Elyse R. Park

Introduction: Given the substantial chronic condition burden among adult survivors of childhood cancer, we explored associations between care coordination and discontinuity with patterns of care and health status. Methods: Data from Childhood Cancer Survivor Study (CCSS) participants with multiple chronic conditions who completed the validated CC‐MC measure of care coordination and discontinuity in 2022 were linked with data from 2019 to 2021 on emergency department [ED] visits, hospitalizations, risk‐based survivorship care advice, recommended screenings, and health status (SF‐36, Brief Symptom Inventory [BSI‐18]). Independent variables included three CC‐MC coordination summary scores: main provider (knowing the patient and coordinating their care), multiple provider (coordinating care within and across clinics), patient‐provider partnership (explaining things, considering patient goals); and discontinuity (dichotomous). Adjusted generalized linear models estimated prevalence ratios (PR), rate ratios (RR), and beta coefficients. Results: Participants ( n = 365) were mean age 48.2 years, 68.5% female, 90.1% non‐Hispanic White. Better main provider (RR = 0.87; 95% CI: 0.77–0.99) and multiple provider (RR = 0.85; 95% CI: 0.80–0.90) scores were associated with less ED use; better multiple provider scores with fewer hospitalizations (RR = 0.88; 95% CI: 0.81–0.96); and better patient‐provider partnership scores with receiving risk‐based survivorship care advice (PR = 1.04; 95% CI: 1.01–1.08). We found no consistent associations between CC‐MC scores and recommended screening, though screening rates were generally high. All three CC‐MC summary scores were associated with fewer BSI global severity score elevations (PR range: 0.62–0.84). Discontinuity was associated with more hospitalizations (RR = 1.61; 95% CI: 1.03–2.51) and BSI global severity score elevations (PR = 4.20; 95% CI: 1.74–10.16). Conclusion: Promoting care coordination across multiple providers and improving continuity may improve care and outcomes in this vulnerable population.

Supplementary Table S1 shows AUDIT-C improvement at 3 and 6 months by treatment and covariates, adjusted for baseline AUDIT-C.

Background:Alcohol and tobacco use are known carcinogens. Treating alcohol and tobacco co-use can improve treatment and survivorship outcomes among patients diagnosed with cancer. Methods:We conducted a post hoc analysis of ECOG-ACRIN EAQ171CD trial participants within the National Cancer Institute (NCI) Community Oncology Research Program (NCORP), examining changes in alcohol use among adults receiving the virtual sustained treatment (VST) for tobacco use intervention versus enhanced usual care (EUC; Quitline referral). Multivariable logistic regression assessed changes in alcohol use disorder (AUD) risk at 3 and 6 months using the Alcohol Use Disorders Identification Test Concise (AUDIT-C). Results:At baseline, participants (N = 305) were classified as having no risk (31%), low/minimal risk (38%), moderate risk (23%), or high risk (8%) for AUD. The mean age was 55.6 years, participants smoked for an average of 33 years, and 18% had alcohol-associated tumors. Participants randomized to EUC were more likely to shift to a lower alcohol risk category than those in the VST arm at 3 months (39% vs. 27%) and 6 months (33% vs. 27%). There was no significant difference in the odds of shifting to a lower risk category for VST versus EUC at 3 months [adjusted odds ratio (OR), 0.56; 95% confidence interval (CI), 0.26–1.18; P = 0.125] or at 6 months (adjusted OR, 0.57; 95% CI, 0.25–1.28; P = 0.172). Conclusions:Patients diagnosed with cancer and engaging in alcohol and tobacco co-use can achieve reductions in alcohol use and risk. Impact:Integrating tailored, co-use–focused strategies into cessation programs may improve changes in modifiable risk behaviors.

