Preferences for breast cancer survivorship programs among multiracial and ethnic women

Preferences for breast cancer survivorship programs among multiracial and ethnic women | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Preferences for breast cancer survivorship programs among multiracial and ethnic women Lisa Anderson, Oindrila Bhattacharyya, Akia Clark, Sharnell Smith, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5312826/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose: With advancements in breast cancer treatment, survivorship has increased, leading to 3.8 million survivors in the US. These women have diverse supportive care needs, often addressed through Survivorship Programs (SPs), which provide clinical and non-clinical support services. SPs aim to deliver a holistic approach to comprehensive breast cancer treatment and recurrence prevention. Historically, disparities in SP utilization exist among minority and elderly women. This study aims to explore trends varying in SP participation by age and race within a single institution. Methods: A retrospective analysis of breast cancer patients' survivorship needs at the James Comprehensive Cancer Center was conducted. Data were collected from JamesCare for Life programs (2019-2022), including demographics and referrals to clinical resources such as Adolescent/Young Adult care, Fertility preservation, Palliative care, Psychosocial support, and Survivorship. Participation in non-clinical areas, including Art, Education, Exercise, Mind-Body-Spirit, and Nutrition, was also evaluated. Descriptive statistics summarized patterns based on age, race, and ethnicity. Results: From 2019-2022, 2,198 patients attended SPs, with Nutrition and Exercise being the most popular. Most attendees were 60-69 years old and White. Black attendees declined from 9.9% (2019) to 5.7% (2022). Clinical resources showed the highest referral rate to survivorship clinics. Black patients saw an increase in palliative care referrals, rising from 11% to 21%. Conclusion: Data reveal differences in clinical referrals by age and race, with fewer referrals for older women and more for Black patients. Participation in non-clinical SPs was similar across groups. Future program development will focus on inclusivity and equitable access. breast cancer survivorship support services race Figures Figure 1 Background Although disparities persist in breast cancer outcomes, patients overall continue to benefit from advances in multimodal treatment leading to increased survival [1,2]. The 5-year survival rates for early-stage cancer are over 90%, and with rising incidence rates and aging of the U.S. population, the estimated number of cancer survivors now exceeds 3.8 million women [2,3]. As the population of survivors increases, resources addressing supportive care needs, including psychological distress and deficits in physical functioning are needed [4]. To address these deficits, many cancer centers offer a variety of programs geared towards survivors and their family members/ support team [4-7]. Studies find that while interest in these survivorship programs (SPs) is generally high, the actual participation remains low. This phenomenon is a result of several barriers including lack of time (82%), work/school (65%), and lack of information about wellness activities (65%) [8]. There are disparities in engagement with support services among racial and ethnic minorities. Specifically, there are limited studies exploring the specific needs of Black breast cancer survivors, and the few that exist report a lack of culturally appropriate cancer resources necessary to help these patients understand and cope with their diagnosis [8-13]. One study found that compared to White survivors, African Americans were more likely to identify barriers related to out-of-pocket costs (28 vs. 51.6 %, p = 0.01), other health care costs (21.3 vs. 45.2 %, p = 0.01), anxiety/worry (29.4 vs. 51.6 %, p = 0.02), and transportation (4.4 vs. 16.1 %, p = 0.03) [11]. Even when survivorship programming is available, participation varies among different racial and ethnic groups. Specifically, Black survivors are less likely to utilize existing cancer support services. At our institution, 1/3 of all women referred to the free survivorship support services and programs never scheduled appointments to complete the referral [14]. To understand patients’ needs, we proposed a retrospective analysis of diverse patients’ needs and preferences in survivorship programs at the James Comprehensive Cancer Center. We evaluated the patient demographics of the participants in the James Care for Life programs, specifically to assess patient participation by age, race and ethnicity. Methods This study is a retrospective analysis of diverse breast cancer patients’ survivorship needs and preferences. The Stephanie Spielman Comprehensive Breast Center provides care for approximately 1000 analytic breast cancer cases per year. As a part of The Ohio State University Comprehensive Cancer Center – James Cancer Hospital (OSUCCC – James), a robust free survivorship support service line for breast cancer patients is provided by physicians, advanced practice providers, psychologists, dieticians, physical therapists, and social workers. Non-clinical services are also widely available to promote holistic wellness and adjustment to life with cancer. These services include cancer and survivorship education, nutrition, exercise, expressive arts, family programming, mind-body-spirit practices, disease-specific support groups, and young adult programming. We abstracted the demographic information of participants who attended the James Care for Life programs from January 2019 through December 2022. We assessed the number of patients referred to individualized clinical resources including Adolescent/young adult care, Fertility preservation, Palliative care, Psychosocial support, and Survivorship. Survivorship is a provider-initiated visit for non-metastatic patients post treatment and includes a treatment summary, holistic needs assessment and healthy lifestyle counseling. Participation in non-clinical program areas included Art, Education, Exercise, Family, Teens, Children, Mind, Body, Spirit, Music, Nutrition, and Young Adult Survivors (ages 18-39). Descriptive statistics were utilized to summarize patterns based on age, race and ethnicity, and zip code observed within our institution. Given small samples, race categories are grouped into non-Hispanic White, Black and other. Data - The Cancer Support Service Line uses an institutional quality dashboard through a data visualization tool