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Mañana, Ana I. Velazquez

Mayo Clinic

University of California, San Francisco

Citations 12

Assessing the financial implications of translating oncology clinical trial informed consent forms in the U.S.
Mañana, Ana I. Velazquez, Florez, Narjust , Idossa, Damé , Patel, Shruti , Wang, Katarina , Florez, Narjust

JCO Oncology Practice | October 7, 2025 | Volume: 21 | Issue: 10_suppl | Pages: 53-53

10.1200/op.2025.21.10_suppl.53 Get It

53 Background: Language barriers affect millions in the US, where nearly 8% of individuals (~ 26 million) have limited English proficiency, making it harder to access, understand, and engage with healthcare services. As clinical trials enroll increasingly diverse participants, ensuring the accessibility and clarity of consent forms is critical. Understanding translation costs can improve budgeting and prevent enrollment delays for non-English-speaking participants. This study evaluates the costs of translating consent forms into three of the most widely spoken non-English languages in the U.S. Methods: In February 2025, we queried ClinicalTrials.gov to identify publicly available consent forms for phase 3 interventional trials in lung, breast, GI, & GU cancers from 2013–2024. In total, 18 consent forms were identified. The U.S. News top 20 U.S. cancer centers were contacted to identify commonly used certified translation companies. We obtained quotes from 8 IRB-certified agencies via online portal for Spanish, Simplified Chinese, and Tagalog translations. Results: The 18 informed consent forms were on average 14 pages long (range: 3-29 pages). Across the 8 translation companies, translating documents into Spanish (average price per document [$pD]: 1088.58) was cheaper than Chinese (average $pD: $1253.94, p < 0.001) and Tagalog (average $pD: $1399.07, p < 0.001). Costs varied significantly by company (p < 0.001). Quality assurance measures, including dual translation and proofreading, were included in 87.5% of quotes. The average turnaround time for translating one consent into 3 different languages was 4 business days (range: 2-8 business days). Conclusions: The cost of translating informed consent forms for oncology clinical trials varies significantly by language and translation company, with Spanish translations being the least expensive and Tagalog the most costly. While translation costs represent a small fraction of overall trial expenses, variability in pricing and turnaround times underscores the need for structured budgeting and standardized translation processes. Translations of informed consents should ideally be completed prior to trial initiation to avoid the delayed recruitment or exclusion of non-English speaking patients. Our results are valuable for researchers & sponsors involved in oncology clinical trials, helping them make informed decisions in budgeting regarding language translation services. Company ID Average $pD, Spanish Average $pD, Chinese Average $pD, Tagalog Spanish $pW Chinese $pW Tagalog $pW 1 840.11 1,054.07 1,054.07 0.16 0.20 0.20 2 1,109.63 1,553.49 1,775.41 0.22 0.28 0.32 3 945.00 1,081.50 1,422.33 0.10 0.17 0.12 4 1,880.56 1,880.56 2,131.94 0.30 0.30 0.34 5 875.35 875.35 875.35 0.15 0.15 0.15 6 1,029.98 1,367.56 1,472.93 0.27 0.36 0.39 7 929.72 978.65 1,125.45 0.14 0.15 0.17 8 1,042.39 1,184.50 1,279.22 0.33 0.37 0.41
Assessing gender disparities in oncology: Less talk, more action.
Mañana, Ana I. Velazquez, Mahtani, Arun , Dizman, Nazlı , Nororis, Mariana Gonzalez, Bernabe, Carolina , Olazagasti, Coral , Celi, Claudia Villa , Sridhar, Arthi , Horiguchi, Miki , Florez, Narjust

Journal of Clinical Oncology | June 26, 2024 | Volume: 42 | Issue: 16_suppl | Pages: 9011-9011

