Patricia I. Jewett

Introduction: Cancer care is burdensome, but patient experience with time and administrative burdens is variable. Our objective was to assess the association between daily administrative tasks, time spent, and reported burden and identify demographic and clinical predictors. Methods: Participants ( n = 122) from two longitudinal studies of individuals receiving cancer treatment utilized a mobile application (Daynamica) to track time spent on cancer care tasks over 28 days. Participants reported distress levels (NCCN Distress Thermometer) and time spent on three administrative tasks daily: scheduling appointments, managing medical bills/claims, and arranging support/transportation. Relationships between distress and tasks were assessed using generalized linear mixed models. Results: Most participants (91.8%) performed at least one administrative task during the study. Participants were more likely to report clinically significant distress (score 4+) on days involving administrative tasks (scheduling [OR = 1.92, 95% CI: 1.40–2.64], managing bills [OR = 2.10, 95% CI: 1.34–3.29], or arranging support [OR = 3.56, 95% CI: 2.19–5.79]) compared to days without these tasks. While the median time spent was low (14 min per week; Q1–Q3: 3–39), the top quartile spent an average of 83 min per week on these tasks. Lack of reliable transportation was the only factor significantly associated with increased time spent on administrative tasks (median 57 vs. 10 min/week, p = 0.01); no other demographic or clinical factors were associated with higher workload. Conclusion: Administrative burden is a distinct psychological stressor for individuals with cancer, regardless of the actual time required for administrative tasks. Interventions should focus on streamlining insurance, care coordination, and administrative processes to reduce patient distress. Trial Registration: ClinicalTrials.gov identifier: NCT05708703, NCT06322992

Background: Financial toxicity is prevalent in cancer survivorship and has been associated with poorer health‐related quality of life (HRQOL), yet longitudinal evidence remains limited. We examined associations between financial toxicity and HRQOL at baseline and 4‐month follow‐up among breast cancer survivors in the BOLD cohort. Methods: Data were drawn from self‐report questionnaires completed by 182 breast cancer survivors at baseline, of whom 146 completed 4‐month follow‐up surveys. Financial toxicity was assessed at baseline using the Comprehensive Score for Financial Toxicity (COST). HRQOL outcomes were assessed at baseline and approximately 4 months later using the Functional Assessment of Cancer Therapy–General (FACT‐G) subscales and total score, and a single‐item measure of sleep disturbance. Multivariable linear regression models estimated adjusted cross‐sectional associations and longitudinal associations between baseline financial toxicity and follow‐up outcomes, adjusting for baseline levels of the corresponding outcome. Longitudinal measurement invariance of the COST was evaluated. Results: Greater baseline financial toxicity was associated with lower baseline physical, social/family, emotional, and functional well‐being, lower FACT‐G total score, and greater sleep disturbance. In longitudinal models, higher baseline financial toxicity was associated with lower follow‐up physical, social/family, emotional, and functional well‐being and lower FACT‐G total score after adjustment for demographic and clinical covariates and the corresponding baseline outcome. Baseline financial toxicity was not associated with follow‐up sleep disturbance. Conclusions: Financial toxicity was associated with poorer HRQOL at baseline and with lower physical, social/family, emotional, functional, and overall HRQOL at follow‐up. These findings support greater attention to financial toxicity in survivorship care.

About one in four U.S. high school students experience peer bullying victimization. Although discrimination based on socially stigmatized identities is increasing, there are few studies examining ethno-racial and religion-identity-based bullying (IBB), or whether school diversity or rural-urban settings modify such bullying experiences. We conducted a cross-sectional analysis of the 2016, 2019 and 2022 Minnesota Student Surveys of eighth and ninth graders. We assessed the associations of bullying victimization due to race/ethnicity/national origin and religion with school ethno-racial diversity, and geographical location by ethno-racial group using multilevel multivariate logistic regression models with random intercepts for schools. Overall, rates of ethno-racial and religious- based bullying were highest in rural (23.7%) and suburban (21.8%) schools. Ethno-racial-based bullying was higher among Black (44.2%), Black Latine (43.8%) and Hmong (40.4%) students in rural areas. Religion-based bullying was most prevalent in rural (10.1%) and urban schools (9.6%) and among Somali students across all locales (21.7% urban, 25.2% suburban and 28.4% town/rural). School ethno-racial diversity was protective against ethno-racial IBB only and for some groups (Black, Asian, multiracial) and not others (e.g., American Indian Alaskan Native, Somali, white). We found differences in the percentage of students reporting IBB by ethno-racial group, school diversity, and school geographic location. Generally, diverse school contexts were associated with a decrease in ethno-racial IBB for most students, especially in suburban schools. It is important to account for subgroup differences in addressing IBB to identify protective contexts. Our findings point to the need for systemic efforts to facilitate positive interpersonal relations in schools, such as policies and training that support teachers as role models and agents of socialization.

