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Background: Palliative care has shown benefit in patients with cancer; however, little is known about the overall utilization of palliative care services in patients with pancreatic cancer and the impact of aggressive end-of-life interventions. This study aimed to explore the incidence of palliative care consultations (PCCs) in hospitalized patients with pancreatic cancer in the United States and the association between palliative care consultations and the use of aggressive interventions at the end of life. Methods: We conducted a retrospective study of patients hospitalized with pancreatic cancer. We examined patient records for 6 months prior to death for the presence of PCCs and aggressive end-of-life (EOL) interventions—emergency department visits, chemotherapy, and ICU stays. The use of EOL interventions was compared between those who did and those who did not receive PCCs, using Chi-square and Whitney U tests. Results: Of the 2883 identified patients, 858 had evidence of a PCC in their record in the last 6 months of life. Patients receiving PCCs were older at the time of death and more likely to receive chemotherapy (22.4% vs. 10.6%) in the last 6 months of life compared to those not receiving a palliative care consult. Similarly, patients with PCCs were more likely to have aggressive interventions in the EOL period. Conclusions: Less than 30% of patients with pancreatic cancer received a PCC. Those who received a PCC had more aggressive interventions in the end-of-life period, differing from what the prior literature has shown. Future investigations are necessary to explore the components and timing of PC and investigate their influence on the utilization of aggressive interventions and patient-centered outcomes. [ABSTRACT FROM AUTHOR]

The article discusses the ethical issues involved in the communication boundaries between patients and clinicians in oncology practice. Topics mentioned include the communication strategies to help promote the well-being of clinician and the quality of patient care, the norms of professionalism, the ethics of sacrifice and balance and the role of institutions in supporting clinicians and patients.

PURPOSE Little data exist regarding approaches to support oncology professionals who deliver cancer care for underserved populations. In response, ASCO developed the Serving the Underserved Task Force to learn from and support oncology professionals serving underserved populations. METHODS The Task Force developed a 28-question survey to assess oncology professionals' experiences and strategies to support their work caring for underserved populations. The survey was deployed via an online link to 600 oncology professionals and assessed respondent and patient demographic characteristics, clinic-based processes to coordinate health-related social services, and strategies for professional society support and engagement.We used chi-square tests to evaluate whether there were associations between percent full-time equivalent (FTE) effort serving underserved populations (<50% FTE v ≥50% FTE) with responses. RESULTS Of 462 respondents who completed the survey (77% response rate), 79 (17.1%) were Asian; 30 (6.5%) Black; 43 (9.3%) Hispanic or Latino/Latina; and 277 (60%) White. The majority (n = 366, 79.2%) had amedical doctor degree (MD). A total of 174 (37.7%) had <25% FTE, 151 (32.7%) had 25%-50% FTE, and 121 (26.2%) had ≥50% FTE effort serving underserved populations. Most best guessed patients' sociodemographic characteristics (n = 388; 84%), while 42 (9.2%) used data collected by the clinic. Social workers coordinated most health-related social services. However, in clinical settings with high proportions of underserved patients, there was greater reliance on nonclinical personnel, such as navigators (odds ratio [OR], 2.15 [95% CI, 1.07 to 4.33]) or no individual (OR, 2.55 [95% CI, 1.14 to 5.72]) for addressing mental health needs and greater reliance on physicians or advance practice practitioners (OR, 2.54 [95% CI, 1.11 to 5.81]) or no individual (OR, 1.91 [95% CI, 1.09 to 3.35]) for addressing childcare or eldercare needs compared with social workers. Prioritization of solutions, which did not differ by FTE effort serving underserved populations, included a return-on-investment model to support personnel, integrated health-related social needs screening, and collaboration with the professional society on advocacy and policy. CONCLUSION The findings highlight crucial strategies that professional societies can implement to support oncology clinicians serving underserved populations with cancer. [ABSTRACT FROM AUTHOR]

The article presents the discussion on persistence of health disparities despite efforts to expand access to healthcare, attributing this to underlying social, economic, and environmental conditions known as social determinants of health (SDOH). Topics include ASCO's commitment to addressing SDOH in cancer care, the formation of a task force to articulate recommendations, and the policy framework guiding ASCO's advocacy efforts.