10.1200/jco.2024.42.16_suppl.9011 Get It

9011 Background: 'Gender disparities' is a familiar term in medicine. Only 35.2% of oncologists in the U.S. self-identified as women in 2021. Women in medicine are undercompensated and underpromoted. Little is known of the experiences of non-U.S. female physicians in the U.S. We created the first cross-sectional study to assess gender disparities in IMGs and Puerto Rican medical graduates (PRMGs) in oncology in the U.S. Methods: An anonymous online survey was created and distributed via Survey Monkey. Eligible participants were non-U.S. IMGs and PRMGs who trained and/or practiced independently in the U.S. Participants were recruited through email and social media from Sept-Dec 2023. Bivariate association analyses were performed using the two-sample Wilcoxon test for ordered categorical variables and Fisher’s exact test for nominal categorical variables. Results: 97 IMGs and PRMGs in oncology completed the survey. As shown in the table, women were more likely to move to the U.S. for family (22.4% vs 6.2%, p=0.040), whereas men did more for financial gains (20.8% vs 6.1%, p=0.040). culture, particularly to the traditions (65.3% vs 43.8%;p=0.042) and dress code (44.9% vs 20.8%, p=0.017). Women experienced higher rates of gender discrimination during training (53.2% vs 4.5%, p <0.001) and independent practice (57.6% vs 3.6%, p<0.001) than men. Women were also more likely than men to face ethnic/racial discrimination during training (69.6% vs 38.1%; p=0.005). Despite lack of statistical significance, higher trends of ethnic/racial discrimination during independent practice were reported by women (table). More women reported no plans on returning home (68.8% vs 38.3%), whereas more men planned to return home at some point (38.3% vs 16.7%). 18.8% of men vs 0% of women elected leadership opportunities as the reason for returning to their home country (p=0.001). Conclusions: Our study reveals the unfortunate reality that many IMG and PRMG women face in oncology in the U.S. Despite national efforts to reduce the gap in gender disparities, minority women continue to experience racial/ethnic and gender discrimination at higher rates than men. To overcome inequities and achieve gender equity pay transparency, diversity in selection committees is necessary. Further, efforts should be across all settings, academia, private practice, and industry. The time for gender equity in oncology is now. [Table: see text]
Going back home: Understanding the challenges of international medical graduates (IMGs) in oncology.
Mañana, Ana I. Velazquez, Mahtani, Arun, Nororis, Mariana Gonzalez, Dizman, Nazlı , Bernabe, Carolina , Olazagasti, Coral , Celi, Claudia Villa , Sridhar, Arthi , Horiguchi, Miki , Florez, Narjust

Journal of Clinical Oncology | June 26, 2024 | Volume: 42 | Issue: 16_suppl | Pages: 9001-9001

10.1200/jco.2024.42.16_suppl.9001 Get It

9001 Background: With an increasingly diverse patient population in the U.S., the need for a diverse clinician workforce has been exemplified. In 2021, 28% of the practicing physicians in the U.S. were born/trained outside of the continental U.S. Though strides in promoting diversity among oncologists have been made, continuous longitudinal assessments and improvements are important to ensure goals are met. We conducted the first cross-sectional study to understand the challenges and experiences of IMGs and Puerto Rican (PR) medical graduates in oncology in the U.S. Methods: An anonymous online questionnaire via Survey Monkey was developed. Non-U.S. IMGs and PRMGs who trained and/or practicing independently in the U.S. were eligible to participate. The study launched on Twitter with promotional materials, inviting participants to complete the survey. A list of IMGs and PR medical graduates was also compiled and an email invitation with the survey link was sent to. The enrollment period was from Sept-Dec 2023. Data was analyzed using descriptive statistics. Results: 97 participants from oncology-related fields completed the survey. Most were attendings (62.9%), and women (50.5%). 95.9% were IMGs and 5.2% PRMGs. 79.4% participants migrated after medical school and 90.7% were still living In the U.S. The main reasons for migrating were looking for better training (63.9%), seeking professional gains (57.7%), and lack of opportunities in their home country (49.5%). Most had to adapt to new cuisine (51.5%), community (53.6%), traditions (54.6%), and celebrations (58.8%). Participants expressed the need to change their dress code (33%), tone of voice (39.2%), the way they spoke (51.5%), and conducted themselves (49.5%). Participants faced racial/ethnic (54.5%), gender (29.7%), and language (41.9%) discrimination during training in the U.S. Similarly, they experienced racial/ethnic (46.8%), gender (32.8%), and language (24.6%) discrimination during independent practice in U.S. Most participants reported moderate personal (57%), yet extreme professional (57.4%) satisfaction in the U.S. 10.5% of participants had returned to their home country, 27.4% planned to, and 53.7% did not plan to return. The main reasons for going back home were family (67%), quality of life (28.9%), and feelings of isolation/lack of community (22.7%). Conclusions: Our study reveals that the main reasons physicians migrate to the U.S. is for education and professional opportunities. Yet these could come at a high cost, leading foreign-born physicians to compromise their true identities. Despite increasing representation of IMGs and PRMGs in the medical field in the U.S., they remain victims of discrimination at frequent rates. It is imperative to implement changes beyond diversifying the work field and strive for equity to create a more conducive environment for minority physicians.
Global retrospective study comparing consolidation ALK tyrosine kinase inhibitors (TKI) to durvalumab (durva) or observation (obs) after chemoradiation (CRT) in unresectable locally-advanced ALK+ non-small cell lung cancer (NSCLC).
Jayakrishnan, Ritujith, Lin, Jessica Jiyeong, Shakya, Purnima, Dilling, Thomas J. , Grohé, Christian , Fitzgerald, Bailey G. , Adib, Elio , Neal, Joel W. , Whitaker, Ryan, Mañana, Ana I. Velazquez, Goldberg, Sarah B. , Nassar, Amin H. , Shepherd, Frances Alice , Lin, Jessica Jiyeong, Lin, Steven H. , Bar, Jair , Gupta, Shruti , Sankar, K. Nathan , Yu, Helena Alexandra , Naqash, Abdul Rafeh , Kim, So Yeon

