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Importance Patients with cancer have high utilization of health care services, and many have high financial burdens from care. High-deductible health plans (HDHPs), which offer lower premiums at the expense of higher deductibles and possibly higher out-of-pocket costs, are associated with decreased care utilization among survivors of cancer. However, it is unclear whether HDHPs are associated with cancer outcomes. Objective To determine whether HDHP status is associated with survival among cancer survivors and individuals without history of cancer and whether financial barriers to care mediate associations between HDHP status and survival. Design, Setting, and Participants This cross-sectional study included US adults ages 18 to 84 years who participated in the National Health Interview Survey from 2011 to 2018. Data were analyzed from December 14, 2023, to December 1, 2025. Exposure HDHP status. Main Outcomes and Measures Outcomes of interest were overall survival (OS) and cancer-specific survival (CSS). Analyses were adjusted for insurance status, marital status, sex, comorbidities, education, household income, geographic region, and cancer site and time since cancer diagnosis (if applicable). Results A total of 147 254 respondents (mean [SD] age, 45.7 [16.4] years; 79 261 [50.9%] female) were identified, including 9799 (5.9%) with history of cancer. A total of 2331 cancer survivors (25.6%) and 37 473 individuals without history of cancer (28.5%) reported an HDHP at the time of NHIS participation. HDHP status was associated with worse OS (hazard ratio [HR], 1.46; 95% CI, 1.19-1.79) and CSS (HR, 1.34; 95% CI, 1.01-1.77) among cancer survivors. In contrast, among adults without history of cancer, HDHP status was not significantly associated with OS (HR, 1.08; 95% CI, 0.96-1.21; P for interaction = .001). In mediation analyses, HDHP status among cancer survivors was associated with increased financial barriers to care, which mediated approximately 30% to 70% of the total association of HDHP with survival. Conclusions and Relevance In this cross-sectional study of nationwide population-based data, HDHPs were associated with worse OS and CSS among cancer survivors. However, HDHPs were not associated with mortality in adults without history of cancer. These data suggest that insurance coverage that financially discourages medical care may financially discourage necessary care and ultimately worsen cancer outcomes.

Abstract Background Chimeric antigen receptor T-cell (CAR-T) and bispecific antibody (BsAb) therapies are both effective for patients with relapsed/refractory (R/R) follicular lymphoma (FL), but differ in treatment schedules and associated “time toxicity,” or contact days spent physically interacting with the healthcare system. While contact days can be estimated from clinical trials, real-world data provides a more nuanced depiction of treatment-related time burden, which may guide treatment decision-making. The comparative time toxicity of CAR-T vs BsAb in R/R FL is not defined. Methods We conducted a multicenter retrospective study of adults with R/R grade 1-3A FL who received standard-of-care CAR-T (axi-cel, tisa-cel, liso-cel) or BsAb (mosunetuzumab, epcoritamab) in the third-line or later setting before Jan 1, 2025. Time toxicity was defined as outpatient or inpatient days with physical health care system contact, counting multiple visits on the same day as only one day. All days after treatment initiation were counted, regardless of disease progression, therapy completion, or relation to FL therapy. Median contact days over 1-year time horizon were compared, stratified by CAR-T vs BsAb, prior lines of therapy (LOT, 2 vs 3+), and time intervals (0-1, 1-3, 3-6, 6-9, and 9-12 months). Progression-free survival (PFS) and overall survival (OS) were calculated from day of CAR-T infusion or day 1, cycle 1 for BsAb. Cox regression and propensity matching (by age, ECOG, refractory to prior LOT, POD24) were used to assess predictors and survival associations with contact days. Results Among 209 patients from 15 U.S. academic centers, median age was 64, 37% were female, 61% received CAR-T (80% axi-cel, 7% liso-cel, 13% tisa-cel) and 39% BsAb (93% mosun, 7% epcor). Most had Grade 1-2 FL (72%), advanced stage (84%), and extranodal disease (51%). Median prior LOT was 3 (range 2-15), 41% were refractory to prior LOT, and 52% had POD24. Median number of BsAb doses was 10 (range 1-36). Patients receiving BsAb were significantly older (p<.01) and had higher CIRS comorbidity scores (p<.02) in both 2 and 3+ prior LOT cohorts, and had higher ECOG scores (p=.01) and were less likely to be refractory to prior LOT (p=.029) in 3+ LOT cohort. There were no differences in POD24 rates between CAR-T and BsAb. Median PFS for the entire cohort was 3.6 yrs; median OS was not reached. In the 2 prior LOT cohort (N=75), 60% received CAR-T and 40% BsAb. With median follow-up of 1.5 years, median PFS was not reached for CAR-T and 1.6 yrs for BsAb (p<.0001). In the 3+ prior LOT cohort (N=134), 62% received CAR-T and 38% BsAb. With median follow-up of 2 yrs, median PFS was 3.6 yrs for CAR-T and 1.6 yrs for BsAb (p=.0044). In propensity matched analysis, PFS was shorter for BsAb in both 2 LOT (HR 9.0, 95% CI 1.14-71.04, p=.037) and 3+ LOT (HR 3.25, 95% CI 1.06-9.97, p=.039) cohorts as compared to CAR-T. There were no significant differences in OS between CAR-T and BsAb. Median contact days were significantly higher for CAR-T vs BsAb in the 0-1 month interval: 19 vs 8 days in 2 LOT (p<.0001) and 18 vs 7 days in 3+ LOT (p<.0001) cohorts. There were no differences in contact days between CAR-T vs BsAb in subsequent time intervals. Over 1 year, CAR-T had significantly more time toxicity than BsAb: median 51 vs 36 contact days in 2 LOT (p<.0001) and 64 vs 38 days in 3L+ LOT (p<.0001) cohorts; these remained significant in the matched analysis. B symptoms (p=.04) and Grade ≥3 cytopenias (p=.007) were associated with higher contact days in 3+ LOT cohort in univariable analysis. Higher contact days were associated with inferior PFS (HR 1.01, 95% CI 1.00-1.02, p=.032) and OS (HR 1.01, 95% CI 1.00-1.02, p=.038) in 3+ LOT cohort regardless of treatment type. Discussion In this large real-world cohort of patients with R/R FL, CAR-T therapy resulted in better PFS but more time toxicity over the first year as compared to BsAb therapy. Excess time toxicity from CAR-T was driven by more contact days in the first month of treatment. This study provides benchmark data for counseling patients about expected time burden of CAR-T (51-64 days) and BsAb (36-38 days) over the first year of these therapies. Further, with superior PFS of CAR-T in this study and minimal impact of time toxicity on survival outcomes, these data can be used to better support shared decision-making in R/R FL by addressing patient preferences regarding both contact days as well as duration of disease control.