called Tableau to monitor clinical services. Data collection of patient demographics, referral patterns, utilization trends, and encounter volumes began in July 2014 (which was the start of the academic and fiscal year) and is updated monthly through the present day. Data collected from participants who register and attend SPs were collected through Qualtrics and an internal REDCap database, funded by the National Center for Advancing Translational Sciences (Grant UL1TR001070). Data is captured by tracking registration, attendance, and post-program evaluations. Program evaluations querying demographic and program acceptability are emailed to all individuals who register and attend a program as well as to walk-in participants who did not register but attended and provided their email address. SPs are offered to cancer survivors and caregivers across all cancer sites. Evaluations are reviewed after every program to measure the effectiveness in meeting the program goals and objectives and to identify trends in registration, attendance, and participant responses that inform necessary changes to the program. Analysis- Descriptive statistics were utilized to summarize available data from the study period. The distribution of participant characteristics is presented using frequencies and percentages for categorical data and using means and standard deviations for continuous data. Zip code data is used to categorize counties of residence within the state of Ohio. Approval for use and publication of our institution’s internal quality data related to this study was granted by The Ohio State University Comprehensive Cancer Center (OSUCCC) – #2023COO46 and the James Quality and Patient Safety Committee. Results The James and Stephanie Spielman Comprehensive Cancer Center treat 1,100 breast cancer patients each year. James Care for Life provides supportive and educational programs that are offered at no charge and available to individuals diagnosed with cancer and their caregivers/family members. Programs can be accessed from the time of diagnosis and throughout survivorship. James Care for Life programs facilitate the holistic treatment of breast cancer including the physical, emotional, spiritual, and practical aspects through education, healthy lifestyle programs and peer support groups. The James Care for Life program areas include Art and Music classes, Living Well with Advanced Breast Cancer, Survivorship Conference, Education, Exercise, Family, Teens, and Children, Mind, Body and Spirit, Nutrition, and Young Survivors. The programs are offered in person and online. Classes are facilitated by other cancer experts including physicians, nurses, dieticians, physical therapists, social workers and integrative medicine and wellness specialists. From 2019-2022, 2,198 breast cancer participants attended James Care for Life programs. The most attended programs during this period were nutrition and exercise. The annual percentage of participants attending nutrition programs ranged from 32.5% (2019) to 39.9% (2022). For exercise, the annual percentage of participants ranged from 13.7% (2019) to 22.6% (2022). Participation in the exercise program increased during the years of the COVID pandemic while participation in the nutrition program decreased. [Table 1] Within the study period, a majority of James Care for Life attendees were White (74.0% - 82.3%). Black attendance decreased from 9.9% (2019) to 5.7% (2022). Asian/Pacific Islander attendees initially made up 4.3% of all attendees in 2019. During the COVID pandemic, their participation increased to 7.4% - 14.0% of all participants and then decreased to 8.7% in 2022. All other minority groups including American Indian, Hispanic/Latino, multi-racial, and other decreased during the COVID pandemic and through 2022. [Table 2] From 2019-2022, the majority of James Care for Life attendees were within the 60-69 age group (45.8% - 60.1%). All age groups except 60-69 years-old and 70+ years age groups had an overall decrease in program participation in 2019 compared to 2022. Patients in the 18-39, 40-49, and 50-59 age ranges participated less during the COVID pandemic while 60-69 years-old and 70+ years-old groups had an increase in participation. Notably, participants age 70+ years-old nearly doubled from 9.4% (2019) to 18.1% (2022). [Table 3] The James and Stephanie Spielman Comprehensive Breast Center offer additional clinical resources with referrals available to breast cancer patients. These clinical resources include Adolescent/Young Adult (AYA), Fertility Preservation, Palliative Care, Psychosocial Oncology (PSO) and Survivorship. These clinical resources are additional visits with a specialty physician or advanced practice provider (APP), or a mental health provider. A total of 5,297 patients were referred to these clinical resources in 4 years. The highest number of referrals were to the survivorship clinics (52%) followed by psychosocial oncology. Of all the clinical resources, the highest proportion of completed referrals were to the Adolescent/Young Adult (97%) and Fertility Preservation (74%) in 2019. The percentage of completed referrals out of total referrals remained the highest for Fertility Preservation in 2022 (80%). The percentage of referrals for Black patients to Palliative Care, Psychosocial Oncology, and Survivorship all increased from 2019 to 2022. Of note, Black patients were frequently referred to Palliative Care, with the proportion of referrals nearly doubling from 11% (2019) to 21% (2022). Referrals to all clinical resources increased for Latino/Hispanic patients from ≤1% in 2019 to 2-6% in 2022. [Table 4] In 2019 most survivorship participants fell within the 65-74 age group (30%), however it was the 55-64 age group that saw the highest referral rate in 2022 (31%). Referrals to survivorship clinics in the 75+ age group saw a 64% decrease within the study period while referrals to palliative care saw a 175% increase. [Table 5] Annually, ~72% of the study population resided in Franklin County, followed by Delaware (up to 10%). [Figure 1] Discussion These data show differences in provider referrals to clinical survivorship resources for different age groups and White compared to Black women. With patient attendance in non-clinical SPs, utilization is similar across race and age groups, with the majority choosing nutrition and exercise programs. Notable, however, is the decrease in Black participants over the study period declining from 9.9% (2019) to 5.7% (2022). This keeps with the observation that Black patients outside of minority serving institutions have lower participation in