Kristi D. Graves

Background: Thyroid cancer is often labeled a “good cancer” due to high survival rates. However, many patients diagnosed with differentiated thyroid cancer (DTC) treated with radioactive iodine (RAI) experience short- and long-term symptoms as a result of treatment. These include salivary dysfunction, dry mouth, dry eyes, and nausea. Despite these challenges, patients report limited knowledge and unmet informational needs regarding RAI symptoms and symptom management. Evidence-based, patient-centered education to support symptom management during DTC survivorship is needed. Our team developed Radioactive Iodine Support (RAI Support), a prototype of a 4-week web-based intervention for RAI symptom management among survivors of DTC. Objective: This study aimed to evaluate the usability of the RAI Support intervention among survivors of DTC who completed RAI treatment and assess preliminary effect sizes of change in RAI symptom burden, self-efficacy for managing chronic symptoms, informational needs, global physical and mental health, and health-related quality of life (HRQOL). Methods: We conducted a longitudinal usability testing study with 8 participants over a 4-week period. At baseline (T1), participants completed an online survey and a 90-minute virtual usability testing session. During usability testing sessions, study staff used a think-aloud protocol to elicit feedback on the content, language, and visual appeal of the prototype across 5 tasks. Participants also completed the System Usability Scale (SUS). Participants were encouraged to continue using the intervention over the 4-week period, during which use data were recorded. A follow-up after assessment (T2) was completed at the end of the 4-week period of home use. Survey outcomes included RAI symptom burden, self-efficacy for managing chronic symptoms, informational needs, global physical and mental health, and HRQOL. Results: Among the 8 survivors of DTC who had undergone RAI treatment (age: mean 45, SD 8.2 years), the mean SUS score was 88.1 (SD 8.7), indicating above-average usability. All participants effectively completed each task, with ease of use ranging from 100% to 87.5% and error rates ranging from 0% to 25%. Preliminary r effect size signals of change were found for improved self-efficacy, global mental health, and HRQOL (r values ranged from 0.31 to 0.45). Conclusions: Survivors of DTC reported above-average usability of the RAI Support prototype and completed each task successfully. Variability in error rates and ease of use suggests that refinements are needed to further optimize usability and patient engagement. RAI Support also shows preliminary promise in improving self-efficacy for symptom management, global mental health, and HRQOL among survivors of DTC. Findings support future pilot testing.

PURPOSE: Engaging community stakeholders in clinical trials planning identifies participation barriers and facilitators to support future trial success. We assessed interest and perceived capacity of NCORP practices and engaged stakeholders to inform a future multi-site clinical trial involving caregivers. METHODS: A cross-sectional survey of NCORP practices (WF-2300CD) assessed interest (somewhat or very likely to participate) and capacity (ie, criteria: ≥5 eligible dyad accruals/quarter, identification of necessary study implementers), and barriers and facilitators to participating in a future cancer caregiver-focused trial. Interest and capacity were estimated with 95% confidence intervals and logistic regression was used to identify significant predictors. Free-text responses were analyzed using content analysis. RESULTS: Among136 initial responding practices, 126(92%) completed the survey (November 2023-April 2024), 56% saw ≥1,000 new patient cases annually, 13.5% served ≥30% racial and ethnic minority patients, and 13.5% were designated critical access hospitals. Overall, 84.9% (95% CI, 77.5%-90.1%) expressed interest in a caregiver-focused trial, but only 37.3% (95% CI, 28.9%-46.4%) met all capacity criteria; capacity was the sole predictor of interest (adjusted-OR 5.79; 95% CI 1.23 to 27.13). Most practices (88.9%) estimated ≥5 eligible caregiver-patient dyads/quarter but only 44.4% believed they could accrue that amount. Key participation barriers included staffing limitations, and challenges related to eligibility and recruitment. Practices emphasized clear guidance on dyad eligibility, recruitment materials, workflow training, and resource considerations to improve trial participation. CONCLUSION: Early stakeholder engagement identified actionable barriers and produced practice-aligned strategies to enhance caregiver trial participation in community oncology settings. Targeted capacity building may improve participation for future caregiver-focused trials.