Purpose: Clinical firearm safety counseling can help prevent firearm injuries, yet many clinicians have not adopted this practice. We collected practical tips from physicians who do such counseling to help others interested in conducting such counseling while perhaps feeling insecure about how to implement it. Design: Qualitative interview study. Setting/Participants: Sixteen physicians who had made clinical firearm safety counseling part of their practice. Methods: An interview guide included questions about how, when, and with whom participants were undertaking firearm safety counseling, motivations, experiences with the counseling, patient reactions, and barriers and facilitators. The interviews were analyzed using inductive thematic analysis. Results: Most (11 out of 16) physicians were in primary care/family medicine or pediatrics; 54% worked in urban, 27% in rural/small town, and 20% in suburban settings. Three takeaways were reported by virtually every participant: firearm safety counseling is not difficult; almost all patients react positively, and occasional skeptical reactions are easily defused; and this counseling does not take much time. Participants kept conversations nonjudgmental and focused on safety, not on firearm ownership itself. Participants’ strong convictions that it was their responsibility to address firearm safety helped them overcome barriers such as lack of time, training, and guidelines. Conclusion: Participants shared actionable ideas on how to facilitate firearm safety counseling, exemplifying ways to encourage firearm safety behaviors.

Purpose: Individuals diagnosed with cancer have extensive and often unmet psychosocial support needs. We established a partnership between the University of Minnesota and Gilda's Club to identify survivorship issues, unmet psychosocial support needs, and barriers to receiving cancer support in rural Minnesota.Methods: We conducted six focus groups and 16 interviews (41 total participants) between November 2022 and January 2024 among cancer survivors living in rural Minnesota. Structured interview guides included questions about survivors’ definition of cancer support, what community support is desired and available, and barriers to obtaining support. Transcripts were analyzed using inductive thematic analysis.Findings: The mean participant age was 57.1 ± 13.4 years; the majority were female (68%), non‐Hispanic White (95%), and college graduates (58%), and they represented many cancer diagnoses, with hematologic (20%) and breast cancers (17%) most frequently reported. Most (73%) were under surveillance (median 4 years from diagnosis). Many participants mentioned extensive travel burdens due to lack of local care, and virtually all participants agreed emotional support was critical. Over half (56%) of participants wished for peer support that they did not have, and 44% said their cancer information needs were insufficiently addressed. Some emphasized that having nurses facilitating care coordination and options for local care made care feel more personalized. Participants identified virtual options for cancer support as potentially beneficial, particularly when meeting in person was not possible.Conclusions: Lack of peer support, lack of local care, and travel burdens are significant concerns among rural cancer survivors. Participants expressed positive views about their rural residence and mentioned alternatives and rural strengths such as virtual support options, help from nurses, and caring relationships in their communities.

Cancer and its care create substantial financial, time, and administrative burdens both for patients and their loved ones. Although cancer-related financial burdens have been well documented in the past decade, time and administrative burdens of cancer care have received substantially less attention. We define time burdens as the burden patients and caregivers experience due to the time needed to complete cancer-related treatment and tasks that take away from other life responsibilities. Relatedly, we conceptualize administrative burdens as those burdens patients and caregivers experience due to cancer-related, resource-consuming bureaucratic and logistical tasks. Finally, financial hardship can be conceptualized as problems patients experience related to the cost of medical care. These burdens do not exist in isolation; time, administrative, and financial burdens intersect with and compound each other. Currently, we have limited evidence-based measures on the objective (eg, scheduling time, transportation, wait time) and subjective (eg, mental, emotional and physical stress) measures of time and administrative burden. We have even more limited evidence of the risk factors for and outcomes from increased time and administrative burdens, and how they differentially impact populations across social and demographic groups. In this commentary, we present a research agenda to map, measure, evaluate, and mitigate the time, administrative, and financial burdens of cancer and its care.

Introduction: High rates of suicidal ideation (SI), suicide attempts (SA), and repetitive nonsuicidal self‐injury (NSSI) among some ethnoracially minoritized United States youth populations may be related to adverse childhood experiences (ACEs) with structural roots.Methods: Using the 2013–2019 Minnesota Student Surveys, we assessed associations of student‐reported structural ACEs (parental incarceration, housing instability, food insecurity, and foster care involvement) with SI, SA, and repetitive NSSI within the past 12 months using multilevel logistic regression stratified by ethnoracial group (American Indian/Alaskan Native [AIAN], Hmong, other Asian, Black Latino, other Latino, Somali, other Black/African American [AA], Native Hawaiian/Pacific Islander [NHPI], and multiracial), and adjusted for sex, grade, ACEs experienced within one's household, mental health treatment, and perceived safety.Results: Structural ACEs were strongly associated with increasing SI, SA, and NSSI. At ≥2 structural ACEs, repetitive NSSI rates ranged from 7% to 29% (female), 8% to 20% (male); SA rates ranged from 13% to 35% (female), 10% to 22% (male); and SI rates ranged from 31% to 50% (female), 20% to 32% (male). Black Latino, NHPI, AIAN, and Black/AA students most often reported structural ACE exposures.Conclusion: Reducing structural ACEs may reduce SI, SA, and repetitive NSSI among ethnoracially minoritized youth populations. Disaggregating diverse youth groups revealed variations in these outcomes that remain hidden when subpopulations are aggregated.

Supplemental Table 1 provides detailed frequencies of sun protection behaviors by ethno-racial group and by rural and urban status, showing differences by behavior across groups.