survivorship support services and programs [10,11,15]. Black women of lower socioeconomic status are also less likely to undergo guideline-concordant survivorship care [16]. Ko, et al recently investigated the unique needs of survivorship care of Black patients at multiple institutions and identified religion and spirituality as key resources for coping with breast cancer [17]. In this study, clinical referrals to palliative care increased for Black patients. Historically, Black patients present with more advanced disease and worse prognosis [1,18,19]. This may necessitate involvement of palliative care services that address pain management in addition to end of life planning. According to SEER data from 2017-2021, breast cancer patients aged 65-74 make up the majority of newly diagnosed female breast cancer, with a median age at diagnosis of 63 years-old [20]. Elderly breast cancer patients commonly present with concurrent increased frailty, comorbid conditions, decreased functional status, and fewer social and economic resources. The unique needs of this vulnerable majority of breast cancer survivors have not been well studied [21,22]. The elderly patients in our study are getting fewer clinical referrals to survivorship, however, they are increasing their participation in James Care for Life programs. It appears they are self-selected for more support services; however, providers are not referring them for a formal survivorship visit as often. In a study by Krok-Schoen et al. analyzing the perspectives of survivorship care plans (SCP) among older breast cancer survivors, while all patients received SCPs, less than a quarter of them were aware of these plans suggesting a communication barrier between patients and their providers. Suggested areas of improvement included clearer communication, more long-term resources, and the use of health coaches to facilitate patients’ adherence to their SCPs [23]. To reduce barriers and facilitate access to survivorship care and services, navigation is increasingly utilized. Although historically associated with screening, navigation can be used across the breast cancer care continuum [24]. Insurvivorship, a navigator can educate women on how to improve their overall wellness, thereby directly impacting the health of a growing population of cancer survivors [25-28]. Studies show that navigation has increased patient reported quality of life [29, 30]. Dixit et al. show trends towards improvement in the change in emotional well-being score, functional well-being score and overall QOL in the intervention arm, but it was not statistically significant. The change in physical well-being scores was similar. There was no difference in the mean self-efficacy scores for both arms [30]. In a recent randomized trial of Hispanic breast cancer survivors, Ramirez et al. showed that navigation resulted in significantly improved quality of life measures in a 6‐month period [31]. Unfortunately, most of these studies did not include Black or elderly women. Establishing survivorship programming for the breast cancer population requires consideration of disparities in patient ages, race and ethnicity, and education among other variables. Monitoring and evaluating these data offerings allow programming tailored to the population. At our institutions patients are majority White and reside within our local catchment (Franklin County), despite our patient catchment extending across the entire state of Ohio and beyond to neighboring states of West Virginia, Indiana, and Kentucky. Therefore, we are not attracting the wider segment of our breast cancer survivors. Even with most of our SPs transitioned to virtual visits, attendance has not broadened beyond Franklin County. There is considerable dynamism with the county population necessitating frequent evaluation of SPs, new immigrant communities and non-native English speakers have changed the local demographic over the years. This will require expansion of programs to Spanish language focus for example. Our current study shows only ~2% of our participants self-reported Hispanic ethnicity which will increase as the local population evolves. Limitations Given the retrospective nature of this study anticipated biases are present. Also, participant self-reported data is at risk for recall bias. Furthermore, the database used is focused on quality evaluation and is therefore limited in terms of the data variables captured. While this manuscript is focused on “patients” and being referred to supportive care resources, JCFL programs aren’t just available for James patients but are also open to community members who might not be James patients and might not have been referred to programs by their healthcare team. This is a limited number but is not differentiated by the current database. Similarly, planned deeper analysis to explore factors associated with participation was limited due to the lack of collected anonymous and individual data. Qualitative data is lacking that would allow for a better understanding of why certain programs were selected and what future individual needs are. Conclusion These descriptive data show the population our current survivorship service line serves and associated participant preferences. Black women underutilize these supportive services, while women over 70 years-old have increased their participation. Further investigation is planned to explore and understand factors associated with SP participation. A necessary first step is to optimize the institutional database to improve post participation data capture. Future program development will address inclusivity of minority and elderly women, as well as ensure equitable access to survivorship resources through navigation. Declarations Statements and Declarations: The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. The authors have no relevant financial or non-financial interests to disclose. References Hill, D.A., et al., Temporal trends in breast cancer survival by race and ethnicity: A population-based cohort study. PLoS One, 2019. 14(10): p. e0224064. Miller KD, Nogueira L, Devasia T, Mariotto AB, Yabroff KR, Jemal A, Kramer J, Siegel RL. Cancer treatment and survivorship statistics, 2022. CA Cancer J Clin. 2022 Sep;72(5):409-436. doi: 10.3322/caac.21731. Epub 2022 Jun 23. PMID: 35736631. Kaur M, Joshu CE, Visvanathan K, Connor AE. Trends in breast cancer incidence rates by race/ethnicity: Patterns by stage, socioeconomic position, and geography in the United States, 1999-2017. Cancer. 