Angie Mae Rodday

PURPOSE: Employment is a core component of development in young adulthood and may be drastically affected by cancer. As part of a multi-institution financial navigation trial (ClinicalTrials.gov identifier: NCT05620979 ), we sought to explore employment-related experiences of long-term young adult (YA) survivors of cancer. METHODS: We conducted a secondary qualitative analysis of YA (age 18-39 years) survivors of hematologic malignancies. Participants completed baseline questionnaires pertaining to education and work. A subset of participants completed an optional semistructured interview after trial completion, focused on financial experiences. To contextualize the cohort and supplement qualitative findings, survey data were analyzed using descriptive statistics. We analyzed interview transcripts using directed content analysis and inductive reasoning to examine employment-related themes. RESULTS: One hundred thirty YA participants (median 31 years; Q1-Q3, 27-35) were enrolled with median time from cancer diagnosis of 10 years (Q1-Q3, 6-16). Most (82%) were currently employed, 77% of whom worked full time; 21% were students. Almost half (46%) reported that cancer continued to affect their education and/or employment; 29% had taken extended work leave in the previous year for cancer-related reasons. Challenges expressed in interviews with 45 participants included difficulties maintaining work because of treatment and side effects, interruptions affecting employment trajectory, and choosing work primarily for insurance/health-related reasons. Recommendations from YAs included building personal financial literacy, seeking financial resources, and suggesting clinicians incorporate screening and training for vocational and financial challenges. CONCLUSION: Many long-term YA survivors of cancer reported substantial, ongoing impacts on their work-related achievement and trajectory. These findings underscore the need for universal screening and support throughout the cancer care continuum.

PURPOSE: To explore long-term young adult (YA) cancer survivors' experience with health insurance in a post–Affordable Care Act (ACA) era. METHODS: This was a mixed-methods analysis of insurance-related data collected from a cohort of English-speaking YA (currently age 18-39 years) blood cancer survivors, ≥3 years from diagnosis, recruited from six US hospitals as part of a financial navigation interventional study (ClinicalTrials.gov identifier: NCT05620979 ). Participants completed baseline questionnaires, with a subset participating in semistructured interviews after the 6-month study period. Summary statistics were reported for survey responses. Qualitative interviews were coded using directed content analysis. RESULTS: A total of 130 long-term (median, 10 [IQR, 6-16] years from diagnosis) YA survivors were enrolled, and 45 participated in interviews. Among the total cohort, most (63%) had employer-based private insurance; 22% had public insurance through Medicaid. Eighteen percent reported seeking a new health insurance plan in the past year to afford survivorship care. Over a fifth (23%) reported not knowing how to seek help navigating insurance, while 30% reported delaying or forgoing survivorship care because of not understanding their insurance plan. Four themes emerged from the interviews: (1) Many YA survivors experience insurance churn (ie, moving between plans or between insured and uninsured status); (2) learning to navigate the insurance system is confusing and not straightforward; (3) interactions related to insurance coverage are time-consuming and stressful; and (4) insurance churn and/or out-of-pocket costs affect YAs' ability to receive optimal medical care. CONCLUSION: Ongoing insurance-related challenges persist for YA cancer survivors in a contemporary post-ACA era. Although the ACA has provided essential coverage for many patients, ongoing issues include excessive insurance churn, lack of navigation resources, and the continued financial burden of out-of-pocket costs.

Opioid use disorder (OUD) has been linked to cardiometabolic diseases in adults through reductions in adiponectin—an adipocytokine with insulin–sensitizing effects. Opioid use during pregnancy dysregulates neonatal growth and may predispose to adult–onset diseases, but the impact of maternal OUD on neonatal adiponectin has not been studied. We hypothesize that maternal OUD also reduces adiponectin level in offspring (primary outcome) and alters growth (secondary outcome). To test our hypothesis, we conducted a prospective, observational pilot study and compared the expression of salivary adiponectin receptor 1/ ADIPOR1 and anthropometric and body composition (fat and fat–free mass) measurements between opioid–exposed and age–matched non–exposed neonates born at ≥34 weeks′ gestation. Data were stratified by exposure and sex using a Student′s t–test. Significance was set at pADIPOR1 was reduced in opioid-exposed neonates (0.27–fold, p<0.01), with the lowest expression in those requiring pharmacotherapy (0.048–fold, p<0.001). Despite the smaller anthropometric measurements in the exposed than non–exposed neonates (2915±625 grams vs. 3209±345 grams, p≡0.02), opioid–exposed neonates had comparable adiposity to non–exposed neonates (8.60±4.52% vs. 8.53±4.00%, p≡0.95). Less breast milk was used in the exposed than non–exposed group (25.7% vs. 71.9%, p<0.01). Maternal OUD may be associated with aberrant growth and excess adiposity in offspring through its effect on adiponectin signaling, predisposing these neonates to cardiometabolic risks.

