The Effect of Body Mass Index and Residence in Food Priority Areas on Patterns-of-Care and Cancer Outcomes in Patients With Stage III Non-Small Cell Lung Cancer.

PURPOSE: Patients living in food priority areas (FPAs), where access to healthy meals is challenging, may be at greater risk of nutritional deficits, leading to poorer cancer outcomes. Currently, there are no published data analyzing how FPAs affect patterns-of-care or outcomes for patients with locally advanced non-small cell lung cancer (NSCLC). We aimed to analyze the effect of residing in an FPA on treatments rendered and cancer outcomes in patients with stage III NSCLC treated at a single institution. METHODS AND MATERIALS: This is a retrospective study of 573 patients with locally advanced NSCLC consecutively treated from January 2000 to January 2020. χ2 and Mann-Whitney U tests were performed to determine differences between select variables. Kaplan-Meier analysis and Cox proportional hazard models were used to analyze overall survival (OS) and freedom from recurrence. Cox regression with forward model selection was used for multivariate analysis. RESULTS: Thirty-two percent of patients resided in an FPA (n = 183) and were more likely to self-identify as Black (P < .0001), single (P < .001), <60 years of age (P = .001), and uninsured (P < .0001), with a lower median income (P < .001). Patients in FPAs also had lower mean pre-chemoradiation (CRT) albumin (P = .002), lower pre-CRT body mass index (BMI) (P = .026), and were less likely to receive trimodality therapy (P ≤ .001) compared with patients not living in FPAs. There was no difference in OS or freedom from recurrence between the 2 cohorts. However, in patients with a normal BMI, either pre-CRT (median OS, 18.4 vs 25.0 months; P = .005) or after CRT (15.1 vs 28.1 months, P = .002), residing in an FPA resulted in an OS detriment. CONCLUSIONS: We demonstrated a clear socioeconomic divide in our patient population with stage III NSCLC, where residing in FPAs was associated with less-aggressive therapy and an OS detriment for patients with a normal-weight BMI. We are currently conducting a prospective study characterizing the nutritional needs of patients, particularly those who live in FPAs.

Identifying Psychosocial Needs of Patients With Cancer Undergoing Curative Radiation Therapy in an Inner-City Academic Center to Address Racial Disparities.

PURPOSE: There are little data quantifying the psychosocial needs of patients with cancer undergoing definitive radiation therapy. These needs significantly affect patients' access to care and treatment outcomes. Thus, our study aimed to characterize the socioeconomic needs of patients with cancer treated at an academic institution in urban and suburban radiation clinics. METHODS AND MATERIALS: A prospective, cross-sectional analysis was performed of patients undergoing curative radiation therapy for head and neck, lung/thoracic, gynecologic, or gastrointestinal malignancies using a questionnaire consolidated from prevalidated surveys. Main outcomes were differences in psychosocial needs stratified by race (Black vs non-Black) and time point (pretreatment, 1 month, 6 months, and 1 year after completion of radiation treatment). χ2 and Mann-Whitney U testing determined statistical differences between selected variables. Binary logistic regression analysis identified predictors of certain socioeconomic needs. RESULTS: Two hundred twenty-one of 266 patients completed the survey, giving a compliance rate of 83%. Black patients were more likely to be single (79% vs 37%; P < .001), reside in zip codes with a lower median income (74% vs 42%; P < .001), and be seen at our inner-city photon location (60% vs 25%; P < .001) compared with non-Black patients. Significantly higher proportions of Black compared with non-Black patients had unmet needs regarding pain (67% vs 39%; P = .005), stress management (64.7% vs 43.3%; P = .009), transportation (64% vs 19%; P < .001), and smoking cessation (35% vs 8.7%; P < .001) when all time points were considered. On multivariate analysis, Black patients were 2.6, 2.2, 7.2, and 3.4 times more likely than non-Black patients to request assistance with pain, stress, transportation, and financial aid, respectively. CONCLUSIONS: We identified disparate psychosocial needs of our cancer population, where Black patients had greater unmet needs than non-Black patients. By doing so, we plan to develop pragmatic, targeted interventions that, when combined with guideline-concordant cancer care, can lead to improvements in cancer outcomes and quality of life before, during, and after radiation therapy.

From Beaming Cancer to Beaming Parent: Paternity Leave Experiences in Radiation Oncology.

PURPOSE: Although supported by most men and women, paternity leave is heavily underused across industries owing in part to external pressures and inconsistent availability. The goal of this study was to assess the use of paternity leave in radiation oncology (RO) practices and identify any associated barriers. METHODS AND MATERIALS: A 36-item survey was distributed via e-mail to 536 male domestic RO attending and resident physicians. Questions assessed paternity leave policies, use, and departmental support. Data were collected using Research Electronic Data Capture from January to February 2021. Descriptive statistics were obtained for analysis, and logistic regression was performed to analyze the association between practice type and presence of policy. RESULTS: The survey response rate was 20% (n = 108), with 98% of participants completing all applicable questions. Respondents included 63 attending physicians (58%) and 45 resident physicians (42%). The median age of all respondents was 35 years. Among all participants, 51 (47%) stated their practice had a formal paternity leave policy. The median time allowed for leave was 4 weeks (range, 0.5 weeks to unlimited), whereas the median time taken was 2 weeks (range, 0.5-12 weeks). Sixteen men felt pressure to take less leave than what was allowed by their policy, and 46% of men stated that in retrospect, they would have taken more time off for paternity leave. CONCLUSIONS: To the authors' knowledge, this is the first study to investigate the use of paternity leave in RO practices in the United States. Integrating expanded family leave policies, including specifically allowing for paternity leave and accompanying these policies with cultural changes acknowledging the importance of family leave, would be beneficial to improving quality of life and work-life balance for parents.