2022 Mar 1;128(5):1015-1023. doi: 10.1002/cncr.34008. Epub 2021 Nov 3. PMID: 34731501; PMCID: PMC9533488. Wong EC, Kaplan CP, Barulich M, Melisko M. Assessing preferences for receiving supportive care resources among patients seen at a Breast Care Center. Breast cancer research and treatment , 183 (2), 381–389. https://doi.org/10.1007/s10549-020-05786-0 Wong EC, Kaplan CP, Dreher N, Hwang J, Van't Veer L, Melisko ME. Integration of Health Questionnaire Systems to Facilitate Supportive Care Services for Patients at an Academic Breast Care Center. JCO Clin Cancer Inform. 2018 Dec;2:1-13. doi: 10.1200/CCI.18.00018. PMID: 30652601. Loibl S, Lederer B. The importance of supportive care in breast cancer patients. Breast Care (Basel). 2014 Apr;9(4):230-1. doi: 10.1159/000366526. PMID: 25404880; PMCID: PMC4209283. O’Malley, D.M., Davis, S.N., Amare, R. et al. User-Centered Development and Patient Acceptability Testing of a Health-Coaching Intervention to Enhance Cancer Survivorship Follow-up in Primary Care. Journal of cancer education : the official journal of the American Association for Cancer Education, 37(3), 788–797. https://doi.org/10.1007/s13187-020-01883-2 Szuhany, K. L., Malgaroli, M., Riley, G., Miron, C. D., Suzuki, R., Park, J. H., Rosenthal, J., Chachoua, A., Meyers, M., & Simon, N. M. (2021). Barriers and engagement in breast cancer survivorship wellness activities. Breast cancer research and treatment , 188 (1), 317–325. https://doi.org/10.1007/s10549-021-06279-4 Coughlin, S. S., Yoo, W., Whitehead, M. S., & Smith, S. A. (2015). Advancing breast cancer survivorship among African-American women. Breast cancer research and treatment , 153 (2), 253–261. https://doi.org/10.1007/s10549-015-3548-3. Haynes-Maslow, L., M. Allicock, and L.S. Johnson, Cancer Support Needs for African American Breast Cancer Survivors and Caregivers. J Cancer Educ, 2016. 31 (1): p. 166-71 Palmer, N.R.A., Weaver, K.E., Hauser, S.P. et al. Disparities in barriers to follow-up care between African American and White breast cancer survivors. Support Care Cancer 23 , 3201–3209 (2015). Binkley JM, Gabram S, Finley J, Fowler D, VanHoose L, McCullough LE. Racial disparity in breast cancer survivorship: themes from a series of four national healthcare provider live virtual forums. J Cancer Surviv. 2023 Aug;17(4):1008-1016. doi: 10.1007/s11764-023-01373-6. Epub 2023 Apr 11. Erratum in: J Cancer Surviv. 2023 Jul 22. doi: 10.1007/s11764-023-01393-2. PMID: 37040001. Pinheiro LC, Samuel CA, Reeder-Hayes KE, Wheeler SB, Olshan AF, Reeve BB. Understanding racial differences in health-related quality of life in a population-based cohort of breast cancer survivors. Breast Cancer Res Treat. 2016 Oct;159(3):535-43. doi: 10.1007/s10549-016-3965-y. Epub 2016 Sep 1. PMID: 27585477; PMCID: PMC5031495 https://doi.org/10.1007/s00520-015-2706-9 Oppong, B.A., et al. Utilization of cancer survivorship services during the COVID-19 pandemic in a tertiary referral center. J Cancer Surviv 17, 1708–1714 (2023) Biancuzzi, H., et al., Post-breast cancer coaching: the synergy between health and fitness through co-production. Ig Sanita Pubbl, 2019. 75 (3): p. 181-187. Samuel CA, Pinheiro LC, Reeder-Hayes KE, et al. To be young, Black, and living with breast cancer: a systematic review of health-related quality of life in young Black breast cancer survivors. Breast Cancer Res Treat. 2016; 160(1): 1-15. doi:10.1007/s10549-016-3963-0 Ko NY, Fikre TG, Buck AK, Restrepo E, Warner ET. Breast cancer survivorship experiences among Black women. Cancer. 2023;129(S19):3087-3101. doi:10.1002/cncr.34634 Erica M. Stringer-Reasor et al., Disparities in Breast Cancer Associated With African American Identity. Am Soc Clin Oncol Educ Book 41, e29-e46(2021).DOI:10.1200/EDBK_319929, Richardson, L.C., et al., Patterns and Trends in Age-Specific Black-White Differences in Breast Cancer Incidence and Mortality - United States, 1999-2014. MMWR Morb Mortal Wkly Rep, 2016. 65(40): p. 1093-1098. Abdel-Razeq H, Abu Rous F, Abuhijla F, Abdel-Razeq N, Edaily S. Breast Cancer in Geriatric Patients: Current Landscape and Future Prospects. Clin Interv Aging. 2022 Sep 28;17:1445-1460. doi: 10.2147/CIA.S365497. PMID: 36199974; PMCID: PMC9527811. Mohile SG, Hurria A, Cohen HJ, et al. Improving the quality of survivorship for older adults with cancer. Cancer. 2016;122(16): 2459-2568. Faul LA, Luta G, Sheppard V, et al. Associations among survivorship care plans, experiences of survivorship care, and functioning in older breast cancer survivors: CALGB/Alliance 369901. J Cancer Surviv. 2014;8(4):627–637. Krok-Schoen JL, Naughton MJ, Noonan AM, Pisegna J, DeSalvo J, Lustberg MB. Perspectives of Survivorship Care Plans Among Older Breast Cancer Survivors: A Pilot Study. Cancer Control. 2020 Jan-Dec;27(1):1073274820917208. doi: 10.1177/1073274820917208. PMID: 32233798; PMCID: PMC7143997. Oppong BA. Rumano R, Paskett ED. Expanding the Use of Patient Navigation: Health Coaching-Based Navigation as a Novel Approach to Addressing Deficits in Breast Cancer Survivorship Support. Breast Cancer Res Treat, 2024 Jan 25. doi: 10.1007/s10549-023-07213-6. Online ahead of print. PMID: 38273216 Coughlin, S.S., et al., Advancing breast cancer survivorship among African-American women. Breast Cancer Res Treat, 2015. 153 (2): p. 253-61. Robinson-White, S., et al., Patient navigation in breast cancer: a systematic review. Cancer Nurs, 2010. 33(2): p. 127-40. Chan, R. J., Milch, V. E., Crawford-Williams, F., Agbejule, O. A., Joseph, R., Johal, J., Dick, N., Wallen, M. P., Ratcliffe, J., Agarwal, A., Nekhlyudov, L., Tieu, M., Al-Momani, M., Turnbull, S., Sathiaraj, R., Keefe, D., & Hart, N. H. (2023). Patient navigation across the cancer care continuum: An overview of systematic reviews and emerging literature. CA: A Cancer Journal for Clinicians, 73(6), 565–589. https://doi.org/10.3322/caac.21788 Baik SH, Gallo LC, Wells KJ. Patient Navigation in Breast Cancer Treatment and Survivorship: A Systematic Review. J Clin Oncol. 2016 Oct 20;34(30):3686-3696. doi: 10.1200/JCO.2016.67.5454. PMID: 27458298; PMCID: PMC5065113. Pratt-Chapman, M., et al., Survivorship navigation outcome measures: a report from the ACS patient navigation working group on survivorship navigation. Cancer, 2011. 117 (15 Suppl): p. 3575-84. Dixit N, Sarkar U, Trejo E, et al. Catalyzing Navigation for Breast Cancer Survivorship (CaNBCS) in Safety-Net Settings: A Mixed Methods Study. Cancer Control. 2021;28. doi:10.1177/10732748211038734 Ramirez, A.G., et al., Quality of life outcomes from a randomized controlled trial of patient navigation in Latina breast cancer survivors. Cancer Med, 2020. 