Journal of Clinical Oncology | June 26, 2024 | Volume: 42 | Issue: 16_suppl | Pages: 8013-8013

10.1200/jco.2024.42.16_suppl.8013 Get It

8013 Background: For patients (pts) with unresectable locally-advanced NSCLC, standard of care involves durva consolidation after concurrent CRT, although its benefit in ALK+ tumors is unclear. The ALINA trial demonstrated adjuvant efficacy of alectinib in resected ALK+ NSCLC, but the optimal consolidation strategy for unresectable locally-advanced ALK+ NSCLC remains elusive. Methods: This multi-institutional international retrospective analysis included pts with stage III unresectable ALK+ NSCLC who received an ALK TKI, durva, or obs alone after concurrent CRT between 2015-2022. Baseline characteristics of age, sex, smoking history, and PD-L1 status were collected. Clinical outcomes including real-world progression-free survival (rw-PFS), overall survival (OS), and treatment-related adverse events (trAE) as defined using CTCAE 5.0 were assessed, and multivariate cox regression models were performed. Results: Sixty-four pts across 16 institutions were included. The median age was 57 (IQR 49-66) and 61% were females. The majority had adenocarcinoma (97%) and had never smoked (58%). 15 received ALK TKI (10 alectinib, 3 crizotinib, 1 brigatinib, 1 lorlatinib), 30 received durva, and 19 received obs alone. There was no significant difference in stage of cancer (IIIA, B, or C) or PD-L1 status among groups. After adjusting for stage and age at CRT initiation, median rw-PFS was significantly longer for ALK TKI (rw-PFS not reached [NR], 95% CI 22.7-NR) vs durva (11.3 months (mo), 95% CI 9.2-18.5, p= 0.005, HR = 0.12) or obs (7.4 mo, 95% CI 3.4-12.5, p < 0.0001). Two (13%) pts progressed on ALK TKI. 25 pts (83%) progressed on durva leading to treatment with ALK TKI in 23, and 18 (95%) progressed while under obs leading to treatment with ALK TKI in 15. 3-year OS was 100% for ALK TKI vs 90.5% for durva vs 63.5% for obs. Median OS was NR (95% CI NR-NR) for both ALK TKI and durva vs 70.6 mo (24.9-NR) in the obs group ( p= 0.03 for both ALK TKI and durva compared to obs). Median duration of therapy was 24.7 mo with ALK TKI and 6.5 mo with durva. Grade ≥3 trAE occurred in 27%, 7%, 6% of pts treated with ALK TKI (1 fatigue, 1 diarrhea, 1 hyperbilirubinemia, 1 pneumonitis), durva (1 fatigue, 1 neutropenia), and obs (1 neutropenia) respectively. Treatment discontinuation due to toxicity occurred in 4 (27%) with ALK TKI and in 3 (10%) with durva. Conclusions: In this retrospective study of stage III ALK+ NSCLC, consolidation ALK TKI demonstrated clinically meaningful improvement in PFS and OS over durva and obs, while showing a slightly higher rate of trAE over dura and obs. Furthermore, we show a high rate of progression following CRT alone in ALK+ NSCLC. These findings underscore the need for prospective molecularly driven trials to determine the optimal consolidation therapy for unresectable ALK+ NSCLC.
Hematology/oncology program director perspectives on recruitment and inclusion of a diverse workforce.
Mañana, Ana I. Velazquez, Idossa, Damé , Franco, Idalid , Hsu, Gerald C, Murphy, Martina, Trejo, Evelin , García-Jímenez, Maria , Williams, Vonetta M. , Hsu, Gerald, Ruiz, Jenny , Durani, Urshila , Weeks, Lachelle D. , Marshall, Ariela L. , Florez, Narjust

