Impact of household income and Special Supplemental Nutritional Program for Women, Infants, and Children on feeding decisions for infants in the United States

BACKGROUND

Despite the known benefits of breastfeeding to infants and mothers, previous studies have demonstrated that underserved women are less likely to exclusively breastfeed. Existing studies on the impact of Special Supplemental Nutritional Program for Women, Infants, and Children enrollment on feeding decisions for infants have conflicting results with low-quality data and metrics.

OBJECTIVE

This study aimed to examine infant feeding trends nationally in the first week postpartum over a 10-year period, comparing breastfeeding rates for primiparous women with low income who used Special Supplemental Nutritional Program for Women, Infants, and Children resources with those women who did not enroll. We hypothesized that although the Special Supplemental Nutritional Program for Women, Infants, and Children is an important resource for new mothers, free formula associated with enrollment in the Special Supplemental Nutritional Program for Women, Infants, and Children may disincentivize women to exclusively breastfeed.

STUDY DESIGN

This was a retrospective cohort study of primiparous women with singleton gestations who gave birth at term and who responded to the Centers for Disease Control and Prevention Pregnancy Risk Assessment Monitoring System between 2009 and 2018. Data were extracted from phases 6, 7, and 8 of the survey. Women with low income were defined as those with a reported annual household income of $35,000 or less. The primary outcome was exclusive breastfeeding after 1 week postpartum. Secondary outcomes included ever breastfeeding, any breastfeeding after 1 week postpartum, and introduction of other liquids within 1 week postpartum. Multivariable logistic regression was used to refine risk estimates with adjustment for mode of delivery, household size, education level, insurance status, diabetes, hypertension, race, age, and BMI.

RESULTS

Among the 42,778 women with low income who were identified, 29,289 (68%) of these women reported receiving Special Supplemental Nutritional Program for Women, Infants, and Children resources. There was no significant difference in the rates of exclusive breastfeeding after 1 week postpartum between those enrolled in the Special Supplemental Nutritional Program for Women, Infants, and Children and those not enrolled (adjusted risk ratio, 1.04; 95% confidence interval, 1.00-1.07; P=.10). However, those enrolled were less likely to ever breastfeed (adjusted risk ratio, 0.95; 95% confidence interval, 0.94-0.95; P<.01) and were more likely to introduce other liquids within 1 week postpartum (adjusted risk ratio, 1.16; 95% confidence interval, 1.11-1.21; P<.01).

CONCLUSION

Although exclusive breastfeeding rates after 1 week postpartum were similar, women enrolled in the Special Supplemental Nutritional Program for Women, Infants, and Children were significantly less likely to ever breastfeed and more likely to introduce formula within the first week postpartum. This suggests that Special Supplemental Nutritional Program for Women, Infants, and Children enrollment may impact the decision to initiate breastfeeding and may represent an important window to test future interventions.

Creating and Activating an Implementation Community to Drive HPV Vaccine Uptake in Texas: The Role of an NCI-Designated Cancer Center

The University of Texas MD Anderson Cancer Center, a comprehensive cancer center designated by the National Cancer Institute (NCI), defines its service population area as the State of Texas (29.1 M), the second most populous state in the country and the state with the greatest number of uninsured residents in the United States. Consistent with a novel and formal commitment to prevention as part of its core mission, alongside clear opportunities in Texas to drive vaccine uptake, MD Anderson assembled a transdisciplinary team to develop an institutional Framework to increase adolescent HPV vaccination and reduce HPV-related cancer burden. The Framework was developed and activated through a four-phase approach aligned with the NCI Cancer Center Support Grant Community Outreach and Engagement component. MD Anderson identified collaborators through data-driven outreach and constructed a portfolio of collaborative multi-sector initiatives through review processes designed to assess readiness, impact and sustainability. The result is an implementation community of 78 institutions collaboratively implementing 12 initiatives within a shared measurement framework impacting 18 counties. This paper describes a structured and rigorous process to set up the implementation of a multi-year investment in evidence-based strategies to increase HPV vaccination that solves challenges preventing implementation of recommended strategies and to encourage similar initiative replication.

Dissociation Among Women with Chronic Pelvic Pain: Relation to Surgical Treatment, Pelvic Pain Severity, and Health-Related Quality of Life

