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width="1.25rem" xmlns="http://www.w3.org/2000/svg"><polyline points="6 9 6 2 18 2 18 9"></polyline><path d="M6 18H4a2 2 0 0 1-2-2v-5a2 2 0 0 1 2-2h16a2 2 0 0 1 2 2v5a2 2 0 0 1-2 2h-2"></path><rect x="6" y="14" width="12" height="8"></rect></svg></a></button></div></div><div><div class="flex flex-wrap"><p class=" text-primary font-semibold">News</p><div class="h-[16px] border-l-2 border-gray-400 mt-1 mx-1"></div><p class=" text-primary font-semibold">Article</p><div class="h-[16px] border-l-2 border-gray-400 mt-1 mx-1 "></div><time class="text-gray-500 " dateTime="2024-11-08T14:38:00.000">November 8, 2024</time></div><h1 class="text-[26px] font-medium leading-8">Research Reveals Common Types of Rituximab-Induced Interstitial Lung Disease in Patients With Lymphoma</h1><div class="py-3 text-gray-600 md:flex flex-col md:justify-between"><div class="flex flex-col xs:flex-row"><p class="mr-1 self-start">Author(s):</p><div class="flex flex-col xs:flex-row mb-3 md:mb-0"><div class="flex flex-wrap"><span class="text-md mr-2"><a class="text-author text-gray-500 hover:text-primary underline hover:no-underline decoration-gray-400" href="/authors/karen-jacobson-sive">Karen Jacobson-Sive</a></span></div></div></div><div class="max-w-full"><div class="flex flex-wrap sm:flex-nowrap items-center w-fit my-2"></div><div class="w-full flex flex-col sm:flex-row justify-between mt-2"><div class="block md:hidden "><div class="mt-2 flex items-center max-w-fit"><button title="Research Reveals Common Types of Rituximab-Induced Interstitial Lung Disease in Patients With Lymphoma" aria-label="facebook" class="react-share__ShareButton" style="background-color:transparent;border:none;padding:0;font:inherit;color:inherit;cursor:pointer"><svg viewBox="0 0 64 64" width="32" height="32"><circle cx="32" cy="32" r="31" fill="#3b5998"></circle><path d="M34.1,47V33.3h4.6l0.7-5.3h-5.3v-3.4c0-1.5,0.4-2.6,2.6-2.6l2.8,0v-4.8c-0.5-0.1-2.2-0.2-4.1-0.2 c-4.1,0-6.9,2.5-6.9,7V28H24v5.3h4.6V47H34.1z" 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background: #7F7F7F; color: white; padding: 2px; border-radius: 100%; } </style></div><style> video::cue { display: inline; background-color: #b8dcf6; padding: 2px 2px; } audio { height: 40px; } .rhap_container { width: 300px !important; border-radius: 100px !important; height: 40px !important; box-shadow: 0px 0px 2px 2px rgba(0,0,0,0.1); } .rhap_progress-section { width: 150px; margin-left: 35px; } .rhap_controls-section { position: relative; bottom: .75rem; } .rhap_time { font-size: 12px; color: rgb(0,55,103); } .rhap_progress-bar { color: rgb(0,55,103) !important; } .rhap_progress-filled { background-color: rgb(0,55,103) !important; } .rhap_progress-indicator { height: 15px; width: 5px; top: -5px; margin-left: 1px; background-color: rgb(0,55,103) !important; } .rhap_repeat-button { display: none; } .rhap_volume-bar, rhap_volume-button, .rhap_volume-indicator { background: rgb(0,55,103) !important; } .rhap_volume-bar { height: 2px; width: 35px; position: relative; left: 22px; bottom: 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lg:justify-end"></div><div class="w-full flex flex-col px-4 py-4 border-t border-b border-solid border-gray-400 my-4 "><h3 class="text-primary text-xl font-semibold">Key Takeaways</h3><ul class="list-disc px-8"><li class="py-2 "> RILD in NHL patients presents as lung disease, organizing pneumonia, and nonspecific interstitial pneumonia, with 179 pathogenic microorganisms identified. </li><li class="py-2 "> The study systematically characterized RILD using bronchoalveolar lavage and high-resolution CT in 321 patients, mostly with diffuse large B-cell lymphoma. </li><li class="py-2 hidden"> BAL findings showed infectious lung disease in 123 patients and noninfectious lung disease in 198 patients, with drug-induced ILD in 27 patients. </li><li class="py-2 hidden"> Understanding RILD's clinical characteristics is essential for effective management in patients undergoing immunochemotherapy.</li></ul><span class="text-xs font-bold text-primary underline cursor-pointer mt-2 ml-4">SHOW MORE</span></div><p class="py-2 mb-2 text-sm italic text-gray-600">Rituximab-induced interstitial lung disease in patients with non-Hodgkin lymphoma presents with distinct clinical characteristics and bronchoalveolar lavage results.</p><div class="py-2"><div class="blockText_blockContent__TbCXh"><p class="pb-2">Rituximab-induced interstitial lung disease (RILD) in patients with non-Hodgkin <a target="_blank" href="https://www.ajmc.com/compendium/oncology">lymphoma</a> (NHL) presents most commonly as lung disease, organizing pneumonia, and nonspecific interstitial pneumonia, and it is associated with 179 pathogenic microorganisms, according to a retrospective study in the <a rel="nofollow noreferrer noopener" target="_blank" href="https://link.springer.com/article/10.1007/s00277-024-06013-2"><em>Annals of Hematology</em></a>.<sup class="text-inherit">1</sup></p><p class="pb-2">“These findings enhance the understanding of RILD in patients with non-Hodgkin lymphoma and serve as a reference for best management guidelines in these patients,” the authors wrote.</p><div class=""><div style="width:30%;float:right;max-width:525px;margin:0 0 1.5rem 1.5rem;clear:both;cursor:" class=" figure"><div class="flex-none relative text-center"><span style="box-sizing:border-box;display:inline-block;overflow:hidden;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;position:relative;max-width:100%"><span style="box-sizing:border-box;display:block;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0;max-width:100%"><img style="display:block;max-width:100%;width:initial;height:initial;background:none;opacity:1;border:0;margin:0;padding:0" alt="" aria-hidden="true" src="data:image/svg+xml,%3csvg%20xmlns=%27http://www.w3.org/2000/svg%27%20version=%271.1%27%20width=%271200%27%20height=%27728%27/%3e"/></span><img alt="doc reviewing lung report | Image Credit: © meeboonstudio - stock.adobe.com" title="doc reviewing lung report | Image Credit: © meeboonstudio - stock.adobe.com" src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" decoding="async" data-nimg="intrinsic" style="position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%;object-fit:contain"/><noscript><img alt="doc reviewing lung report | Image Credit: © meeboonstudio - stock.adobe.com" title="doc reviewing lung report | Image Credit: © meeboonstudio - stock.adobe.com" srcSet="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F877b0bbc24b826cebff91a2ed1be5d858fe976a1-1200x728.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=1200&q=75 1x, /_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F877b0bbc24b826cebff91a2ed1be5d858fe976a1-1200x728.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=75 2x" src="/_next/image?url=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0vv8moc6%2Fajmc%2F877b0bbc24b826cebff91a2ed1be5d858fe976a1-1200x728.jpg%3Ffit%3Dcrop%26auto%3Dformat&w=3840&q=75" decoding="async" data-nimg="intrinsic" style="position:absolute;top:0;left:0;bottom:0;right:0;box-sizing:border-box;padding:0;border:none;margin:auto;display:block;width:0;height:0;min-width:100%;max-width:100%;min-height:100%;max-height:100%;object-fit:contain" loading="lazy"/></noscript></span></div><div id="image-caption" class="text-gray-500 italic"><div class="blockText_blockContent__TbCXh"><p class="pb-2">Researchers performed chest high-resolution CT to evaluate the extent, distribution, and radiologic patterns of interstitial lung disease in 321 patients. | Image Credit: © meeboonstudio - stock.adobe.com</p></div></div><div class="top-[-100%] block w-[1px] transition-opacity duration-500 ease-in-out opacity-0 overflow-hidden"><img class="m-auto absolute inset-0 max-w-[0%] max-h-[0%] border-[3px] border-solid border-white shadow-[0px_0px_8px_rgba(0,0,0,0.3)] box-border transition ease-in-out duration-500" src="https://cdn.sanity.io/images/0vv8moc6/ajmc/877b0bbc24b826cebff91a2ed1be5d858fe976a1-1200x728.jpg?fit=crop&auto=format"/></div></div><style> #image-caption p{ font-size: 12px; max-width: 525px; margin: 0 auto; text-align: center; } </style></div><p class="pb-2">The study is the first to systematically characterize RILD in patients with NHL according to bronchoalveolar lavage (BAL) findings and treatment course of RILD, according to the authors.</p><p class="pb-2">Researchers performed chest high-resolution CT (HRCT) to evaluate the extent, distribution, and radiologic patterns of the disease in 321 patients who developed RILD between 2020 and 2022.</p><p class="pb-2">More than three-quarters of patients (79.8%) were diagnosed with diffuse large B-cell lymphoma. The remaining patients had the following: marginal zone lymphoma (10.9%); follicular lymphoma (2.5%); Burkitt lymphoma (2.2%); mantle cell lymphoma (2.2%); high-grade B-cell lymphoma (1.5%); chronic lymphocytic leukemia/small lymphocytic lymphoma (0.9%). The chemotherapy regimen was resiniferatoxin (RTX) plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) in all patients.</p><p class="pb-2">BAL was performed in 299 patients to analyze cellular distribution and identify pathogens using metagenomic next-generation sequencing. The remaining patients could not undergo bronchoscopy because of severe clinical symptoms. Radiological and bronchoscopic BAL findings revealed infectious lung disease in 123 patients and noninfectious lung disease in 198 patients.</p><p class="pb-2">After multidisciplinary team discussions of the histological results, it was determined that 27 patients had drug-induced ILD, 9 patients had lymphoma infiltrating the lungs, 6 patients had fungal infections, and 3 patients had <br/><em>Mycobacterium tuberculosis</em> infections. Among the 27 patients with drug-induced ILD, pathological examination showed 10 patients with organizing pneumonia, 5 patients with nonspecific interstitial pneumonia, 5 patients with hypersensitivity pneumonitis, and 3 patients with eosinophilic pneumonia.</p><p class="pb-2">Of the 217 patients who underwent metagenomic next-generation sequencing, 179 pathogenic microorganisms were detected, including bacteria (77), viruses (45), <em>Pneumocystis jirovecii</em> strains (28), fungi (17), <em>M tuberculosis </em>(6), and atypical pathogens (6).</p><p class="pb-2">All patients received combination therapy. Cyclophosphamide, doxorubicin, vincristine, and prednisone were the most commonly administered regimens. The median time from treatment to RILD development was 1.7 months.</p><p class="pb-2">Patients were classified as having RILD if both rituximab for NHL and ILD were present. ILD was defined as diffuse interstitial lung infiltrates detected on chest HRCT. Patients were excluded if they had any of the following: known congenital lung disease; mental or cognitive impairment; use of other new anti-tumor drugs; severe comorbidities such as severe pulmonary infection, severe heart disease, or liver and kidney dysfunction, which could interfere with research results; patients receiving radiation therapy; and incomplete case or simultaneous participation in other clinical studies.</p><p class="pb-2">Slightly more than half (58.9%) the patients were male, and the median patient age was 48 years (range, 17–78 years).</p><p class="pb-2">This year, an estimated 20,140 patients will die of NHL, comprising 3.3% of all US cancer deaths, according to the National Cancer Institute.<sup class="text-inherit">2</sup></p><p class="pb-2">“The clinical, histopathological, and radiological characteristics of ILD and secondary diseases, as well as those of infectious and non-infectious pneumonia of this type, overlap considerably,” the authors stated.<sup class="text-inherit">1</sup> “Therefore, understanding the clinical characteristics of RILD and its active prevention and treatment is essential for patients undergoing immunochemotherapy.”