Introduction:
Increasing complexity of prior authorizations has created significant barriers to care, resulting in treatment delays for patients undergoing anti-cancer therapies. Complicated insurance requirements ranked in the top 5 challenges by respondents to Association of Cancer Care Centers (ACCC) Financial Advocacy census survey in 2023. In response, ACCC launched a prior authorization initiative to support oncology teams in navigating these challenges to promote the delivery of high-quality patient care.

Objective:
This initiative aimed to demonstrate effective strategies, tips, and interventions that facilitate successful prior authorization submissions for multidisciplinary oncology professionals.

Method:
ACCC developed a six-part expert-led webinar series and tip sheets addressing critical aspects of prior authorization: medical necessity, billing and coding comprehension, and documentation requirements.

Results:
A total of 778 oncology multidisciplinary members registered for the series, with 511 (66%) participating in the live sessions. Over 1,544 views have been recorded since the webinars commenced, highlighting the need for more training. During a webinar, one participant shared, "Authorizations are complex, it's good to come together and share best practices.”

Conclusion:
The strong attendance underscores the growing burden faced by oncology providers in managing prior authorizations, which often require extensive documentation and justification to secure necessary treatments for patients. This initiative meets an urgent educational need and emphasizes the importance of public health: streamlining administrative procedures in cancer care can enhance patient outcomes and improve access to vital therapies. By gaining the necessary skills and knowledge, oncology teams can reduce treatment delays and advance health equity in cancer care.

Introduction

Analysis of SEER data reveals stable overall colorectal cancer incidence (APC: 0.04%, p=0.8942) masking demographic, anatomical, and stage-based shifts with critical public health implications. These emerging patterns challenge current screening paradigms and highlight disparities. Statistical analysis of SEER database using Annual Percent Change (APC) methodology to assess trends across age groups, demographics, anatomical sites, and cancer stages. Chi-square tests and ANOVA were employed to evaluate significant differences between subgroups.

Analysis

• Significant increase in younger populations: 10-14 years (26.02%, p=0.0002), 15-19 years (15.31%, p=0.0003), 20-24 years (7.58%, p=0.0005), 25-29 years (4.77%, p<0.0001)
• Racial/ethnic disparities: Hispanic (3.28%, p<0.0001), American Indian/Alaska Native (2.62%, p=0.0001), Asian/Pacific Islander (1.36%, p=0.0036)
• Anatomical shifts: Rectal cancer increased (1.08%, p=0.0085) while rectosigmoid decreased (-1.60%, p=0.0001)
• Stage progression: Decreasing localized (-1.12%, p=0.0337) and in situ cancers (-9.08%, p=0.0001); increasing distant metastatic disease (1.50%, p<0.0001)

Discussion

The dramatic rise in early-onset colorectal cancer, particularly among certain racial/ethnic groups, suggests underlying changes in risk factors, screening practices, or disease biology. The shift toward later-stage diagnosis and rectal tumors indicates potential delays in detection and anatomical predilections in younger patients. Gender differences in stage distribution (p<0.0001) warrant further investigation into sex-based screening approaches.

Conclusion & Public Health Interventions

Evidence supports lowering screening age below 45 for high-risk individuals, implementing culturally-appropriate screening for minority populations, and developing risk assessment tools for young adults. Public education campaigns should emphasize symptom awareness among younger populations and primary care providers. Research into biological mechanisms driving these epidemiological shifts is critically needed to inform prevention strategies.

Background: The Korean Survey for Cancer Survivorship (KSCS) aims to collect comprehensive data on the health behaviors, quality of life (QoL), and socioeconomic problems of cancer survivors. Understanding these aspects is vital in guiding healthcare practices and policy decisions to enhance cancer survivorship support. This study aims to assess the effects of employment changes on cancer survivors’ psychological health and QoL.

Methods: The nationwide survey targeted cancer survivors diagnosed with one or more of seven major cancers in Korea (breast, colorectal, liver, lung, stomach, prostate, gynecological) who had completed active treatment. Depression, anxiety, and QoL were assessed using the PHQ-9, GAD-7, and EQ-5D-3L, respectively.