Introduction: Palliative care (PC) utilization remains low among pancreatic cancer patients. This study explores the association of PC with mental health service and pharmacotherapy utilization among pancreatic cancer patients.Methods: Retrospective analysis was conducted on a sample of patients in the United States with newly diagnosed pancreatic cancer using Electronic Health Record data from Optum's Integrated Claims-Clinical data set. Subsequent diagnoses of anxiety and depression and PC consultation encounters were determined using ICD-9/10 codes. Adjusted associations of mental health treatments with PC and patient characteristics were quantified using multiple logistic regression. Results: Among newly diagnosed pancreatic cancer patients (n = 4029), those with PC consultations exhibited a higher prevalence of anxiety (33.9% vs. 22.8%) and depression (36.2% vs. 23.2%). Mental health service use and pharmacotherapy varied, with the highest utilization among patients having both anxiety and depression. Treatment pattern was also influenced by age (aOR 1.832 for age <55 vs. 65–70 years). Notably, PC consultations showed no significant effect on the likelihood of documented treatment. Discussion: Our study emphasizes underutilization of PC and MH treatment for pancreatic cancer patients. These findings imply a crucial need for further investigation into palliative care's role in addressing mental health concerns among pancreatic cancer patients. [ABSTRACT FROM AUTHOR]

Osteoarthritis (OA) is the most common joint disease in the US and can increase the risk of depression. Both depression and OA disproportionately affect women, yet this study is one of few on depression prevalence, treatment across age groups, and predictors in women with OA. Data were extracted from the 2011–March 2020 National Health and Nutrition Examination Survey (NHANES). Women aged ≥ 45 years with self-reported osteo- or degenerative arthritis were included. Outcomes were depression (assessed with PHQ-9) and treatment (self-reported pharmacotherapy and mental health services). Logistic regression was used to examine associations between age group, covariates, and outcomes. Overall, depression prevalence was 8%, with higher proportions among those 45–64 years old. Aging was associated with reduced odds of depression (Age 65–79: OR 0.68 (95% CI: 0.52–0.89); Age 80+: OR 0.49 (95% CI: 0.33–0.74); vs. Age 45–54). Of those with a positive depression screen, 21.6% documented some form of treatment. Age group was not statistically different between those treated and those not treated. Women aged 45–64 with osteoarthritis may be at increased risk of depression, and most are not treated. As depression is related to increased pain and risk of rehospitalization, future research should prioritize interventions to increase uptake of depression treatment. [ABSTRACT FROM AUTHOR]

Background: Hospice is intended to promote the comfort and quality of life of dying patients and their families. When patients are discharged from hospice prior to death (ie, experience a "live discharge"), care continuity is disrupted. This systematic review summarizes the growing body of evidence on live discharge among hospice patients with Alzheimer's Disease and related dementias (ADRD), a clinical subpopulation that disproportionately experiences this often burdensome care transition. Methods: Researchers conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Reviewers searched AgeLine, APA PsycINFO (Ovid), CINAHL Plus with Full Text, ProQuest Dissertations & Theses Global, PubMed, Scopus, and Web of Science (Core Collection). Reviewers extracted data and synthesized findings from 9 records, which reported findings from 10 individual studies. Results: The reviewed studies, which were generally of high quality, consistently identified diagnosis of ADRD as a risk factor for live discharge from hospice. The relationship between race and live hospice discharge was less clear and likely dependent upon the type of discharge under investigation and other (eg, systemic-level) factors. Research on patient and family experiences underscored the extent to which live hospice discharge can be distressing, confusing, and associated with numerous losses. Conclusion: Research specific to live discharge among ADRD patients and their families is limited. Synthesis across included studies points to the importance for future research to differentiate between types of live discharge—revocation vsversus decertification—as these are vastly different experiences in choice and circumstances. [ABSTRACT FROM AUTHOR]