</p><p class="pb-2"><strong>References</strong></p><ol class="my-2"><li class="list-decimal ml-8">Zou W, Zhang J, Li Y, et al. Interstitial lung disease presents with varying characteristics in patients with non-Hodgkin lymphoma undergoing rituximab containing therapies. <em>Ann Hematol</em>. Published online September 25, 2024. doi:10.1007/s00277-024-06013-2</li><li class="list-decimal ml-8">Cancer stat facts: non-Hodgkin lymphoma. Accessed October 9, 2024. National Cancer Institute. https://seer.cancer.gov/statfacts/html/nhl.html</li></ol></div></div><div class="flex items-center lg:w-3/4 mb-4 pb-12"></div><div class="jsx-19ede9f0a5a45918 py-4 relative bg-primary md:px-8 -ml-6 xs:ml-0 w-screen xs:w-auto"><div class="jsx-19ede9f0a5a45918 px-4 sm:px-0"><div class="flex justify-between items-center py-1 space-x-4 border-0 select-none sm:border-b border-secondary"><div class="text-3xl text-white text-lg sm:text-3xl">Related Videos</div></div></div><div style="scroll-snap-type:none" class="jsx-19ede9f0a5a45918 flex items-start overflow-x-auto space-x-4 py-4 relative mx-auto w-full pl-4"><a id="" class="w-[200px] h-fit space-y-3 flex-none select-none no-underline" style="scroll-snap-align:center;text-decoration:none" href="/view/transforming-oncology-care-with-ai-driven-insights"><div class="w-full shadow-md shadow-gray-800 overflow-hidden relative bg-white aspect-video"><span 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Lahoud, MD, cochair of our Institute for Value-Based Medicine® evening hosted with NYU Langone Health, he addressed medical mistrust in underrepresented communities.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/how-english--and-spanish-preferring-patients-with-cancer-decide-on-emergency-care?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/5421358c8f117ee86126333e135f08cf1e61ded6-778x382.png?fit=crop&auto=format" alt="AJMC" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 13th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/how-english--and-spanish-preferring-patients-with-cancer-decide-on-emergency-care?utm_source=www.ajmc.com&utm_medium=relatedContent">How English- and Spanish-Preferring Patients With Cancer Decide on Emergency Care </a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/arthur-s-hong-md-mph">Arthur S. Hong, MD, MPH</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/beverly-kyalwazi-md">Beverly Kyalwazi, MD</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/ethan-a-halm-md-mph-mba">Ethan A. Halm, MD, MPH, MBA</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/d-mark-courtney-md-msci">D. Mark Courtney, MD, MSCI</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/john-w-sweetenham-md">John W. Sweetenham, MD</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/navid-sadeghi-md">Navid Sadeghi, MD, MSPH</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/john-v-cox-do-mba">John V. Cox, DO, MBA</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/simon-j-craddock-lee-phd-mph">Simon J. Craddock Lee, PhD, MPH</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/how-english--and-spanish-preferring-patients-with-cancer-decide-on-emergency-care?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Care delivery innovations to help patients with cancer avoid emergency department visits are underused. The authors interviewed English- and Spanish-preferring patients at 2 diverse health systems to understand why.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div></div></div></div><div class="relative hidden sm:block"><div class="mt-4 overflow-hidden"><div class="flex justify-between"><div class="flex items-center clear-both pt-4 pb-2 text-3xl lg:text-2xl xl:text-3xl min-w-fit ">Related Content </div><div class="hidden lg:flex w-full flex-col justify-end items-end"><div class="hidden w-full lg:flex flex-wrap pb-2 gap-x-2 gap-y-1 justify-end items-end"></div></div></div><div class="w-full mb-2 border border-secondary"></div><div class="lg:hidden flex flex-wrap items-center"></div><div class="flex flex-wrap w-full"><div class="jsx-ad50481d5ee26850 w-full h-full"><div><div><div class="text-[8px] text-center text-gray-500 hidden">Advertisement</div><div id="div-gpt-ad-infeed-1"></div></div></div><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/fda-approves-zanidatamab-hrii-for-her2-biliary-tract-cancer?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/2f366a4ab7421a6a697b539c22b8aedf46713899-6000x4000.jpg?fit=crop&auto=format" alt="FDA approval. | Image Credit: syahrir - stock.adobe.com" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 21st 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/fda-approves-zanidatamab-hrii-for-her2-biliary-tract-cancer?utm_source=www.ajmc.com&utm_medium=relatedContent">FDA Approves Zanidatamab-hrii for HER2+ Biliary Tract Cancer</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/cameron-santoro">Cameron Santoro</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/fda-approves-zanidatamab-hrii-for-her2-biliary-tract-cancer?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Currently, chemotherapy remains a common treatment for biliary tract cancers, which have a limited survival rate. </div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/exploring-racial-ethnic-disparities-in-cancer-care-prior-authorization-decisions?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/9de113904a026205cbaf84d08420c4065d52fd67-1000x563.jpg?fit=crop&auto=format" alt="managed care cast logo" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">October 24th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/exploring-racial-ethnic-disparities-in-cancer-care-prior-authorization-decisions?utm_source=www.ajmc.com&utm_medium=relatedContent">Exploring Racial, Ethnic Disparities in Cancer Care Prior Authorization Decisions</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/brooke-mccormick">Brooke McCormick</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/exploring-racial-ethnic-disparities-in-cancer-care-prior-authorization-decisions?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">On this episode of Managed Care Cast, we're talking with the author of a study published in the October 2024 issue of The American Journal of Managed Care® that explored prior authorization decisions in cancer care by race and ethnicity for commercially insured patients.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex md:hidden justify-center items-center"></div><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/uniting-to-support-patients-with-cancer-beyond-treatment?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/7b19fa1e939847d53496336b563fea0181d9d5dc-1200x675.jpg?fit=crop&auto=format" alt="Kasey Bond, MPH, Perlmutter Cancer Center" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 17th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/uniting-to-support-patients-with-cancer-beyond-treatment?utm_source=www.ajmc.com&utm_medium=relatedContent">Uniting to Support Patients With Cancer Beyond Treatment</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/maggie-l-shaw">Maggie L. Shaw</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/uniting-to-support-patients-with-cancer-beyond-treatment?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Kasey Bond, MPH, of Perlmutter Cancer Center at NYU Langone Health, speaks to why it’s vital to keep patients at the center of all strategic partnerships between academic institutions and community-based oncology practices.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/examining-low-value-cancer-care-trends-amidst-the-covid-19-pandemic?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/453ff95d3edc29442e2af71658751e2f26adc78e-2500x2500.jpg?fit=crop&auto=format" alt="Managed Care Cast logo" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">April 25th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/examining-low-value-cancer-care-trends-amidst-the-covid-19-pandemic?utm_source=www.ajmc.com&utm_medium=relatedContent">Examining Low-Value Cancer Care Trends Amidst the COVID-19 Pandemic</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/brooke-mccormick">Brooke McCormick</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/examining-low-value-cancer-care-trends-amidst-the-covid-19-pandemic?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">On this episode of Managed Care Cast, we're talking with the authors of a study published in the April 2024 issue of The American Journal of Managed Care® about their findings on the rates of low-value cancer care services throughout the COVID-19 pandemic. </div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/bridging-cancer-care-gaps-and-overcoming-medical-mistrust?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/80d574f277e911213ab8880dab0037a65359a6ac-1280x720.jpg?fit=crop&auto=format" alt="Oscar B. Lahoud, MD, NYU Langone Health" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 13th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/bridging-cancer-care-gaps-and-overcoming-medical-mistrust?utm_source=www.ajmc.com&utm_medium=relatedContent">Bridging Cancer Care Gaps and Overcoming Medical Mistrust</a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/maggie-l-shaw">Maggie L. Shaw</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/bridging-cancer-care-gaps-and-overcoming-medical-mistrust?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">In this clip from our interview with Oscar B. Lahoud, MD, cochair of our Institute for Value-Based Medicine® evening hosted with NYU Langone Health, he addressed medical mistrust in underrepresented communities.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div><div class="jsx-ad50481d5ee26850 w-full h-full"><div class="jsx-ad50481d5ee26850 flex flex-col sm:flex-row justify-between my-4 "><a class="jsx-ad50481d5ee26850" href="/view/how-english--and-spanish-preferring-patients-with-cancer-decide-on-emergency-care?utm_source=www.ajmc.com&utm_medium=relatedContent"><img src="https://cdn.sanity.io/images/0vv8moc6/ajmc/5421358c8f117ee86126333e135f08cf1e61ded6-778x382.png?fit=crop&auto=format" alt="AJMC" width="288" class="jsx-ad50481d5ee26850 max-h-[200px] xs:w-[288px] "/></a><div class="jsx-ad50481d5ee26850 article-detail flex flex-col gap-[0.2rem] w-full sm:w-[46%] md:w-[65%]"><span class="jsx-ad50481d5ee26850 article-publish-date block italic text-sm text-gray-500 mt-[1rem] sm:mt-0">November 13th 2024</span><p class="jsx-ad50481d5ee26850 article-title font-bold text-[1rem]"><a class="jsx-ad50481d5ee26850" href="/view/how-english--and-spanish-preferring-patients-with-cancer-decide-on-emergency-care?utm_source=www.ajmc.com&utm_medium=relatedContent">How English- and Spanish-Preferring Patients With Cancer Decide on Emergency Care </a></p><div class="jsx-ad50481d5ee26850 authors flex-row wrap gap-[0.2rem]"><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/arthur-s-hong-md-mph">Arthur S. Hong, MD, MPH</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/beverly-kyalwazi-md">Beverly Kyalwazi, MD</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/ethan-a-halm-md-mph-mba">Ethan A. Halm, MD, MPH, MBA</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/d-mark-courtney-md-msci">D. Mark Courtney, MD, MSCI</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/john-w-sweetenham-md">John W. Sweetenham, MD</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/navid-sadeghi-md">Navid Sadeghi, MD, MSPH</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/john-v-cox-do-mba">John V. Cox, DO, MBA</a><span class="jsx-ad50481d5ee26850 mr-1 ml-[1px]"> </span><a class="jsx-ad50481d5ee26850 text-[#00ADEF] underline text-sm italic" href="/authors/simon-j-craddock-lee-phd-mph">Simon J. Craddock Lee, PhD, MPH</a></div><div class="jsx-ad50481d5ee26850 article-summary"><a class="jsx-ad50481d5ee26850" href="/view/how-english--and-spanish-preferring-patients-with-cancer-decide-on-emergency-care?utm_source=www.ajmc.com&utm_medium=relatedContent"><div class="jsx-ad50481d5ee26850 text-sm text-gray-500 py-1">Care delivery innovations to help patients with cancer avoid emergency department visits are underused. The authors interviewed English- and Spanish-preferring patients at 2 diverse health systems to understand why.