Journal of Clinical Oncology | June 4, 2023 | Volume: 41 | Issue: 16_suppl | Pages: 11005-11005

10.1200/jco.2023.41.16_suppl.11005 Get It

11005 Background: Despite progress in the enrollment of underrepresented in medicine (UIM) individuals in medical schools, hematology/oncology (HO) remains one of the least diverse medical subspecialties. We evaluated current recruitment efforts and barriers to the inclusion of UIM individuals in HO fellowship programs. Methods: We conducted a national online survey of program directors (PDs) and associate PDs (reported in aggregate as PDs) of adult and pediatric HO fellowships. Each PD received a unique survey link via email and 4 email reminders over the 8-week study period. Interim results at 4-weeks are presented and summarized with descriptive statistics. Results: At a pre-defined interim time point of 4 weeks, 78 HO PDs participated (18% response rate) and 69 completed the survey (88% completion rate). Most self-identified as women (57%, n = 38) and White (55%, n = 37), were affiliated with an academic program (79%, n = 53), and led an adult HO fellowship (73%, n = 49). Most PDs reported under or no representation of UIM faculty in their divisions; 9% (n = 6) self-identified as UIM. PDs reported their HO fellowships matched a median of 3 UIM fellows over the last 5 years (IQR 2-5 over 5 years); 46% (n = 32) reported UIM recruitment was unchanged and 4% (n = 3) decreased during this period. About half of PDs (51%, n = 35), matched a UIM candidate in the 2023 match. Of the 21% (n = 14) of PDs whose programs had no UIM fellows, 0% matched a UIM applicant in the 2023 match. 52% (n = 36) of PDs endorsed an inability to match UIM applicants despite consistently ranking them highly. PDs perceive the top 3 barriers to UIM recruitment as: low number of UIM applicants (53%, n = 41), geographic program location (50%, n = 39), and lack of diverse faculty/fellows in their program (42%, n = 31). 10% (n = 7) also reported meeting resistance about DEI initiatives. While 53% (n = 41) of PDs believe fellow demographics should reflect the local population, 23% (n = 16) don’t know how to increase diversity and 11% (n = 8) do not believe their program’s diversity needs to increase. In answers to open ended questions, some PDs expressed disagreement with the definition of UIM and reported a perceived limited number of qualified UIM applicants. Almost all institutions provide DEI training (96%, n = 72) for faculty and most PDs believe it has improved recruitment and inclusion of diverse individuals (52% and 65%, respectively). Yet, 34% (n = 23) agree that UIM fellows in their program are treated differently because of their race/ethnicity and 22% (n = 15) agree that UIM fellows repress their identity or background to be respected by faculty, peers, and staff. Conclusions: Historically and currently excluded populations remain underrepresented in the HO workforce. PDs face multiple barriers to the recruitment of diverse fellows, including differing views on the definition of UIM and perception of the value of diversity in the physician workforce.
EGFR tyrosine kinase inhibitors (TKIs) versus durvalumab (durva) following concurrent chemoradiation (CRT) in unresectable EGFR-mutant non-small-cell lung cancer (NSCLC).
Adib, Elio , Aredo, Jacqueline V. , Parikh, Kaushal , Mañana, Ana I. Velazquez, Ragavan, Meera Vimala , Lin, Jessica Jiyeong, Fitzgerald, Bailey G. , Grohé, Christian , Neal, Joel W. , Wakelee, Heather A. , Naqash, Abdul Rafeh , Goldberg, Sarah B. , Naqash, Abdul Rafeh , Nassar, Amin H. , Feng, Jamie , Harris, Jeremy P. , Lin, Jessica Jiyeong, Piotrowska, Zofia , Sankar, K. Nathan , Shepherd, Frances Alice , Herbst, Roy S. , Kim, So Yeon