9 (21): p. 7837-7848. Tables Table 1. James Care for Life Attendance by Program Area: Total Number of Participant Attendees in Calendar Years 2019-2022 Program Area Total Breast Cancer Participants – CY2019 Total Breast Cancer Participants – CY2020 Total Breast Cancer Participants – CY2021 Total Breast Cancer Participants - CY2022 Art 24(5.8%) 24(4.6%) 16(2.7%) 14(2.6%) Ask the Expert – Living Well with Advanced Breast Cancer 13(3.1%) 29(5.5%) NA – Program on Hold 18(3.3%) Breast Cancer Survivorship Conference 78(18.8%) 61(11.6%) 41(6.8%) 44(8.1%) Education 41(9.9%) 41(8.0%) 59(9.8%) 55(10.2%) Exercise 57(13.7%) 168(32.1%) 227(37.7%) 122(22.6%) Family, Teens, Children 13(3.1%) 4(0.8%) 5(0.8%) 1(0.2%) Mind, Body, Spirit 41(9.9%) 65(12.4%) 103(17.1%) 66(12.2%) Music 7(1.7%) 4(0.8%) 4(0.7%) 5(0.9%) Nutrition 135(32.5%) 121(23.1%) 142(23.6%) 216(39.9%) Young Survivors 6(1.4%) 6(1.1%) 5(0.8%) 0(0.0%) Table 2. James Care for Life Attendance by Participant Race/Ethnicity: Total Number of Participant Attendees in Calendar Years 2019-2022 Program Participant Race/Ethnicity Total Breast Cancer Participants – CY2019 Total Breast Cancer Participants – CY2020 Total Breast Cancer Participants - CY2021 Total Breast Cancer Participants – CY 2022 African American/Black 41(9.9%) 43(8.2%) 40(6.6%) 31(5.7%) American Indian 4(1.0%) 0(0.0%) 1(0.2%) 1(0.2%) Asian/Pacific Islander 18(4.3%) 39(7.4%) 84(14.0%) 47(8.7%) Caucasian/White 307(74.0%) 409(78.1%) 448(74.4%) 445(82.3%) Hispanic/Latino 7(1.7%) 5(1.0%) 0(0.0%) 4(0.7%) Multi-racial 14(3.4%) 10(1.9%) 6(1.0%) 6(1.1%) Other 19(4.6%) 15(2.9%) 23(3.8%) 2(0.4%) Did not answer 5(12%) 3(0.6%) 0(0.0%) 5(0.9%) Table 3. James Care for Life Attendance by Participant Age: Total Number of Participant Attendees in Calendar Years 2019-2022 Program Participant Age Total Breast Cancer Participants – CY2019 Total Breast Cancer Participants – CY2020 Total Breast Cancer Participants - CY2021 Total Breast Cancer Participants – CY 2022 18-39 years old 25(6.0%) 17(3.2%) 15(2.5%) 20(3.7%) 40-49 years old 53(12.8%) 47(9.0%) 65(10.8%) 35(6.5%) 50-59 years old 79(19.0%) 99(18.9%) 88(14.6%) 87(16.1%) 60-69 years old 190(45.8%) 315(60.1%) 324(53.8%) 262(48.4%) 70+ years old 39(9.4%) 32(6.1%) 82(13.6%) 98(18.1%) Did not answer 29(7.0%) 14(2.7%) 28(4.7%) 39(7.2%) Table 4. Clinical Resource Referrals by Race : Total Number of Participants Referred to Clinical Resources in Calendar Years 2019 and 2022 Clinical Resource 2019 Total Referrals Completed Referrals % Race Ethnicity Black White Asian Other Not Hispanic or Latino Latino/ Hispanic Other Unknown AYA 38 37 97% Fertility Preservation 38 28 74% 99% 1% 99% 1% Palliative Care 112 64 57% 11% 89% 99% 1% Psychosocial Oncology 379 190 50% 11% 84% 1% 4% 99% 1% Survivorship (Survivorship, Sexual Health) 797 546 69% 9% 85% 2% 4% 98% 1% 1% Clinical Resource 2022 Total Referrals Completed Referrals % Race Ethnicity Black White Asian Other Not Hispanic or Latino Latino/ Hispanic Other Unknown AYA 116 60 52% 13% 83% 2% 2% 96% 2% 2% Fertility Preservation 20 16 80% 13% 68% 19% 94% 6% Palliative Care 120 63 53% 21% 74% 5% 97% 3% Psychosocial Oncology 401 212 53% 17% 76% 3% 4% 98% 2% Survivorship (Survivorship, Sexual Health) 584 372 64% 14% 81% 1% 4% 97% 2% 1% Table 5. Clinical Resource Referrals by Age: Total Number of Participant Referred to Clinical Resources in Calendar Years 2019 and 2022 CY 2019 25-34 35-44 45-54 55-64 65-74 75+ TOTALS AYA - - - - - - - Fertility 2(11.1%) 10(55.6%) 4(22.2%) 2(11.1%) 0 (0.0%) 0(0.0%) 18(2.2%) Palliative 1(2.1%) 6(12.8%) 10(21.2%) 14(29.8%) 12(25.5%) 4(8.5%) 47(5.8%) PSO 9(4.7%) 24(12.6%) 59(31.1%) 53(27.9%) 34(17.9%) 11(5.8%) 190(23.6%) Survivorship 5(0.9%) 32(5.8%) 130(23.6%) 149(27.1%) 164(29.8%) 70(12.7%) 550(68.3%) CY 2022 23-34 35-44 45-54 55-64 65-74 75+ TOTALS AYA 21(31.8%) 43(65.5%) 2(3.0%) 0(0.0%) 0(0.0%) 0(0.0%) 66(8.6%) Fertility 10(47.6%) 11(52.4%) 0(0.0%) 0(0.0%) 0(0.0%) 0(0.0%) 21(2.7%) Palliative 2(2.8%) 13(18.1%) 11(15.3%) 17(23.6%) 18(25.0%) 11(15.3%) 72(32.4%) PSO 11(4.4%) 44(17.7%) 75(30.1%) 60(24.1%) 46(18.5%) 13(5.2%) 249(32.4%) Survivorship 7(1.9%) 42(11.6%) 75(20.8%) 111(30.7%) 101(28.0%) 25(6.9%) 361(46.9%) Additional Declarations No competing interests reported. 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Oppong","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABEElEQVRIiWNgGAWjYBACewbGBgkQgx/Ct4FJMOPUYtgA1mLAINkA5qcR1mJwgIEBrAXEAILDRNgy+3DjzS8VfxgMbvcefFzw67yc/IzsxA8MFdaJDbj8wpfYbC1zBmjLnXPJxjP7bhsb3MjdLMFwJh2nFsMexjZpyTaglhs5ZtK8PbcTN0jkbmNgbDuMU4vBGZCWf3At5xLnzwBp+Ydfi+THBqgWnh8HEhtugLQ04NYCdFizNcMxYx7JOUC/8DYkGxucebtZIuFYujFO7/OwP7z5o0ZOjl8aGGI8f+zk5NtzN374UGMti0sLCDDzMDDwMEgAScY2qFACHuUgwPgDRIK0MPwhoHQUjIJRMApGJAAA929ccLqtn0EAAAAASUVORK5CYII=","orcid":"","institution":"The Ohio State University Wexner Medical Center","correspondingAuthor":true,"prefix":"","firstName":"Bridget","middleName":"A.","lastName":"Oppong","suffix":""}],"badges":[],"createdAt":"2024-10-22 14:53:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5312826/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5312826/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":70963104,"identity":"85677046-b3d2-4b70-a2ae-d0a648191ea9","added_by":"auto","created_at":"2024-12-09 15:45:58","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":30143,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend.\u003c/p\u003e","description":"","filename":"OppongSurvivorshipProgramFigure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5312826/v1/dffc5350264159c31b35818d.jpg"},{"id":74096014,"identity":"e8ba5815-a719-4da6-88bc-74e1ff0c8631","added_by":"auto","created_at":"2025-01-17 17:08:47","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1135186,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5312826/v1/1dbc5e5e-87db-42a4-88d2-37de2299ffca.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Preferences for breast cancer survivorship programs among multiracial and ethnic women","fulltext":[{"header":"Background","content":"\u003cp\u003eAlthough disparities persist in breast cancer outcomes, patients overall continue to benefit from advances in multimodal treatment leading to increased survival [1,2]. The 5-year survival rates for early-stage cancer are over 90%, and with rising incidence rates and aging of the U.S. population, the estimated number of cancer survivors now exceeds 3.8 million women [2,3]. As the population of survivors increases, resources addressing supportive care needs, including psychological distress and deficits in physical functioning are needed [4]. To address these deficits, many cancer centers offer a variety of programs geared towards survivors and their family members/ support team [4-7].