Chronic pelvic pain (CPP) is associated with a history of trauma and symptoms of somatoform dissociation. We aimed to describe how somatoform dissociation impacts CPP symptoms, surgical treatment, and health-related quality of life (HRQOL). Patients (N = 133) diagnosed with CPP presenting for an appointment at a women's health clinic between November, 2019 - July, 2021 were recruited to participate in a cross-sectional study and complete a survey assessing symptoms of somatoform dissociation, post-traumatic stress disorder (PTSD), pelvic pain severity, history of CPP-related surgeries, and mental and physical HRQOL. We also conducted a post-hoc analysis assessing correlations of individual symptom items on the Somatoform Dissociation Questionnaire (SDQ-20) with HRQOL outcomes. We did not find a relationship between somatoform dissociation and pelvic pain severity or surgical history. Physical HRQOL outcomes were related to somatoform dissociation, PTSD symptoms, and pelvic pain severity, while mental HRQOL outcomes were connected to somatoform dissociation and PTSD symptoms. Our study reveals preliminary evidence suggesting that among CPP patients, HRQOL outcomes are affected by unique profiles of positive and negative symptoms of somatoform dissociation, including sensory disturbances, localized genital pain, and generalized numbness and bodily analgesia. Addressing specific symptoms of somatoform dissociation may enhance HRQOL among trauma-exposed women with CPP. Replication studies are needed to validate our findings. Integrating trauma-informed approaches, including standardized evaluations of trauma exposure and symptoms of somatoform dissociation into routine care for women with CPP is encouraged.

Childhood betrayal trauma, dissociation, and shame impact health-related quality of life among individuals with chronic pelvic pain

BACKGROUND

High betrayal trauma (HBT), or interpersonal trauma perpetrated by someone close, is linked to dissociation and shame, while trauma perpetrated by someone less close, low betrayal trauma (LBT) is associated with post-traumatic stress disorder (PTSD).

OBJECTIVE

Child interpersonal trauma is common among women with chronic pelvic pain (CPP) and can negatively impact physical and mental health-related quality of life (HRQOL). Our study investigates unexplored connections between these variables.

PARTICIPANTS & SETTING

Survey data were analyzed from 96 English-speaking female patients with CPP at a women's health clinic (mean age = 33, 59 % White non-Hispanic, 62 % married or cohabitating, 61.5 % completed post-high school degree); prevalence of HBT and LBT were 65.2 % and 45.6 %, respectively.

METHODS

Multiple regression analyzed relationships between mental and physical HRQOL and dissociation, shame, and PTSD. Parallel mediation analyses examined indirect relationships between mental and physical HRQOL and exposure to childhood HBT and LBT.

RESULTS

Dissociation was related to worse physical HRQOL, while shame was related to worse physical and mental HRQOL. Dissociation and shame mediated relationships between childhood HBT and current mental (R² = 0.08, p = .01) and physical (R² = 0.11, p = .002) HRQOL. Shame, but not PTSD, mediated relationships between childhood LBT and current mental (R² = 0.14, p < .001) and physical (R² = 0.16, p < .001) HRQOL.

CONCLUSIONS

Our study provides preliminary evidence that dissociation and shame negatively impact HRQOL among individuals with CPP in the context of exposure to different types of childhood betrayal trauma. Replication studies to validate our results with larger samples and longitudinal designs are encouraged.

Creating a bundled care payment model for treatment of pelvic floor disorders: introducing value into urogynecology

Ineffective healthcare delivery and expenditures associated with the traditional fee for service in-person models have turned attention toward alternative payment models as a means of enhancing healthcare quality in the United States. Bundled care payment models are a form of alternate payment models that provide a single reimbursement for all services rendered for an episode of care and have been developed extensively in primary care settings with limited literature in urogynecology. We describe the process used to create a bundled care payment model for women seeking care in a subspecialty clinic for pelvic floor disorders in partnership with our safety net insurer. The process included estimation of prior average spend, the design of an integrated practice unit, creation of pelvic floor pathways, approximation of utilization rates, and estimation of reimbursement and expenses.

Cancer Survivors' Reported Discussions with Health Care Providers About Follow-Up Care and Receipt of Written Care Plans

Prior studies reveal gaps in cancer survivors' discussions with health care providers about follow-up care and receipt of care plans; however, whether survivorship care planning may vary by cancer type is not known. We surveyed 615 survivors of breast, colorectal, prostate, lung cancer, and melanoma enrolled in three health plans to examine cancer survivors' self-reported discussions of follow-up care, including the need for surveillance, late and long-term effects, emotional needs, and health behaviors. We assessed whether cancer survivors received a written treatment summary and post-treatment care instructions. Most (92%) survivors reported having a discussion about the need for surveillance; 75%, late and long-term effects; 69%, lifestyle and health behaviors; and 53%, emotional and social needs. Most (88%) reported receiving post-treatment care instructions and 47%, a treatment summary. While there was little difference among survivors' receipt of surveillance or health behavior recommendations by cancer type (p = 0.85 and p = 0.66, respectively), discussions of late and long-term effects occurred among 82% of prostate, 78% of breast, 73% of melanoma, 72% of colorectal, and 67% of lung survivors (p = 0.06). Approximately half of survivors reported discussions of emotional needs, with modest differences by cancer type (p = 0.08). Our findings indicate that most patient-provider discussions cover information on surveillance, with less emphasis on late and long-term effects, lifestyle and health behaviors, and substantially less focusing on emotional and social needs. No or modest differences in discussions occurred by cancer type. Whether tailoring information to individual cancer survivor needs is beneficial should be examined.