Journal of Clinical Oncology | June 4, 2023 | Volume: 41 | Issue: 16_suppl | Pages: 8567-8567

10.1200/jco.2023.41.16_suppl.8567 Get It

8567 Background: Adjuvant osimertinib (osi) improves disease-free survival (DFS) in patients (pts) with resected, early-stage, EGFR-mutant (EGFRmut) NSCLC, yet the benefit of osi after CRT in pts with unresectable locally advanced NSCLC is unknown. Post-hoc analysis of the PACIFIC trial showed a lack of survival benefit with consolidation durva versus placebo in pts with EGFRmut NSCLC. Comparisons between consolidation durva and EGFR TKIs in unresectable EGFRmut NSCLC following CRT are lacking. Methods: We conducted a multi-institutional retrospective analysis of pts with stage III unresectable EGFRmut NSCLC (exon19 deletion, exon21 L858R), who received EGFR TKI or durva after ≥ 2 cycles of platinum-based chemotherapy plus definitive radiation therapy between 2015-2022. Baseline characteristics including age, sex, smoking history, PD-L1 status, and outcomes on DFS, overall survival (OS), and safety were collected. Multivariable (MVA) cox regression analysis was used for statistical analysis. Treatment-related adverse events (trAE) were defined using CTCAE 5.0. Results: Seventeen pts from 12 institutions received an EGFR TKI (osi, n=15; erlotinib, n=2), and 13 pts received consolidation durva. Median follow-up was 23 months. Median age of all pts was 61 years (IQR:52-72) and 76.7% were female. Most pts in both groups had never-smoked and had adenocarcinoma. All pts received ≥ 60 Gy of radiation with concurrent chemotherapy. PD-L1 expression was ≥ 50% in 1/10 (10%) pts treated with durva vs 6/13 (46.2%) treated with TKI, p=0.09. Median duration on treatment for EGFR TKI and durva was 12.2 months and 4.8 months, respectively. Pts treated with EGFR TKI had significantly longer 24-month DFS versus pts treated with durva after adjusting for stage (3A vs 3B vs 3C) (Table). Any grade tRAE occurred in 58.8% (10/17) of pts treated with EGFR TKI vs 38.5% (5/13) with durva. Grade > 3 tRAE occurred in 15.4% (1 pneumonitis and 1 AST/ALT elevation) of pts treated with durva but in none of pts treated with EGFR TKI. Three pts within each arm came off treatment due to toxicity (EGFR TKI: 1 pneumonitis and 2 dermatitis; durva: 1 of each pneumonitis, Type 1 diabetes, AST/ALT elevation). Conclusions: EGFR TKI therapy after definitive CRT was associated with significantly longer DFS compared to durva in this retrospective study of pts with stage III unresectable EGFRmut NSCLC, without unanticipated safety signals. Follow-up is ongoing and OS outcomes will be evaluated subsequently. Further investigation is warranted to define the optimal therapy for locally advanced EGFRmut NSCLC. [Table: see text]
Impact of COVID-19 on work-related fatigue and satisfaction among oncology providers in Latin America: An analysis of the HOLA COVID-19 study.
Mañana, Ana I. Velazquez, Ramirez, Carolina Bernabe, Bergerot, Paulo Gustavo , Adaniel, Christina , Ramírez, Francisca, Mesias, Jesus Del Santo Anampa, Cajina, Carmen, Mena, Evelin, Menendez, Alvaro G. , Bezares, Raimundo, Duran, Liseth Duque, Corrales, Luis-Alberto, Duma, Narjust , Bernabe, Carolina , Olazagasti, Coral , Soto-Perez-de-Celis, Enrique , Corona-Cruz, José Francisco , Riaño, Ivy , Gracia, Elías , Castillo, O. , Bergerot, Cristiane Decat

Journal of Clinical Oncology | June 2, 2021 | Volume: 39 | Issue: 15_suppl | Pages: 11014-11014

