215 Background: With early screening and advances in treatment, prostate cancer (PC) patients are living longer and facing increasingly complex therapeutic decisions alongside significant financial burden related to care (e.g., copays, coinsurance, other out-of-pocket (OOP) costs). Conversations with providers about financial concerns can help patients navigate these decisions, thereby promoting delivery of quality care and improving quality of life. We characterized financial toxicity (FT) and patient-provider communication about cancer-related cost among PC patients and survivors. Methods: 107 PC patients and survivors enrolled in Cancer Support Community’s Cancer Experience Registry completed items assessing FT (11-item FACIT-COST measure; range = 0-44, lower scores indicate greater FT). Items include ability to meet monthly expenses, financial stress, and cancer/treatment influence on financial situation. Frequencies and correlations between FT, health care team (HCT) communication, and socio-demographics were examined. Results: Participants were 89% non-Hispanic White, 5% Black, 2% Hispanic; mean age was 68 years (SD = 7.5). Median time since diagnosis was 3 years; 19% reported experiencing symptoms of PC at the time of diagnosis. 21% were ever metastatic, 22% experienced a recurrence, and 48% reported currently receiving treatment. 29% were employed full- or part-time; 52% spent at least $100/month on all OOP PC costs, 30% spent $250 or more, 16% spent $500 or more. Mean FT score was 28 (SD = 11.9). 67% reported members of their HCT did not discuss cost of treatment, 55% did not discuss impact of PC and treatment on work, 77% did not discuss financial distress. While most participants were satisfied with their doctor’s explanation of benefits (89%) and risks/side effects (79%) for each treatment option, only 49% were satisfied with how much their HCT discussed financial costs of each option. Greater patient confidence in communicating with doctor about PC was significantly associated with less FT ( r= .19, p< .05), but experiencing more FT was not correlated with a greater likelihood of HCT discussing cost of treatment ( r= -.05, p= .63) or discussing impact of cancer and treatment on work ( r= .04, p= .67). Conclusions: Results indicate that patients with greater financial toxicity report less confidence in communicating with their doctor about PC, however providers are not frequently or systematically initiating discussions around cost and impact on work even among those experiencing the highest levels of financial burden. Findings underscore the critical value of transparency about health care costs and impact, as well as support for providers in communicating effectively with patients about costs and available resources, to improve patient quality of life and health outcomes.
e18716 Background: The COVID-19 pandemic has uniquely impacted the lives of people with cancer, but the specifics of these impacts are not fully understood. We examined: 1) the impact of COVID-19 on cancer-related health care, and 2) patients’ most prominent COVID-related concerns. Methods: From Sept-Dec 2020, 502 cancer patients completed an online survey about disruptions in cancer-related health care (types and causes of disruptions and length of health care delays). COVID-related concerns (e.g., accessing basic and medical needs, financial concerns, psychosocial impact) were assessed via 25 items rated not at all to extremely concerning, or not applicable. Group differences were examined with Pearson Chi-Square. Sample: 75% women, 82% White, age range 20-88 years (M = 60, SD = 12.1); 61% in remission, 16% experiencing cancer relapse, 13% experiencing cancer for the first time; current stage: 40% metastatic, 25% localized, 35% no stage/don’t know; time since diagnosis range 0-36 years (M = 8.8, SD = 7.0); primary cancer diagnoses: 29% breast, 27% blood cancers, 6% prostate, 5% lung, 5% colorectal, and 28% other; 47% currently in treatment. 49% were tested for COVID-19, 3% tested positive. Results: 40% (n = 200) reported a disruption in cancer-related health care: of these, 34% reported disruption in imaging services, 30% lab service, 26% routine screening, 25% supportive services, 12% treatment session (including 46% chemotherapy, 13% radiation, 13% hormone therapy, 4% surgery), and 14% other disruption, with 10% reporting delay in cancer diagnosis. Nearly half with care delays reported a delay of 2-3 months (18%) or 3+ months (30%), with 3+ months delays occurring most often for routine screenings (40%) and supportive services (37%). Primary causes for disruptions included clinicians recommending the delay (46%) and patient fear of contracting COVID-19 via in person care (31%). The top 3 areas of COVID-19-related concerns ( somewhat to extremely concerned) were: 1) others not following safety recommendations e.g., wearing masks (85%), 2) getting COVID-19 due to a weakened immune system (76%), and 3) worrying about loved ones’ health (73%). Those in remission less frequently experienced delay in care (35%) than those with first time cancer (50%) or relapse (51%, χ2= 10.5, p < .05), and those in current treatment more frequently experienced delay in care (44%) than those not in treatment (36%, χ2= 3.5, p < .10). Conclusions: Findings highlight the substantial impact of COVID-19 on cancer care, across various forms of care needs and health services. Patients experiencing cancer for the first time, a cancer relapse, or those undergoing treatment reported high levels of delays, with many delays in excess of 3 months. Given the unique impact of COVID-19 to cancer patients, these results highlight opportunities for care service delivery improvements as the health care community navigates competing priorities of patient safety and care quality.