</div></a></div></div></div><div style="border-bottom:1px solid #CCCCCC" class="jsx-ad50481d5ee26850"></div></div></div></div></div><div class="pb-24"></div></div><script type="application/ld+json">{"@context":"https://schema.org","@type":"NewsArticle","headline":"Research Reveals Common Types of Rituximab-Induced Interstitial Lung Disease in Patients With Lymphoma","datePublished":"2024-11-08T14:38:00.000Z","dateModified":"2024-11-06T14:53:41Z","inLanguage":"en-US","image":"https://cdn.sanity.io/images/0vv8moc6/ajmc/877b0bbc24b826cebff91a2ed1be5d858fe976a1-1200x728.jpg?fit=crop&auto=format","mainEntityOfPage":{"@type":"WebPage","@id":"https://www.ajmc.com/view/research-reveals-common-types-of-rituximab-induced-interstitial-lung-disease-in-patients-with-lymphoma"},"publisher":{"@type":"Organization","name":"AJMC","logo":{"@type":"ImageObject","url":"https://www.ajmc.com/ajmc_logo_inverted.png"}},"keywords":"lymphoma,rituximab,lung","articleBody":"Rituximab-induced interstitial lung disease (RILD) in patients with non-Hodgkin lymphoma (NHL) presents most commonly as lung disease, organizing pneumonia, and nonspecific interstitial pneumonia, and it is associated with 179 pathogenic microorganisms, according to a retrospective study in the Annals of Hematology.1\n\n“These findings enhance the understanding of RILD in patients with non-Hodgkin lymphoma and serve as a reference for best management guidelines in these patients,” the authors wrote.\n\n\n\nThe study is the first to systematically characterize RILD in patients with NHL according to bronchoalveolar lavage (BAL) findings and treatment course of RILD, according to the authors.\n\nResearchers performed chest high-resolution CT (HRCT) to evaluate the extent, distribution, and radiologic patterns of the disease in 321 patients who developed RILD between 2020 and 2022.\n\nMore than three-quarters of patients (79.8%) were diagnosed with diffuse large B-cell lymphoma. The remaining patients had the following: marginal zone lymphoma (10.9%); follicular lymphoma (2.5%); Burkitt lymphoma (2.2%); mantle cell lymphoma (2.2%); high-grade B-cell lymphoma (1.5%); chronic lymphocytic leukemia/small lymphocytic lymphoma (0.9%). The chemotherapy regimen was resiniferatoxin (RTX) plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) in all patients.\n\nBAL was performed in 299 patients to analyze cellular distribution and identify pathogens using metagenomic next-generation sequencing. The remaining patients could not undergo bronchoscopy because of severe clinical symptoms. Radiological and bronchoscopic BAL findings revealed infectious lung disease in 123 patients and noninfectious lung disease in 198 patients.\n\nAfter multidisciplinary team discussions of the histological results, it was determined that 27 patients had drug-induced ILD, 9 patients had lymphoma infiltrating the lungs, 6 patients had fungal infections, and 3 patients had \nMycobacterium tuberculosis infections. Among the 27 patients with drug-induced ILD, pathological examination showed 10 patients with organizing pneumonia, 5 patients with nonspecific interstitial pneumonia, 5 patients with hypersensitivity pneumonitis, and 3 patients with eosinophilic pneumonia.\n\nOf the 217 patients who underwent metagenomic next-generation sequencing, 179 pathogenic microorganisms were detected, including bacteria (77), viruses (45), Pneumocystis jirovecii strains (28), fungi (17), M tuberculosis (6), and atypical pathogens (6).\n\nAll patients received combination therapy. Cyclophosphamide, doxorubicin, vincristine, and prednisone were the most commonly administered regimens. The median time from treatment to RILD development was 1.7 months.\n\nPatients were classified as having RILD if both rituximab for NHL and ILD were present. ILD was defined as diffuse interstitial lung infiltrates detected on chest HRCT. Patients were excluded if they had any of the following: known congenital lung disease; mental or cognitive impairment; use of other new anti-tumor drugs; severe comorbidities such as severe pulmonary infection, severe heart disease, or liver and kidney dysfunction, which could interfere with research results; patients receiving radiation therapy; and incomplete case or simultaneous participation in other clinical studies.\n\nSlightly more than half (58.9%) the patients were male, and the median patient age was 48 years (range, 17–78 years).\n\nThis year, an estimated 20,140 patients will die of NHL, comprising 3.3% of all US cancer deaths, according to the National Cancer Institute.2\n\n“The clinical, histopathological, and radiological characteristics of ILD and secondary diseases, as well as those of infectious and non-infectious pneumonia of this type, overlap considerably,” the authors stated.1 “Therefore, understanding the clinical characteristics of RILD and its active prevention and treatment is essential for patients undergoing immunochemotherapy.”\n\nReferences\n\nZou W, Zhang J, Li Y, et al. Interstitial lung disease presents with varying characteristics in patients with non-Hodgkin lymphoma undergoing rituximab containing therapies. Ann Hematol. Published online September 25, 2024. doi:10.1007/s00277-024-06013-2\n\nCancer stat facts: non-Hodgkin lymphoma. Accessed October 9, 2024. National Cancer Institute. https://seer.cancer.gov/statfacts/html/nhl.html","description":"Rituximab-induced interstitial lung disease in patients with non-Hodgkin lymphoma presents with distinct clinical characteristics and bronchoalveolar lavage results.","author":[{"@type":"Person","name":"Karen Jacobson-Sive"}]}</script></div></div><div class="flex-none w-[300px] z-[9999] relative hidden md:block"><div style="top:5rem" class="sticky custom-spacing"><div class="collapse-container " style="overflow:hidden;max-height:900px;transition:max-height .4s ease-in-out"></div></div></div></div><div id="div-gpt-ad-pixel" style="width:1px;height:1px" class=""></div><noscript><iframe src="https://www.googletagmanager.com/ns.html?id=GTM-NK5KQXS" height="0" width="0" style="display:none;visibility:hidden"></iframe></noscript><div id="footerOuterWrap" class=" mx-auto flex"><div class="bg-[#00598D] xl:w-[70%] w-[70%] py-12 pl-auto"><div class="xxl:w-[75%] w-[90%] ml-auto"><div><span 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The remaining patients had the following: marginal zone lymphoma (10.9%); follicular lymphoma (2.5%); Burkitt lymphoma (2.2%); mantle cell lymphoma (2.2%); high-grade B-cell lymphoma (1.5%); chronic lymphocytic leukemia/small lymphocytic lymphoma (0.9%). The chemotherapy regimen was resiniferatoxin (RTX) plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) in all patients.","_key":"6df25fbb7adf0"}]},{"_key":"97677f1556f5","markDefs":[],"upload_doc":null,"uploadAudio":null,"medias":null,"children":[{"marks":[],"text":"BAL was performed in 299 patients to analyze cellular distribution and identify pathogens using metagenomic next-generation sequencing. The remaining patients could not undergo bronchoscopy because of severe clinical symptoms. 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Cyclophosphamide, doxorubicin, vincristine, and prednisone were the most commonly administered regimens. The median time from treatment to RILD development was 1.7 months."}]},{"style":"normal","_key":"a97d0f4d0060","markDefs":[],"upload_doc":null,"uploadAudio":null,"medias":null,"children":[{"_type":"span","marks":[],"text":"Patients were classified as having RILD if both rituximab for NHL and ILD were present. ILD was defined as diffuse interstitial lung infiltrates detected on chest HRCT. Patients were excluded if they had any of the following: known congenital lung disease; mental or cognitive impairment; use of other new anti-tumor drugs; severe comorbidities such as severe pulmonary infection, severe heart disease, or liver and kidney dysfunction, which could interfere with research results; patients receiving radiation therapy; and incomplete case or simultaneous participation in other clinical studies.","_key":"7df2b8d6019f0"}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Slightly more than half (58.9%) the patients were male, and the median patient age was 48 years (range, 17–78 years).","_key":"df8f1eb9e67d0"}],"_type":"block","style":"normal","upload_doc":null,"uploadAudio":null,"medias":null,"_key":"f18543956047"},{"medias":null,"markDefs":[],"children":[{"_type":"span","marks":[],"text":"This year, an estimated 20,140 patients will die of NHL, comprising 3.3% of all US cancer deaths, according to the National Cancer Institute.","_key":"565b20954a2d0"},{"_type":"span","marks":["superscript"],"text":"2","_key":"b89f9a51617e"}],"_type":"block","style":"normal","_key":"6666f1dad79d","upload_doc":null,"uploadAudio":null},{"markDefs":[],"children":[{"text":"“The clinical, histopathological, and radiological characteristics of ILD and secondary diseases, as well as those of infectious and non-infectious pneumonia of this type, overlap considerably,” the authors stated.","_key":"aaa09a16b43d0","_type":"span","marks":[]},{"_type":"span","marks":["superscript"],"text":"1","_key":"17e88407478a"},{"marks":[],"text":" “Therefore, understanding the clinical characteristics of RILD and its active prevention and treatment is essential for patients undergoing immunochemotherapy.”","_key":"5915f2373255","_type":"span"}],"_type":"block","upload_doc":null,"uploadAudio":null,"medias":null,"style":"normal","_key":"d8f19339340f"},{"style":"normal","upload_doc":null,"uploadAudio":null,"medias":null,"_key":"64796aef38bf","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"References","_key":"d47e2782b6ab0"}],"_type":"block"},{"markDefs":[],"children":[{"text":"Zou W, Zhang J, Li Y, et al. 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stock.adobe.com","imgcaption":[{"style":"normal","_key":"4ff64d1a7cc9","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Currently, chemotherapy remains a common treatment for biliary tract cancers, which have a limited survival rate. | Image Credit: syahrir - stock.adobe.com","_key":"8fe70b7b62430"}],"_type":"block"}],"disableLightBox":true,"_type":"figure","alignment":"right","widthP":50},{"style":"normal","_key":"3d5baa7f612b","markDefs":[],"children":[{"_type":"span","marks":[],"text":"The FDA granted accelerated approval to zanidatamab-hrii (Ziihera) for the treatment of adults with previously treated, unresectable or metastatic HER2-positive biliary tract cancer.","_key":"98e6235d75570"},{"_type":"span","marks":["superscript"],"text":"1","_key":"ac9c5ed96d07"}],"_type":"block"},{"style":"normal","_key":"8fd10176d3d2","markDefs":[],"children":[{"_type":"span","marks":["superscript"],"text":"","_key":"8db2d9b0dabe"}],"_type":"block"},{"children":[{"_type":"span","marks":[],"text":"Zanidatamab will be manufactured by Zymeworks Inc., a clinical-stage biotechnology company, along with Jazz Pharmaceuticals.","_key":"c54a61663ace0"},{"_type":"span","marks":["superscript"],"text":"2","_key":"2107f555a5b3"},{"_type":"span","marks":[],"text":" The approval was based on the results from the ","_key":"98a0cd99795f"},{"_type":"span","marks":["dab9285731d5"],"text":"HERIZON-BTC-01 trial","_key":"c54a61663ace1"},{"marks":[],"text":", which analyzed zanidatamab as a single agent in patients with previously treated HER2-positive biliary tract cancer.","_key":"c54a61663ace2","_type":"span"}],"_type":"block","style":"normal","_key":"d8f496347c08","markDefs":[{"nofollow":true,"blank":true,"_type":"link","href":"https://ascopubs.org/doi/10.1200/JCO.2023.41.16_suppl.4008","_key":"dab9285731d5"}]},{"markDefs":[],"children":[{"text":"","_key":"b9bc7bea86bf0","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"4a113b11ecb2"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Biliary tract cancers encompass an estimated 3% of all gastrointestinal cancers and have a limited survival rate.","_key":"4c43de26b6d70"},{"marks":["superscript"],"text":"3","_key":"eee1f791b014","_type":"span"},{"_type":"span","marks":[],"text":" These types of cancers include intrahepatic cholangiocarcinoma, extrahepatic cholangiocarcinoma, gallbladder cancer, and ampullary carcinoma. While targeted therapies exist for biliary tract cancers, chemotherapy remains a highly common treatment for patients.","_key":"6ad1953cfa11"}],"_type":"block","style":"normal","_key":"d74c3ccbac7d"},{"children":[{"_type":"span","marks":[],"text":"","_key":"9c65b9f0059d0"}],"_type":"block","style":"normal","_key":"5c94e13abbe0","markDefs":[]},{"children":[{"_key":"feccfa5a708e0","_type":"span","marks":[],"text":"\"Metastatic biliary tract cancer, BTC [biliary tract cancer], places a significant burden on patients, affecting their quality of life and their emotional and mental well-being, as well as that of their families,\" Stacie Lindsey, chief executive officer and founder of the Cholangiocarcinoma Foundation, said in a press release."