10.1200/jco.2021.39.15_suppl.11014 Get It

11014 Background: The well-being of oncology providers (OP) is in jeopardy with increasing workload, limited resources, and personal challenges that result from the COVID-19 pandemic. We aim to evaluate the impact of COVID-19 on work-related (WR) satisfaction and fatigue among OP in Latin America. Methods: We conducted an international cross-sectional online survey of OP practicing in Latin America. The survey was administered in English, Spanish, and Portuguese. Data was analyzed using descriptive statistics and Chi-square tests. Results: In August 2020, 704 OP from 20 Latin American countries completed the survey (77% of 913 who started the survey). Table outlines baseline characteristics. Higher frequency of WR fatigue (67% vs. 58%, p=0.010) and exhaustion (81% vs. 70%, p=0.001) were reported by OP who cared for patients with COVID-19, compared to OP who cared for patients without COVID-19. Providers that observed delays in referrals to radiation (p=0.002) and surgery (p=0.04) reported WR fatigue at higher rates than their counterparts. Higher exhaustion (p=0.016) and dissatisfaction (p=0.046) were reported by OP who lacked access to supportive services, as social work. A significantly higher proportion of women reported WR fatigue (72% vs. 56%, p=0.003) and exhaustion (86% vs. 68%, p=0.001), when compared to men. Women were more likely than men to endorse higher current levels of fatigue when compared to pre-COVID-19 (61% vs. 46%, p=0.0001). To reduce stress, women were more likely than men to cut the time spent watching the news (p=0.002). Both genders declined research collaborations and speaking opportunities. Conclusions: Fatigue and dissatisfaction with work-life were prevalent among OP in Latin America. Higher rates of WR fatigue were seen in women, OP caring for patients with COVID-19, and OP with patients who experienced cancer care delays. Our data imply that OP may be a prime target for psychosocial support, particularly as current challenges will continue for the foreseen future. Baseline characteristics (N=704).[Table: see text]
The HOLA COVID-19 study: Evaluating the impact of caring for patients with COVID-19 on cancer care delivery in Latin America.
Ramirez, Carolina Bernabe, Mañana, Ana I. Velazquez, Adaniel, Christina , Ramírez, Francisca, Mesias, Jesus Del Santo Anampa, Cajina, Carmen, Mena, Evelin, Menendez, Alvaro G. , Idrobo, Henry , Bezares, Raimundo, Duran, Liseth Duque, Bergerot, Paulo Gustavo , Duma, Narjust , Bernabe, Carolina , Olazagasti, Coral , Bergerot, Cristiane Decat , Soto-Perez-de-Celis, Enrique , Corona-Cruz, José Francisco , Riaño, Ivy , Gracia, Elías , Castillo, O.

Journal of Clinical Oncology | June 2, 2021 | Volume: 39 | Issue: 15_suppl | Pages: 1537-1537

10.1200/jco.2021.39.15_suppl.1537 Get It

1537 Background: The severe acute respiratory syndrome 2 (SARS-cov-2) virus causing COVID-19 has brought great challenges to global health services affecting cancer care delivery, outcomes, and increasing the burden in oncology providers (OP). Our study aimed to describe the challenges that OP faced while delivering cancer care in Latin America. Methods: We conducted an international cross-sectional study using an anonymous online survey in Spanish, Portuguese, and English. The questionnaire included 43 multiple choice questions. The sample was stratified by OP who have treated patients with COVID-19 versus those who have not treated patients with COVID-19. Data was analyzed with descriptive statistics and Chi-square tests. Results: A total of 704 OP from 20 Latin American countries completed the survey (77% of 913 who started the survey). Oncologists represented 46% of respondents, followed by 25% surgical-oncologists. Of the respondents, 56% treated patients with COVID-19. A significant proportion of OP reported newly adopting telemedicine during COVID-19 (14% vs 72%, p=0.001). More than half (58%) of OP reported making changes to the treatments they offered to patients with cancer. As shown in the table, caring for patients with COVID-19 significantly influenced practice patterns of OP. Access to specialty services and procedures was significantly reduced: 40% noted significantly decreased or no access to imaging, 20% significantly decreased or no access to biopsies, 65% reported delays in surgical oncology referrals, and 49% in radiation oncology referrals. A vast majority (82%) reported oncologic surgeries were delayed or cancelled, which was heightened among those treating patients with COVID-19 (87% vs 77%, p=0.001). Conclusions: The COVID-19 pandemic has significantly affected the way cancer care is delivered in globally. Although changes to healthcare delivery are necessary as a response to this global crisis, our study highlights the significant disruption and possible undertreatment of patients with cancer in Latin America that results from COVID-19.[Table: see text]
The Impact of COVID-19 on Hematology-Oncology Fellowship Programs: Program Director Perspectives
Mañana, Ana I. Velazquez, Reynolds, Robby , Kumbamu, Ashok , Murphy, Martina, Henry, Elizabeth , Lee, Alfred Ian , Durani, Urshila , Reynolds, Robby, Das, Devika , Marshall, Ariela L.