Exploring barriers to the receipt of necessary medical care among cancer survivors under age 65 years

PURPOSE

With increasing cancer care costs and greater patient cost-sharing in the USA, understanding access to medical care among cancer survivors is imperative. This study aims to identify financial, psychosocial, and cancer-related barriers to the receipt of medical care, tests, or treatments deemed necessary by the doctor or patient for cancer among cancer survivors age < 65 years.

METHODS

We used data on 4321 cancer survivors aged 18-64 years who completed the 2012 LIVESTRONG Survey. Multivariable logistic regression was used to identify risk factors associated with the receipt of necessary medical care, including sociodemographic, financial hardship, debt amount, caregiver status, and cancer-related variables.

RESULTS

Approximately 28% of cancer survivors were within 1 year, and 43% between 1 and 5 years, since their last treatment at the time of survey. Nearly 9% of cancer survivors reported not receiving necessary medical care. Compared to survivors without financial hardship, the likelihood of not receiving necessary medical care significantly increased as the amount of debt increased among those with financial hardship (RRFinancial hardship w/< $10,000 debt = 1.94, 95% CI 1.55-2.42, and RR RRFinancial hardship w/≥ $10,000 debt = 3.41, 95% CI 2.69-4.33, p < 0.001). Survivors who reported lack of a caregiver, being uninsured, and not receiving help understanding medical bills were significantly more likely to not receive necessary medical care.

CONCLUSION

We identified key financial and insurance risk factors that may serve as significant barriers to the receipt of necessary medical care among cancer survivors age < 65 in the USA IMPLICATIONS FOR CANCER SURVIVORS: The majority of cancer survivors reported receiving medical care either they or their doctors deemed necessary. However, identifying potentially modifiable barriers to receipt of necessary medical cancer care among cancer survivors age < 65 is imperative for developing interventions to ensure equitable access to care and reducing cancer disparities.

The Presence of MMP-20 Reinforces Biomimetic Enamel Regrowth

Biomimetic synthesis of artificial enamel is a promising strategy for the prevention and restoration of defective enamel. We have recently reported that a hydrogel system composed of chitosan-amelogenin (CS-AMEL) and calcium phosphate is effective in forming an enamel-like layer that has a seamless interface with natural tooth surfaces. Here, to improve the mechanical system function and to facilitate the biomimetic enamel regrowth, matrix metalloproteinase-20 (MMP-20) was introduced into the CS-AMEL hydrogel. Inspired by our recent finding that MMP-20 prevents protein occlusion inside enamel crystals, we hypothesized that addition of MMP-20 to CS-AMEL hydrogel could reinforce the newly grown layer. Recombinant human MMP-20 was added to the CS-AMEL hydrogel to cleave full-length amelogenin during the growth of enamel-like crystals on an etched enamel surface. The MMP-20 proteolysis of amelogenin was studied, and the morphology, composition, and mechanical properties of the newly grown layer were characterized. We found that amelogenin was gradually degraded by MMP-20 in the presence of chitosan. The newly grown crystals in the sample treated with MMP-20-CS-AMEL hydrogel showed more uniform orientation and greater crystallinity than the samples treated with CS-AMEL hydrogel without MMP-20. Stepwise processing of amelogenin by MMP-20 in the CS-AMEL hydrogel prevented undesirable protein occlusion within the newly formed crystals. As a result, both the modulus and hardness of the repaired enamel were significantly increased (1.8- and 2.4-fold, respectively) by the MMP-20-CS-AMEL hydrogel. Although future work is needed to further incorporate other enamel matrix proteins into the system, this study brings us one step closer to biomimetic enamel regrowth.

For Working-Age Cancer Survivors, Medical Debt And Bankruptcy Create Financial Hardships

The rising medical costs associated with cancer have led to considerable financial hardship for patients and their families in the United States. Using data from the LIVESTRONG 2012 survey of 4,719 cancer survivors ages 18-64, we examined the proportions of survivors who reported going into debt or filing for bankruptcy as a result of cancer, as well as the amount of debt incurred. Approximately one-third of the survivors had gone into debt, and 3 percent had filed for bankruptcy. Of those who had gone into debt, 55 percent incurred obligations of $10,000 or more. Cancer survivors who were younger, had lower incomes, and had public health insurance were more likely to go into debt or file for bankruptcy, compared to those who were older, had higher incomes, and had private insurance, respectively. Future longitudinal population-based studies are needed to improve understanding of financial hardship among US working-age cancer survivors throughout the cancer care trajectory and, ultimately, to help stakeholders develop evidence-based interventions and policies to reduce the financial hardship of cancer.

Cancer survivors' experiences with insurance, finances, and employment: results from a multisite study

BACKGROUND

Cancer has significant implications on survivors' insurance coverage, financial status, and employment. We aimed to examine how these outcomes vary for survivors of different cancer types.

METHODS

Using the Cancer Survivorship Supplement of the Medical Expenditures Panel Survey (MEPS), in 2013, we surveyed survivors of five common cancers who were diagnosed during 2003-2008 and were continuously enrolled in one of three health plans in Massachusetts, Colorado, and Washington State.