},{"marks":["superscript"],"text":"1","_key":"aa46be63f42a","_type":"span"}],"_type":"block","style":"normal","_key":"8da0979b9516","markDefs":[]},{"style":"normal","_key":"d4ab63b4c4f9","markDefs":[],"children":[{"_key":"683fc781e2860","_type":"span","marks":[],"text":""}],"_type":"block"},{"_key":"447c1e6e2b86","markDefs":[],"children":[{"marks":[],"text":"The study enrolled 87 patients with HER2-amplified, locally advanced unresectable or metastatic biliary tract cancer in 2 cohorts. Patients received 20 mg/kg zanidatamab intravenously every 2 weeks until disease progression or unacceptable toxicity, for an average of 5.6 months.","_key":"599212f17bd30","_type":"span"}],"_type":"block","style":"normal"},{"_key":"303f274b5373","markDefs":[],"children":[{"_key":"d442a9a823c40","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_key":"4ffa0fde190d0","_type":"span","marks":[],"text":"The first cohort included patients who were immunohistochemistry (IHC) 2+/3+ (n = 80) while the second cohort included patients who were IHC 0/1+ (n = 7). Tumors were reassessed every 8 weeks. Primary end points included the objective response rate by independent central review in cohort 1 while efficacy and safety outcomes were the secondary end points."}],"_type":"block","style":"normal","_key":"94543a8c3ac9"},{"_key":"bb3964ecd099","markDefs":[],"children":[{"text":"","_key":"4d860110db270","_type":"span","marks":[]}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"“Zanidatamab has demonstrated antitumor activity and is now a new option for patients with HER2-positive biliary tract cancer,” commented James Harding, MD, gastrointestinal oncologist and early drug development specialist at Memorial Sloan Kettering Cancer Center.","_key":"43405c812f820"},{"_type":"span","marks":["superscript"],"text":"1","_key":"bb246e09b399"}],"_type":"block","style":"normal","_key":"397b5e99afc6"},{"markDefs":[],"children":[{"_type":"span","marks":["superscript"],"text":"","_key":"bd936c277c0e"}],"_type":"block","style":"normal","_key":"47b6bf634538"},{"style":"normal","_key":"82e3f7567cca","markDefs":[{"blank":true,"_type":"link","href":"https://clinicaltrials.gov/study/NCT06282575?term=NCT06282575\u0026rank=1","_key":"718dbb375962","nofollow":true}],"children":[{"_type":"span","marks":[],"text":"The accelerated approval of zanidatamab was granted based on the 52% objective response rate among patients, as well as the 14.9 months average duration of treatment. The phase 3 ","_key":"8553e7c3fa2b0"},{"_type":"span","marks":["718dbb375962"],"text":"HERIZON-BTC-302 trial","_key":"8553e7c3fa2b1"},{"marks":[],"text":" is ongoing and is looking to evaluate zanidatamab combined with standard-of-care therapy vs standard-of-care therapy alone in the first-line treatment setting.","_key":"8553e7c3fa2b2","_type":"span"}],"_type":"block"},{"children":[{"_key":"9487c4e455d50","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal","_key":"f5c9136731cf","markDefs":[]},{"markDefs":[],"children":[{"text":"Common adverse reactions among patients who received zanidatamab included diarrhea, infusion-related reaction, abdominal pain, and fatigue. Serious adverse reactions included biliary obstruction, biliary tract infection, sepsis, pneumonia, diarrhea, gastric obstruction, and fatigue. Only 1 patient had a fatal adverse reaction of hepatic failure and 2.5% of patients permanently discontinued due to adverse reactions.","_key":"a20e77ccb2790","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"c5aaf4453503"},{"style":"normal","_key":"6b64593f4ab0","markDefs":[],"children":[{"text":"","_key":"588170b38d2c0","_type":"span","marks":[]}],"_type":"block"},{"children":[{"_type":"span","marks":[],"text":"Zanidatamab is currently being investigated for its potential in treating additional tumor types. Phase 3 trials are underway to explore its efficacy in gastroesophageal adenocarcinomas (GEAs) and metastatic breast cancer. The HERIZON-GEA-01 trial is evaluating zanidatamab combined with chemotherapy, with or without tislelizumab, as a first-line treatment for advanced/metastatic HER2-positive GEAs.","_key":"a68cdc0698240"}],"_type":"block","style":"normal","_key":"b0df167c5067","markDefs":[]},{"_type":"block","style":"normal","_key":"645bbcf4c6e9","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"a47ab69188a0"}]},{"_key":"50709ae9aaca","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Additionally, the EmpowHER-303 trial is assessing the combination of zanidatamab and physician's choice of chemotherapy for patients with HER2-positive metastatic breast cancer who have progressed on or are intolerant to prior trastuzumab deruxtecan therapy.","_key":"460fb9a3b2f50"}],"_type":"block","style":"normal"},{"children":[{"_key":"88754338a48c","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal","_key":"34391ed0bef8","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"References","_key":"02465ef318a70"}],"_type":"block","style":"normal","_key":"4e5e4db552af"},{"markDefs":[{"nofollow":true,"blank":true,"_type":"link","href":"https://www.prnewswire.com/news-releases/jazz-pharmaceuticals-announces-us-fda-approval-of-ziihera-zanidatamab-hrii-for-the-treatment-of-adults-with-previously-treated-unresectable-or-metastatic-her2-positive-ihc-3-biliary-tract-cancer-btc-302312216.html","_key":"8b77f4fd151e"}],"children":[{"text":"1. Jazz Pharmaceuticals announces US FDA approval of Ziihera (zanidatamab-hrii) for the treatment of adults with previously treated, unresectable or metastatic HER2-positive (IHC 3+), biliary tract cancer (BTC). News release. PR Newswire; November 20, 2024. Accessed November 21, 2024. 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","_key":"ff419e0d27f30"},{"_key":"ff419e0d27f31","_type":"span","marks":["b2a30fc0a30f"],"text":"https://ir.zymeworks.com/news-releases/news-release-details/fda-grants-us-approval-ziiherar-zanidatamab-hrii-treatment"}],"_type":"block"},{"_key":"f2cd62b2d0bb","markDefs":[],"children":[{"marks":[],"text":"3. Ayasun R, Ozer M, Sahin I. The role of HER2 status in the biliary tract cancers. 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My takeaway from that was really that there's power in numbers and that all of us have a responsibility to do right by the patient. I think that same theme was carried through the other discussions from Dr Roy [Brita Roy, MD, MPH, MHS, NYU Grossman School of Medicine] and Dr Lacouture [Mario Lacouture, MD, NYU Langone Health].","_key":"ed7c1c5475e40"}],"_type":"block","style":"normal","_key":"57164a9cf698","markDefs":[]},{"_type":"block","style":"normal","_key":"fa59c3ec95ea","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"c40b1e4700890"}]},{"children":[{"_type":"span","marks":[],"text":"Dr Lacouture, I've had the pleasure of working with quite a bit, and with Dr Roy as well. And they sort of came at it from 2 different angles. Dr Lacouture was talking about the need to use specialists across all of our communities to help treat the symptoms for our cancer patients. I think a lot of people think about cancer treatment only as the patient getting chemo or the patient getting radiation or the patient having surgery. But the importance of his talk was to say that there are lots of other things associated with those treatments that are affecting these patients, and it's really important that we partner with those providers in the community and those that are part of some of our larger systems to provide that support to the patients close to where they live.","_key":"e197a62d86430"}],"_type":"block","style":"normal","_key":"f92fcd06e540","markDefs":[]},{"markDefs":[],"children":[{"text":"","_key":"18e4472a762b0","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"59d059e1c8b3"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"It can already be a lot for them to have to travel into the city or out to Long Island or to South Brooklyn for some kind of treatment, and being able to say, “Oh, I have this rash from my chemotherapy. I need to go see a dermatologist,” and these partnerships are allowing us to provide those services as close as possible to where the patient lives.","_key":"24e0c41cf1b50"}],"_type":"block","style":"normal","_key":"e4c74bf2b663"},{"_type":"block","style":"normal","_key":"c519ea27112e","markDefs":[],"children":[{"_key":"e1aa629596150","_type":"span","marks":[],"text":""}]},{"style":"normal","_key":"d8ada0f105f1","markDefs":[],"children":[{"marks":[],"text":"And then I think Dr Roy was coming at it from the perspective of being able to offer services to patients using community-based organizations [CBOs] and how important it is for our academic systems and our community-based practices to work with these CBOs to provide services that undoubtedly affect the patient's health outcomes, but are not services that our institutions might have the ability to provide—so things like supporting patients that have housing insecurity, or helping to provide food to those who might have food insecurity, or dealing with transportation or childcare issues.","_key":"37fda9f2061b0","_type":"span"}],"_type":"block"},{"style":"normal","_key":"b1bd262eba7b","markDefs":[],"children":[{"_key":"17da22514e2d0","_type":"span","marks":[],"text":""}],"_type":"block"},{"markDefs":[],"children":[{"marks":[],"text":"I think the takeaway from all 3 of these discussions is that no one entity in any of these areas is able to do everything for everyone, and we really need to come together and identify what each of our strengths is, and then make sure that we're leaning on each other to support the patient for things that might not be in our wheelhouse.","_key":"a31a31cf78940","_type":"span"}],"_type":"block","style":"normal","_key":"edebdacde6c6"},{"style":"normal","_key":"d9e05cb7f3f1","markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"586b9492b15c0"}],"_type":"block"},{"_key":"e58bee079839","markDefs":[],"children":[{"text":"The patient is at the center of everything regardless of what kind of institution you're working in, whether that's a community-based organization, an academic medical center, or a community-based medical practice. Part of it is what I said earlier about the fact that we need to leverage each other's strengths. It’s our responsibility to treat the whole person and not just the patient's cancer. That is even another reason why we need to all come together and partner.The last thing we want to do is make somebody feel like they are only a diagnosis. And so I think that's another big takeaway.","_key":"ead0d2a4f2540","_type":"span","marks":[]}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"c2a6e253ef410"}],"_type":"block","style":"normal","_key":"94c6ed571b52"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"And then the last one I would say is that it's important, especially in academic medicine, that we are collaborating with trusted members of the community, and that it's important that our patients feel comfortable to speak up and feel like they're being heard and feel like they're being represented. 