101Background: Acute lymphoblastic leukemia (ALL) is a common cancer among children and young adults which requires prompt, specialized care. Adolescents and young adults (AYA) experience inferior ...

<p>Higher county‐level medical debt was associated with delays in cancer treatment initiation. Policies aimed at preventing and alleviating medical debt could be effective strategies for improving access to timely treatment.</p>

Mobility limitations can have significant impacts on physical, psychological, and social well-being for older adults. Mobility aids, such as standard manual wheelchairs, can be significant tools fo...

<h2>Abstract</h2><h3>Objectives</h3><p>Previous studies examining biases in pain reporting among nursing home (NH) residents have excluded short-stay residents (NH stay <100 days). This study of short-stay NH residents in the United States estimates pain prevalence under self-reported and staff-reported assessment in the Minimum Data Set (MDS) 3.0 and estimates whether there are differences by dementia/cognitive status, and racial/ethnic identity.</p><h3>Design</h3><p>Cross-sectional study.</p><h3>Setting and Participants</h3><p>Short-stay NH residents in the United States with pain assessments from MDS 3.0 in the first two quarters of 2019, shortly after new pain measures were introduced.</p><h3>Methods</h3><p>In 2 independent samples of short-stay residents with either self-reported pain assessment (n = 858,646 residents) or staff-reported pain assessment (n = 29,538 residents), we calculated the odds of reporting significant pain using mixed effects logistic models adjusted for key resident and facility characteristics.</p><h3>Results</h3><p>Overall, 9.60% of short-stay residents self-reported moderate to severe pain and 34.04% of staff-reported residents. In both samples, in the fully adjusted model, the odds of reporting pain were significantly lower among residents with (vs without) diagnosed dementia, with moderate to severe cognitive impairment (vs cognitively intact), and with minoritized racial/ethnic identities (vs White) [odds ratios ranging from 0.37 to 0.93; <i>P</i> < .001], after adjusting for the ability to understand, unclear speech, poor hearing, length of stay, functional capacity, mental illness, other comorbidities, age, and facility characteristics.</p><h3>Conclusions and Implications</h3><p>Among short-stay NH residents, disparities in pain reporting for residents with cognitive impairment, dementia, and minoritized racial/ethnic identity exist in both self-reported and staff-reported samples. Our study identifies potential underreporting of pain by cognitive status and racial/ethnic identity. Future work should explore whether lower rates of reporting pain reflect actual differences in experienced pain or bias due to measurement error.</p>

<h2>Abstract</h2><h3>Objectives</h3><p>Previous studies examining biases in pain reporting among nursing home (NH) residents have excluded short-stay residents (NH stay <100 days). This study of short-stay NH residents in the United States estimates pain prevalence under self-reported and staff-reported assessment in the Minimum Data Set (MDS) 3.0 and estimates whether there are differences by dementia/cognitive status, and racial/ethnic identity.</p><h3>Design</h3><p>Cross-sectional study.</p><h3>Setting and Participants</h3><p>Short-stay NH residents in the United States with pain assessments from MDS 3.0 in the first two quarters of 2019, shortly after new pain measures were introduced.</p><h3>Methods</h3><p>In 2 independent samples of short-stay residents with either self-reported pain assessment (n = 858,646 residents) or staff-reported pain assessment (n = 29,538 residents), we calculated the odds of reporting significant pain using mixed effects logistic models adjusted for key resident and facility characteristics.</p><h3>Results</h3><p>Overall, 9.60% of short-stay residents self-reported moderate to severe pain and 34.04% of staff-reported residents. In both samples, in the fully adjusted model, the odds of reporting pain were significantly lower among residents with (vs without) diagnosed dementia, with moderate to severe cognitive impairment (vs cognitively intact), and with minoritized racial/ethnic identities (vs White) [odds ratios ranging from 0.37 to 0.93; <i>P</i> < .001], after adjusting for the ability to understand, unclear speech, poor hearing, length of stay, functional capacity, mental illness, other comorbidities, age, and facility characteristics.</p><h3>Conclusions and Implications</h3><p>Among short-stay NH residents, disparities in pain reporting for residents with cognitive impairment, dementia, and minoritized racial/ethnic identity exist in both self-reported and staff-reported samples. Our study identifies potential underreporting of pain by cognitive status and racial/ethnic identity. Future work should explore whether lower rates of reporting pain reflect actual differences in experienced pain or bias due to measurement error.</p>

11011Background: Managing cancer care can be highly demanding, consuming time and energy. Measuring this time has been limited to date. We sought to comprehensively measure the time spent on cancer...