\u003c/p\u003e\n\u003cp\u003eStudies find that while interest in these survivorship programs (SPs) is generally high, the actual participation remains low. This phenomenon is a result of several barriers including lack of time (82%), work/school (65%), and lack of information about wellness activities (65%) [8]. There are disparities in engagement with support services among racial and ethnic minorities. Specifically, there are limited studies exploring the specific needs of Black breast cancer survivors, and the few that exist report a lack of culturally appropriate cancer resources necessary to help these patients understand and cope with their diagnosis [8-13]. One study found that compared to White survivors, African Americans were more likely to identify barriers related to out-of-pocket costs (28 vs. 51.6 %, p\u0026thinsp;=\u0026thinsp;0.01), other health care costs (21.3 vs. 45.2 %, p\u0026thinsp;=\u0026thinsp;0.01), anxiety/worry (29.4 vs. 51.6 %, p\u0026thinsp;=\u0026thinsp;0.02), and transportation (4.4 vs. 16.1 %, p\u0026thinsp;=\u0026thinsp;0.03) [11].\u003c/p\u003e\n\u003cp\u003eEven when survivorship programming is available, participation varies among different racial and ethnic groups. Specifically, Black survivors are less likely to utilize existing cancer support services. At our institution, 1/3 of all women referred to the free survivorship support services and programs never scheduled appointments to complete the referral [14]. To understand patients\u0026rsquo; needs, we proposed a retrospective analysis of diverse patients\u0026rsquo; needs and preferences in survivorship programs at the James Comprehensive Cancer Center. We evaluated the patient demographics of the participants in the James\u003cem\u003eCare\u003c/em\u003e for \u003cem\u003eLife\u003c/em\u003e programs, specifically to assess patient participation by age, race and ethnicity.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis study is a retrospective analysis of diverse breast cancer patients\u0026rsquo; survivorship needs and preferences. The Stephanie Spielman Comprehensive Breast Center provides care for approximately 1000 analytic breast cancer cases per year. As a part of The Ohio State University Comprehensive Cancer Center \u0026ndash; James Cancer Hospital (OSUCCC \u0026ndash; James), a robust free survivorship support service line for breast cancer patients is provided by physicians, advanced practice providers, psychologists, dieticians, physical therapists, and social workers. Non-clinical services are also widely available to promote holistic wellness and adjustment to life with cancer. These services include cancer and survivorship education, nutrition, exercise, expressive arts, family programming, mind-body-spirit practices, disease-specific support groups, and young adult programming. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe abstracted the demographic information of participants who attended the James\u003cem\u003eCare\u003c/em\u003e for\u003cem\u003e\u0026nbsp;Life\u003c/em\u003e programs from January 2019 through December 2022. We assessed the number of patients referred to individualized clinical resources including Adolescent/young adult care, Fertility preservation, Palliative care, Psychosocial support, and Survivorship. Survivorship is a provider-initiated visit for non-metastatic patients post treatment and includes a treatment summary, holistic needs assessment and healthy lifestyle counseling. Participation in non-clinical program areas included Art, Education, Exercise, Family, Teens, Children, Mind, Body, Spirit, Music, Nutrition, and Young Adult Survivors (ages 18-39). Descriptive statistics were utilized to summarize patterns based on age, race and ethnicity, and zip code observed within our institution. Given small samples, race categories are grouped into non-Hispanic White, Black and other.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eData\u003cstrong\u003e-\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe Cancer Support Service Line uses an institutional quality dashboard through a data visualization tool called Tableau to monitor clinical services. Data collection of patient demographics, referral patterns, utilization trends, and encounter volumes began in July 2014 (which was the start of the academic and fiscal year) and is updated monthly through the present day. Data collected from participants who register and attend SPs were collected through Qualtrics and an internal REDCap database, funded by the National Center for Advancing Translational Sciences (Grant UL1TR001070). Data is captured by tracking registration, attendance, and post-program evaluations. \u0026nbsp;Program evaluations querying demographic and program acceptability are emailed to all individuals who register and attend a program as well as to walk-in participants who did not register but attended and provided their email address. SPs are offered to cancer survivors and caregivers across all cancer sites.\u0026nbsp;Evaluations are reviewed after every program to measure the effectiveness in meeting the program goals and objectives and to identify trends in registration, attendance, and participant responses that inform necessary changes to the program.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAnalysis-\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eDescriptive statistics were utilized to summarize available data from the study period. The distribution of participant characteristics is presented using frequencies and percentages for categorical data and using means and standard deviations for continuous data. Zip code data is used to categorize counties of residence within the state of Ohio. Approval for use and publication of our institution\u0026rsquo;s internal quality data related to this study was granted by The Ohio State University Comprehensive Cancer Center (OSUCCC) \u0026ndash; #2023COO46 and the James Quality and Patient Safety Committee.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe James and Stephanie Spielman Comprehensive Cancer Center treat 1,100 breast cancer patients each year. James\u003cem\u003eCare\u003c/em\u003e for \u003cem\u003eLife\u003c/em\u003e provides supportive and educational programs that are offered at no charge and available to individuals diagnosed with cancer and their caregivers/family members. Programs can be accessed from the time of diagnosis and throughout survivorship. James\u003cem\u003eCare\u003c/em\u003e for \u003cem\u003eLife\u003c/em\u003e programs facilitate the holistic treatment of breast cancer including the physical, emotional, spiritual, and practical aspects through education, healthy lifestyle programs and peer support groups. The James\u003cem\u003eCare\u003c/em\u003e for\u003cem\u003e\u0026nbsp;Life\u003c/em\u003e program areas include Art and Music classes, Living Well with Advanced Breast Cancer, Survivorship Conference, Education, Exercise, Family, Teens, and Children, Mind, Body and Spirit, Nutrition, and Young Survivors. The programs are offered in person and online.