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I actually moved to NYU with a focus on NYU Brooklyn exactly for that purpose.","_key":"fccf87dab39c0","_type":"span"}]},{"_key":"5220b509d7b4","markDefs":[],"children":[{"_key":"047857ecb49e0","_type":"span","marks":[],"text":""}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"marks":[],"text":"Just to give you an idea of the kind of patients we're seeing here in Brooklyn, Sunset Park, 82% of our patients have insurance that's government funded, mostly Medicaid. And we understand the challenges for many of our often underserved but also underresourced patients to be able to travel to an academic center to have access to novel therapies. So, ways that academic centers have now begun to come up with in order to bridge the gap between these patients and the care they want to be able to provide to them is by bringing academic centers to the community directly.","_key":"bc00417bb5b30","_type":"span"}],"_type":"block","style":"normal","_key":"37f6f5d09dd3"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"","_key":"15942fedb8c70"}],"_type":"block","style":"normal","_key":"1a418cac6dbf"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"NYU is spread across almost all of the New York boroughs, but also across Long Island, and the thought is that we would have sites close enough to the community with a hospital hub. We have 1 full hospital in Brooklyn, 1 on Long Island—soon another one—and 1 in Manhattan, and this way patient can travel easily. 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I don't want to go back to the Tuskegee experiments and all of that, but there's mistrust that has been there, and whenever historically they had been presented with clinical trials, they thought that they were the guinea pig for something that really there was no knowledge of.","_key":"efaa405b68f30","_type":"span","marks":[]}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"text":"","_key":"da5b71b0519e0","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"fea1840ac09a"},{"_key":"fc2dd04f9c70","markDefs":[],"children":[{"_type":"span","marks":[],"text":"So one key is to change the narrative around that. Now, we no longer have our patients feel like they're guinea pigs. We rather offer them the opportunity to have access to potential novel therapy ahead of the rest of the community—before it's even approved—while we believe it will have an effective role in their disease management. 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Existing delivery innovations to reduce ED use are underused, and reasons for this are not understood. Patients who recently visited the ED may provide insights into these patterns of care.","_key":"d58188880301"}],"_type":"block","style":"normal","_key":"8d8e6bfde37d"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Study Design:","_key":"9007054d7a240"},{"text":" Qualitative study of semistructured patient interviews from April 2019 to April 2022.","_key":"10c0269f3a82","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"eb62a7e4baf1"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Methods: ","_key":"29b85de7d5250"},{"_type":"span","marks":[],"text":"We interviewed patients diagnosed with cancer within the prior 6 months from the University of Texas Southwestern Medical Center and its academically affiliated but clinically distinct safety-net health system Parkland Health who had recently visited their respective ED. We completed 29 interviews in English and 11 in Spanish, then analyzed the interviews with the constant comparative method.","_key":"ecbf1ec4aaea"}],"_type":"block","style":"normal","_key":"9abb2e8f3f8e"},{"_type":"block","style":"normal","_key":"83468212fec6","markDefs":[],"children":[{"text":"Results:","_key":"c8fadfe8e4030","_type":"span","marks":["strong"]},{"text":" Nearly all patients were unaware of, but interested in using, 24/7 telephone triage and oncology urgent care clinics. Safety-net patients, especially Spanish-preferring patients, reported less access to outpatient cancer teams. Patients did not weigh symptom severity to decide between sites of care, but insured patients were concerned about the cost of hospital visits. Patients did not look forward to visiting the ED but understood its advantages, and for safety-net patients, the ED was the main way to access physicians. When patients were discharged home, they were relieved not to be hospitalized, and the good clinical experience inadvertently reinforced future ED use.","_key":"cfaee39deecc","_type":"span","marks":[]}]},{"style":"normal","_key":"bfeb26c5e245","markDefs":[],"children":[{"text":"Conclusions:","_key":"b8517ede40f40","_type":"span","marks":["strong"]},{"_type":"span","marks":[],"text":" Even robust education programs for patients with cancer may have difficulty conveying the availability of innovative clinical services. Patient perspectives on avoidable ED visits may differ from policy makers’ definitions.","_key":"98556819723a"}],"_type":"block"},{"_type":"block","style":"normal","_key":"73107ee1503c","markDefs":[{"href":"https://doi.org/10.37765/ajmc.2024.89628","_key":"2ebbbb8062b2","nofollow":true,"blank":true,"_type":"link"}],"children":[{"_key":"c9a976621df5","_type":"span","marks":["em","strong"],"text":"Am J Manag Care. 2024;30(11):e312-e319. "},{"marks":["strong","em","2ebbbb8062b2"],"text":"https://doi.org/10.37765/ajmc.2024.89628","_key":"df3be7e4b507","_type":"span"}]},{"style":"normal","_key":"8504d996f2fc","markDefs":[],"children":[{"_key":"03ccbc22c663","_type":"span","marks":["aligncenter"],"text":"_____"}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Takeaway Points","_key":"63bb7ef1f768"}],"_type":"block","style":"normal","_key":"d62bccc74002"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Despite extensive counseling and quality-certified patient education programs, patients of diverse backgrounds were unaware of, but very interested in using, available clinical innovations to help them avoid emergency department (ED) visits during cancer treatment.","_key":"70bff2f1af750"}],"level":1,"_type":"block","style":"normal","_key":"46eafcc7f45c","listItem":"bullet"},{"listItem":"bullet","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Patients did not describe weighing the severity of symptoms to decide between different sites of care.","_key":"65dd9baec0ef0"}],"level":1,"_type":"block","style":"normal","_key":"6346e887fdf4"},{"_key":"a333a37c1e6c","listItem":"bullet","markDefs":[],"children":[{"_type":"span","marks":[],"text":"It is necessary to carefully incorporate patient viewpoints to tailor communications and bridge care disparities, being cognizant of language barriers.","_key":"345e84219b880"}],"level":1,"_type":"block","style":"normal"},{"listItem":"bullet","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Although policy makers consider ED home discharges to be avoidable visits, patients found them to be valuable. Good ED care experiences may inadvertently reinforce future ED use.","_key":"291341da52300"}],"level":1,"_type":"block","style":"normal","_key":"8f6859e38dd1"},{"style":"normal","_key":"81328bab90ea","markDefs":[],"children":[{"_key":"bda6607049f2","_type":"span","marks":["aligncenter"],"text":"_____"}],"_type":"block"},{"_key":"0e8584bba991","markDefs":[],"children":[{"text":"Unplanned hospital care (emergency department [ED] and inpatient admissions) is recognized as a frequent,","_key":"947f4cb4dd6a0","_type":"span","marks":[]},{"_key":"056b60592fc0","_type":"span","marks":["superscript"],"text":"1-3"},{"_type":"span","marks":[],"text":" disruptive,","_key":"6431cbdb084a"},{"_type":"span","marks":["superscript"],"text":"4-6","_key":"af2f1ef33edd"},{"_type":"span","marks":[],"text":" highly variable,","_key":"f2ba98e2c6e6"},{"_type":"span","marks":["superscript"],"text":"7","_key":"22a95c5d7e8d"},{"_key":"1854a7375d8c","_type":"span","marks":[],"text":" and financially burdensome"},{"_type":"span","marks":["superscript"],"text":"8-10","_key":"33f3bf839053"},{"_type":"span","marks":[],"text":" aspect of cancer treatment. Adults with cancer are hospitalized from the ED more than 60% of the time,","_key":"9b913cd675c2"},{"text":"1,11","_key":"1c1292f9528e","_type":"span","marks":["superscript"]},{"_type":"span","marks":[],"text":" resulting in substantial overrepresentation among the inpatient population. Existing quality measures from Medicare track ED home discharges and admissions for potentially avoidable conditions among patients receiving chemotherapy, including vomiting, dehydration, and pain.","_key":"61e94dacd7d8"},{"_type":"span","marks":["superscript"],"text":"12","_key":"b6fa069f8d7e"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_key":"ef305ffb3ad90","_type":"span","marks":[],"text":"Studies have found that patients are loath to “bother” their oncologists with acute concerns, even though they experience uncertainty navigating care for new or worsening symptoms."},{"_type":"span","marks":["superscript"],"text":"13","_key":"6f5eed2ebbae"},{"_type":"span","marks":[],"text":" Patients also struggle to select the site of care that appropriately matches the severity of their condition.","_key":"5c93c3f66683"},{"_type":"span","marks":["superscript"],"text":"14-16","_key":"3a0699e3002b"}],"_type":"block","style":"normal","_key":"c6373b3a5912"},{"_key":"84ea32add98a","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Oncology urgent care clinics have shown promise in reducing ED use among adults newly diagnosed with cancer.","_key":"3a49c4edb3ab0"},{"marks":["superscript"],"text":"17,18","_key":"1a40ebedc3ca","_type":"span"},{"_type":"span","marks":[],"text":" These clinics are staffed by advanced practice providers, who obtain basic laboratory testing and imaging, deliver intravenous therapies, and monitor patients for prolonged periods.","_key":"f149fe04d62d"},{"_type":"span","marks":["superscript"],"text":"17,19-21","_key":"82eb5a42bfff"},{"text":" These innovative clinics also are underused.","_key":"6efc8e0a5374","_type":"span","marks":[]},{"_key":"95445955f0eb","_type":"span","marks":["superscript"],"text":"18"},{"marks":[],"text":" One explanation may be that they are too novel for patients to easily understand. Patients may also have had bad prior experiences with telephone triage or oncology urgent care.","_key":"5c07260303d9","_type":"span"}],"_type":"block","style":"normal"},{"_key":"d425faebd6a2","markDefs":[],"children":[{"_type":"span","marks":[],"text":"We sought to understand perspectives from adults with cancer who visited the ED. Patients were being treated at 1 of 2 health systems that make up the Harold C. Simmons Comprehensive Cancer Center in Dallas, Texas: University of Texas Southwestern Medical Center (hereafter, University) and Parkland Health (hereafter, Safety Net), the main cancer care provider for the uninsured in Dallas County. Although the health systems share academic affiliation, their clinical operations are distinct. Both have 24/7 clinician phone access and have had oncology urgent care since 2015. During business hours, oncology-dedicated clinicians triage calls and schedule oncology urgent care visits; after hours, generalist clinicians triage calls and can only refer for scheduling the next day. Notably, the University practice is certified by the American Society of Clinical Oncology Quality Oncology Practice Initiative (ASCO QOPI),","_key":"98604f3f28e10"},{"_key":"585a1aa01d7d","_type":"span","marks":["superscript"],"text":"22"},{"_key":"23c29cb19b44","_type":"span","marks":[],"text":" meaning that its patient education efforts are very robust. The Safety Net practice also incorporates patient navigators, literature, and regular counseling throughout treatment."