Background: Parkinson's Disease (PD) affects over 10 million people worldwide. Many PD patients experience comorbid anxiety disorders, which have been correlated with reduced quality of life and can manifest at any time during the course of PD, including prior to motor symptom onset. Purpose: Prior work has demonstrated that patients diagnosed with depression following a PD diagnosis are less likely to receive depression treatment, but no such study has been conducted for anxiety. Research Design: A cross-sectional analysis of secondary electronhic health record data was conducted. Study Sample: Data was obtained through Optum® de-identified Electronic Health Record dataset, using ICD-9 and ICD-10 diagnosis codes to determine PD status and comparing index date of anxiety and PD diagnoses to classify patients by relative time of diagnosis. Data Analysis: Multivariate logistic regression was performed to assess factors associated with receipt of mental health treatment. Results: Of PD patients with anxiety, 52% documented a diagnosis of anxiety prior to PD. Overall, 69% documented some treatment, with 79% of those diagnosed with anxiety prior to PD receiving some treatment compared to 59% of those diagnosed with anxiety on or after PD (P < 0.001). Conclusion: Patients with PD and subsequent anxiety diagnoses are less likely to receive treatment. Further study could explore reasons for variations in mental health care within the context of an existing PD diagnosis. [ABSTRACT FROM AUTHOR]

Background: Aerodigestive care is one model of multi-disciplinary care, which is a valuable tool for both providers and patients. Aerodigestive care models are associated with improved outcomes, reduced anesthesia exposure, reduction in hospital admissions, and fewer days of missed work or school. This is the first study to explore national usage and cost trends in combined endoscopy utilization to identify gaps in care and the potential for financial resource optimization. Methods: Data from the Healthcare Cost and Utilization Project (HCUP) Kid's Inpatient Sample (KID) was used from 2016 and 2019. Diagnoses and procedures were identified using ICD-10 codes, for patients with hospital length of stay less than 1 day. Demographic data were identified, and survey-weighted means and proportions were computed. Bivariate comparisons were made using Rao Scott Chi-Square tests. National estimates of charges were computed with discharge weights, developed using the American Hospital Association (AHA) universe. Key results: White, high-income patients, and those at urban teaching hospitals received the greatest proportion of combined endoscopic procedures. The cost/charges associated with combined endoscopies are less than for separate gastrointestinal (GI) or airway only endoscopies combined. However, combined procedures comprise a smaller share of national aggregate cost. Conclusions: National utilization trends highlight racial and socioeconomic disparities and suggest differences in access based on hospital characteristics, despite the reduced cost/charges of the combined procedure. For patients with a need for combined aerodigestive procedures, there appears to be a cost-savings opportunity to increase efforts for combined procedures at the level of the clinician or hospital. [ABSTRACT FROM AUTHOR]

Simple Summary: Overcoming cancer health disparities requires an understanding of the etiologies that drive these persistent disparities. To date, little knowledge exists regarding barriers and facilitators experienced by clinicians in their delivery of cancer care for populations most at risk for cancer disparities, such as low-income and racially and ethnically minoritized populations. The aim of this study was to assess the perspectives of clinicians across the United States, with a particular emphasis on understanding modifiable barriers to ensuring evidence-based cancer care delivery for populations most at risk for cancer disparities. Findings revealed the impact of clinical infrastructure, resources, and support to deliver cancer care equitably, social and economic challenges that often inhibit evidence-based care delivery, and the crucial importance of relationships with the community and other clinicians in the community, as well as attention to clinician wellness. These findings reveal areas of unmet need ripe for solutions to achieve cancer health equity. Background: The American Society of Clinical Oncology established the 'Supporting Providers Serving the Underserved' (SUS) Task Force with a goal to develop recommendations to support cancer clinicians who deliver care for populations at risk for cancer disparities. As a first step, the Task Force explored barriers and facilitators to equitable cancer care delivery. Methods: Clinicians across the United States who deliver care predominantly for low-income and racially and ethnically minoritized populations were identified based on lists generated by the Task Force and the Health Equity Committee. Through purposive sampling based on geographical location, clinicians were invited to participate in 30-60 min semi-structured interviews to explore experiences, barriers, and facilitators in their delivery of cancer care. Interviews were recorded, transcribed, imported into qualitative data management software, and analyzed using thematic analysis. Results: Thematic analysis revealed three major themes regarding barriers (lack of executive leadership recognition of resources; patient-related socio-economic needs; clinician burnout) and two major themes regarding facilitators (provider commitment, experiential training). Conclusions: Findings reveal modifiable barriers and potential solutions to facilitate equitable cancer care delivery for populations at risk for cancer disparities. [ABSTRACT FROM AUTHOR]

Narrative is the basic mode of human interaction and a fundamental way of acquiring knowledge. In the rapidly growing field of health communication, narrative approaches are emerging as a promising set of tools for motivating and supporting health-behavior change. This article defines narrative communication and describes the rationale for using it in health-promotion programs, reviews theoretical explanations of narrative effects and research comparing narrative and nonnarrative approaches to persuasion, and makes recommendations for future research needs in narrative health communication.