Background: With the availability of newer acute myeloid leukemia (AML) treatment combinations and targeted therapies, it is important for patients to understand all available treatment options, including their associated benefits, risks and side effects, before treatment decisions are made. Open communication between patients and clinicians about such options is a critical step toward collaborative treatment decision-making. The purpose of this study is to characterize AML patient experiences regarding treatment decision-making (TDM) and satisfaction with health care team (HCT) communication. Methods: Fifty-six (56) AML patients and survivors enrolled in the Cancer Support Community's online survey, the Cancer Experience Registry®. Forty (40) participants completed survey items pertinent to TDM and satisfaction with HCT communication. Items assessed participants' knowledge about treatment options prior to making a treatment decision, involvement in the TDM process, perceived preparation to discuss treatment options with their doctor, satisfaction with their doctor's explanation of the benefits of each treatment option, satisfaction with their doctor's explanation of the risks and side effects of each treatment option (response options for these five items: 0-4, where 0=Not at all and 4=Very much), and desire for additional support prior to making a treatment decision (response options: Yes/No). Frequencies for these items and socio-demographic and clinical history measures were examined. Results: Among the 40 participants who completed TDM measures, 55% were female and 95% were White, with a mean (SD) age of 52.7 (12.9) years (range: 20-77). Mean time since diagnosis was 5.6 years. Forty-three (43%) percent of participants reported that they were receiving treatment at the time of survey completion, and 28% indicated having ever experienced a recurrence of their cancer. While 65% of participants reported that they were quite a bit or very much involved in their TDM process, only 43% indicated that they were quite a bit or very much knowledgeable about their treatment options prior to making their treatment decision, and 40% of participants reported that they would have liked more support prior to making their treatment decision. More than half of respondents indicated that they were quite a bit or very much satisfied with their doctor's explanation of the benefits of each treatment option (55%), and the risks and side effects of each treatment option (58%); however, only 38% of participants indicated that they felt quite a bit or very much prepared to discuss treatment options with their doctor. Conclusions: Findings demonstrate that substantial proportions of AML patients and survivors express considerable involvement in their treatment decision-making process, and satisfaction with their doctor's explanation of the benefits and the risks and side effects of each treatment option. However, fewer individuals diagnosed with AML reported high levels of knowledge about their treatment options prior to making their treatment decision, and relatively few felt prepared to discuss treatment options with their doctor. Furthermore, many AML patients and survivors indicated a desire for additional support prior to making a treatment decision. Together, results highlight a need for resources, such as TDM guides or in-person counseling, to enhance HCT communication surrounding TDM for individuals with AML. Such efforts may provide AML patients with sufficient knowledge about treatment options to ensure that they feel adequately prepared to discuss these options and select the appropriate treatment pathway. Disclosures Kranzler: Astellas Pharma US, Inc.: Research Funding; Pharmacyclics, Inc.: Research Funding; Janssen Oncology: Research Funding; Takeda Oncology: Research Funding; Jazz Pharmaceuticals: Research Funding. Fortune:Genentech: Research Funding; Boston Scientific Foundation: Research Funding. Leblanc:UpToDate: Patents & Royalties: Royalties; Agios, AbbVie, and Bristol Myers Squibb/Celgene: Speakers Bureau; AstraZeneca: Research Funding; AbbVie, Agios, Amgen, AstraZeneca, CareVive, BMS/Celgene, Daiichi-Sankyo, Flatiron, Helsinn, Heron, Otsuka, Medtronic, Pfizer, Seattle Genetics, Welvie: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; American Cancer Society, BMS, Duke University, NINR/NIH, Jazz Pharmaceuticals, Seattle Genetics: Research Funding. Liesveld:Abbvie: Honoraria; Onconova: Other: data safety monitoring board. Zaleta:Pfizer, Inc.: Research Funding; Athenex Oncology: Research Funding; Gilead Sciences, Inc: Research Funding.