}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"73a01b7e249a","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"METHODS","_key":"dbdee72972650"}]},{"children":[{"_type":"span","marks":["strong"],"text":"Overview","_key":"aa70b56561db0"}],"_type":"block","style":"normal","_key":"d95ab1adf801","markDefs":[]},{"markDefs":[],"children":[{"text":"We used comparative thematic analysis to design semistructured interviews for adults with cancer who visited the ED. We sought to understand decision-making, attitudes, beliefs, and barriers to access that influenced decisions to present to the ED in the context of their ED visit experience. Our initial deductive approach was supplemented by inductive analysis to draw connections among the coded data.","_key":"060ac059457f0","_type":"span","marks":[]}],"_type":"block","style":"normal","_key":"b3bf2ff924b9"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Interview Guide Development","_key":"80c858f23d390"}],"_type":"block","style":"normal","_key":"6024a2fbf1dd"},{"children":[{"_type":"span","marks":[],"text":"Interview guides were informed by the conceptual model for nonurgent ED use","_key":"8ff2645755470"},{"_type":"span","marks":["superscript"],"text":"23","_key":"81243dd4f824"},{"_type":"span","marks":[],"text":" and based on an interview guide for a general ED population.","_key":"207422aece6b"},{"_type":"span","marks":["superscript"],"text":"14","_key":"c38313525d08"},{"_type":"span","marks":[],"text":" The conceptual model outlines 6 causal pathway factors involved in patients deciding on an ED visit. Interviews covered decision-making, patient education, oncology team communication, and support for self-management.","_key":"32c85414a00d"}],"_type":"block","style":"normal","_key":"be7c9defe6d5","markDefs":[]},{"_key":"236866923132","markDefs":[],"children":[{"_key":"371ed97acc120","_type":"span","marks":[],"text":"We sought insights into questions generated by prior work"},{"_type":"span","marks":["superscript"],"text":"6,18,24,25","_key":"7017adf1ce54"},{"marks":[],"text":": (1) How do prior ED experiences affect ED use after a cancer diagnosis?; (2) Why do patients not use existing phone triage assistance before going to the ED?; (3) Who else do patients rely on for triage help?; (4) Does cancer team communication or a language barrier impact ED decision-making?; and (5) Are patients aware of existing oncology urgent care clinics?","_key":"1b7a5dcc3a6a","_type":"span"}],"_type":"block","style":"normal"},{"_key":"944eb7364df9","markDefs":[],"children":[{"_type":"span","marks":[],"text":"We piloted the interview guide with the Parkland Patient and Family Advisory Council, a group of 12 patients who provided feedback on wording and content.","_key":"f4a63df7c8fc0"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"text":"Participants and Setting","_key":"e10bd302067d0","_type":"span","marks":["strong"]}],"_type":"block","style":"normal","_key":"468f64686aee"},{"_key":"941d7d90f4fc","markDefs":[],"children":[{"_type":"span","marks":[],"text":"From the electronic health record (EHR) (Epic), we purposively identified patients who visited their respective hospital ED with a nonleukemia","_key":"44c2377717d30"},{"marks":["superscript"],"text":"26","_key":"5e5776e3cb6a","_type":"span"},{"_type":"span","marks":[],"text":" cancer diagnosis. We narrowed to patients whose initial diagnosis was within 6 months (180 days) and excluded those with dementia or speech difficulty or whose high-severity illness precluded an interview. We sent letters notifying patients of study eligibility, then called EHR-listed phone numbers to complete interviews.","_key":"557b2d2c1d0c"}],"_type":"block","style":"normal"},{"_key":"0bab08cb4073","markDefs":[],"children":[{"_key":"d8951e3e0f790","_type":"span","marks":[],"text":"The Safety Net practice serves a large number of non-English–preferring patients (~33%), a plurality of whom prefer Spanish; only 10% of University patients prefer a language other than English."},{"_type":"span","marks":["superscript"],"text":"6,24","_key":"67b7ceb260c6"},{"marks":[],"text":" More than 70% of Safety Net patients are uninsured or enrolled in Medicaid compared with 15% of University patients.","_key":"e674382c954f","_type":"span"},{"_key":"8656fa2025b1","_type":"span","marks":["superscript"],"text":"24"},{"_type":"span","marks":[],"text":" English-language interview guides were reviewed to be accessible to those with low literacy and translated using “broadcast Spanish” as a standard so that translations were intelligible to Spanish speakers from different regions.","_key":"6a919535b4aa"},{"_type":"span","marks":["superscript"],"text":"27","_key":"b85683ad9f01"}],"_type":"block","style":"normal"},{"_key":"18ee5dd54599","markDefs":[{"nofollow":true,"blank":true,"_type":"link","href":"https://cdn.sanity.io/files/0vv8moc6/ajmc/de5fe549ae4d17f181c0e99cde9a38965cdc1d20.pdf","_key":"34c51e5ce2ae"}],"children":[{"_type":"span","marks":[],"text":"Additional details are in the ","_key":"31f8bc68570c0"},{"_type":"span","marks":["strong"],"text":"eAppendices ","_key":"31f8bc68570c1"},{"_type":"span","marks":[],"text":"(","_key":"31f8bc68570c2"},{"_type":"span","marks":["34c51e5ce2ae"],"text":"available at ","_key":"191e6623d18e"},{"_key":"31f8bc68570c3","_type":"span","marks":["strong","34c51e5ce2ae"],"text":"ajmc.com"},{"_type":"span","marks":[],"text":"): interview guides in ","_key":"31f8bc68570c4"},{"_type":"span","marks":["strong"],"text":"eAppendix A","_key":"31f8bc68570c5"},{"text":" (English) and ","_key":"31f8bc68570c6","_type":"span","marks":[]},{"_type":"span","marks":["strong"],"text":"eAppendix B","_key":"31f8bc68570c7"},{"_type":"span","marks":[],"text":" (Spanish), COREQ (Consolidated Criteria for Reporting Qualitative Research) in ","_key":"31f8bc68570c8"},{"text":"eAppendix C","_key":"31f8bc68570c9","_type":"span","marks":["strong"]},{"_type":"span","marks":[],"text":", coding tree in ","_key":"31f8bc68570c10"},{"_type":"span","marks":["strong"],"text":"eAppendix D","_key":"31f8bc68570c11"},{"_type":"span","marks":[],"text":", and recruitment diagram in ","_key":"31f8bc68570c12"},{"_type":"span","marks":["strong"],"text":"eAppendix E","_key":"31f8bc68570c13"},{"text":".","_key":"31f8bc68570c14","_type":"span","marks":[]}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"0f411fde8972","markDefs":[],"children":[{"_type":"span","marks":[],"text":"The study was approved by the University of Texas Southwestern Institutional Review Board (STU-122017-056) and Parkland Office of Research Administration. Participants provided verbal consent. We collected limited patient information to maintain anonymity.","_key":"1b5d87915d270"}]},{"style":"normal","_key":"e1ffdb94eb32","markDefs":[],"children":[{"_key":"2b8c61237ce50","_type":"span","marks":["strong"],"text":"Data Collection"}],"_type":"block"},{"markDefs":[],"children":[{"_key":"ef911a21bf4a0","_type":"span","marks":[],"text":"The interviews lasted 30 to 45 minutes and were audio recorded, transcribed, and coded in Excel (Microsoft). Eligible participants were mailed a study information letter to their home address followed by up to 2 telephone calls to complete interviews. Participants received a $20 gift card after completing interviews. We explained that we wished to understand their decision-making surrounding a recent ED visit in the context of their cancer care. Patients were at home and interviewed only once and no others were known to be present during the interviews. Transcripts were not returned to participants for comment, nor did we request feedback on findings. We did not exclude patients if they were hospitalized, and all patients who were hospitalized began their hospital care with an ED arrival."}],"_type":"block","style":"normal","_key":"7f45be06e2da"},{"markDefs":[],"children":[{"marks":["strong"],"text":"Analysis","_key":"b56d4f47f11e0","_type":"span"}],"_type":"block","style":"normal","_key":"fd5ae6344912"},{"markDefs":[],"children":[{"_key":"0c25156484800","_type":"span","marks":[],"text":"Analysis was guided by the Theoretical Domains Framework (TDF)."},{"_type":"span","marks":["superscript"],"text":"28","_key":"580d991dc2a5"},{"_key":"1c11cca5d3c0","_type":"span","marks":[],"text":" The TDF outlines 14 domains that organize patient behaviors and has been used extensively to understand “behavior change to investigate implementation problems” in health care."},{"text":"28","_key":"2a0beba6727d","_type":"span","marks":["superscript"]},{"_type":"span","marks":[],"text":" The lead author (A.S.H.) and associates interviewed (A.B.C., J.P., M.M., N.L., R.T.) and coded (A.O.) the interview transcripts using iterative thematic analysis techniques and the constant comparative method.","_key":"42444c9ddb6e"},{"_type":"span","marks":["superscript"],"text":"29","_key":"5ffd8969af9b"},{"marks":[],"text":" Spanish interviews were conducted by certified team members (A.B.C., M.M.). Field notes were made after each interview. Transcripts were reviewed to identify emergent themes and subthemes and subsequently coded (A.S.H., A.O.) using an integrated (deductive and inductive) code structure.","_key":"586a251b8f79","_type":"span"},{"marks":["superscript"],"text":"29,30","_key":"e2c47c95ed9f","_type":"span"},{"_type":"span","marks":[],"text":" Initial coding was conducted as interviews were completed, allowing us to identify when we had reached thematic saturation and no further interviews were needed.","_key":"63ebc2a37fd9"},{"_key":"333544343e1d","_type":"span","marks":["superscript"],"text":"31"},{"_type":"span","marks":[],"text":" The finalized code structure was applied to all transcripts. We classified responses into the relevant TDF domains, clarifying each constitutive construct of each domain within the context of a recent ED visit. We then inductively analyzed across the patient’s cancer-treating hospital (University or Safety Net) and preferred language (English or Spanish).","_key":"e17395262c48"}],"_type":"block","style":"normal","_key":"7168b3ba3110"},{"markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"COVID-19 Pandemic","_key":"8fa70fc992120"}],"_type":"block","style":"normal","_key":"77d7c2b98807"},{"_key":"8fe864b3957a","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Our study overlapped with the onset of the COVID-19 pandemic. We reviewed the interview guide to consider whether any changes were needed, but noted that several questions already presented opportunities to surface pandemic-related impacts (eg, Recent ED Visit #1, 2, 3, 5, 7 and Future Care #4 in eAppendix A). Although we added an analysis between the pre– and post–pandemic onset interviews, we determined that revising the interview guide midway could introduce systematic bias in our data collection and risk impacting our planned analyses by centering participant reactions on pandemic-related questions.","_key":"189466c382140"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"c9dda83dc126","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"RESULTS","_key":"f8927fd2a71f0"}]},{"style":"normal","_key":"1e5671135080","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Interviews were conducted between April 2019 and April 2022; of 197 eligible patients, 40 (20%) completed interviews. The 157 participants who did not participate either declined without specifying a reason or did not return voicemail messages.","_key":"716c611c33430"}],"_type":"block"},{"_type":"block","style":"normal","_key":"22905d129cc2","markDefs":[{"nofollow":true,"blank":true,"_type":"link","href":"https://cdn.sanity.io/images/0vv8moc6/ajmc/b397f8e0ea3403102252ea9889f79dbbac600a16-1081x909.jpg","_key":"1e71bce12d87"}],"children":[{"_key":"835851c50a720","_type":"span","marks":[],"text":"From April 2019 to February 2020 (pre–COVID-19 pandemic), an initial 13 University patients were interviewed, then another 11 from June 2020 to August 2020. From April 2020 to April 2022, 5 English-preferring and 11 Spanish-preferring Safety Net patients were interviewed to reach saturation within subgroups (treating health system and preferred language). Of the interviewees, 14 of 24 (58%) University and 9 of 16 (56%) Safety Net interviewees were female. See "},{"_type":"span","marks":["strong","1e71bce12d87"],"text":"Table 1","_key":"835851c50a721"},{"_type":"span","marks":[],"text":" for additional demographic and cancer details.","_key":"835851c50a722"}]},{"markDefs":[],"children":[{"_key":"7ee1a8b9cf5a0","_type":"span","marks":["strong"],"text":"Views on Health"}],"_type":"block","style":"normal","_key":"0f6dd2f17731"},{"_type":"block","style":"normal","_key":"cbe61fab605d","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Interviewees