RESULTS

Among 615 eligible respondents, 96 % reported having health insurance at the time of or since diagnosis; of those, few reported barriers in coverage to visit doctors or facilities of their choice. Approximately 15 % reported experiencing financial hardships due to cancer. Of the 334 who responded as having been employed at the time of or since diagnosis, approximately 25 % reported that they or their spouses remained at their jobs due to concerns about losing medical insurance. Further, 63 % reported making changes in their jobs or careers (e.g., took extended time off, worked part time, or declined promotion) due to cancer, and 42 % reported that cancer interfered with their physical and/or mental tasks at work or reduced productivity. Negative employment and financial implications were most common among those with lung, breast, and colorectal cancer, and those diagnosed before age 65.

CONCLUSIONS

In this insured population, few experienced restrictions in cancer care coverage, though maintaining health insurance often drove employment decisions. Significant negative effects on finances and employment were observed among specific cancer types and younger survivors.

IMPLICATIONS FOR CANCER SURVIVORS

Our study findings emphasize a need to identify ways of supporting survivors and provide tailored resources to reduce the untoward financial and work-related implications of cancer.

Estimating the health and economic burden of cancer among those diagnosed as adolescents and young adults

Adolescent and young adult cancer survivors-those who were ages 15-39 at their first cancer diagnosis-have important health limitations. These survivors are at risk for higher health care expenditures and lost productivity, compared to adults without a history of cancer. Using Medical Expenditure Panel Survey data, we present nationally representative estimates of the economic burden among people who were diagnosed with cancer in adolescence or young adulthood. Our findings demonstrate that surviving cancer at this age is associated with a substantial economic burden. Compared to adults without a history of cancer, adolescent and young adult cancer survivors had excess annual medical expenditures of $3,170 per person and excess annual productivity losses of $2,250 per person. Multifaceted prevention strategies, including education and sustained intervention programs to ensure access to lifelong risk-based follow-up care, may be effective ways to improve the economic outcomes associated with cancer survivorship in this population.

Psychometric investigation of benefit finding among long-term cancer survivors using the Medical Expenditure Panel Survey

PURPOSE

Benefit finding has been shown to be beneficial for people with cancer and may be an indication that one is coping adequately with the stress of cancer. This study evaluated the psychometric properties of a four-item benefit finding measure from the cancer survivorship supplement of the Medical Expenditure Panel Survey (MEPS).

METHODS

Long-term survivors (5-10 years post-diagnosis) of breast, prostate, colorectal or lung cancer or melanoma (n = 594) completed the MEPS cancer supplement survey in 2013. Four items asked about benefit finding after the cancer: stronger person, coping better, positive changes and having healthier habits. Information on sociodemographics, disease and activity limitations after the cancer was also collected. We examined factor structure, reliability (Kuder-Richardson 20) and validity.

RESULTS

The four benefit finding items did not appear to measure one factor. Three of the benefit finding items (stronger person, coping better, positive changes) were related to gender, receipt of chemotherapy and activity limitations but not cancer stage, time since diagnosis or income. Having healthier habits was unrelated to any sociodemographic or disease variable.

CONCLUSIONS

Three of the items (stronger person, coping better, positive changes) appeared to have validity as they were related to variables that literature has shown are related to benefit finding. However, having healthier habits is likely measuring a separate but related construct. This short instrument may be used in future studies assessing benefit finding post cancer; however, the four items should be analyzed separately.

Challenges with insurance and finances: Results from the 2012 Livestrong survey

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Background: More than 1.5 million new cancer cases occur each year in the U.S., and accessing health care is critical for mortality as well as for improving survivorship outcomes for cancer survivors. Methods: LIVESTRONG conducted an online survey of cancer survivors from June to December 2012. The current analyses include 4,320 respondents who were U.S. residents and diagnosed in 2002 or later. Results: Survivors in this study reported that for those who did not receive all of the medical care they needed they did not receive care because the insurance company wouldn’t pay for the care (41%) or they couldn’t afford the care (23%), with nine percent being denied health insurance coverage due to a cancer diagnosis. Other challenges reported included insurance not paying for a second opinion (8%) or the doctor/facility of the survivor’s choice (18%). Controlling for demographic and cancer-related factors, those diagnosed most recently (2010-2012) were less likely to report experiencing these challenges. Compounding insurance issues was the financial burden. Thirty percent of survivors reported that they or their family members had to borrow money or go into debt because of their cancer and five percent of survivors reported spending down their assets to qualify for Medicaid or a cancer-related program. Conclusions: In previous studies, patients who lack sufficient health insurance coverage tend to have poorer health outcomes. Overall, the data highlights that more can be done to connect survivors with the needed insurance and financial resources they need to access adequate cancer care during their treatment and beyond. [Table: see text]