\u0026nbsp;Classes are facilitated by other cancer experts including physicians, nurses, dieticians, physical therapists, social workers and integrative medicine and wellness specialists. From 2019-2022, 2,198 breast cancer participants attended James\u003cem\u003eCare\u003c/em\u003e for \u003cem\u003eLife\u0026nbsp;\u003c/em\u003eprograms. The most attended\u0026nbsp;programs\u0026nbsp;during this period were nutrition and exercise. The annual percentage of participants attending nutrition programs ranged from 32.5% (2019) to 39.9% (2022).\u0026nbsp;For exercise, the annual percentage of participants ranged from 13.7% (2019) to 22.6% (2022). Participation in the exercise program increased during the years of the COVID pandemic while participation in the nutrition program decreased. [Table 1]\u003c/p\u003e\n\u003cp\u003eWithin the study period, a majority of James\u003cem\u003eCare\u003c/em\u003e for \u003cem\u003eLife\u003c/em\u003e attendees were White (74.0% - 82.3%). Black attendance decreased from 9.9% (2019) to 5.7% (2022). Asian/Pacific Islander attendees initially made up 4.3% of all attendees in 2019. During the COVID pandemic, their participation increased to 7.4% - 14.0% of all participants and then decreased to 8.7% in 2022. All other minority groups including American Indian, Hispanic/Latino, multi-racial, and other decreased during the COVID pandemic and through 2022. [Table 2]\u003c/p\u003e\n\u003cp\u003eFrom 2019-2022, the majority of James\u003cem\u003eCare\u003c/em\u003e for \u003cem\u003eLife\u003c/em\u003e attendees were within the 60-69 age group (45.8% - 60.1%). All age groups except 60-69 years-old and 70+ years age groups had an overall decrease in program participation in 2019 compared to 2022. Patients in the 18-39, 40-49, and 50-59 age ranges participated less during the COVID pandemic while 60-69 years-old and 70+ years-old groups had an increase in participation. Notably, participants age 70+ years-old nearly doubled from 9.4% (2019) to 18.1% (2022). [Table 3]\u003c/p\u003e\n\u003cp\u003eThe James and Stephanie Spielman Comprehensive Breast Center offer additional clinical resources with referrals available to breast cancer patients. These clinical resources include Adolescent/Young Adult (AYA), Fertility Preservation, Palliative Care, Psychosocial Oncology (PSO) and Survivorship. These clinical resources are\u0026nbsp;additional visits with a specialty physician or advanced practice provider (APP), or a mental health provider. A total of 5,297 patients were referred to these clinical resources in 4 years. The highest number of referrals were to the survivorship clinics (52%)\u0026nbsp;followed by psychosocial oncology. Of all the clinical resources, the highest proportion of completed referrals were to the Adolescent/Young Adult (97%) and Fertility Preservation (74%) in 2019. The percentage of completed referrals out of total referrals remained the highest for Fertility Preservation in 2022 (80%). The percentage of referrals for Black patients to Palliative Care, Psychosocial Oncology, and Survivorship all increased from 2019 to 2022. Of note, Black patients were frequently referred to Palliative Care, with the proportion of referrals nearly doubling from 11% (2019) to 21% (2022). Referrals to all clinical resources increased for Latino/Hispanic patients from \u0026le;1% in 2019 to 2-6% in 2022. [Table 4]\u003c/p\u003e\n\u003cp\u003eIn 2019 most survivorship participants fell within the 65-74 age group (30%), however it was the 55-64 age group that saw the highest referral rate in 2022 (31%). Referrals to survivorship clinics in the 75+ age group saw a 64% decrease within the study period while referrals to palliative care saw a 175% increase. [Table 5]\u003c/p\u003e\n\u003cp\u003eAnnually, ~72% of the study population resided in Franklin County, followed by Delaware (up to 10%). [Figure 1]\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThese data show differences in provider referrals to clinical survivorship resources for different age groups and White compared to Black women. With patient attendance in non-clinical SPs, utilization is similar across race and age groups, with the majority choosing nutrition and exercise programs. Notable, however, is the decrease in Black participants over the study period\u0026nbsp;declining from 9.9% (2019) to 5.7% (2022). This keeps with the observation that Black patients outside of minority serving institutions have lower participation in survivorship support services and programs\u0026nbsp;[10,11,15].\u0026nbsp;Black women of lower socioeconomic status are also less likely to undergo guideline-concordant survivorship care [16]. Ko, et al recently investigated the unique needs of survivorship care of Black patients at multiple institutions and identified religion and spirituality as key resources for coping with breast cancer [17]. In this study, clinical referrals to\u0026nbsp;palliative care increased\u0026nbsp;for Black patients. Historically, Black patients present with more advanced disease and worse prognosis [1,18,19]. This may necessitate involvement of palliative care services that address pain management in addition to end of life planning.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAccording to SEER data from 2017-2021, breast cancer patients aged 65-74 make up the majority of newly diagnosed female breast cancer, with a median age at diagnosis of 63 years-old [20]. Elderly breast cancer patients commonly present with concurrent increased frailty, comorbid conditions, decreased functional status, and fewer social and economic resources.\u003c/p\u003e\n\u003cp\u003eThe unique needs of this vulnerable majority of breast cancer survivors have not been well studied [21,22]. The elderly patients in our study are getting fewer clinical referrals to survivorship, however, they are increasing their participation in James\u003cem\u003eCare\u003c/em\u003e for \u003cem\u003eLife\u0026nbsp;\u003c/em\u003eprograms. It appears they are self-selected for more support services; however, providers are not referring them for a formal survivorship visit as often. In a study by Krok-Schoen et al. analyzing the perspectives of survivorship care plans (SCP) among older breast cancer survivors, while all patients received SCPs, less than a quarter of them were aware of these plans suggesting a communication barrier between patients and their providers. Suggested areas of improvement included clearer communication, more long-term resources, and the use of health coaches to facilitate patients\u0026rsquo; adherence to their SCPs [23].