Faculty Bibliography

INTRODUCTION/BACKGROUND:Sexual and gender minority (SGM) populations experience health disparities linked to minority stress (socially-based stressors), including proximal (e.g., SGM internalized stigma) and distal stressors (e.g., negative bias from non-SGM people toward SGM individuals). We synthesized and evaluated the effectiveness of interventions reducing proximal and distal SGM stress. METHODS:We followed PRISMA and Joanna Briggs Institute guidelines (CRD42024604568). Five databases were searched and eligible studies evaluated interventions reducing minority stress with sufficient data for effect size estimation. We estimated three-level multivariate meta-regression models for distal and proximal minority stress using restricted maximum likelihood estimation and robust standard error estimates. RESULTS:Fifty-one studies (31 distal, 20 proximal) with 11253 participants (SGM n = 3168) were included. Distal stress interventions yielded a null-to-small pooled effect (g = 0.185, 95% CI = 0.078, 0.292). Psychological interventions had a small effect (g = 0.361, 95% CI = 0.178, 0.544) and outperformed psychoeducation and social contact-based interventions (-0.257 < β < -0.221, p < 0.05). For proximal minority stress, although the overall pooled effect was nonsignificant (g = 0.071, 95% CI = -0.154, 0.297) the intervention × outcome interaction was (Wald Q = 4.661, p = 0.005). Narrative therapy targeting identity affirmation showed a large pooled effect (g = 1.846, 95% CI = 1.032, 2.659). Pairwise contrasts using this intervention-outcome combination as reference indicated that psychoeducation and psychological interventions had greater effects on internalized stigma and perceived social support (2.172 < β < 2.719, p < 0.05). CONCLUSION/CONCLUSIONS:Psychological interventions may reduce both proximal and distal stress. However, aligning interventions to specific minority stressors may yield greater benefit on SGM populations' health.

Bright IDEAS-Young Adults (Bright IDEAS-YA) is a problem-solving skills training intervention that has been adapted for young adults with cancer. Presently, a multisite randomized control trial is being conducted to determine Bright IDEAS-YA's efficacy in supporting a young adult population. This case study demonstrates the young adult adaptation of Bright IDEAS - Bright IDEAS-YA - being delivered to a young adult cancer patient via telehealth. Telehealth is a novel delivery method for Bright IDEAS and Bright IDEAS-YA that was established due to COVID-19 safety precautions. The patient, who reported challenges in several life domains, was taught how to apply the Bright IDEAS-YA framework over six telehealth sessions. After completing the Bright IDEAS-YA framework, the patient reported increased feelings of confidence in managing new stressors, which was corroborated through outcome measures delivered during and following intervention. This case illustrates how early psychosocial intervention following a cancer diagnosis, delivered via telehealth, can help patients develop and implement personal strategies to reduce stress levels.

BACKGROUND:There is very little information on the experiences of transgender and gender diverse (TGD) youth with cancer. AIMS/OBJECTIVE:To examine clinical characteristics and care trajectories of TGD youth a history of cancer. METHODS:This case series reviewed records of 2790 pediatric gender clinic patients seen between 2007 and 2022 to identify 14 with a history of cancer diagnosis. Demographics, clinical characteristics, disclosure of gender identity to oncology teams, oncology teams' use of correct names and pronouns, documented interprofessional communication between gender health and oncology teams, and course of medical gender affirmation were reviewed. RESULTS:Of 14 TGD youth with a history of cancer, 11 (78.6%) were diagnosed prior to presenting to the gender clinic (mean [SD] = 8.2 [4.7] years), three following initial gender care (mean [SD] = 1.1 [0.2] years). Six (42.9%) patients were engaged in annual survivorship care when presenting, and 8 (57.1%) were seen concurrently by both clinics. Nine (64.3%) patients had documented communication between teams. Three-quarters of patients who were seen concurrently by both clinics had documented interprofessional communication. Eight (57.1%) patients received gender affirming hormones, after cancer treatment concluded. CONCLUSION/CONCLUSIONS:TGD youth with cancer experiences present for gender affirming care and merit clinical attention. There was variability in (1) patients' and families' disclosure of TGD identities to oncology teams, (2) whether oncology documentation consistently used patients' correct name and pronouns, and (3) whether there was documented interprofessional consultation between teams. There is need for ongoing improvement in research and clinical protocols for TGD youth with cancer.

BACKGROUND:Pediatric cancer patients' oncology teams regularly take on a primary care role, but due to the urgent nature of cancer treatment, developmental screenings may be deprioritized. This leaves patients at risk of developmental diagnoses and referrals being delayed. AIMS/OBJECTIVE:Clarify the current developmental surveillance and screening practices of one pediatric oncology team. MATERIALS AND METHODS/METHODS:Researchers reviewed charts for patients (n = 66) seen at a pediatric oncology clinic in a suburban academic medical center to determine engagement in developmental screening (including functioning around related areas such as speech, neurocognition, etc.) and referrals for care in these areas. RESULTS:Developmental histories were collected from all patients through admission history and physical examination (H&P), but there was no routinized follow-up. Physicians did not conduct regular developmental screening per American Academy of Pediatrics guidelines for any patients but identified n = 3 patients with needs while the psychology team routinely surveilled all patients seen during this time (n = 41) and identified n = 18 patients as having delays. DISCUSSION/CONCLUSIONS:Physicians did not routinely screen for development needs beyond H&P and were inconsistent in developmental follow-up/referrals. Integrated psychologists were key in generating referrals for developmental-based care. However, many oncology patients were not seen by psychologists quickly or at all, creating a significant gap in care during a crucial developmental period. CONCLUSION/CONCLUSIONS:The case is made for further routinization of ongoing developmental screening in pediatric oncology care.