Advance care planning (ACP) conversations about treatment preferences and end-of-life goals relate to positive outcomes for patients and families, though ongoing barriers exist. Additionally, providers personal discomfort and personal experiences may influence how they engage (or avoid) ACP conversations. Narrative medicine (NM) offers one approach to help practitioners develop ability to hear and understand the story of others in ways that may overcome barriers to quality conversations. This study investigated the effectiveness of a 3-hour NM workshop to develop communication skills around ACP and facilitate reflection on the relationship between personal experiences and professional practices in ACP and end-of-life care. Twenty-five participants completed post-assessments of the workshop. Key themes included increased awareness, improved skills for active listening and eliciting stories, and improved understanding of how personal experiences shape professional practice. Results indicate practitioners value the NM approach to ACP suggesting this approach may provide impactful change in practice. [ABSTRACT FROM AUTHOR]

Depression is a common, potentially debilitating non-motor symptom of Parkinson's disease which may manifest at any time and can respond to treatment. Although depression is a known primary mediator of health-related quality of life, it is currently unknown whether the timing of depression diagnosis relative to PD diagnosis affects receipt of depression treatment. Electronic health record data were examined to explore differences in depression treatment among patients diagnosed with depression before or after PD diagnosis. Compared to PD patients diagnosed with depression prior to PD, those diagnosed with depression following PD are less likely to receive any treatment, either pharmacologic or non-pharmacologic, indicating a temporal association between the time of PD diagnosis and receipt of depression treatment. This highlights a potentially substantial treatment gap, despite the existence of efficacious treatment. Diagnosis with PD appears to alter depression treatment and further research is warranted to determine potential causes and effective interventions. [ABSTRACT FROM AUTHOR]

To determine the accuracy of personal breast cancer risk estimation, interviews were conducted of 110 women between November 2004 and May 2005 during primary care visits. The average age of the women was 39 years. Considering their lifetime breast cancer risk, 49% of women perceived their risk to be low, 35% average, and 11% high. Compared to Gall-model lifetime risk scores, 62% of women were inaccurate and underestimated or overestimated risk. Factors affecting accuracy of risk prediction were race, family history of cancer, alcohol use and exercise. Our study highlights the need for personalized breast cancer education between an individual woman and her health care provider. doi: 10.1080/03630240802092431 KEYWORDS. Breast cancer, risk, Gail-model, race, exercise, health behavior

Objective: Diabetes technology is available and its efficacy and safety have been demonstrated; however, there is little evidence as to how this technology is being utilized and its effectiveness in vulnerable populations. This study evaluated differences in outcomes for young adults in the United States (U.S.) from lower socioeconomic (SES) backgrounds with type 1 diabetes (T1D) managed on continuous subcutaneous insulin infusion (CSII) versus multiple daily injections (MDI) or fixed‐dose insulin (FDI). Research design, methods and participants: Utilizing the Optum® de‐identified Electronic Health Record data set between 2008 and 2018 to perform a retrospective, cohort study, we identified 805 subjects with T1D aged 18–30 years with Medicaid. We evaluated median difference in HbA1c between CSII and MDI/FDI users for 24 months. Predictors of diabetic ketoacidosis (DKA)‐associated hospitalizations by CSII use were evaluated using logistic regression. Results: CSII users showed statistically significant lower median HbA1c values at 24 months of follow‐up compared to individuals on MDI/FDI. Non‐white individuals were at lower odds of receiving treatment with CSII. Subjects on CSII were not more likely to be hospitalized for DKA compared to subjects treated with MDI/FDI. Older subjects were at lower odds of being hospitalized for DKA. Males and subjects followed by Endocrinologists were at higher odds of being hospitalized for DKA. Conclusions: Young adults with T1D from lower SES backgrounds show improved glycaemic control when in CSII compared to MDI/FDI without increases in hospitalizations for DKA. [ABSTRACT FROM AUTHOR]

