Improving adherence to cancer care for socioeconomically disadvantaged patients with central nervous system tumors.

Abstract

2033 Background: Socially disadvantaged patients often face significant barriers to adhering to and completing cancer treatment. Patients with central nervous system (CNS) tumors experience cognitive, neuropsychiatric, speech, motor, sensory, and gait symptoms that exacerbate socioeconomic barriers to care. The Integrated Cancer Care Access Network (ICCAN) is a multi-institutional program developed by Memorial Sloan Kettering Cancer Center’s Immigrant Health and Cancer Disparities Service (IHCD). Through ICCAN, patients are provided with patient navigation and resources to mitigate barriers to treatment adherence and completion. While ICCAN has been shown to increase treatment adherence and completion for patients with other cancers, it has not historically enrolled patients with CNS tumors. Methods: Under this pilot ICCAN-CNS program, 58 patients with either primary brain tumors or brain metastases were referred to the program. Of these, 45 patients enrolled, 5 patients died before contact was made, 2 patients declined participation, and 4 patients could not be reached. The patient population was evenly split between primary brain tumors (mainly glioblastomas and low-grade gliomas) and brain metastases. Patients were eligible if they were 18 years or older and receiving active treatment or were under active surveillance. If a patient was eligible, they were administered an extensive needs assessment survey that took 60 minutes to complete. The interviews consisted of basic demographic questions, Alliance Distress Screening Tool, Health Related Social Needs (HRSN) Assessment, Essential Needs Assessment, Patient Satisfaction with Cancer Care questionnaire, and an ICCAN-CNS specific questionnaire for patients with brain tumors. Caregivers were allowed to assist patients with neurocognitive or speech deficits in completing the survey questions. Patients were then provided with both patient navigation and resources depending on their needs. Follow-up assessments were conducted at the 2-, 4-, and 6-month marks. Results: Patients with CNS tumors completed the initial needs assessments and additional questionnaires. Trends of delayed responses and the need for questions to be repeated were observed, however, patients were still able to express socioeconomic needs. The main needs expressed among these patients were income, employment issues due to lack of ability to work from their cancer, food access, and transportation to appointments. Overall, the response to the program was positive from patients, with many patients accessing resources with the assistance of the access facilitator. Conclusions: This pilot demonstrates the feasibility and value of including CNS tumor patients in patient and resource navigation programs. Future plans include a randomized controlled trial using the ICCAN intervention for patients with glioblastoma.