PURPOSE/OBJECTIVE:Cancer care for lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other sexuality and gender diverse (LGBTQIA +) individuals is marked by disparities stemming from a history of discrimination, stigma, and systemic inequities. For LGBTQIA + individuals seeking cancer care, cancer center websites may be a first point of contact with healthcare. Two complementary studies sought to evaluate the LGBTQIA + inclusivity of cancer centers' websites. METHODS:The authors conducted two studies in 2022-2023, reviewing the websites of National Cancer Institute (NCI)-designated cancer centers and Children's Oncology Group (COG)-designated health systems and cancer centers. Reviewers manually searched websites and coded several Yes/No criteria for LGBTQIA + inclusivity. RESULTS:Among the 65 NCI cancer centers' websites in 2023, 66% included a nondiscrimination statement, 71% mentioned LGBTQIA + health disparities, 65% included LGBTQIA + tailored resources, and 66% had articles about LGBTQIA + health. There was a trend of increased inclusivity across categories from 2022 to 2023. Among the 204 COG-designated health system websites in 2023, there were 60 pediatric care websites and 144 lifespan care websites. A total of 79.9% of COG health system websites referenced LGBTQIA + patients (80.0% of pediatric and 79.9% of lifespan sites), 16.7% of COG cancer center websites referenced LGBTQIA + patients in the context of cancer care (6.7% of pediatric and 20.8% of lifespan sites), and 82.4% yielded results when search terms were input (83.3% of pediatric and 81.9% of lifespan sites). CONCLUSIONS:Adult and pediatric cancer centers' websites have varying levels of LGBTQIA + inclusivity based on nondiscrimination statements, articles, and the availability of LGBTQIA + resources. While there have been some improvements in inclusivity on the NCI-designated cancer centers' websites between 2022 and 2023, there is a need for further improvement.

The National Comprehensive Cancer Control Program, a Centers for Disease Control and Prevention funded program, supports cancer coalitions across the United States (US) in efforts to prevent and control cancer including development of comprehensive cancer control (CCC) plans. CCC plans often focus health equity within their priorities, but it is unclear to what extent lesbian, gay, bisexual, transgender, queer/questioning, plus (LGBTQ+) populations are considered in CCC plans. We qualitatively examined to what extent LGBTQ+ populations were referenced in 64 U.S. state, jurisdiction, tribes, and tribal organization CCC plans. A total of 55% of CCC plans mentioned LGBTQ+ populations, however, only one in three CCC plans mentioned any kind of LGBTQ+ inequity or LGBTQ+ specific recommendations. Even fewer plans included mention of LGBTQ+ specific resources, organizations, or citations. At the same time almost three fourths of plans conflated sex and gender throughout their CCC plans. The findings of this study highlight the lack of prioritization of LGBTQ+ populations in CCC plans broadly while highlighting exemplar plans that can serve as a roadmap to more inclusive future CCC plans. Comprehensive cancer control plans can serve as a key policy and advocacy structure to promote a focus on LGBTQ+ cancer prevention and control.

BACKGROUND & AIMS/OBJECTIVE:The COVID-19 pandemic created intersecting health risks for incarcerated people with a history of substance use disorder (SUD). To reduce exposure to COVID-19 in prison, several US states enacted decarceration legislation. New Jersey enacted the Public Health Emergency Credit Act (PHECA), granting early release to thousands of incarcerated persons meeting eligibility criteria. This study undertook to explore how large scale decarceration during the pandemic impacted the reentry process for released individuals with SUDs. METHODS:Twenty seven participants involved in PHECA releases - 21 persons released from NJ carceral facilities with past/present SUDs (14 with opioid use disorder, 7 with other SUDs) and 6 reentry service providers acting as key informants - completed phone interviews on PHECA experiences from February-June 2021. Cross-case thematic analysis of transcripts identified common themes and divergent perspectives. RESULTS:Respondents described challenges consistent with long-documented reentry difficulties including housing and food insecurity, difficulty accessing community services, insufficient employment opportunities, and limited access to transportation. Challenges that were pertinent to mass release during a pandemic included limited access to communication technology and community providers and community providers exceeding enrollment capacity. Despite reentry difficulties, respondents identified many areas where prisons and reentry service providers adapted to meet novel challenges presented by mass decarceration during the COVID-19 pandemic. Facilitators made available by prison and reentry provider staff included providing released persons with cell phones, transportation assistance at transit hubs, prescription support for medications for opioid use disorder, and pre-release assistance with ID and benefits through NJ's Joint Comprehensive Assessment Plan. CONCLUSIONS:Formerly incarcerated people with SUDs experienced reentry challenges during PHECA releases similar to those that occur during ordinary circumstances. Despite barriers faced during typical releases and novel challenges unique to mass release during a pandemic, providers made adaptations to support released persons' successful reentry. Recommendations are made based on areas of need identified in interviews, including reentry service provision facilitating housing and food security, employment, medical services, technology fluency, and transportation. In anticipation of future large scale releases, providers will benefit from planning ahead and adapting to address temporary increases in resource demands.

Treatment gaps in meeting the neuropsychological needs of young adult (YA) cancer survivors can be attributed to several clinical and systemic reasons. Access to neurocognitive care can be increased through the effective integration of neuropsychological monitoring and intervention in survivorship care. In this brief report, we aim to compare the efficacy of a brief neuropsychological screener (DIVERGT) in meeting the assessment and referral needs of pediatric and YA cancer survivors (n = 40) as part of a wellness and survivorship clinic. Participants (n = 40) were patients who presented to a pediatric oncology survivorship clinic over the span of 15 months.