described their health and health care use before and after cancer. The vast majority reported “very good” health prior to their diagnosis, with little need for ED care. After cancer diagnosis, interviewees described drastically increased vigilance in monitoring their symptoms. Interviewees described their overall health as going “downhill” or “diminished.” Although we did not prompt about fear, patients described being “more apprehensive” and that this fear directly drove their care seeking: “When an unexpected pain comes up, I have to go to the emergency room” and “I [go to the doctor more often] because I’m afraid.”","_key":"05f6e8df0b3c0"}]},{"_key":"7023cf06dcdb","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Patients reported financial barriers limiting their acute care options, but the specifics differed: A University patient mentioned that “I don’t want to be hospitalized...; it’s expensive, even with insurance,” whereas a Safety Net patient described limited choice in facility: “[I] don’t have a lot of options to go to other places [because of no health insurance].... I wouldn’t even know how to [look for other doctors].”","_key":"02d4fb44f9c80"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"523f5c19a048","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Triage Resources","_key":"e6cd8706b1d20"}]},{"style":"normal","_key":"f185a5680dc3","markDefs":[],"children":[{"marks":[],"text":"University patients contacted their cancer care team for triage advice, with some having the cell phone number of their oncologist. Those with primary care physicians described difficulty reaching them in a timely fashion. Although a few University patients used family members for triage help, they were usually clinicians (“I would probably stick with…my cousin, who’s a doctor,” one said). In contrast, Safety Net patients described little ability to quickly contact their outpatient team; Spanish-preferring Safety Net patients primarily relied on nonclinician family for triage advice.","_key":"0d1af9f924470","_type":"span"}],"_type":"block"},{"markDefs":[],"children":[{"_key":"cbc6ef9c3d3e0","_type":"span","marks":[],"text":"Despite this, we noted only subtle differences in cancer team communication satisfaction across language. University patients described ample time for education and counseling, and easily getting questions answered. Although Safety Net patients were satisfied with communication from their team, they were not as enthusiastic as the University patients. Spanish-preferring Safety Net patients were similarly polite but noted delays in relaying test results, except when the oncologist spoke Spanish."}],"_type":"block","style":"normal","_key":"5fe731c8188d"},{"style":"normal","_key":"8bbf28cb09f3","markDefs":[{"nofollow":true,"blank":true,"_type":"link","href":"https://cdn.sanity.io/images/0vv8moc6/ajmc/6c36af4a0cebe469c1214789cf85dd02b8a3dbb5-2113x2814.jpg","_key":"cdb06ad854e0"}],"children":[{"_key":"b34f665eb4b50","_type":"span","marks":[],"text":"When University patients were referred to the ED, this was not a negative experience and did not discourage future triage use. For Safety Net patients, going to the ED was the simplest way to be evaluated by a physician. Across groups, patients were largely unaware of the telephone triage lines. The only Safety Net patient who knew about the triage line had used it before, avoided an ED visit, and was quite pleased with the experience (Safety Net, female, English in "},{"_type":"span","marks":["strong","cdb06ad854e0"],"text":"Table 2","_key":"b34f665eb4b51"},{"_key":"b34f665eb4b52","_type":"span","marks":[],"text":")."}],"_type":"block"},{"_type":"block","style":"normal","_key":"fd4d41473e15","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Oncology Urgent Care","_key":"a8207af9d5a60"}]},{"_key":"268d1c20aba3","markDefs":[],"children":[{"_type":"span","marks":[],"text":"There was almost no awareness of the oncology urgent care clinics. Where there was recognition, it was vague: “I think they did tell me, but I don’t remember” (Safety Net, female, Spanish). Minor themes included hesitation that their condition was too severe and no after-hours availability. However, patients immediately grasped how these clinics could be useful and were eager to learn how to access them in the future (Table 2).","_key":"ff53ae9e25700"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"text":"ED Experiences","_key":"27f8af9ea9610","_type":"span","marks":["strong"]}],"_type":"block","style":"normal","_key":"0536cd3f8f4c"},{"style":"normal","_key":"96a27e70ce99","markDefs":[{"href":"https://cdn.sanity.io/images/0vv8moc6/ajmc/b539a287688a0a65ce38436d2dcfa77b3698f634-2113x2171.jpg","_key":"008e201f7a8d","nofollow":true,"blank":true,"_type":"link"},{"blank":true,"_type":"link","href":"https://cdn.sanity.io/images/0vv8moc6/ajmc/3f7610c55178d0957d700770e313400b12ce7ddc-2113x1536.jpg","_key":"aed0c6e6c4ff","nofollow":true}],"children":[{"_type":"span","marks":[],"text":"We outline inductive findings that included perspectives on future use and ED alternatives in ","_key":"9a8b251aa8020"},{"_type":"span","marks":["strong"],"text":"Table 3 [","_key":"9a8b251aa8021"},{"_type":"span","marks":["strong","008e201f7a8d"],"text":"part A","_key":"6b7cc32ee795"},{"text":" and ","_key":"11cf5ae2a9d1","_type":"span","marks":["strong"]},{"_key":"c5ff2d6f5a20","_type":"span","marks":["strong","aed0c6e6c4ff"],"text":"part B"},{"marks":["strong"],"text":"]","_key":"33e7d41b0303","_type":"span"},{"_type":"span","marks":[],"text":". First, patients did not describe weighing the severity of their symptoms to judge the appropriate setting for their care. Because all new symptoms were of uncertain but potentially high severity, patient goals were simply to identify and manage the cause of symptoms. University and Safety Net patients largely found that they were seen quickly in the ED and were impressed by this. Although patients perceived that they were seen sooner because they had cancer, they did not perceive that having cancer impacted their likelihood of hospitalization.","_key":"9a8b251aa8022"}],"_type":"block"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"However, ED visits were not always streamlined. The University patients who had prolonged ED waits were quite aggrieved, with one saying “[going to the ED] was a mistake…a day from hell.” Other patients outlined negative experiences stemming from the subsequent hospitalization, including childcare lapses, lack of sleep, and the expense despite insurance.","_key":"9bf51aa7e6740"}],"_type":"block","style":"normal","_key":"1cd9f12fcb46"},{"_key":"60ecf074a2d7","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Perspectives on Delivery Innovations","_key":"a6f8552c7d1e0"}],"_type":"block","style":"normal"},{"style":"normal","_key":"fa6b713c76f8","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Patients understood that the main benefit of an ED visit was comprehensive evaluation at any hour of the day. Although many patients were excited by the convenience of possibly being treated at home, they seemed bewildered by the idea. Patients consistently noted that their home lacked diagnostic equipment, especially advanced imaging. As far as a window for intervention, we noted that University patients waited minutes to hours before deciding to go to the ED, but Safety Net patients waited 1 to 3 days.","_key":"80da71bee59d0"}],"_type":"block"},{"markDefs":[],"children":[{"_key":"9d25adbdee140","_type":"span","marks":[],"text":"Although patients preferred in-person triage and their personal oncologist as the triaging clinician, they were open to video, telephone, or texting options with a range of clinicians. There were few common concerns surrounding the triage options, but patients across health systems were concerned about the technological expertise needed for video visits, lack of immediate care after a virtual evaluation, and even language literacy required to text (“The truth, I’m gonna be honest with you, [is that] I don’t know how to write,” said one Safety Net, male, Spanish-speaking patient). We also noted a lost opportunity: Patients at both health systems did not receive follow-up calls after the ED visit."}],"_type":"block","style":"normal","_key":"368e6e8db701"},{"markDefs":[],"children":[{"marks":["strong"],"text":"COVID-19 Pandemic","_key":"7641f9abd85b0","_type":"span"}],"_type":"block","style":"normal","_key":"fa635d6d5382"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Rather than differences, we found many similarities between interviews straddling pandemic onset. Most notably, prior to the pandemic, patients reported using respiratory masks and concerns about exposure to infectious agents in the ED waiting room as often as they did after the pandemic’s onset. Patients also viewed ED alternatives similarly over time; the primary concern was that they were too sick for a virtual evaluation. We did not detect differences in factors that patients weighed when visiting the ED during the pandemic.","_key":"2d1caea9496e0"}],"_type":"block","style":"normal","_key":"5c6ba49c06e9"},{"children":[{"text":"DISCUSSION","_key":"077273aa0d120","_type":"span","marks":["strong"]}],"_type":"block","style":"normal","_key":"9c8ea0a12517","markDefs":[]},{"markDefs":[],"children":[{"marks":[],"text":"Patients who recently visited the ED at a University and a Safety Net health system were not aware of, but were very interested in using, existing telephone triage and oncology urgent care clinics to avoid a future ED visit. We found broad similarities in ED decision-making: Patients understood that it has comprehensive evaluation capabilities, is open 24/7, and for Safety Net patients it was the most direct route to be evaluated by a doctor. Patients were of 2 minds on ED use: No one looked forward to visiting the ED, but when asked about how their ED experience would impact how they seek care in the future, patients were overall impressed by the clinical care and suggested they would strongly consider visiting again.","_key":"dc42674558f60","_type":"span"}],"_type":"block","style":"normal","_key":"dc5324f909f7"},{"markDefs":[],"children":[{"_key":"86802d7788c90","_type":"span","marks":[],"text":"Patients did not describe weighing the clinical severity of their symptoms to determine the most appropriate setting for care. Patients did not perceive that it was desirable to avoid low-severity ED visits; many were pleased to be discharged home and to avoid a hospital stay."}],"_type":"block","style":"normal","_key":"c56a8819a814"},{"_key":"9475de893744","markDefs":[],"children":[{"text":"Although addressing Spanish language needs is front of mind in the Safety Net system, we still identified differences in communication robustness compared with that reported by University patients. It was notable that to Safety Net patients, being evaluated by a physician was synonymous with going to the ED. A stark difference was that some University patients had their oncologist’s personal cell phone number and others relied on clinician family as backup, whereas Safety Net patients primarily relied on nonclinician family for clinical advice.","_key":"fedf5b0526770","_type":"span","marks":[]}],"_type":"block","style":"normal"},{"style":"normal","_key":"80a8f2f9f3f3","markDefs":[],"children":[{"_key":"3718f61655640","_type":"span","marks":[],"text":"We are particularly troubled by patients’ lack of awareness of the 24/7 oncology triage lines. The University practice even carries the ASCO QOPI certification, yet patients who had visited the ED continued to describe fear and uncertainty when deciding how to manage new symptoms."}],"_type":"block"},{"children":[{"text":"Despite nearly all recent Medicare Oncology Care Model participants listing ED use reduction as a goal,","_key":"5dd44c7ab2ab0","_type":"span","marks":[]},{"text":"32","_key":"9ec95dc1fbae","_type":"span","marks":["superscript"]},{"_type":"span","marks":[],"text":" including both the Safety Net and the University practices, few provider groups achieved this.","_key":"50fe1a7e4804"},{"_type":"span","marks":["superscript"],"text":"33","_key":"ec9963c74649"},{"_key":"0f7c7c135bb8","_type":"span","marks":[],"text":" Medicare’s Enhancing Oncology Model successor program also requires 24/7 access to care and patient navigation, but our findings suggest that maximizing these services may require additional implementation effort."