Introduction Epididymal tumors are rare malignancies with sparse research available to guide recommendations. We sought to characterize malignant epididymal tumors in the United States using population level data. Material and methods The Surveillance, Epidemiology, and End-Results database was queried for patients diagnosed with malignant epididymal tumors between 1975-2016. International classification of disease for oncology code C63.0 was used to identify population with disease of interest. Primary objective was to characterize patient demographics, disease characteristics, and management. Secondary objectives included overall and cancer-specific survival (CSS) utilizing Kaplan-Meier (KM) analysis. Results A total of 66 cases of malignant epididymal tumors were identified during the study period. The cohort was largely white (84.8%), with a mean age of diagnosis of 46.9 years old. The predominant histology consisted of rhabdomyosarcoma 26%, leiomyosarcoma 23%, liposarcoma 17%, adenocarcinoma 9%, and malignant fibrous histiocytoma 5%. During histopathological assessment, 21.1% of tumors were classified as high-grade while 71.2% exhibited sarcomatoid elements. Majority of patients presented with localized disease (68.2%), whereas regional (18.2%) and distant (13.2%) disease was less frequently discovered. All patients were diagnosed by surgical therapy consisting of radical epididymectomy (39.4%), partial epididymectomy (27.3%) or 'unknown surgery' (33.3%). Meanwhile, 15.2% and 34.8% received radiation and chemotherapy, respectively. KM analysis revealed an 84.9% CSS at 5-years. Over 60% of documented cases have arisen since 2000, with 3.0% of the cohort diagnosed in 2016, increased from 1.5% of the diagnoses in 1975. Conclusions Malignant epididymal tumors are exceedingly rare and typically present with localized disease. Surgical excision is associated with an estimated 85% CSS at 5-years. [ABSTRACT FROM AUTHOR]

There are many calls for increased rigor in interprofessional research, and scale validation improvements are particularly needed. Specifically, current validation efforts are limited, as few interprofessional scale development studies report evidence of convergent and discriminant validity. These are core aspects of establishing nomological networks and construct validity, and thus form the foundation of interprofessional theory, research, and practice. This paper focuses on the importance of construct validation for interprofessional measurement tools, reviewing key concepts, extant scales and their validation efforts, and providing recommendations for future interprofessional scale validation. We also provide a step-by-step guide for scale development and validation that we hope will be valuable for future researchers and scale developers in the interprofessional literature. [ABSTRACT FROM AUTHOR]

An integral component of interprofessional education (IPE) is the development of a collaboration-ready health-care workforce. While collaboration is a fundamental element of IPE, there is no existing measure of collaboration skills that is not context specific. This article describes the development and initial validation of the Self-Assessed Collaboration Skills (SACS) measure. Items were initially drawn from the Collaboration Skills Assessment Tool rubric, an educational assessment tool. The SACS measure was piloted in a sample of students in an introductory IPE course. Following scale revision, the SACS was piloted a second time in a sample of students in an IPE health systems course and then validated in a sample of students in an introductory IPE course. Exploratory factor analysis was used to assess scale factor structure in Pilots 1 and 2 and confirmatory factor analysis to confirm factor structure in the validation sample. Convergent and discriminant validity were also assessed. The final SACS measure is an 11-item scale consisting of three dimensions of collaboration: information sharing, learning, and team support. The SACS measure demonstrates high internal consistency and both convergent and discriminant validity as a measure of collaboration. The SACS can be implemented in any setting for assessing collaboration in clinical and nonclinical contexts. [ABSTRACT FROM AUTHOR]

1. Describe the characteristics associated with being offered a palliative care consultation in women with metastatic breast cancer. 2. Describe the association between palliative care consultation and hospital length of stay in women with metastatic breast cancer. The purpose of this study was to determine the incidence of inpatient palliative care consultations (PCC) in women with metastatic breast cancer and to examine the association between palliative care consultation and hospital length of stay (LOS) and in-hospital costs in a nationally representative sample. Women 18 years and older with a metastatic breast cancer related hospitalization in the Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Database (NIS) 1998-2017 were included in the study. Multivariable logistic and linear regression analyses were used to examine the effects of patient and hospital characteristics on the receipt of inpatient palliative care, length of stay, and total hospital charges. SAS software survey procedures (version 9.4, SAS Institute Inc, Cary, NC). The average age in the study population (N=513,509) was 63 years. Most women were white (73.2%) and received governmental types of insurance (58.4%). Older women were associated with higher odds of getting PCC [aOR 95% CI (60-69 yrs: 1.08 (1.01 1.16); ≥70 yrs: 1.25 (1.17 1.34)]. Women of races other than white [Black: 1.12 (1.07 1.16); other races 1.08 (1.04 1.13)] were more likely to receive PCC. Women receiving governmental insurance had slightly lower odds of receiving palliative care compared to commercially insured women [0.94 (0.91 0.98)]. Comorbid conditions increased odds of receiving a PCC. Hospitals were likely to charge patients receiving palliative care services less compared to patients who did not have a PCC encounter (Estimate: -5450; 95% CI: -5968, -4936 despite being associated with higher odds of a longer hospital stay (> 4 days) [1.17 (1.14 1.20)]. Our study found that inpatient PCC for women with metastatic breast cancer increased LOS. Inpatient PCC was provided to sicker patients; hence, targeted interventions must be implemented to increase PCC for metastatic breast cancer patients in the United States. [ABSTRACT FROM AUTHOR]

