Improving Access to Clinical Trials and Adherence to Cancer Care in Underserved Patients with Central Nervous System Tumors
Steven Shafeek1, Ashley Phillips2, Francesca Gany3, Joshua Budhu3
1Sophie Davis School of Biomedical Education, City College of New York, 2Immigrant Health and Cancer Disparities Service, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 3Department of Neurology, Memorial Sloan Kettering Cancer Center
Objective:
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Background:
Historically marginalized groups (HMG) have disproportionately more social and economic barriers during cancer treatment. The Integrated Cancer Care Access Network (ICCAN) based at Memorial Sloan Kettering is a multi-institutional initiative which assists patients who express socioeconomic needs. Our study aims to assess the impact of Memorial Sloan Kettering’s ICCAN program at improving cancer treatment adherence, and quality of life among Central Nervous System (CNS) cancer patients of minority or immigrant backgrounds.  
Design/Methods:

Participants were recruited from Memorial Sloan Kettering’s inpatient and outpatient services through primary provider recommendation and chart review demonstrating social and economic need. In this qualitative study, eligible participants included patients who were 18 years or older and who are currently receiving treatment, or under active surveillance within the following two months. Nine participants were interviewed by the student intern. Initial demographic information, followed by an Essential Needs Assessment, ICCAN-CNS Additional Questions, Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder 7 Item Scale Score (GAD7), Distress Thermometer (NCCN), FACT-G Questionnaire, and Financial Toxicity (COST FACIT), were used to develop an understanding of the patient’s needs. A Caregiver was able to answer for patients with aphasias or cognitive impairment. 

Results:

Interviews revealed that the pilot-cohort of patients with CNS tumors were able to successfully complete the initial needs assessments and additional questionnaires. Trends of delayed responses and need for questions to be repeated were observed, however, patients were still able to express socioeconomic needs. Patient needs included housing insecurity, food scarcity, transportation costs, out-of-pocket expenses, as well as quality of life concerns such as understanding prognosis and managing symptoms.

Conclusions:
This pilot study provides evidence that patients with CNS tumors can participate in the ICCAN intervention and assessment, with additional modifications such as including caregivers in the interview, simplifying language in the intake forms, and making adjustments for cognitive or language impairment.