11084Background: Natural disasters are increasingly common in the U.S., causing significant localized disruptions to cancer care. The American Society of Clinical Oncology (ASCO) examines the suppl...

11011Background: Managing cancer care can be highly demanding, consuming time and energy. Measuring this time has been limited to date. We sought to comprehensively measure the time spent on cancer...

Over 8 million patients experiencing cancer face health-related social needs (HRSN) challenges, such as food, housing, and financial insecurity, that directly impact their health outcomes. While patients may participate in the screening of unmet social needs with their healthcare&nbsp;provider, it is not well understood if patients will self-screen and act on referrals to community services. Therefore, we conducted a mixed-methods study in which we pilot-tested a patient-centered oncology-focused digital social care referral platform, ConnectedNest. We recruited 13 cancer-focused community-based organizations (CBOs) and 41 individuals (e.g., patients, survivors, and caregivers) affected by cancer to participate in the study. Individuals used the application on their phones for 3&nbsp;months. They completed a social needs assessment and were provided with a personalized list of local CBO programs that could address these unmet needs. Quantitative analyses described participant HRSN and connections to referred programs.&nbsp;User experience surveys were collected over 30 and 60&nbsp;days to understand their experience. Individuals were also invited to participate in an a semi-structured&nbsp;interview to understand barriers and facilitators for social care referrals. Participants reported needs across 14 categories, with an average of 4.5 HRSN per participants. The top 3 reported needs were physical activity, financial strain, and mental health. Using our social care referral platform, approximately 39% of participants were able to connect with local CBOs. Three topic areas emerged from the participant interviews, highlighting that personal motivation, the participant's role, and the interest in services affected the participant's use of the technology. This study demonstrates the potential for digital social care referral platforms to bridge individuals affected by cancer with vital CBO resources to address HRSNs.

Over 8 million patients experiencing cancer face health-related social needs (HRSN) challenges, such as food, housing, and financial insecurity, that directly impact their health outcomes. While patients may participate in the screening of unmet social needs with their healthcare&nbsp;provider, it is not well understood if patients will self-screen and act on referrals to community services. Therefore, we conducted a mixed-methods study in which we pilot-tested a patient-centered oncology-focused digital social care referral platform, ConnectedNest. We recruited 13 cancer-focused community-based organizations (CBOs) and 41 individuals (e.g., patients, survivors, and caregivers) affected by cancer to participate in the study. Individuals used the application on their phones for 3&nbsp;months. They completed a social needs assessment and were provided with a personalized list of local CBO programs that could address these unmet needs. Quantitative analyses described participant HRSN and connections to referred programs.&nbsp;User experience surveys were collected over 30 and 60&nbsp;days to understand their experience. Individuals were also invited to participate in an a semi-structured&nbsp;interview to understand barriers and facilitators for social care referrals. Participants reported needs across 14 categories, with an average of 4.5 HRSN per participants. The top 3 reported needs were physical activity, financial strain, and mental health. Using our social care referral platform, approximately 39% of participants were able to connect with local CBOs. Three topic areas emerged from the participant interviews, highlighting that personal motivation, the participant's role, and the interest in services affected the participant's use of the technology. This study demonstrates the potential for digital social care referral platforms to bridge individuals affected by cancer with vital CBO resources to address HRSNs.

We assessed the effect of the time requirements of cancer care on other life activities and time burden reduction priorities among breast and gynecologic cancer survivors. A total of 224 participants with gynecologic or breast cancer from two cohort studies completed a cross-sectional survey regarding logistic and time burdens of cancer care. We compared agreement with the importance of minimizing travel time, wait time, and trips to the cancer center as well as whether cancer care visits interfered with other activities (dependent care, chores, leisure activities) by employment, education, cancer type, cancer treatment status, dependent status, rural-urban residence, and income. About half (108/217, 49.8%) of participants agreed minimizing time burdens was important. Some agreed that cancer care visits interfered with leisure time (31/215, 14.4%) or impacted their ability to care for dependents (17/215, 7.9% [15.9% among those with dependents, 7/44]). Retired participants, compared to working participants, less often agreed with the importance of minimizing travel time (36.5% [31/85] versus 58.0% [58/100]), trips to the cancer center (34.5% [30/87] versus 58.0% [58/100]), and wait time (35.8% [29/81] versus 56.0% [56/100]). Participants with incomes &lt;$50,000 and those receiving maintenance treatment most often agreed that minimizing wait time was important. Those not working (and not retired or on disability) and those receiving active treatment most often agreed that care interfered with leisure activities. Minimizing the time needed for cancer care-related tasks matters to patients, especially to those with lower incomes, receiving treatment, and working. In-depth research among demographically diverse populations is needed to evaluate specific time use patterns within cancer care and their association with objective and subjective burden.