Blood | February 6, 2021 | Volume: 136 | Issue: Supplement 1 | Pages: 24-25

10.1182/blood-2020-141514 Get It

Introduction The COVID-19 pandemic has significantly affected many aspects of healthcare, including medical education and training. Its impact on hematology/oncology (HO) fellowship programs has not yet been characterized. Methods The American Society of Hematology (ASH) and American Society of Clinical Oncology (ASCO) sent an anonymous survey in June 2020 to all HO program directors (PDs) addressing program changes during the COVID-19 pandemic and their perception of impact on trainees' experience, education, and mental health. The survey included 32 multiple-choice and open-ended questions. Participants who completed the survey received a $10 gift card. Quantitative descriptive analyses of multiple-choice questions were conducted. Open-ended responses were analyzed qualitatively using NVivo software. Results Of 233 invited PDs, 103 (44%) respondents completed the survey; 22 additional surveys were incomplete and not included in the analysis. Table 1 summarizes PDs and program characteristics. In response to the pandemic, 42% (N=43) of programs removed fellows from outpatient clinics and 63% (N=65) changed research location to home (Figure 1). Most PDs reported their fellows were participating in telehealth for HO care (79%, N=81) and 21% (N=22) had their fellows re-deployed to cover medicine and other non-HO services. To support fellows' mental health most programs held additional virtual meetings (76%, N=78) and social events (52%, N=54). Twenty one percent of PDs (N=22) reported their program's professional development funds were completely cut or frozen and 17% (N=17) had funds cut slightly. Most PDs reported the pandemic negatively impacted fellowship overall (67% slight to significant negative impact, N=69), 72% identified clinical education as negatively impacted (72% slight to significant negative impact, N=74), and 35% (N=36) reported significant negative impact on research training/productivity. Twenty three percent (N=24) of PDs thought their fellows were not able to make good use of their time during the pandemic, professionally speaking. One third (33%, N=34) of PDs anticipated the pandemic would lead to lack of fellow clinical preparedness, 24% (N=25) with need to make up clinical rotations, and 15% (N=15) anticipated a negative impact on HO board pass rates. Post-pandemic, most PDs plan to maintain some virtual educational sessions (73%, N=75) and telehealth in fellows' continuity clinic (55%, N=57). Among PDs, the prevalence of burnout increased from 16% (N=16) pre-pandemic to 45% (N=46) during the pandemic (p&lt;0.0001). Seventeen percent (N=18) of PDs witnessed moderate signs of fellow burnout and 52% (N=54) witnessed minor signs of fellow burnout during the pandemic. Several educational and research constraints were identified via qualitative analysis: limited in-person clinical rotations, supervision of telehealth encounters, training year promotion and making up clinical time, limited professional development activities, board exam cancellations, and inability to perform research. Additional PD-identified trainee concerns included: ability to obtain childcare, separation from family, and Visa concerns among international fellows. PDs anticipated that financial constraints leading to cuts or removal of discretionary funds may have negative consequences for fellows' professional development activities and could force PDs to decrease program size in the future. PD recommendations for ASH and ASCO included: reducing or eliminating fellow membership fees, providing free access to educational materials and meetings, eliminating in-training examination fees, providing virtual sessions on career development, telehealth and wellness, virtual journal clubs, PD webinars focused on navigating fellowship issues and virtual interviews, and extending ASCO YIA funding for a second year. Conclusions PDs reported that their fellowship programs' clinical, educational, and research experiences have been impacted by the COVID-19 pandemic. PDs are concerned about the impact of budget cuts on fellows' professional and career development. PD burnout increased during the pandemic and most PDs observed at least mild burnout among their fellows. Professional societies can support fellowship programs by limiting fees and costs associated with membership, exams, and meetings, and increasing virtual opportunities for both fellows and PDs. Disclosures Velazquez Manana: Portola Pharmaceuticals: Other: Immediate family member stock ownership; Midatech: Other: Immediate family member stock ownership; Corbus Pharmaceuticals: Other: Immediate family member stock ownership.
Measuring the Impact of COVID-19 on Hematology-Oncology Trainees: A Quantitative and Qualitative Assessment
Mañana, Ana I. Velazquez, Nelson, Marquita , Gollapudi, Anurekha, Reynolds, Robby , Thompson, John Colton, Kumbamu, Ashok , Murphy, Martina, Henry, Elizabeth , Lee, Alfred Ian , Durani, Urshila , May, Jori E. , Zheng, Ze , Alam, Sara Taveras , Reynolds, Robby, Das, Devika , Marshall, Ariela L. , Wun, Ted , Weeks, Lachelle D.