Younger survivors' insurance concerns

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Background: Each year approximately 70,000 adolescents and young adults (AYAs) are diagnosed with cancer—many of whom will experience insurance issues. While the Affordable Care Act (ACA) is intended to address many insurance issues, cancer survivors are dealing with these issues now. Methods: From June to December 2012, LIVESTRONG conducted an online survey modeled after the Medical Expenditure Panel Survey (MEPS) Cancer Survivorship Supplement to understand the practical concerns of survivors, including insurance issues. Analyses here includes 1,209 AYA respondents compared to 3,557 respondents diagnosed over the age 40. Results: Overwhelmingly, participants in this survey had insurance at some point since diagnosis (94%), yet AYAs were significantly less likely to have had insurance (p<.001). AYAs were significantly more likely to have experienced issues with insurance (Table), but both groups were unlikely to have received help for negative effects due to insurance (AYA = 30%; non-AYAs=25%). In terms of help seeking, AYAs were significantly more likely to have received help from family members (p<.001). Both groups indicated a number of reasons for not seeking help for insurance issues - most frequently citing "I have addressed this on my own” (18%) and “I tried to receive help but was unsuccessful” (17%). Conclusions: Results from this study indicate there are many issues related to insurance coverage for survivors, which in most cases were significantly more impactful for AYA survivors. Additionally, there are many challenges survivors face in terms of getting their insurance needs met. Finally, it’s important to consider the full implications of what it means for AYAs to be reliant on family members – for both the survivor and their family. The AYA period often denotes a time that individuals are trying to separate from family, yet cancer may make this separation considerably more challenging. While ACA is intended to address some of these issues, cancer survivors are dealing with insurance issues now, and we should consider how to address these issues more quickly. [Table: see text]

Who is receiving survivorship care plans? Findings from the 2012 LIVESTRONG survey

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Background: There are more than 14 million cancer survivors in the US – a number that is on the rise. Care coordination resources will be essential to provide support to this growing population. Key stakeholders, including the Commission on Cancer (CoC) and the Institute of Medicine, have proposed survivorship care plans (SCPs) as a way to extend support. However, limited research has been conducted to date on SCPs. Methods: In 2012, the LIVESTRONG Foundation (LIVESTRONG) administered a survey to understand the role of a treatment summary (TS) and SCPs and how they fit into survivors’ care. Logistic regression models were conducted to identify factors associated with receiving SCPs or TS. Results: 5,303 survivors responded to these questions. While 92% of these respondents received information about where to return to for cancer check-ups, only 51% reported receiving a TS and 17% reported receiving a SCP. Survivors who were more likely to receive SCPs if they had a navigator (p<.001) and if they were male, black, had finished treatment within the past year, or received care at a university-based medical center or community cancer center (p < 0.05). Also, those receiving a SCP were significantly more likely to have had a detailed discussion with a provider regarding long-term side effects, emotional needs, and lifestyle recommendations. Specifically, 60% of those with a SCP discussed long-term effects compared to 39% who did not. Conclusions: Results here indicate that few survivors receive SCPs but survivors reported benefits from receiving them. Currently many workflow barriers impede delivering SCPs, and LIVESTRONG is working with key stakeholders including the CoC to automate the LIVESTRONG Care Plan powered by Penn Medicine’s OncoLink through a registry and EMR system to understand how to address this issue.

Sharing hope: Preserving fertility through partnership

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Background: Each year about 70,000 individuals aged 15-39 are diagnosed with cancer. Unfortunately, essential cancer treatments often negatively impact an individual’s fertility. The average cost of fertility preservation ranges upwards of $12,000 for women and $1,500 for men and most insurance companies typically do not cover pre-treatment fertility preservation. Not only do these individuals experience a life-threatening cancer diagnosis, they are also faced with the possibility of not having children of their own in the future. The LIVESTRONG Foundation’s Fertile Hope Program provides educational information and timely pre-treatment financial assistance to cancer survivors whose medical treatments present the risk of infertility. Female participants receive the medication at no cost through the Foundation’s partnership with EMD Serono, and all survivors can receive at least a 25% discount, on preservation services at the more than 350 partnering fertility clinics. Methods: LIVESTRONG Navigators implementing this program track all interactions on an ongoing basis. Additionally, in 2012, clients who had been approved for the program within the last 12 months and those who had been approved two or more years ago received an online survey (N=200 and 105 respondents respectively). Results: In 2012, 3,353 individuals (1,537 men and 1,816 women) saved a total of $12,542,114 through this program. Survey respondents indicated that they value the speed of the process and the opportunity to preserve their fertility. Interestingly, respondents noted that they learned about the program through a reproductive doctor, but they learned about fertility-related issues through an oncologist. Finally, respondents indicated that 14 babies have been born as a result of this program. Conclusions: This program has made a unique and measurable change to improve the quality of life of survivors. By providing information and support as well as reducing costs, survivors have the potential to fulfill their aspirations to bear a biological child. Ensuring that providers who share information about fertility-related issues are informed about these types of programs could help to ensure all interested survivors have access to discounted, timely fertility preservation.