<p>Introduction: Adolescents and young adults (AYAs), particularly those 19-34, are the most highly uninsured age group in the United States. AYAs lacking any insurance or having public health insurance have been consistently found to have worse survival after a cancer diagnosis than those with private insurance, highlighting the need to better understand survival disparities and improve outcomes in this population. We examined the association of health insurance with stage at diagnosis, cancer treatment, location of cancer care, healthcare utilization, and chronic medical conditions/late effects (e.g., cardiovascular, respiratory, and endocrine diseases) and survival.</p>

11071Background: The cost of cancer care has increased dramatically over the past decades, increasing the financial burden on patients. However, current estimates of...

<p>Cannabis use among individuals with cancer is best understood using survey self-report. As cannabis remains federally illegal, surveys could be subject to nonresponse and measurement issues impacting data quality. We surveyed individuals using medical cannabis for a cancer-related condition in the Minnesota Medical Cannabis Program (MCP). Although survey responders are older, there are no differences by race and ethnicity, gender, or receipt of reduced cannabis registry enrollment fee. Responders made a more recent purchase and more recently completed an independent symptom assessment for the registry than nonresponders, suggesting some opportunity for nonresponse error. Among responders, self-report and MCP administrative data with respect to age, race, gender, registry certification, and cannabis purchase history were similar. Responders were less likely to report receipt of Medicaid than would be expected based on registry low-income enrollment eligibility. Although attention should be paid to potential for nonresponse error, surveys are a reliable tool to ascertain cannabis behavior patterns in this population.</p>

<h3>Importance</h3><p>Medicare Advantage (MA) plans receive capitated per enrollee payments that create financial incentives to provide care more efficiently than traditional Medicare (TM); however, incentives could be associated with MA plans reducing use of beneficial services. Postacute care can improve functional status, but it is costly, and thus may be provided differently to Medicare beneficiaries by MA plans compared with TM.</p><h3>Objective</h3><p>To estimate the association of MA compared with TM enrollment with postacute care use and postdischarge outcomes.</p><h3>Design, Setting, and Participants</h3><p>This was a cohort study using Medicare data on 4613 hospitalizations among retired Ohio state employees and 2 comparison groups in 2015 and 2016. The study investigated the association of a policy change with use of postacute care and outcomes. The policy changed state retiree health benefits in Ohio from a mandatory MA plan to subsidies for either supplemental TM coverage or an MA plan. After policy implementation, approximately 75% of retired Ohio state employees switched to TM. Hospitalizations for 3 high-volume conditions that usually require postacute rehabilitation were assessed. Data from the Medicare Provider Analysis and Review files were used to identify all hospitalizations in short-term acute care hospitals. Difference-in-difference regressions were used to estimate changes for retired Ohio state employees compared with other 2015 MA enrollees in Ohio and with Kentucky public retirees who were continuously offered a mandatory MA plan. Data analyses were performed from September 1, 2019, to November 30, 2023.</p><h3>Exposures</h3><p>Enrollment in Ohio state retiree health benefits in 2015, after which most members shifted to TM.</p><h3>Main Outcomes and Measures</h3><p>Received care in an inpatient rehabilitation facility, skilled nursing facility, or home health, or any postacute care; the occurrence of any hospital readmission; the number of days in the community during the 30 days after hospital discharge; and mortality.</p><h3>Results</h3><p>The study sample included 2373 hospitalizations for Ohio public retirees, 1651 hospitalizations for other Humana MA enrollees in Ohio, and 589 hospitalizations for public retirees in Kentucky. After the 2016 policy implementation, the percentage of hospitalizations covered by MA decreased by 70.1 (95% CI, −74.2 to −65.9) percentage points (pp), inpatient rehabilitation facility admissions increased by 9.7 (95% CI, 4.7 to 14.7) pp, use of only home health or skilled nursing facility care fell by 8.6 (95% CI, −14.6 to −2.6) pp, and days in the community fell by 1.6 (95% CI, −2.9 to −0.3) days for Ohio public retirees compared with other Humana MA enrollees in Ohio. There was no change in 30-day mortality or hospital readmissions; similar results were found by comparisons using Kentucky public retirees as a control group.</p><h3>Conclusions and Relevance</h3><p>The findings of this cohort study indicate that after a change in retiree health benefits, most Ohio public retirees shifted from MA to TM and received more intensive postacute care with no significant change in measured short-term postdischarge outcomes. Future work should consider additional measures of postacute functional status over a longer follow-up period.</p>