230 Background: The burden of symptoms and financial toxicity are well-documented adverse effects of cancer treatments. Recently, logistic toxicity has emerged, referring to the detrimental impact of logistical demands associated with cancer treatment on patient well-being. For non- English speaking patients, language barriers can affect their treatment experience, increasing logistic burdens. Methods: Between September 2024 and May 2025, semi-structured qualitative interviews were conducted with 21 low English proficiency (LEP)/non-English speaking adults with cancer. The interviews explored logistic challenges faced due to LEP and its impact on patients' cancer care experience. Transcripts were analyzed using an inductive thematic analysis approach. Results: Of the 39 identified eligible individuals, 26 provided consent, and 21 (81%) completed the interview. The most common primary language of the participants was Spanish (9, 43%), followed by Somali (3, 14%), Arabic and Korean (2, 9%), and Amharic, Mandarin, Hmong, Russian, and Vietnamese (1, 5%). Seven major themes emerged regarding the logistic burdens of cancer care: (1) communication challenges, (2) navigating healthcare systems, (3) emotional distress from diagnosis and communication barriers, (4) financial toxicity, (5) transportation challenges, (6) adverse treatment effects, and (7) concerns about the political climate and its impact on resources. Conclusions: The increase in non-English languages in the U.S. highlights the need to understand the unique challenges faced by these patients. This study identified logistic toxicity themes consistent with previous research, while also revealing unique challenges. Further research is necessary to explore strategies to mitigate logistic burdens among those with LEP. Theme Illustrative Quotes Communication challenges “Communication with the psychologist was challenging … I couldn’t express myself effectively and it left me unsatisfied with the interaction.” Navigating healthcare systems “dealing with the insurance, it has been difficult … I have to depend on another person to help me” Emotional distress from diagnosis and communication barriers “In addition to my sickness, the lack of communication and understanding… makes me very sad.” Financial toxicity “...there's no income. There is nothing to feed our children.” Transportation challenges “I have to leave home 2 or 3 hours in advance because people will help me, not within my time, but within their own time.” Adverse treatment effects “I noticed weird feelings in my limbs. I'm not able to write down or hold anything. It makes everything difficult.” Concerns about current political climate and its impact on existing resources “… that they don't want Spanish spoken in the United States. They're not going to provide help for people like me at the hospitals…”