Fertility preservation cost and use: Results from the LIVESTRONG survey

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Background: Each year nearly 70,000 adolescents and young adults (AYAs) are diagnosed with cancer. Recently, steps have been taken to address infertility, which is an important issue experienced by AYAs. For example, ASCO QOPI includes fertility standards and Walgreens and the LIVESTRONG Foundation provide financial assistance for fertility preservation medications. To better understand the current state of fertility preservation, eight questions on this topic were included on the LIVESTRONG Survey. Methods: From June to December 2012, LIVESTRONG conducted an online survey (N = 6,313). Analysis here includes the 1,333 AYA respondents who were diagnosed since 2002. Results: Only 24% of respondents (42% of males, 12% of females) indicated they took steps to preserve their fertility before beginning treatment. Top reasons for not preserving their fertility were not receiving information about options (19%) and/or information about the risks to their fertility (14%). For the AYAs who did preserve their fertility, the median amount spent on fertility expenses was between $1,000 and $2,499 (Table) with males spending significantly less than females (p < 0.001). Mostly commonly, males used sperm banking (97%) while females used egg and embryo banking (each 35%). The majority all who attempted to become pregnant were successful (58% and 68% respectively). Conclusions: Results from this analysis indicate that few survivors took steps to preserve their fertility before starting treatment. Yet for those who were interested in preserving their fertility and starting a family, the majority of individuals were successful. Many individuals reported not preserving their fertility due to a lack of information or resources. While a relatively small number of survivors will have fertility concerns, this is an important quality of life issue for those who do. [Table: see text]

Potential benefits of treatment summaries for survivors' health and information needs: results from a LIVESTRONG survey

PURPOSE

Treatment summaries (TSs), a critical component of survivorship care plans, have been identified as a tool to improve outcomes for the 14 million cancer survivors in the United States.

METHODS

In 2010, the LIVESTRONG Foundation fielded the LIVESTRONG Survey for People Affected by Cancer. The survey was designed to assess the physical, emotional, and practical concerns after cancer as well as receipt of treatment summaries. Participants were recruited online and through national partners.

RESULTS

Over a 9-month period, > 12,000 people completed the survey, including 3,682 post-treatment cancer survivors (PTCSs). PTCSs who received a TS reported that they were closer to time since diagnosis or end of treatment (P < .01), more likely to have received chemotherapy (P < .01), more likely to have received the majority of their health care from a medical oncologist (P < .05), experiencing significantly fewer post-treatment emotional concerns (P < .05), and significantly less likely to say that they had learned to live with their concerns (P < .05). PTCSs who received a TS more often reported that their needs had been met, including receiving information about possible late effects, care they received during treatment, and care they received after treatment.

CONCLUSIONS

Receipt of a TS was associated with a variety of positive outcomes; however, only approximately one third of PTCSs received one. Future studies focused on patient perspectives on care planning tools can help to improve optimal survivorship care delivery. Possible solutions for improving access to a TS are included.

What Do People Affected by Cancer Think About Electronic Health Information Exchange? Results From the 2010 LIVESTRONG Electronic Health Information Exchange Survey and the 2008 Health Information National Trends Survey

PURPOSE

The Health Information Technology for Economic and Clinical Health (HITECH) Act has placed an emphasis on electronic health information exchange (EHIE). Research on needs of patient, especially those touched by cancer, has been sparse. Here, we present data on preferences for EHIE among those touched by cancer compared with a nationally representative sample of American adults.

METHODS

TWO SURVEYS WERE USED: an online survey designed by LIVESTRONG (the Lance Armstrong Foundation) and a dual-frame, nationally representative sample of adults collected through the National Cancer Institute's Health Information National Trends Survey (HINTS).

RESULTS

The LIVESTRONG EHIE survey yielded a sample of 8,411 respondents, including 433 currently receiving cancer treatment, 298 living with cancer as a chronic disease, 2,343 post-treatment survivors, and 5,337 with no history of cancer. The HINTS sample consisted of 7,674 respondents representative of the general adult population. Comparisons revealed a strong positive view of the value of EHIE within the cancer-relevant groups, especially among those living with cancer as a chronic disease. Only about half of the general population showed a similar degree of enthusiasm for EHIE. When asked about specific functions for EHRs, respondents valued privacy and security above all, followed by improving care coordination and data sharing between providers.

CONCLUSION

These data suggest that the EHIE needs among those touched by cancer may be greater than in the general population. This is particularly important because people affected by cancer are among those who access our health care system most frequently and who have the most at stake.