Background: Triple negative breast cancer (TNBC) can spread quickly and has a higher rate of recurrence than other breast cancers. Due to TNBC’s aggressive nature and treatment, patients can experience adverse symptoms and side effects. Palliative care (PC) is intended to improve health-related quality of life (HRQOL) for patients with serious disease at any stage of their illness. However, PC is often conflated with end-of-life care which can affect its rates of utilization. The goals of this study were to explore how TNBC patients characterize their HRQOL by time since diagnosis and describe the rate of utilization in the past year of PC providers for symptom and side effect management. Methods: Data was collected through Cancer Support Community’s Cancer Experience Registry® (CER). From Jan 2015 to Aug 2021, 209 individuals with TNBC enrolled in the CER and completed the Patient-Reported Outcomes Measurement Information System-29 (PROMIS-29 v2.0) profile measure. Five domains assess symptoms with higher scores corresponding to worse symptomology (depression, anxiety, pain interference, fatigue, and sleep disturbance) and two domains assess function with lower scores corresponding to worse functioning (physical and social). Scale scores were converted to standardized T scores and compared against the U.S. population (M=50, SD=10) and reference values for newly diagnosed patients with all types of breast cancer. We considered a group score difference of 3 points clinically meaningful. Moderate to severe impairments are reported as percentages of the sample that have PROMIS scores >1SD from M=50. Of the 209 TNBC patients, 66 (32%) participated after Nov 2018 and answered newer survey items about utilization of PC providers in the past year. Results: Participants were mainly Non-Hispanic White (81%); resided in suburban/urban areas (84%); reported household income >$40K (64%); Mean age=53y (SD=10; range 28-77). Median time since diagnosis was 2y. 25% reported advanced or metastatic disease; 41% were currently receiving treatment. TNBC patients reported elevated symptoms and deficits in functioning relative to the U.S. population (score difference>3) for all PROMIS subscales except depression (M=51.9) and social function (M=48.8). Fatigue and anxiety scores were highest (M=55.3 and M=56.2, respectively) exceeding the threshold for mild severity. About one-third of participants reported moderate to severe levels of symptom impairment for fatigue (36%), anxiety (36%), and pain interference (32%). Newly diagnosed participants reported higher levels of symptom severity and functional deficits which improved over time; however, survivors’ PROMIS scores remained worse than the U.S population for fatigue and anxiety. Compared to reference values for breast cancer patients, newly diagnosed (< 2y) TNBC participants (n=83) reported elevated symptoms for fatigue, anxiety, and depression and worse social function (score differences, 4.0, 9.1, 5.3, and 3.9, respectively). In the past year, 69% saw an oncology provider for symptom and side effect support, 44% saw a primary care provider, and 9% a PC provider. Some participants sought care for symptom and side effect management from allied and psychosocial providers such as pharmacists (28%), counselors (25%), and physical therapists (24%). Conclusions: Among TNBC patients, we observed higher levels, on average, of fatigue, anxiety, and depression, and lower social function compared to reference values for breast cancer patients and the U.S. population. Symptom severity and functional deficits were highest among individuals newly diagnosed with TNBC suggesting the importance of incorporating PC into cancer care early in the disease course. TNBC patients and survivors most frequently rely on primary care and oncology care teams for management of symptoms. Future research should examine access barriers to PC providers. Citation Format: Madyson L. Popalis, Heather Badt, Kara Doughtie, Caroline Lawrence, Melissa F. Miller. Symptom and Functional Status for Individuals with Triple Negative Breast Cancer and Palliative Care Utilization: Findings from the Cancer Experience Registry [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P5-07-10.
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