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Adolescent and young adult survivors of cancer (aged 15-39 years) frequently engage in hazardous alcohol use, which can have multiple mental and physical health effects. The aim of this study was 2-fold, to identify the necessary adaptations to an existing motivational interviewing-based mHealth (mobile health) alcohol reduction intervention, called Tracking and Reducing Alcohol Consumption (TRAC), for posttreatment adolescents and young adults, and to develop a tailored intervention for this vulnerable and underserved population. This was a qualitative study consisting of key informant interviews with posttreatment adolescents and young adults aged 18-39 years, oncology and psych-oncology providers, and community advocates (n=15) to inform the adaptation of TRAC. Thematic qualitative analysis of interview findings was conducted to determine necessary changes to the intervention protocol and content, which would ultimately lead to the development of the new TRAC adolescent and young adult intervention. Key informant interviews revealed a need for the intervention to address cancer-specific alcohol use triggers such as scan-related anxiety, financial toxicity, and reproductive health concerns. They also indicated the need to provide education on the link between alcohol and cancer and to reduce the time burden of the intervention, given the many competing life demands of adolescents and young adults. Significant changes were made to the TRAC intervention to create the TRAC adolescent and young adult. We reduced the number of required sessions from 8 to 4, introduced a session devoted to managing cancer-specific triggers, and provided survivors with more information about alcohol and its relationship to cancer. There is potential to increase alcohol intervention relevance and fit for adolescents and young adults by including tailored content relevant to their life experiences while also maintaining core components of such interventions, such as self-monitoring and goal-setting. Remote, brief interventions are important for ensuring acceptability. The new TRAC adolescent and young adult intervention represents a potentially valuable tool in addressing high rates of hazardous alcohol use among this population and warrants further evaluation in randomized trials.

Purpose Despite clinical guidelines, palliative care is underutilized during advanced stage lung cancer treatment. To inform interventions to increase its use, patient-level barriers and facilitators (i.e., determinants) need to be characterized, especially among patients living in rural areas or those receiving treatment outside academic medical centers. Methods Between 2020 and 2021, advanced stage lung cancer patients ( n  = 77; 62% rural; 58% receiving care in the community) completed a one-time survey assessing palliative care use and its determinants. Univariate and bivariate analyses described palliative care use and determinants and compared scores by patient demographic (e.g., rural vs. urban) and treatment setting (e.g., community vs. academic medical center) factors. Results Roughly half said they had never met with a palliative care doctor (49.4%) or nurse (58.4%) as part of cancer care. Only 18% said they knew what palliative care was and could explain it; 17% thought it was the same as hospice. After palliative care was distinguished from hospice, the most frequently cited reasons patients stated they would not seek palliative care were uncertainty about what it would offer (65%), concerns about insurance coverage (63%), difficulty attending multiple appointments (60%), and lack of discussion with an oncologist (59%). The most common reasons patients stated they would seek palliative care were a desire to control pain (62%), oncologist recommendation (58%), and coping support for family and friends (55%). Conclusion Interventions should address knowledge and misconceptions, assess care needs, and facilitate communication between patients and oncologists about palliative care.

Purpose Clinical guidelines recommend early palliative care for patients with advanced lung cancer. In rural and underserved community oncology practices with limited resources, both primary palliative care from an oncologist and specialty palliative care are needed to address patients’ palliative care needs. The aim of this study is to describe community oncology clinicians’ primary palliative care practices and perspectives on integrating specialty palliative care into routine advanced lung cancer treatment in rural and underserved communities. Methods Participants were clinicians recruited from 15 predominantly rural community oncology practices in Kentucky. Participants completed a one-time survey regarding their primary palliative care practices and knowledge, barriers, and facilitators to integrating specialty palliative care into advanced-stage lung cancer treatment. Results Forty-seven clinicians (30% oncologists) participated. The majority (72.3%) of clinicians worked in a rural county. Over 70% reported routinely asking patients about symptom and physical function concerns, whereas less than half reported routinely asking about key prognostic concerns. Roughly 30% held at least one palliative care misconception (e.g., palliative care is for only those who are stopping cancer treatment). Clinician-reported barriers to specialty palliative care referrals included fear a referral would send the wrong message to patients (77%) and concern about burdening patients with appointments (53%). Notably, the most common clinician-reported facilitator was a patient asking for a referral (93.6%). Conclusion Educational programs and outreach efforts are needed to inform community oncology clinicians about palliative care, empower patients to request referrals, and facilitate patients’ palliative care needs assessment, documentation, and standardized referral templates.