Who is receiving survivorship care plans? Findings from the 2012 Livestrong survey

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Background: There are more than 14 million cancer survivors in the US – a number that is on the rise. Care coordination resources will be essential to provide support to this growing population. Key stakeholders, including the Commission on Cancer (CoC) and the Institute of Medicine, have proposed survivorship care plans (SCPs) as a way to extend support. However, limited research has been conducted to date on SCPs. Methods: In 2012, the LIVESTRONG Foundation (LIVESTRONG) administered a survey to understand the role of a treatment summary (TS) and SCPs and how they fit into survivors’ care. Logistic regression models were conducted to identify factors associated with receiving SCPs or TS. Results: 5,303 survivors responded to these questions (Table). While 92% of these respondents received information about where to return to for cancer check-ups, only 51% reported receiving a TS and 17% reported receiving a SCP. Survivors who were more likely to receive SCPs if they had a navigator (p<.001) and if they were male, Black, had finished treatment within the past year, or received care at a university-based medical center or community cancer center (p < 0.05). Also, those receiving a SCP were significantly more likely to have had a detailed discussion with a provider regarding long-term side effects, emotional needs, and lifestyle recommendations. Specifically, 60% of those with a SCP discussed long-term effects compared to 39% who did not. Conclusions: Results here indicate that few survivors receive SCPs but survivors reported benefits from receiving them. Currently many workflow barriers impede delivering SCPs, and LIVESTRONG is working with key stakeholders including the CoC to automate the LIVESTRONG Care Plan powered by Penn Medicine’s OncoLink through a registry and EMR system to understand how to address this issue. [Table: see text]

Associations between receipt of a treatment summary, emotional concerns, and patterns of care among post-treatment cancer survivors

52

Background: Treatment summaries (TS), a critical component of survivorship care plans, were identified as a tool to improve long-term outcomes for the 12 million cancer survivors alive in the United States. Methods: In 2010, the Lance Armstrong Foundation fielded the LIVESTRONG Survey for People Affected by Cancer. Respondents were recruited through several channels including partnerships with national organizations such as ASCO. Over a 9-month period, 12,682 people completed the survey, including 3,682 post-treatment cancer survivors (PTCS). The survey addressed post-treatment concerns including receipt of TS. Full survey results were presented at the 2011 ASCO Annual Meeting. Results: Receipt of TS data was available for 3,042 PTCS: average age (50); female (65%); average time since diagnosis (6 years); received a TS (34%). PTCS who received TS reported that they were closer to time since diagnosis or since treatment ended (p < 0.01); more likely to have received chemotherapy (p < 0.01); more often receiving the majority of their health care from a medical oncologist (p < 0.05); experiencing significantly fewer (p < 0.05) post-treatment emotional concerns (including emotional distress; fears of recurrence; concerns about family risk; and appearance concerns) and were more likely to have received care; significantly less likely to say that they had “learned to live with” their concerns (p <0.05)—the most common reason among participants for not receiving care. Finally, receipt of a TS was related to higher information efficacy (p < 0.01; which appeared to mediate the relationship between receipt of a TS and fewer emotional concerns). PTCS who received a TS more often reported that their needs were met including information received about possible late-effects; care they got during treatment; and care they received after treatment. Conclusions: These results support the provision of TS to PTCS. Receipt of TS was associated with a variety of positive outcomes; however, only about one-third of PTCS received one. Future studies focused on patient perspectives on care planning tools, such as treatment summaries and care plans, can help to improve optimal survivorship care delivery.

Cancer survivors’ perspectives on the U.S. generic drug shortage

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Background: Approximately 1.6 million new cancer cases are expected to be diagnosed in 2012 in the United States, making the need for generic cancer treatment drugs widespread. Methods: In late 2011, LIVESTRONG fielded the Drug Shortage Survey, which mirrored the questions from the American Hospital Association drug shortage survey for providers reworded for a patient audience. The primary goals of the brief survey were to 1) assess if survivors were aware of a generic drug shortage in the U.S. and 2) gauge the impact that the drug shortage has had on people affected by cancer. Individuals were asked to participate in this online survey through a number of means (including the LIVESTRONG Blog). Results: Between October 31, 2011 and January 30, 2012, 114 individuals completed the drug shortage survey, including 54 individuals who have been personally diagnosed with cancer. A little under half of the respondents (47%) felt they or a loved one had been impacted by the drug shortage, while an additional 30% were not sure if they had been impacted. Of the individuals impacted, the most commonly reported adverse effects of the drug shortage were not receiving medications needed for cancer treatment (40%) and receiving different medications (36%). The table highlights the reported effects. Conclusions: Results from this survey indicate that for cancer survivors who chose to participate in this survey who had been impacted by the drug shortage, the impact has been very significant. Additionally, results indicate that more information may need to be disseminated to the patient population about the drug shortage. [Table: see text]

Associations between receipt of a treatment summary, emotional concerns, and patterns of care among post-treatment cancer survivors