Blood | November 4, 2020 | Volume: 136 | Issue: Supplement 1 | Pages: 20-21

10.1182/blood-2020-143347 Get It

Introduction: While the COVID-19 pandemic has affected many aspects of clinical care, research, and medical training, its impact on hematology-oncology trainees and professional development has not been described. The American Society of Hematology (ASH) and the American Society of Clinical Oncology (ASCO) sought to assess the impact of COVID-19 on fellows enrolled in hematology-oncology programs. Methods: In spring 2020, ASH and ASCO developed and administered a survey by e-mail to active hematology-oncology fellow members. Response formats used both a semi-Likert scale and open-ended text. Questions focused on fellow experiences and how changes in their programs have impacted their personal and professional lives across several domains. Multiple-choice responses were analyzed using descriptive statistics, and NVivo software was used for qualitative analysis of open-ended questions. Results: Respondent demographics are described in Table 1. Of 2,306 trainees, 620 (27%) responded to the survey. Most respondents continued patient care responsibilities during the pandemic (80%). Almost half of all trainees (47%) reported that they felt less productive than usual. Stress and/or anxiety about the current situation was the most cited factor affecting productivity in the overall cohort (Figure 1). One-third (33%) of respondents had volunteered or were assigned to clinical/non-clinical COVID-19-related efforts. Of the 90 visa holders in our cohort, 30% (N=27) reported experiencing issues with their visa/immigration status. Eight percent of respondents stated their career plans had changed due to COVID-19. Of those who said their plans had changed, 30 respondents were considering careers in academia pre-pandemic and 11 were considering private practice. However, only 14 respondents were considering academia post-pandemic while 19 were interested in private practice. Overall, most respondents had concerns about at least one of the following: salary reductions, availability of networking events, family well-being, mental health and obtaining a job (Figure 2). The prevalence of burnout increased from 22% (N=105) before the pandemic to 33% (N=161) during (p&lt;.001). Of the respondents who did not report burnout before COVID-19, 22% noted new-onset burnout during the pandemic. New-onset burnout prevalence varied based on the type of work respondents performed: no COVID-related work (17%), COVID-related non-clinical work (26%), and COVID-related clinical work (34%) (p&lt;0.01). The open-ended responses yielded several consistent themes. Clinical and educational constraints were enumerated: lost learning opportunities due to low patient volumes, unavailability of colleagues to discuss cases, and overall low perceived quality of virtual learning. Trainees also reported reduced motivation to complete work within a stipulated time frame due to lack of robust discussions in the virtual environment and technological challenges in navigating educational resources. Trainee research was also severely impacted as laboratories closed, experimental animal colonies were lost, and many research activities ceased. Respondents also expressed concern that cuts in research training initiatives and budgets would jeopardize faculty positions for graduating fellows and that funding for travel and conferences was suspended. Fellows' recommendations for ASH and ASCO included improved online education, virtual research training and networking opportunities, practical guidance on caring for immune-compromised patients during the pandemic, increased funding resources for trainees, mental health resources, and advocating on behalf of trainee visa holders. Conclusions: Hematology-oncology trainees reported their training experiences have been deeply impacted by the COVID-19 pandemic. A majority of trainees are concerned about the negative impact on career opportunities, research funding, financial well-being, and mental health. Burnout increased during COVID-19, especially in trainees who were assigned to specific COVID-related efforts. Training programs and professional societies can support trainees by increasing trainee research funding, online networking and learning opportunities, mental health resources and, support for international trainees. Disclosures Velazquez Manana: Corbus Pharmaceuticals: Other: Immediate family member stock ownership; Portola Pharmaceuticals: Other: Immediate family member stock ownership; Midatech: Other: Immediate family member stock ownership. Wun:Glycomimetics, Inc.: Consultancy.