Artificial intelligence (AI) is increasingly being used to support patient-provider communication, yet patient perspectives on AI-generated responses to medical questions remain unclear. This study explored patient perspectives of the benefits, concerns, and recommended uses of AI-generated responses to patient portal messages in a healthcare setting. We conducted qualitative analysis of survey responses completed by adult patients to three open-ended questions regarding the perceived benefits, concerns, and recommendations related to AI-generated message replies. Patients (N=222) identified several perceived benefits of AI-generated patient portal responses including increased patient access and lowered clinician burden, while also highlighting concerns about the accuracy and personalization of the information received. Patients recommended that AI-generated patient portal messages be reviewed by clinicians, clearly labeled as AI-generated, and used primarily for routine or lower-complexity inquiries. Patients treated at a neurology department recognized meaningful potential benefits of AI-generated responses in healthcare messaging but also expressed concerns. These mixed perspectives, examined here in the understudied context of AI use in patient portal messaging, suggest that successful implementation may depend on transparent disclosure, human oversight, maintained clinician access, and concise, accurate, and empathetic responses.

Approximately 34% of cancer survivors are not working compared with 15% of healthy controls [1], and this trend persists years after diagnosis [2]. Employment provides important psychological and f...

Background: Alcohol and tobacco use are known carcinogens. Treating alcohol and tobacco co-use can improve treatment and survivorship outcomes among patients diagnosed with cancer. Methods: We conducted a post hoc analysis of ECOG-ACRIN EAQ171CD trial participants within the National Cancer Institute (NCI) Community Oncology Research Program (NCORP), examining changes in alcohol use among adults receiving the virtual sustained treatment (VST) for tobacco use intervention versus enhanced usual care (EUC; Quitline referral). Multivariable logistic regression assessed changes in alcohol use disorder (AUD) risk at 3 and 6 months using the Alcohol Use Disorders Identification Test Concise (AUDIT-C). Results: At baseline, participants (N = 305) were classified as having no risk (31%), low/minimal risk (38%), moderate risk (23%), or high risk (8%) for AUD. The mean age was 55.6 years, participants smoked for an average of 33 years, and 18% had alcohol-associated tumors. Participants randomized to EUC were more likely to shift to a lower alcohol risk category than those in the VST arm at 3 months (39% vs. 27%) and 6 months (33% vs. 27%). There was no significant difference in the odds of shifting to a lower risk category for VST versus EUC at 3 months [adjusted odds ratio (OR), 0.56; 95% confidence interval (CI), 0.26–1.18; P = 0.125] or at 6 months (adjusted OR, 0.57; 95% CI, 0.25–1.28; P = 0.172). Conclusions: Patients diagnosed with cancer and engaging in alcohol and tobacco co-use can achieve reductions in alcohol use and risk. Impact: Integrating tailored, co-use–focused strategies into cessation programs may improve changes in modifiable risk behaviors.

Introduction: Most adults with opioid use disorder (OUD) smoke cigarettes, and cessation rates with food and drug administration-approved medications are low. Switching to e-cigarettes (EC) is an effective cigarette reduction method in adults without OUD but has not been rigorously evaluated in adults with OUD. Methods: Adults (N = 41) in OUD treatment who smoked ≥5 cigarettes/day (CPD), used EC ≤3 of prior 30 days, and did not want to quit smoking, were randomized to receive an 8 week supply of the National Institute on Drug Abuse's standardized research EC immediately (SREC, n = 22) or after an 8-week delay (waitlist control; WLC, n = 19). Participants reported past 24-h CPD and EC use in daily texts for 8 weeks and research assessments and biochemical monitoring (eg, carbon monoxide [CO]) every 2 weeks for 8 weeks. Results: Participants had a mean age of 50, were 76% male, 88% white. From Baseline (BL) to Week 8, the change in CPD differed significantly between groups (P = .001) with a larger decrease in CPD in SREC vs. WLC (SREC 15.3 at BL to 7.2 CPD at W8, WLC 14.2 to 12.8). There was a significant reduction in breath CO levels within SREC across the 8-weeks (from 22.9 at BL to 12.5 at W8, P < .001), that was larger than WLC (23.7 vs. 20.3, P = .042) (group × time P = .071). No group differences were observed on nicotine dependence, withdrawal, or OUD stability (P’s > .05). Conclusion: Provision of ECs to people with OUD who smoke, not planning to quit, resulted in reduced combusted tobacco use, exposure and no worsening withdrawal, dependence, or OUD stability. Implications: There is a paucity of rigorous RCTs testing switching adults with opioid use disorder (OUD) from cigarettes to e-cigarettes for changing cigarette use behavior. We conducted a randomized waitlist-controlled trial of effects of e-cigarette provision on cigarette consumption and tobacco exposure in adults in OUD treatment and found that provision of e-cigarettes resulted in reduced combusted tobacco use and tobacco exposure without worsening nicotine withdrawal, dependence, or OUD stability. E-cigarettes are a feasible, acceptable, and likely effective cigarette reduction strategy for adults in OUD treatment not interested in quitting smoking.