Results: A total of 983 cancer survivors participated and were categorized by post-diagnosis duration (1 to <3 years, 3 to <5 years, and ≥5 years). The period post-diagnosis was found to significantly affect the cancer survivors' depression and anxiety levels, and QoL. Survivors diagnosed within 1–<3 years ago reported the highest rates of moderate-severe depression (50.0%), moderate-severe depression anxiety (49.0%), and poorest QoL (47.2%). Employment changes, such as work leave, unemployment, or change of job, were significantly associated with worse health outcomes, including higher rates of moderate-severe depression (OR=4.39; 95% CI 2.43–7.96), moderate-severe anxiety (OR=3.63; 95% CI 1.68–7.88), and extreme QoL problems (OR=6.37; 95% CI 2.03–20.00).

Conclusion: The findings emphasize the significant impact of employment status on the mental health and quality of life of cancer survivors. Providing support for cancer survivors to return to the workplace would be an essential component of cancer survivorship policies.

Background: Early treatment of breast cancer (BC) after diagnosis improves treatment outcomes and patients’ survival. Although Black women have the highest mortality of BC in Tennessee, no study investigated their interval time to treatment initiation (ITTI) after diagnosis. Our study evaluated the trends and identified risk factors and disparities associated with the ITTI of invasive BC among Black women in Tennessee.

Methods: We used a population-based retrospective Tennessee Cancer Registry data (2005-2017) of 6,601 invasive BC Black patients. We estimated the ITTI and examined the trend over time, conducted bivariate Kruskal Wallis to determine the within-group and pairwise differences in the ITTI, and unadjusted and adjusted multivariable Cox proportional hazard regression to assess the relative risk, trends, identified risk factors and disparities associated with delayed ITTI.

Results: Overall, we found an increasing trend in the crude median ITTI and relative risk of BC ITTI based on age, county of residence, insurance, and treatment type. In an adjusted model, patients aged 65-74 years compared to <45 years (adjusted hazard ratio[aHR]=1.22, 95% confidence interval[CI]=1.06-1.40), living in Appalachian Tennessee compared to non-Appalachian Tennessee (aHR=1.23, 95% CI=1.12-1.37), and those receiving surgery (aHR=1.18, 95% CI=1.03-1.36), radiotherapy(aHR=1.19, 95% CI=1.10-1.28), and chemotherapy (aHR=1.11, 95% CI=1.02-1.21) had a significantly increased relative risk of delaying BC treatment beyond the 3.86 median weeks ITTI after diagnosis.

Conclusion: Our study identified BC Black patients at risk of treatment delay in Tennessee. Therefore, BC interventions to improve early treatment should target these populations to reduce BC mortality among Black women in Tennessee.

This study addresses a research gap concerning the socio-ecological drivers of cervical cancer screening rates in rural Southern United States by examining the relationships between Medicaid policy, rurality, and cervical cancer screening using a health equity lens.

Retrospective, cross-sectional data from the 2010–2020 Behavioral Risk Factor Surveillance System (BRFSS) were analyzed. The outcome of interest was cervical cancer screening behavior, defined as self-reported receipt of a Pap test within recommended intervals. Key predictors included Medicaid expansion status, rural residence, insurance coverage, race/ethnicity, and income. A survey-weighted logistic regression model was used, adjusting for age, marital status, and education.

The analytic sample included women aged 21–65 across 12 Southern states (n ≈ 85,000 across years). Women in Medicaid expansion states had higher odds of Pap test uptake compared to non-expansion states (adjusted odds ratio [aOR]: 1.42, 95% CI: 1.27–1.58). Rural residence was associated with lower screening odds (aOR: 0.76, 95% CI: 0.68–0.84), though this effect was moderated by Medicaid expansion (interaction p = 0.03). Insurance status (aOR: 1.83, 95% CI: 1.55–2.17) and income level (aOR: 1.34, 95% CI: 1.11–1.60) remained significant predictors. Racial differences were attenuated after adjusting for structural factors.

Cervical cancer screening disparities in the rural South are shaped by policy-driven and place-based social drivers of health. Medicaid expansion, insurance coverage, and geographic access were key factors in shaping preventive care behavior. These findings support targeted structural interventions, such as Medicaid expansion, rural health investment, and culturally tailored outreach, to improve screening equity in underserved populations.