Objectives/hypothesis: To 1) examine the characteristics of patients who develop second primary malignancies (SPMs) from an index human papillomavirus (HPV)-related head and neck squamous cell carcinoma (HNSCC) and HPV-unrelated HNSCC and to 2) compare overall survival between those with HPV-related and HPV-unrelated index HNSCC among patients who develop SPM.Study Design: Retrospective cohort analysis.Methods: A retrospective study was conducted of 113,259 patients who were diagnosed with HNSCC from 2000 to 2014. SPM was defined as the first subsequent primary cancer occurring at least 2 months after index cancer diagnosis, and HPV-relatedness was based on whether patients' index HNSCC was potentially HPV-related or HPV-unrelated. Multivariable Fine and Gray (FG) competing-risks regression models were used to estimate factors associated with risk of SPM by HPV-relatedness. Among patients with SPM, an adjusted Cox proportional hazards (PH) regression model was used to assess the association between HPV-relatedness and survival.Results: Approximately 13,900 patients (12.3%) developed SPM. In the FG model, patients with HPV-unrelated HNSCC had a 15% higher risk of developing SPM (adjusted hazard ratio: 1.15, 95% confidence interval: 1.10-1.20) than those with potentially HPV-related HNSCC, but the same characteristics were associated with SPM development. In the Cox PH model, patients with SPM whose index HNSCC was HPV-unrelated had higher risk of death than those whose index HNSCC was potentially HPV-related (adjusted hazard ratio: 1.06; 95% confidence interval: 1.02-1.11).Conclusions: Patients with HPV-unrelated HNSCC have a higher risk of SPM development than do those with HPV-related HNSCC. Effective secondary disease-prevention strategies should be established to improve long-term patient outcomes.Level Of Evidence: NA Laryngoscope, 129:1828-1835, 2019. [ABSTRACT FROM AUTHOR]

While there are a growing number of cancer survivors, this population is at increased risk of developing second primary malignancies (SPMs). We described the incidence, most common tumor sites, and trends in burden of SPM among survivors of the most commonly diagnosed smoking‐related cancers. The current study was a population‐based study of patients diagnosed with a primary malignancy from the top 10 smoking‐related cancer sites between 2000 and 2014 from Surveillance, Epidemiology, and End Results data. SPM risks were quantified using standardized incidence ratios (SIRs) and excess absolute risks (EARs) per 10,000 person‐years at risk (PYR). Trends in the burden of SPM were assessed using Joinpoint regression models. A cohort of 1,608,607 patients was identified, 119,980 (7.5%) of whom developed SPM (76% of the SPMs were smoking‐related). The overall SIR of developing second primary malignancies was 1.51 (95% CI, 1.50–1.52) and the EAR was 73.3 cases per 10,000 PYR compared to the general population. Survivors of head and neck cancer had the highest risk of developing a SPM (SIR = 2.06) and urinary bladder cancer had the highest excess burden (EAR = 151.4 per 10,000 PYR). The excess burden of SPM for all smoking‐related cancers decreased between 2000 and 2003 (annual percentage change [APC] = −13.7%; p = 0.007) but increased slightly between 2003 and 2014 (APC = 1.6%, p = 0.032). We show that 1‐in‐12 survivors of smoking‐related cancers developed an SPM. With the significant increase in the burden of SPM from smoking‐related cancers in the last decade, clinicians should be cognizant of long‐term smoking‐related cancer risks among these patients as part of their survivorship care plans. What's new? As more people survive cancer, understanding second primary malignancies (SPMs) is increasingly important. Here, the authors describe the incidence, most common sites, and trends in burden of second cancers in people who had survived one of the top 10 smoking‐related cancers. 1 in 12 survivors of smoking‐related cancers developed a second primary malignancy, they found. Patients with head and neck cancer had the highest risk of a second cancer, while those with urinary cancers experience the highest excess cancer burden. Oropharyngeal cancers were the most common, and lung cancers represented the largest proportion of the excess burden. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine whether racial disparities in reconstruction in the United States vary by geographic region. The SEER database years 2000‐2013 was queried for all mastectomies in women ages 20‐85+. Logistic regression was used to examine the main effects and interaction of race and geographic region on reconstruction. Hot spot Analysis was used to examine clustering of reconstruction across counties by race. We found large regional variation in racial differences in the rate of immediate postmastectomy reconstruction. Understanding how racial disparities vary by region can identify important factors for intervention to reduce disparities in practice. [ABSTRACT FROM AUTHOR]