Abstract Rationale: Effective communication is crucial in healthcare, especially in acute care settings, so that patients/family members can understand treatment options, and share preferences and goals of care. For those with a non-English language preference (NELP), or who have difficulty communicating in English, professional interpreters are recognized as the gold standard in supporting bidirectional communication. However, interpreters are not always readily available for all languages or clinical settings prompting the exploration of other options for translation and interpretation. The recent developments in artificial intelligence (AI), specifically machine translation have enabled more accurate and emotional machine interpretation and translation. Methods: We conducted a systematic review to explore the usability and usefulness of AI-assisted interpretation and translation tools for improving communication between patients and clinicians including verbal and written communication. A comprehensive search of several databases including Ovid MEDLINE(R), Ovid Embase, APA PsycInfo, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus via Elsevier was performed, resulting in 2629 studies. We included studies evaluating tools for direct patient-clinician communication. For verbal communication, we included articles assessing speech interpretation, and for written communication, we focused on discharge instruction translation. Results: A total of 18 studies were included in the final analysis. Among these, 5 assessed the use of speech interpretation and 13 examined text translation of discharge materials. 14 (78%) studies found these novel AI tools beneficial for patient care, whereas 11 (62%) studies highlighted the risks, indicating that these tools can lead to serious mistakes with potential clinical harm. 5 (28%) studies reported participant satisfaction with the use of these tools in their care. Translation and interpretation accuracy varied notably across languages, with lower accuracy scores observed in languages with limited digital resources, such as Haitian Creole and Vietnamese. Conclusion: AI-assisted interpretation and translation in healthcare has several advantages including broader language accessibility than usual resources and potential cost savings for institutions and demonstrates evidence of patient satisfaction. However, these novel tools operate using multiple phases and each stage is prone to errors which may negatively impact patient care and outcomes.. AI-based interpretation and translation show promising potential, however, it is not yet ready for widespread clinical use, so professional language interpreters should be used whenever possible. Future studies should focus on evaluating accuracy as well as how best to integrate these technologies in real-time clinical settings without compromising patient safety and quality of care.

Aromatase inhibitor–induced musculoskeletal symptoms (AIMSS) were first recognized as a distinct entity in 2001, 5 years after the approval of the first aromatase inhibitor, anastrozole. Musculoskeletal symptoms can severely affect patients’ quality of life and also lead to premature discontinuation of aromatase inhibitor therapy. Several interventions for managing AIMSS have been investigated in the last decade, with some demonstrating promise. This article provides an evidence-based summary to guide practicing oncologists in regard to the epidemiology, prevention, and treatment of AIMSS.

PURPOSE: Routine use of extended-fraction (> 10 fractions) radiation therapy (RT) for palliation of bone metastases is recognized as a low-value intervention by the American Society for Radiation Oncology. We examined contemporary practice patterns of, and physician characteristics associated with extended-fraction RT use. MATERIALS AND METHODS: We conducted a retrospective cohort study using Medicare fee-for-service data. We included patients who underwent 2- or 3-dimensional external-beam RT for bone metastases between January 1, 2016, and December 31, 2018. Physicians treating > 10 patients over the study period were analyzed for their individual practice. Hierarchic logistic regression modeling was used to identify patient- and physician-level factors associated with extended-fraction RT use. RESULTS: A total of 12,221 patients (median age, 75.6 years; 40.9% women, 87.6% white) were included. The rate of extended-fraction RT was 23.4%. A total of 1,432 physicians treated any patient. Among the 382 physicians treating > 10 patients, 127 (33.2%) used extended-fraction RT > 30% (consensus threshold). Physician factors associated with decreased odds of extended-fraction RT were years since medical school graduation (≤ 10 years and 11-20 years v ≥ 31 years: adjusted odds ratio [aOR], 0.32 [95% CI, 0.20 to 0.51] and 0.64 [95% CI, 0.44 to 0.93]) and practicing in the Northeast or Midwest versus the South (aOR, 0.36 [95% CI, 0.22 to 0.58] and 0.48 [95% CI, 0.31 to 0.74]). Physicians treating > 20 patients ( v 11-14 patients) over the study period had increased odds of delivering extended-fraction RT (aOR, 1.53 [95% CI, 1.10 to 2.12]). CONCLUSION: In this study, almost one fourth of patients received extended-fraction RT, and one third of physicians had an extended-fraction RT use rate of > 30%. Personalized feedback of performance data, clinical pathways and peer review, and updated reimbursement models are potential mechanisms to address this low-value care.