PURPOSE: We characterized patient portal signup in the electronic health record and messaging use among vulnerable oncology patients identified as having newly initiated an oral anticancer medication (OAM), evaluating opportunities to improve patient portal adoption and thus patient communication with their oncology care teams. PATIENTS AND METHODS: We conducted a retrospective analysis of patients who newly initiated an OAM at Tufts Medical Center between October 1, 2022, and March 31, 2024. Vulnerability was defined as meeting at least one of the following criteria: age ≥75 years; non-English language; or subsidized insurance (Medicaid only or Medicare with Medicaid as a secondary insurance). Active portal use was defined as having at least one message in the portal; meaningful use was defined as patient-provider bidirectional messaging. Portal messaging proxy use was determined by message content screening. Fisher's exact test evaluated the impact of vulnerability on portal signup rate. Logistic regression was performed to identify factors associated with portal signup and meaningful use. RESULTS: Among the study population (N = 280), 56% met the criteria of vulnerability. Although the overall portal signup rate was 74%, it was 64% among vulnerable patients and 87% in nonvulnerable patients ( P < .0001). Non-English language was associated with lower rate of portal signup ( P < .0001), but none of the vulnerable characteristics were associated with decreased meaningful use. Messaging by proxy was used by 17% of vulnerable versus 2.8% of nonvulnerable patients who signed up for portal. Among patients who signed up, 31% used the portal to communicate about OAM. CONCLUSION: Although patient portal signup was lower among vulnerable patients, once adopted, vulnerable patients demonstrated comparable meaningful use and greater proxy engagement. Fostering patient portal adoption requires a targeted approach with patient navigation and patient proxy engagement.

Background: Health-related quality of life (HRQoL) was recently demonstrated to improve throughout therapy for high-risk pediatric Hodgkin lymphoma (HL); however, average scores may not reflect individual differences. This study aimed to identify subgroups of patients with similar HRQoL trajectories from pre- to post-therapy. Methods: AHOD1331 trial participants aged 11-20 (n = 268; mean [SD] age = 15.6 [1.9]; 48% male) completed the Child Health Ratings Inventories–Global scale (HRQoL) prior to treatment, after cycle 2, after cycle 5, and the end of treatment. Group-based trajectory models (GBTMs) identified latent clusters of individuals with similar HRQoL patterns over time. Multivariable multinomial logistic regression estimated the association between a priori defined characteristics and membership in trajectory-based groups. Log-rank tests examined differences in post-T4 progression-free survival (PFS) by trajectory groups. Results: GBTM identified 3 HRQoL groups: Group 1 (consistently unfavorable [25.7%]), Group 2 (moderate-and-increasing [44.8%]), and Group 3 (consistently favorable [29.5%]). Older age (odds ratio = 1.24, 95% confidence interval = 1.03 to 1.50; P = .022), female sex (2.48, 1.23 to 4.99; P = .011), and Hispanic ethnicity (2.31, 0.97 to 5.50; P = .059) were associated with increased odds of membership in Group 1 vs Group 3. Older age (1.18, 1.00 to 1.39; P = .038) and B-symptoms (2.18, 1.09 to 4.33; P = .027) were associated with increased odds of Group 2 membership vs Group 3. Group membership was not associated with post-T4 PFS. Conclusions: A subgroup of high-risk pediatric HL patients experience persistently poor HRQoL, starting at diagnosis and continuing through therapy. Age, female sex, Hispanic ethnicity, and B-symptoms were linked to worse HRQoL. These findings can help identify patients at higher risk for poor HRQoL and guide intervention. ClinicalTrials.gov: NCT02166463.

Supplemental Table 1 shows baseline (1995) characteristics of invited, included, and excluded participants.

Supplemental Table 4 shows path analysis coefficients for the effect of factors related to growth and development on log-transformed absolute dense area

Supplemental Table 3 shows linear regression analysis of growth and developmental factors with absolute measures of breast density, by age at mammogram.

Background:High mammographic density is one of the strongest breast cancer risk factors; however, determinants of high mammographic density are understudied in Black women. We assessed growth and development factors across the lifecourse in relation to mammographic density.Methods:Within the Black Women’s Health Study, we used Cumulus software to assess percent mammographic density from digital screening mammograms for 5,905 women ages 40 to 74 years. We fit linear regression models to quantify the association of lifecourse characteristics including birthweight, childhood somatotype, age at menarche, body mass index (BMI) at age 18 years, height, BMI at mammography, and adulthood waist-to-hip ratio with density overall and by age. We also performed a path analysis to assess the total and mediating effects of the growth and development factors on density.Results:BMI at age 18 years, height, BMI at mammography, and waist-to-hip ratio were significantly and inversely associated with density. On path analysis, total effects of childhood somatotype (standardized β = −0.05, P < 0.001), BMI at age 18 years (standardized β = −0.13, P < 0.001), BMI at mammography (standardized β = −0.22, P < 0.001), and waist-to-hip ratio (standardized β = −0.04, P < 0.001) were associated with density.Conclusions:Several factors across the lifecourse—greater childhood somatotype, BMI at age 18 years, height, BMI at mammography, and waist-to-hip ratio—were associated with lower mammographic density in this cohort of Black women.Impact:Body size closer to the time of mammography may be more meaningful in determining mammographic density, though early-life adiposity also influences mammographic density.See related In the Spotlight, p. 1541