Objective: Research outside the United States shows that certain subgroups of patients (eg, those who are older, male, of low socioeconomic status, and uninsured) are less likely than others to report receiving diabetes self-management education (DSME); however, less is known about DSME uptake in the United States. We examined sociodemographic, patient, and behavioral characteristics associated with DSME in a nationally representative sample. Methods: We analyzed data from the 2011-2013 Behavioral Risk Factor Surveillance System for 84 179 adults who self-identified receiving a diagnosis of diabetes. We constructed weighted, multivariate logistic regression models to examine the associations between DSME and sociodemographic characteristics (age, sex, race/ethnicity, marital status, education, and annual household income), patient characteristics (body mass index, having a regular provider, health insurance status, health status, and insulin use), and self-management behaviors (home foot examination, home blood glucose testing, and physical activity). Results: More than half (n = 45 557, 53.7% [weighted]) of respondents reported engaging in DSME. Compared with non-Hispanic white adults, non-Hispanic black adults were more likely to engage in DSME (adjusted odds ratio [aOR] = 1.17; 95% confidence interval [CI], 1.07-1.29). Respondents were less likely to engage in DSME if they were male (aOR = 0.85; 95% CI, 0.80-0.91) or Hispanic (aOR = 0.81; 95% CI, 0.71-0.92), were a high school graduate (but no college; aOR = 0.71; 95% CI, 0.66-0.78) or less than a high school graduate (aOR = 0.51; 95% CI, 0.45-0.59), had an annual household income of $15 000-$24 999 (aOR = 0.81; 95% CI, 0.73-0.89) or <$15 000 (aOR = 0.70; 95% CI, 0.62-0.78), or had no health insurance (aOR = 0.87; 95% CI, 0.76-0.98). DSME was significantly associated with all 3 self-management behaviors. Conclusions: Increasing public health interventions aimed at educating people with diabetes about self-management could improve outcomes. [ABSTRACT FROM AUTHOR]

Background: Although practitioners overwhelmingly agree on the importance of advance care planning (ACP) and preparing for the end of life (EOL), the process is fraught with barriers. Objective: The goal of this research was to explore potential connections between providers’ own personal experiences and current professional practices in ACP and EOL care. Design: A cross-sectional survey design, gathering voluntary, anonymous responses from participants between August and December 2016. The survey sought information from providers in 3 distinct areas: (1) personal experiences of loss, (2) personal ACP, and (3) professional practices related to ACP and EOL care. Setting/Participants: One hundred and ninety health-care professionals (primarily physicians, nurses, and social workers) participated in the survey across a greater, Metropolitan area in the Midwest. Measurements: Questions for professional practices were subscales from the End-of-Life Professional Caregiver Survey: Patient- and Family-Centered Communication (PFCC) and Effective Care Delivery (ECD). Questions developed by the research team were evaluated by judges chosen for clinical and/or research expertise. Results: Numerous connections were found between professionals’ histories of loss, personal ACP, and professional practices. For example, both clinicians with personal experience caring for someone who is dying and clinicians who had completed their own ACP scored higher in both PFCC and ECD and were more likely to refer patients to hospice and palliative care. Conclusions: Results support educational interventions involving opportunities for reflection and completion and communication about ACP. Additionally, educational opportunities for students in health care should focus on incorporating both ACP and greater exposure to hospice and palliative care. [ABSTRACT FROM AUTHOR]