and clear. The burden came in the form of unexpected costs such as transportation to appointments, as well as emotional burdens such as AYAs worrying about how much their family sacrificed for their care or caregivers worrying about the AYA's physical and financial future. Support, in the form of familial, community, healthcare institution, and insurance, was critical to mitigating the effects of financial toxicity in this population. Participants emphasized the importance of meeting individual financial needs by routinely and consistently asking about financial factors and providing clear guidance to navigate these needs. CONCLUSION Younger AYAs and their caregivers experience significant financial challenges and unmet health-related social needs during cancer treatment and often rely on key supports to alleviate these unmet needs. When developing interventions to mitigate financial toxicity, clinicians and health systems should prioritize clear, consistent, and tailorable approaches to support younger AYA cancer survivors and their families.
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Affiliation(s)
- Melissa P. Beauchemin
- School of NursingColumbia University Irving Medical CenterNew YorkNew YorkUSA
- Herbert Irving Comprehensive Cancer CenterColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Samrawit Solomon
- School of NursingColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Claudia L. Michaels
- School of NursingColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Kathryn McHenry
- School of MedicineColumbia University Irving Medical CenterNew YorkNew YorkUSA
| | - Eleanor Turi
- Perelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Rhea Khurana
- School of NursingColumbia University Irving Medical CenterNew YorkNew YorkUSA
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Hudson MM, Bhatia S. Mind the Gap: A Multiprong Approach to Minimizing the Gap in Outcomes Among Adolescents and Young Adults With Cancer. J Clin Oncol 2024; 42:617-620. [PMID: 38060999 DOI: 10.1200/jco.23.02240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 11/02/2023] [Indexed: 02/16/2024] Open
Affiliation(s)
| | - Smita Bhatia
- University of Alabama at Birmingham, Birmingham, AL
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