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Background: Treatment summaries (TS), a critical component of survivorship care plans, were identified as a tool to improve long-term outcomes for the 12 million cancer survivors alive in the US. Methods: In 2010, the Lance Armstrong Foundation fielded the LIVESTRONG Survey for People Affected by Cancer. Respondents were recruited through several channels including partnerships with national organizations such as ASCO. Over a 9 month period, more than people completed the survey, including 3,682 post-treatment cancer survivors (PTCS). The survey addressed post-treatment concerns including receipt of TS. Full survey results were presented at the 2011 ASCO Conference. Results: Receipt of TS data was available for 3042 PTCS: average age (50); female (65%); average time since diagnosis (6 years); received a TS (34%). PTCS who received TS reported that they were: Closer to time since diagnosis or since treatment ended (p<0.01); more likely to have received chemotherapy (p<0.01); more often receiving the majority of their health care from a medical oncologist (p<0.05); experiencing significantly fewer (p<0.05) post-treatment emotional concerns (including emotional distress; fears of recurrence; concerns about family risk; and appearance concerns) and were more likely to have received care; significantly less likely to say that they had “learned to live with” their concerns (p<0.05) – the most common reason among participants for not receiving care. Finally, receipt of a TS was related to higher information efficacy (p<0.01; which appeared to mediate the relationship between receipt of a TS and fewer emotional concerns). PTCS who received a TS more often reported that their needs were met including information received about possible late-effects; care they got during treatment; and care they received after treatment. Conclusions: These results support the provision of TS to PTCS. Receipt of TS was associated with a variety of positive outcomes; however, only about one-third of PTCS received one. Future studies focused on patient perspectives on care planning tools, such as treatment summaries and care plans, can help to improve optimal survivorship care delivery.

Using new media to reach Hispanic/Latino cancer survivors

In the USA, cancer is a leading cause of morbidity and premature death among the Hispanic/Latino population. It is estimated that one in two Hispanic men and one in three Hispanic women will be diagnosed with cancer during their lifetime (American Cancer Society 2010). Despite this significant cancer burden, few innovative strategies for communication and outreach to this population currently exist. In 2009, LIVESTRONG launched a national outreach campaign, which utilized social marketing, specifically targeting Hispanics with the goal of increasing awareness and usage of LIVESTRONG's Spanish-language cancer navigation resources. This campaign, one of the first undertaken by a national cancer-related organization, led to increased awareness and utilization of resources, including a 238% increase in traffic over traditional marketing campaigns which focused on radio alone. The success of this campaign highlights the use of social media as a cost-effective method to raise awareness of cancer resources among Hispanics.

Molecular cloning, expression, and pharmacological characterization of humEAA1, a human kainate receptor subunit

Kainate is a potent neuroexcitatory agent; its neurotoxicity is thought to be mediated by an ionotropic receptor with a nanomolar affinity for kainate. In this report, we describe the cloning of a cDNA encoding a human glutamate ionotropic receptor subunit protein from a human hippocampal library. This cDNA, termed humEAA1, is most closely related to rat and human cDNAs for kainate receptor proteins and, when expressed in COS or Chinese hamster ovary cells, is associated with high-affinity kainate receptor binding. We have successfully established cell lines stably expressing humEAA1. This is the first report of establishment of stable cell lines expressing a glutamate receptor subunit. The relative potency of compounds for displacing [3H]kainate binding of humEAA1 receptors expressed in these stable cell lines was kainate > quisqualate > domoate > L-glutamate >> (RS)-alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid > dihydrokainate > 6,7-dinitroquinoxaline-2,3-dione > 6-cyano-7-nitroquinoxaline-2,3-dione. Homooligomeric expression of humEAA1 does not appear to elicit ligand-gated ion channel activity. Nevertheless, the molecular structure and pharmacological characterization of high-affinity kainate binding of the humEAA1 expressed in the stable cell line (ppEAA1-16) suggest that the humEAA1 is a subunit protein of a human kainate receptor complex.

Molecular structure and pharmacological characterization of humEAA2, a novel human kainate receptor subunit

A cDNA encoding a novel human glutamate receptor subunit protein was isolated from a human hippocampal library. This cDNA, termed humEAA2, is most closely related to rat cDNAs for kainate receptor proteins and, when expressed in COS cells, is associated with high affinity kainate receptor binding. The relative potency of compounds in displacing [3H]kainate binding was kainate greater than quisqualate greater than domoate greater than L-glutamate much greater than 6,7-dinitroquinoxaline-2,3-dione greater than dihydrokainate greater than 6-cyano-7-nitroquinoxaline-2,3-dione greater than (RS)-alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid. Homomeric expression of humEAA2 does not appear to elicit ligand-gated channel activity. Nevertheless, the molecular structure and pharmacology of high affinity kainate binding suggest that humEAA2 is a novel subunit protein of a human kainate receptor complex.

Housing the homeless mentally ill: a longitudinal study of a treatment approach

In a one-year study of 49 homeless chronic mentally ill patients, the subjects, selected at admission for inpatient treatment, were randomly assigned to one of two groups. One group was placed in an experimental residential treatment program following discharge, and the other group received standard postdischarge care. Subjects were interviewed every four months during the year as well as at index hospitalization and discharge. Although the study remains exploratory due to the small sample size and case attrition, the authors found that compared with the control group, the subjects in the residential treatment program spent significantly more nights in adequate shelter, spent fewer nights in hospitals or undomiciled, and were more satisfied with and committed to their living arrangements.