PURPOSE: Persistent smoking among patients diagnosed with cancer is associated with adverse clinical outcomes, yet tobacco treatment has not been integrated into community oncology settings. We conducted a trial of a virtual sustained tobacco treatment intervention across community oncology settings nationwide. METHODS: This randomized controlled trial compared the effectiveness of sustained telehealth counseling plus medication (virtual sustained treatment [VST]) to referral to the National Cancer Institute (NCI) quitline (enhanced usual care [EUC]) in assisting patients recently diagnosed with cancer to quit smoking. The VST group received up to 11 synchronous telehealth sessions (four weekly, four biweekly, three monthly) of motivational counseling and up to 12 weeks of free nicotine replacement therapy (NRT). RESULTS: From August 2019 to December 2022, 306 English- and Spanish-speaking patients were randomly assigned from 37 NCI Community Oncology Research Program community sites. Participants were 70.9% female; 86.3% was White; the median age was 57 years; and 45.4% had non–smoking-related tumors. A total of 221 of 302 (73.2%) smoked within 30 minutes of waking. Six-month, 7-day point abstinence rates were 28.4% (42 of 148) in the VST group versus 14.7% (21 of 143) in the EUC group; there were no significant treatment moderators. A total of 80.8% (126 of 156) of VST participants engaged in counseling, and 85.7% (108 of 126) were dispensed NRT. Participants who completed >8 sessions versus P = .005. VST participants were almost four times more likely to report guideline-concordant smoking cessation medication use. Continuous abstinence and significant reduction rates at 6 months were higher in the VST group. The incremental cost per quit was $7,724 in US dollars. CONCLUSION: Among recently diagnosed patients, sustained remotely delivered telehealth counseling and free NRT were well utilized and nearly doubled 6-month quit rates compared with EUC. Findings support the benefit of adopting sustained tobacco treatment within community oncology care settings nationwide.

Background: Many female colorectal and anal cancer survivors experience distressing changes to sexual well-being (e.g., dyspareunia, low libido) after treatment. Though mind-body programming has previously shown benefit for women’s sexual well-being, no existing program is available to address women’s sexual well-being specifically following colorectal and anal cancer treatment. Objective: This two-phase study describes initial development of a group mind-body program for women’s sexual well-being in colorectal and anal cancer survivorship. Methods: Phase 1 includes individual interviews with 18 female colorectal and anal cancer survivors and 8 clinicians at an academic comprehensive cancer center, focusing on intervention priorities and session content. In Phase 2, female colorectal and anal cancer survivors from the same cancer center participated in an open pilot trial of the group sexual well-being program (6 weeks; 2 groups with 6 participants in total). Qualitative and quantitative feedback regarding preliminary feasibility and acceptability were interpreted holistically to inform next steps for intervention refinement. Results: In Phase 1, patients identified priorities for intervention, clarified interest in mind-body practices, and highlighted key program modifications (e.g., addressing ostomy use, prioritizing patient privacy in groups). Clinicians expressed positive feedback on the proposed intervention and noted key areas of unmet need for the patients they serve. In Phase 2, preliminary program feasibility (100% of those enrolled attending at least 4 of 6 sessions) and acceptability (83.3% rating their comfort level in groups ≥ 4 on a 5-point scale) were supported. Average group cohesiveness across 6 valid items was high ( M = 4.6, range 3.8-5.0). Conclusion: There is clear need for specialized sexual well-being programming for female colorectal and anal cancer survivors. The initial iteration of this mind-body group program was well-received by participants with several key areas for improvement identified that will inform iterative refinement of this novel group intervention.