The National Cancer Institute (NCI) awarded administrative supplements to 11 NCI-designated cancer centers to build capacity for financial navigation services and collect preliminary data to implement and evaluate financial navigation programs. Preliminary findings from the projects were shared during a virtual conference in October 2022. This paper reflects major themes from the conference, the now completed projects, and findings from scientific literature to propose a set of recommendations for addressing financial hardship as part of cancer care delivery. Recommendations include the following principles. Healthcare systems should implement financial hardship screening using validated, culturally appropriate tools, considering patient literacy and language needs. Screening programs should be universal with assessments repeated over time. Financial navigation services should be available to help patients manage direct and indirect costs of care, access financial assistance and navigate employment-related challenges. Financial navigators should receive specialized training to build their knowledge of healthcare billing, insurance, financial assistance, and patient advocacy while also preparing them to support patients and leverage local and regional resources. A multidisciplinary care team approach should be applied to developing and implementing financial hardship screening and navigation services. Finally, health systems should harmonize information technology and workflows across departments involved in screening and financial navigation service delivery and automate screening, referral, and care team notification processes. Future research should address outstanding knowledge gaps, including the optimal interval for screening, how to identify patient needs early to mitigate downstream financial hardship, and the ideal components and timing of financial navigation for different settings and populations.

Background: Few studies have examined whether specific symptoms following radioactive iodine (RAI) treatment are associated with worse health-related quality of life (HRQOL) among patients with differentiated thyroid cancer (DTC), a population that is understudied in cancer survivorship research. More specifically, the relationship between RAI symptom burden and holistic HRQOL measures has not yet been evaluated in this population. The aims of this study were to 1) evaluate the correlation between a comprehensive patient-reported RAI symptom measure, the SAlivary, LAcrimal, and NaSal (SALANS) measure, and HRQOL (FACT-G7) in patients with DTC following RAI treatment and 2) evaluate the relationships between HRQOL, RAI symptom burden, and psychosocial factors among patients treated with RAI for DTC. Methods: We recruited participants through a national thyroid cancer patient organization to complete an exploratory cross-sectional online survey. Pearson correlation coefficients were used to evaluate the associations between the FACT-G7 and SALANS measure. Hierarchical linear regression models were used to assess the associations between HRQOL, patient-reported RAI symptom burden, and psychosocial factors, controlling for demographic and clinical factors. We used t -tests to identify variables related to clinically meaningful decreases in HRQOL. Results: Sixty-nine patients (mean age = 40.4 years, SD = 14.48) who received RAI treatment (M = 1.0, SD = 0.78) within 3 years of diagnosis (M = 1.4, SD = 0.77) completed an online survey. Statistically significant moderate negative correlations were found between the RAI symptom burden scales and HRQOL ( r = −0.39 to −0.60, P < 0.001). Worse HRQOL was significantly associated with greater RAI symptom burden (β = −0.46, P = 0.003), greater distress (β = −0.38, P = 0.003), and lower self-efficacy (β = 0.47, P = 0.002), controlling for demographics and clinical factors. Compared with those with high HRQOL, those with low HRQOL reported significantly ( P < 0.05) greater symptom burden related to RAI treatment, particularly xerostomia, sialadenitis, taste changes, dry eyes, epiphora, and nasal symptoms. Conclusions: Greater RAI symptom burden, greater distress, and lower self-efficacy were associated with worse HRQOL among patients with DTC after RAI treatment. Identifying treatment- and psychosocial-related risk factors of worse HRQOL could help inform future targets for thyroid cancer survivorship care and patients who may benefit from supportive interventions.

