Integrated practice units present an opportunity over siloed survivorship care settings

Abstract Given the rapidly rising cancer burden in the USA, the need to innovate survivorship care for oncology patients is rising rapidly. The current body of empirical evidence in survivorship care has focused on care provided by general practitioners (GP) and specialists/surgeons (SS). In particular, current evaluations address cost of care, cancer recurrence, quality of life, and overall survival of patients, with results indicating no statistically significant differences in GP- and SS-led care models and little emphasis on the broader characteristics of care settings. We fill this gap in survivorship care by introducing a perspective on the potential for holistic care delivery with a multidisciplinary team approach at integrated practice units (IPUs). Additionally, we propose a comprehensive examination of survivorship care across GP-, SS-, and IPU-led settings to provide researchers and practitioners with solid ground to determine the optimal survivorship care model, considering four key characteristics: (1) operating mode and skills, (2) cost and accountability of care, (3) health outcome measurement, and (4) workflow and scheduling

Weight gain after in vitro fertilization: a potential consequence of controlled ovarian stimulation

In the USA, 42% of adult women were estimated to have obesity, and 13% of women of childbearing age similarly have impaired fecundity. Obesity is associated with infertility such that patients with obesity often seek out in vitro fertilization (IVF) services. Here, we report on the case of a woman with childhood-onset class II obesity who had been undergoing treatment with phentermine and topiramate prior to undergoing 3 cycles of IVF. With each cycle, the patient temporarily gained 13–15 lbs. during controlled ovarian stimulation (COS). Weight gain from COS may be clinically relevant and merits further study to optimize weight status across women’s reproductive life and to better assist women who gain weight secondary to IVF. Incorporating weight monitoring into IVF protocols may also help better characterize the scope of weight gain from COS

Whether the Weather Will Help Us Weather the COVID-19 Pandemic: Using Machine Learning to Measure Twitter Users’ Perceptions

Objective: The potential ability for weather to affect SARS-CoV-2 transmission has been an area of controversial discussion during the COVID-19 pandemic. Individuals’ perceptions of the impact of weather can inform their adherence to public health guidelines; however, there is no measure of their perceptions. We quantified Twitter users’ perceptions of the effect of weather and analyzed how they evolved with respect to real-world events and time. Materials and Methods: We collected 166,005 English tweets posted between January 23 and June 22, 2020 and employed machine learning/natural language processing techniques to filter for relevant tweets, classify them by the type of effect they claimed, and identify topics of discussion. Results: We identified 28,555 relevant tweets and estimate that 40.4 % indicate uncertainty about weather’s impact, 33.5 % indicate no effect, and 26.1 % indicate some effect. We tracked changes in these proportions over time. Topic modeling revealed major latent areas of discussion. Discussion: There is no consensus among the public for weather’s potential impact. Earlier months were characterized by tweets that were uncertain of weather’s effect or claimed no effect; later, the portion of tweets claiming some effect of weather increased. Tweets claiming no effect of weather comprised the largest class by June. Major topics of discussion included comparisons to influenza’s seasonality, President Trump’s comments on weather’s effect, and social distancing. Conclusion: We exhibit a research approach that is effective in measuring population perceptions and identifying misconceptions, which can inform public health communications

Racial and ethnic disparities in end-of-life care for patients with oesophageal cancer: death trends over timeResearch in context

Summary: Background: Given significant morbidity and mortality associated with oesophageal cancer, supportive, high-quality end-of-life care is critical. Most patients with advanced cancer prefer to die at home, but incongruence between preferred and actual place of death is common. Here, we examined trends and disparities in location of death among patients with oesophageal cancer. Methods: Using the Centers for Disease Control and Prevention Wide-Range Online Data for Epidemiologic Research database, we utilized multinomial logistic regression to assess associations between sociodemographic characteristics and location of death for patients with oesophageal cancer (n = 237,063). Additionally, we utilized linear regression models to evaluate the significance of changes in location of death trends over time and disparities in the relative change in location of death trends across sociodemographic groups. Findings: From 2003 to 2019, there was a decrease of deaths in hospitals, nursing homes, and outpatient medical facilities/emergency departments and an increase of deaths at home and in hospice. Relative to White decedents, Black and Asian decedents were less likely to die at home (relative risk ratio (RRR): 0.58 [95% confidence interval (CI): 0.56–0.60], RRR: 0.57 [95% CI: 0.53–0.61]) and in hospice (RRR: 0.67 [95% CI: 0.64–0.71], RRR: 0.49 [95% CI: 0.43–0.55]) when compared to the hospital. Similar disparities were noted for American Indian and Alaska Native (AIAN) decedents. These disparities persisted even upon stratifying by the number of listed causes of death, a proxy for severity of illness. Time trend analysis indicated that increases in deaths in hospice over time occurred at a slower rate for AIAN and Asian decedents relative to White decedents. Interpretation: 2 in 5 patients with oesophageal cancer die at home, with an increasing proportion dying at home and in hospice—in line with general patient preferences. However, location of death disparities have largely persisted over time among racial and ethnic minority groups. Our findings suggest the importance of improving access to advance care planning and delivering tailored, person-centred interventions. Funding: None

A burden shared: the financial, psychological, and health-related consequences borne by family members and caregivers of people with cancer in India

Abstract In India, approximately 1.4 million new cases of cancer are recorded annually, with 26.7 million people living with cancer in 2021. Providing care for family members with cancer impacts caregivers’ health and financial resources. Effects on caregivers’ health and financial resources, understood as family and caregiver “financial toxicity” of cancer, are important to explore in the Indian context, where family members often serve as caregivers, in light of cultural attitudes towards family. This is reinforced by other structural issues such as grave disparities in socioeconomic status, barriers in access to care, and limited access to supportive care services for many patients. Effects on family caregivers’ financial resources are particularly prevalent in India given the increased dependency on out-of-pocket financing for healthcare, disparate access to insurance coverage, and limitations in public expenditure on healthcare. In this paper, we explore family and caregiver financial toxicity of cancer in the Indian context, highlighting the multiple psychosocial aspects through which these factors may play out. We suggest steps forward, including future directions in (1) health services research, (2) community-level interventions, and (3) policy changes. We underscore that multidisciplinary and multi-sectoral efforts are needed to study and address family and caregiver financial toxicity in India

Racial disparities in treatment delay among younger men with prostate cancer

Young men (6 months since diagnosis. Of the 89,196 men <= 55 years included, young Black men experienced treatment delays beyond six months more frequently than young White men (7.39% vs. 3.96%; AOR 1.95, 95% CI 1.81-2.09, p < 0.001), a disparity that was greater than that among men ages 56-64 (p(interaction) < 0.001). This result persisted upon restricting the sample to men with private insurance/managed care. The finding that Black men with localized PC experienced treatment delays almost twice as frequently as White men underscores access barriers that may go beyond the direct costs of care