<p>Patients with stage IV GI cancer spent 1 in 4 days alive with health care contact!</p>

Background: Multimorbidity is associated with premature mortality and excess health care costs. The burden of multimorbidity is highest among patients with cancer, yet trends and determinants of multimorbidity over time are poorly understood. Methods: Via Medicare claims linked to Cancer Prevention Study II data, group-based trajectory modeling was used to compare National Cancer Institute comorbidity index score trends for cancer survivors and older adults without a cancer history. Among cancer survivors, multinomial logistic regression analyses evaluated associations between demographics, health behaviors, and comorbidity trajectories. Results: In 82,754 participants (mean age, 71.6 years [SD, 5.1 years]; 56.9% female), cancer survivors (n = 11,265) were more likely than older adults without a cancer history to experience the riskiest comorbidity trajectories: (1) steady, high comorbidity scores (remain high; odds ratio [OR], 1.36; 95% CI, 1.29–1.45), and (2) high scores that increased over time (start high and increase; OR, 1.51; 95% CI, 1.38–1.65). Cancer survivors who were physically active postdiagnosis were less likely to fall into these two trajectories (OR, 0.73; 95% CI, 0.64–0.84, remain high; OR, 0.42; 95% CI, 0.33–0.53, start high and increase) compared to inactive survivors. Cancer survivors with obesity were more likely to have a trajectory that started high and increased (OR, 2.83; 95% CI, 2.32–3.45 vs. normal weight), although being physically active offset some obesity-related risk. Cancer survivors who smoked postdiagnosis were also six times more likely to have trajectories that started high and increased (OR, 6.86; 95% CI, 4.41–10.66 vs. never smokers). Conclusions: Older cancer survivors are more likely to have multiple comorbidities accumulated at a faster pace than older adults without a history of cancer. Weight management, physical activity, and smoking avoidance postdiagnosis may attenuate that trend.

Background: Multimorbidity is associated with premature mortality and excess health care costs. The burden of multimorbidity is highest among patients with cancer, yet trends and determinants of multimorbidity over time are poorly understood. Methods: Via Medicare claims linked to Cancer Prevention Study II data, group-based trajectory modeling was used to compare National Cancer Institute comorbidity index score trends for cancer survivors and older adults without a cancer history. Among cancer survivors, multinomial logistic regression analyses evaluated associations between demographics, health behaviors, and comorbidity trajectories. Results: In 82,754 participants (mean age, 71.6 years [SD, 5.1 years]; 56.9% female), cancer survivors (n = 11,265) were more likely than older adults without a cancer history to experience the riskiest comorbidity trajectories: (1) steady, high comorbidity scores (remain high; odds ratio [OR], 1.36; 95% CI, 1.29–1.45), and (2) high scores that increased over time (start high and increase; OR, 1.51; 95% CI, 1.38–1.65). Cancer survivors who were physically active postdiagnosis were less likely to fall into these two trajectories (OR, 0.73; 95% CI, 0.64–0.84, remain high; OR, 0.42; 95% CI, 0.33–0.53, start high and increase) compared to inactive survivors. Cancer survivors with obesity were more likely to have a trajectory that started high and increased (OR, 2.83; 95% CI, 2.32–3.45 vs. normal weight), although being physically active offset some obesity-related risk. Cancer survivors who smoked postdiagnosis were also six times more likely to have trajectories that started high and increased (OR, 6.86; 95% CI, 4.41–10.66 vs. never smokers). Conclusions: Older cancer survivors are more likely to have multiple comorbidities accumulated at a faster pace than older adults without a history of cancer. Weight management, physical activity, and smoking avoidance postdiagnosis may attenuate that trend.