BACKGROUND Thyroid cancer is often labeled a “good cancer” due to high survival rates. However, many patients diagnosed with differentiated thyroid cancer (DTC) treated with radioactive iodine (RAI) experience short- and long-term symptoms as a result of treatment. These include salivary dysfunction, dry mouth, dry eyes, and nausea. Despite these challenges, patients report limited knowledge and unmet informational needs regarding RAI symptoms and symptom management. Evidence-based, patient-centered education to support symptom management during DTC survivorship is needed. Our team developed Radioactive Iodine Support (RAI Support), a prototype of a 4-week web-based intervention for RAI symptom management among survivors of DTC. OBJECTIVE This study aimed to evaluate the usability of the RAI Support intervention among survivors of DTC who completed RAI treatment and assess preliminary effect sizes of change in RAI symptom burden, self-efficacy for managing chronic symptoms, informational needs, global physical and mental health, and health-related quality of life (HRQOL). METHODS We conducted a longitudinal usability testing study with 8 participants over a 4-week period. At baseline (T1), participants completed an online survey and a 90-minute virtual usability testing session. During usability testing sessions, study staff used a think-aloud protocol to elicit feedback on the content, language, and visual appeal of the prototype across 5 tasks. Participants also completed the System Usability Scale (SUS). Participants were encouraged to continue using the intervention over the 4-week period, during which use data were recorded. A follow-up after assessment (T2) was completed at the end of the 4-week period of home use. Survey outcomes included RAI symptom burden, self-efficacy for managing chronic symptoms, informational needs, global physical and mental health, and HRQOL. RESULTS Among the 8 survivors of DTC who had undergone RAI treatment (age: mean 45, SD 8.2 years), the mean SUS score was 88.1 (SD 8.7), indicating above-average usability. All participants effectively completed each task, with ease of use ranging from 100% to 87.5% and error rates ranging from 0% to 25%. Preliminary r effect size signals of change were found for improved self-efficacy, global mental health, and HRQOL (r values ranged from 0.31 to 0.45). CONCLUSIONS Survivors of DTC reported above-average usability of the RAI Support prototype and completed each task successfully. Variability in error rates and ease of use suggests that refinements are needed to further optimize usability and patient engagement. RAI Support also shows preliminary promise in improving self-efficacy for symptom management, global mental health, and HRQOL among survivors of DTC. Findings support future pilot testing.

Background: We aimed to identify health-related quality of life (HRQOL) profiles among breast cancer survivors and factors associated with each profile. Methods: Breast cancer survivors diagnosed 6–13 months earlier completed surveys assessing sociodemographic, clinical, and HRQOL variables (NIH PROMIS short forms). Using latent profile analysis (LPA), we grouped survivors into HRQOL profiles of PROMIS scores based on model fit and clinical interpretability. We used multinomial logistic regression models to determine clinical, psychosocial, and demographic factors associated with each HRQOL profile. Results: Among 1,638 breast cancer survivors, we identified four HRQOL profiles: high (20.3% of survivors), average (34.5%), low (33.1%), and very low (12.1%). Membership in the low or very low versus high HRQOL profile was associated with: <high school versus college/graduate [low OR = 2.98 (1.29, 6.85); very low OR = 4.51 (1.53, 13.33)]; not working [low OR = 2.20 (1.41, 3.43); very low OR = 4.32 (2.33, 8.00)]; lack of consistent companionship [low OR = 3.67 (1.85, 7.25); very low OR = 6.22 (2.78, 13.92)]; and history of: lung condition [low OR = 2.42 (1.34, 4.36); very low OR = 4.28 (2.09, 8.77)]; anxiety/depression [low OR = 2.76 (1.71, 4.46); very low OR = 8.86 (4.74, 16.56)]; sleep disturbance [low OR = 2.97 (1.25, 7.06); very low OR = 6.21 (2.40, 16.08)]; and chemotherapy [low OR = 3.29 (2.13, 5.08); very low OR = 7.34 (3.75, 14.37)]. Protective factors associated with reduced likelihood of low/very low HRQOL profile membership included higher: financial well-being [low OR = 0.82 (0.74, 0.90); very low OR = 0.78 (0.68, 0.89)] and spirituality [low OR = 0.63 (0.56, 0.71); very low OR = 0.53 (0.45, 0.62)]. Conclusion: About 45% of early-phase breast cancer survivors in the present sample experienced low or very low HRQOL; early identification and targeted interventions can be used to improve HRQOL over time.