Background: Cancer staging systems play a pivotal role in clinical decision-making and policy development, significantly impacting global cancer outcomes. However, their reliability and worldwide applicability depend critically on methodological rigor in prognostic studies, especially concerning accurate sample size calculations. Methodological limitations, particularly inadequate consideration of inter-center variability, can compromise staging system robustness and generalizability, disproportionately affecting diverse populations.

Methods: We conducted extensive power analyses (Lachin, 1986) and sample size calculations (Riley, 2019; Riley, 2022) tailored specifically for prognostic studies aimed at developing and validating cancer staging systems with time-to-event outcomes. Conservative statistical assumptions were employed, based on historical clinical data and hazard ratio estimations, while accounting explicitly for potential inter-center variability. Simulation-based methods were also utilized to assess uncertainties inherent in hazard ratio estimations and ensure adequate statistical power (90%) with adjustments for multiple comparisons using Bonferroni correction.

Results: Our analysis indicated significant variability in required sample sizes depending on the assumptions regarding hazard ratios and inter-center variability. Considering realistic clustering scenarios, necessary sample sizes increased notably (up to a 30%), underscoring the importance of robust calculations that account for diverse institutional practices and patient populations. Simulation-based approaches further emphasized the importance of addressing uncertainties in prognostic factors, improving reliability and applicability of staging systems.

Conclusion: Robust methodological design, including rigorous sample size calculations that address inter-center variability and hazard ratio uncertainties, is essential for developing reliable and generalizable cancer staging systems. Such methodological rigor is crucial for ensuring equitable cancer outcomes globally, benefiting diverse patient populations.

Cervical cancer is preventable through HPV vaccination and early detection, yet it remains a public health challenge. This study aims to identify barriers preventing women from accessing cervical cancer preventive tools and design strategies to overcome them. We will enroll 1,500 women from both urban and rural areas for high-risk HPV using self-administered swabs and surveys. hrHPV-positive women will be screened for a potential marker of cancer development using DNA hypermethylation, to explore the validity of this triage test. The study, launched in September 2024 at the Medicine Primary Care Clinic at UMC in New Orleans, has enrolled 48 women, with eight participants having hrHPV present. Recruitment at the Shreveport site started in December 2024, utilizing a Mobile Health Unit to enhance accessibility across more than 20 rural clinical sites. Ten women were enrolled, with two testing positive for HPV. Participants expressed high satisfaction and acceptance of the self-administered vaginal swab, with most samples demonstrating high quality. Surveys have been collected, and hrHPV-positive women have been referred for gynecological follow-up. Participants with hrHPV-positive have been referred for follow-up gynecological care. Thirty percent of women who test positive for HPV never receive follow-up care, missing a chance to prevent cervical cancer. Our Mobile Health Unit brings screening to rural and underserved areas to overcome geographic and logistical barriers. The long-term goal is to develop a replicable and sustainable care delivery model for cervical cancer prevention in Louisiana and across the US.

Introduction: HPV vaccination rates in the U.S.A. remain below the Healthy People 2030 goal of 80% completion for adolescents. The Adolescent Vaccination Program (AVP) is an evidence-based, multi-component program demonstrated to increase HPV vaccination rates in pediatric clinics through the implementation of six evidence-based strategies (immunization champions, assessment and feedback, continuing education, provider prompts, parent reminders, and parent education). The purpose of this study was to test the feasibility of using the AVP Implementation Tool (AVP-IT) (www.avptexas.org) for online clinic decision support over 33 months to implement AVP strategies in safety net clinics that care for the medically underserved. Methods: AVP immunization clinic staff ‘champions’ in four Ibn Sina safety net clinics in Texas completed tailored Action Plans within the AVP-IT to guide strategy implementation, received webinar trainings from the research team commensurate to each AVP strategy, and participated in monthly monitoring calls with AVP-IT project staff over a 33-month period. Results: All clinics made progress toward full implementation of AVP strategies. AVP-IT implementation provided an immediate 3-month boost in HPV vaccine initiation rates (p<0.001) but this was not longitudinally significant. A positive long-term trend (p<0.001) was observed despite low post-pandemic rates. EHR optimization to access valid and reliable data is indicated to mitigate assessment and reporting barriers. Conclusion: The AVP-IT promises accessible, practical, and scalable decision support to implement strategies to increase HPV vaccination rates. Facilitators include ongoing expert support to champions to supplement the Action Plan and access to reliable and valid EHR-derived vaccination data.