},{"_type":"span","marks":["superscript"],"text":"25","_key":"d4e7fd4ed6de"}],"_type":"block","style":"normal","_key":"12fcf8bd2d01","markDefs":[]},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Our study builds on a qualitative study of patients who had visited the ED of a single center.","_key":"dc5ef5f8e6280"},{"_type":"span","marks":["superscript"],"text":"13","_key":"721aeb98f5ae"},{"marks":[],"text":" We note similar findings of fear driving patient decisions. We extend these findings to encompass a diverse group of patients and add that ED decision-making occurs relatively rapidly and is largely built on existing understandings of ED care. Our study provides insight into a finding from the literature that a patient’s ED visit history has strong positive correlation with future ED visits.","_key":"4ac06980b145","_type":"span"},{"_key":"75c198eaf253","_type":"span","marks":["superscript"],"text":"24,34,35"}],"_type":"block","style":"normal","_key":"0ec1c9a391f9"},{"style":"normal","_key":"9f041e7c472f","markDefs":[],"children":[{"_type":"span","marks":[],"text":"It was instructive that after visiting the ED, patients immediately grasped what oncology urgent care clinics offered and how they could be useful. Because patients are scheduled to be seen at these clinics after phone triage, a common point of improvement would be to increase phone triage use. The existing phone lines could bridge disparities that we found in access to clinician advice, and tracking the proportion of ED visits without a preceding triage call would constitute a form of data-driven improvement—2 other requirements of the Enhancing Oncology Model.","_key":"af4377245b5c0"},{"_type":"span","marks":["superscript"],"text":"36","_key":"ef5f64b4b4f1"}],"_type":"block"},{"children":[{"_type":"span","marks":[],"text":"These findings underscore the importance of tailoring communications to the patient’s perspective when educating on acute care management during cancer treatment. Tailoring education messaging around prompts such as “when you are not feeling well and not sure what to do” may be a more memorable way to introduce the triage line.","_key":"9ae8dba1a37e0"}],"_type":"block","style":"normal","_key":"d4896866f864","markDefs":[]},{"_type":"block","style":"normal","_key":"0b059491c494","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Finally, we uncovered patient perspectives that complicate policy and health system definitions of avoidable care. It did not even occur to patients that ED home discharges were undesirable. Patients were pleased to avoid the cost and disruption of a hospital admission. One patient noted that much of the existing patient education he received directed him to go to the ED “without calling.” Additionally, because of overall confidence in ED clinical management, these experiences seemed to reinforce the ED as a good option for future acute care.","_key":"c6f8895f5a940"}]},{"style":"normal","_key":"dff6e1e88e1c","markDefs":[],"children":[{"marks":["strong"],"text":"Limitations","_key":"221c250ec74e0","_type":"span"}],"_type":"block"},{"children":[{"marks":[],"text":"Although we conducted interviews until thematic saturation for English- and Spanish-preferring patients, a very small proportion of University patients prefer Spanish and these patients were not interviewed. Although patients with higher-acuity illness were not interviewed, our aim was to understand use of existing ED alternatives, and lower-acuity ED visits are more important to understand. Interview nonrespondents may have been less receptive to participating due to bad care experiences. However, we captured a wide range of positive, neutral, and negative ED experiences, with the negatives encompassing a range of issues, as noted. It is possible that patients with negative phone triage experiences were less likely to respond, but patients were chiefly unaware of triage lines. Our findings do not reflect patients who were seen in the oncology urgent care clinics. Finally, our interviews straddled the onset of the COVID-19 pandemic. Although we noted mainly similarities in decision-making across the pandemic’s onset, patients who did not visit the ED were not included in our study.","_key":"426b04c70db30","_type":"span"}],"_type":"block","style":"normal","_key":"22cdb77a5976","markDefs":[]},{"_key":"ec2387c57e6c","markDefs":[],"children":[{"_key":"cb7b6be2c2430","_type":"span","marks":["strong"],"text":"CONCLUSIONS"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"59d618742fe9","markDefs":[],"children":[{"_type":"span","marks":[],"text":"Despite limited prior ED use, patients newly diagnosed with cancer know what ED care offers, which largely drives their decision-making. Patients viewed the benefits of ED visits differently from policy makers’ goals. Even robust patient education efforts may require further redesign to consider patient perspectives because seemingly straightforward clinical services may be unfamiliar to them. Future work should incorporate a range of patient perspectives to understand this challenging aspect of acute care delivery.","_key":"e8a8591e8c080"}]},{"_key":"354d77b2813f","markDefs":[],"children":[{"_type":"span","marks":["strong"],"text":"Acknowledgments","_key":"a2edd46e44110"}],"_type":"block","style":"normal"},{"_key":"94af67fdfe0a","markDefs":[],"children":[{"_type":"span","marks":[],"text":"The authors are grateful to the patient participants who contributed their time during a tumultuous phase of their life, as well as the Parkland Oncology Patient and Family Advisory Council’s valuable contributions to the interview guide. The authors gratefully acknowledge the research coordination and assistance from Ana Belen Conrado, Bryan Elwood, Nidhish Lokesh, Molly McGuire, Jessica Phillips, Rithwik Terala, Ann Ostrom, Christopher Clark, and Hannah Fullington.","_key":"ef87e344a88f0"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"3e33bbeae441","markDefs":[],"children":[{"marks":[],"text":"The content is solely the responsibility of the authors and does not necessarily represent the official views of Texas Health Resources, the University of Texas Southwestern Medical Center, the National Institutes of Health, the Agency for Healthcare Research and Quality, or the American Cancer Society. The funders had no role in the design and conduct of the study; collection, management, and analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.","_key":"e583b3ba67790","_type":"span"}]},{"_type":"block","style":"normal","_key":"178e7fe7fcba","markDefs":[],"children":[{"_type":"span","marks":["strong","em"],"text":"Author Affiliations:","_key":"3f2e51a3c1d50"},{"_type":"span","marks":[],"text":" Department of Internal Medicine (ASH, BK, JWS), Peter O’Donnell Jr. School of Public Health (ASH), Harold C. Simmons Comprehensive Cancer Center (ASH, JWS, NS, JVC), and Department of Emergency Medicine (DMC), University of Texas Southwestern Medical Center, Dallas, TX; Department of Medicine, Rutgers Robert Wood Johnson Medical School (EAH), New Brunswick, NJ; Parkland Health (NS, JVC), Dallas, TX; Department of Population Health, University of Kansas School of Medicine (SJCL), Kansas City, KS.","_key":"3f2e51a3c1d51"}]},{"_key":"037f7292bd01","markDefs":[],"children":[{"_type":"span","marks":["strong","em"],"text":"Source of Funding:","_key":"9b460b0cc5940"},{"_type":"span","marks":[],"text":" This work was supported by the Texas Health Resources Clinical Scholars Program, by a National Cancer Institute Cancer Center Support Grant (1P30CA142543), and a Clinician Scientist Development Grant (CSDG-20-023-01-CPHPS) from the American Cancer Society.","_key":"9b460b0cc5941"}],"_type":"block","style":"normal"},{"_type":"block","style":"normal","_key":"82675e386955","markDefs":[],"children":[{"_type":"span","marks":["strong","em"],"text":"Prior Presentation:","_key":"06f6d49df78a0"},{"_key":"06f6d49df78a1","_type":"span","marks":[],"text":" Portions of this work have been presented at the American Society for Clinical Oncology annual meeting (June 2-6, 2023; Chicago, IL), and the AcademyHealth Annual Research Meeting (June 24-27, 2023; Seattle, WA)."}]},{"style":"normal","_key":"97dfed0b4a78","markDefs":[],"children":[{"_type":"span","marks":["strong","em"],"text":"Author Disclosures:","_key":"cbc542aae4c10"},{"_type":"span","marks":[],"text":" The authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.","_key":"cbc542aae4c11"}],"_type":"block"},{"style":"normal","_key":"5aa79d999fed","markDefs":[],"children":[{"_type":"span","marks":["strong","em"],"text":"Authorship Information:","_key":"4ed30b4407650"},{"_type":"span","marks":[],"text":" Concept and design (ASH, EAH, NS, SJCL); acquisition of data (ASH); analysis and interpretation of data (ASH, BK, EAH, DMC, JWS, NS, JVC, SJCL); drafting of the manuscript (ASH, BK, EAH, DMC, JVC); critical revision of the manuscript for important intellectual content (ASH, BK, EAH, DMC, JWS, NS, JVC, SJCL); provision of patients or study materials (ASH); obtaining funding (ASH); administrative, technical, or logistic support (JWS); and supervision (EAH, DMC, SJCL).","_key":"4ed30b4407651"}],"_type":"block"},{"markDefs":[],"children":[{"marks":["strong","em"],"text":"Address Correspondence to:","_key":"ebda0c9a33d90","_type":"span"},{"_type":"span","marks":[],"text":" Arthur S. Hong, MD, MPH, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9169. Email: Arthur.Hong@UTSouthwestern.edu.","_key":"ebda0c9a33d91"}],"_type":"block","style":"normal","_key":"16c66532c1a8"},{"markDefs":[],"children":[{"text":"REFERENCES","_key":"254b51a567c40","_type":"span","marks":["strong"]}],"_type":"block","style":"normal","_key":"ab303af1e2a0"},{"_type":"block","style":"normal","_key":"bd1c823450c3","markDefs":[],"children":[{"_type":"span","marks":[],"text":"1. Rivera DR, Gallicchio L, Brown J, Liu B, Kyriacou DN, Shelburne N. Trends in adult cancer-related emergency department utilization: an analysis of data from the Nationwide Emergency Department Sample. ","_key":"c74f412bab3b0"},{"_type":"span","marks":["em"],"text":"JAMA Oncol","_key":"c74f412bab3b1"},{"text":". 2017;3(10):e172450. doi:10.1001/jamaoncol.2017.2450","_key":"c74f412bab3b2","_type":"span","marks":[]}]},{"markDefs":[],"children":[{"marks":[],"text":"2. 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Existing delivery innovations to reduce ED use are underused, and reasons for this are not understood. Patients who recently visited the ED may provide insights into these patterns of care.","_key":"b813f5d7f6a00"}],"_type":"block","style":"normal"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Study Design: Qualitative study of semistructured patient interviews from April 2019 to April 2022.","_key":"932ddc8620050"}],"_type":"block","style":"normal","_key":"600825253d3d"},{"markDefs":[],"children":[{"_type":"span","marks":[],"text":"Methods: We interviewed patients diagnosed with cancer within the prior 6 months from the University of Texas Southwestern Medical Center and its academically affiliated but clinically distinct safety-net health system Parkland Health who had recently visited their respective ED. 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When patients were discharged home, they were relieved not to be hospitalized, and the good clinical experience inadvertently reinforced future ED use.","_key":"cb8da8a131930"}],"_type":"block","style":"normal","_key":"1ec259f3842f"},{"children":[{"_key":"7eab87bb47080","_type":"span","marks":[],"text":"Conclusions: Even robust education programs for patients with cancer may have difficulty conveying the availability of innovative clinical services. 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