Background: A preliminary randomized controlled trial was conducted to evaluate the impact of a culturally tailored, group‐based intervention for Latina breast cancer survivors (BCSs) and their caregivers on survivors’ quality of life (QOL) compared to usual care services provided by community‐based organizations.Methods: This study randomized 136 Latina BCSs and 136 caregivers in Washington, DC; New York, New York; and San Jose, California to an eight‐session culturally tailored coping and communication intervention (n = 70 dyads) or usual care support services via community‐based organizations (n = 66 dyads). QOL domains (anxiety, depression, fatigue, physical functioning, and social functioning) were measured at baseline, immediately post‐intervention, and 6 months post‐intervention.Results: Among the 70 dyads in the intervention, 71.4% (n = 50) attended five or more of the eight sessions, which demonstrated high engagement; 82% of participants were retained at 6 months. Results indicated clinically significant improvements in Latina BCSs’ reports of anxiety and fatigue at 6 months postintervention compared to BCSs in usual care; however, after adjustment for multiple comparisons, results were not statistically significant.Conclusions: A culturally tailored, group‐based intervention for Latina BCSs and their caregivers led to clinically relevant but not statistically significant improvements in survivors’ anxiety and fatigue compared to usual services provided by community‐based organizations. Interventions conducted in partnership with community‐based organizations yield high engagement and retention; these types of collaborative approaches to psychosocial services have the potential to positively affect Latina BCSs’ QOL.

Environmental cues can signal identity threat (e.g., potential discrimination) or identity safety (e.g., belonging) to socially marginalized people. However, scant research has examined safety and threat cues in healthcare. In our T1‐T2 concurrent triangulation mixed‐methods study, participants (age 35–60; ∼25% each cisgender Black women, Black men, Latina, Latino) completed quantitative (n = 288) and qualitative (n = 80) surveys. Participants rated their past healthcare experiences and future cancer screening intentions, analyzed via multiple regression. Participants responded to short‐answer questions about their healthcare experiences to identify cues to identity threat and/or identity safety, analyzed via grounded theory. Identity safety related to prostate, breast, and colorectal cancer screening intentions, controlling for mistrust and past discrimination. Qualitative results concurred, indicating that interpersonal cues and environmental features cue safety or threat. Our findings support that Black and Latine people value identity safety in cancer screening, and future interventions could test promoting safety cues to promote cancer screening.

Most cancer patients undergoing hematopoietic stem cell transplant report elevated symptoms and reduced health-related quality of life during peritransplant. These concerns can become persistent. A prior randomized controlled trial showed that expressive helping-a low-burden, brief intervention combining expressive writing with a novel peer support writing exercise-reduced psychological distress and physical symptoms in long-term transplant survivors with moderate/high persistent symptoms. The Writing for Insight, Strength, and Ease trial evaluated the use of expressive helping during peritransplant, when symptoms peak and early intervention could prevent the development of persistent symptoms. Three hundred sixty-six adult blood cancer patients (44.3% female, 74.6% White, 13.4% Black, 11.5% Hispanic/Latinx) scheduled for allogeneic (33.9%) or autologous (66.1%) transplant were randomized to complete either expressive helping or a neutral writing task in four writing sessions beginning pretransplant and ending 4 weeks posthospital discharge. Symptom severity (primary outcome), distress (depressive symptoms, generalized and cancer-specific anxiety), health-related quality of life, and fatigue were measured in multiple assessments from prerandomization to 12 months postintervention. Primary endpoints at 3 and 12 months postintervention estimated short- and long-term intervention effects. Moderation analyses explored subgroup differences in intervention efficacy. Mixed models with repeated measures analyses revealed no statistically or clinically significant intervention effects on primary or secondary outcomes. Moderation analyses did not identify subgroups of participants who benefitted from the intervention. Findings do not support use of expressive helping during peritransplant. We recommend that survivors with persistent symptoms complete expressive helping at least 9 months posttransplant, consistent with evidence from a prior trial. (PsycInfo Database Record (c) 2025 APA, all rights reserved).