\u003c/p\u003e\n\u003cp\u003eTo reduce barriers and facilitate access to survivorship care and services,\u0026nbsp;navigation is increasingly utilized. Although historically associated with screening, navigation can be used across the breast cancer care continuum [24]. Insurvivorship, a navigator can educate women on how to improve their overall wellness, thereby directly impacting the health of a growing population of cancer survivors\u0026nbsp;[25-28].\u0026nbsp;Studies show that navigation has increased patient reported quality of life\u0026nbsp;[29, 30]. \u0026nbsp; Dixit et al. show trends towards improvement in the change in emotional well-being score, functional well-being score and overall QOL in the intervention arm, but it was not statistically significant. The change in physical well-being scores was similar. There was no difference in the mean self-efficacy scores for both arms\u0026nbsp;[30]. In a recent randomized trial of Hispanic breast cancer survivors, Ramirez et al. showed that navigation resulted in significantly improved quality of life measures in a 6‐month period\u0026nbsp;[31].\u0026nbsp;Unfortunately, most of these studies did not include Black or elderly women.\u003c/p\u003e\n\u003cp\u003eEstablishing survivorship programming for the breast cancer population requires consideration of disparities in patient ages, race and ethnicity, and education among other variables. Monitoring and evaluating these data offerings allow programming tailored to the population. \u0026nbsp;At our institutions patients are majority White and reside within our local catchment (Franklin County), despite our patient catchment extending across the entire state of Ohio and beyond to neighboring states of West Virginia, Indiana, and Kentucky. Therefore, we are not attracting the wider segment of our breast cancer survivors. Even with most of our SPs transitioned to virtual visits, attendance has not broadened beyond Franklin County. There is considerable dynamism with the county population necessitating frequent evaluation of SPs, new immigrant communities and non-native English speakers have changed the local demographic over the years. This will require expansion of programs to Spanish language focus for example. Our current study shows only ~2% of our participants self-reported Hispanic ethnicity which will increase as the local population evolves.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eLimitations\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eGiven the retrospective nature of this study anticipated biases are present. Also, participant self-reported data is at risk for recall bias. Furthermore, the database used is focused on quality evaluation and is therefore limited in terms of the data variables captured. While this manuscript is focused on \u0026ldquo;patients\u0026rdquo; and being referred to supportive care resources, JCFL programs aren\u0026rsquo;t just available for James patients but are also open to community members who might not be James patients and might not have been referred to programs by their healthcare team. This is a limited number but is not differentiated by the current database. Similarly, planned deeper analysis to explore factors associated with participation was limited due to the lack of collected anonymous and individual data. Qualitative data is lacking that would allow for a better understanding of why certain programs were selected and what future individual needs are.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThese descriptive data show the population our current survivorship service line serves and associated participant preferences. Black women underutilize these supportive services, while women over 70 years-old have increased their participation. Further investigation is planned to explore and understand factors associated with SP participation. A necessary first step is to optimize the institutional database to improve post participation data capture. Future program development will address inclusivity of minority and elderly women, as well as ensure equitable access to survivorship resources through navigation.\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eStatements and Declarations:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript. The authors have no relevant financial or non-financial interests to disclose.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eHill, D.A., et al., Temporal trends in breast cancer survival by race and ethnicity: A population-based cohort study. PLoS One, 2019. 14(10): p. e0224064.\u003c/li\u003e\n \u003cli\u003eMiller KD, Nogueira L, Devasia T, Mariotto AB,\u0026nbsp;Yabroff KR, Jemal A, Kramer J, Siegel RL. Cancer treatment and survivorship statistics, 2022. CA Cancer J Clin. 2022 Sep;72(5):409-436. doi: 10.3322/caac.21731. Epub 2022 Jun 23. PMID: 35736631.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eKaur M, Joshu CE, Visvanathan K, Connor AE. Trends in breast cancer incidence rates by race/ethnicity: Patterns by stage, socioeconomic position, and geography in the United States, 1999-2017. Cancer. 2022 Mar 1;128(5):1015-1023. doi: 10.1002/cncr.34008. Epub 2021 Nov 3. PMID: 34731501; PMCID: PMC9533488.\u003c/li\u003e\n \u003cli\u003eWong EC, Kaplan CP, Barulich M, Melisko M. Assessing preferences for receiving supportive care resources among patients seen at a Breast Care Center. \u003cem\u003eBreast cancer research and treatment\u003c/em\u003e, \u003cem\u003e183\u003c/em\u003e(2), 381\u0026ndash;389. https://doi.org/10.1007/s10549-020-05786-0 \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eWong EC, Kaplan CP, Dreher N, Hwang J, Van\u0026apos;t Veer L, Melisko ME. Integration of Health Questionnaire Systems to Facilitate Supportive Care Services for Patients at an Academic Breast Care Center. JCO Clin Cancer Inform. 2018 Dec;2:1-13. doi: 10.1200/CCI.18.00018. PMID: 30652601.\u003c/li\u003e\n \u003cli\u003eLoibl S, Lederer B. The importance of supportive care in breast cancer patients. Breast Care (Basel). 2014 Apr;9(4):230-1. doi: 10.1159/000366526. PMID: 25404880; PMCID: PMC4209283.\u003c/li\u003e\n \u003cli\u003eO\u0026rsquo;Malley, D.M., Davis, S.N., Amare, R. \u003cem\u003eet al.\u003c/em\u003e User-Centered Development and Patient Acceptability Testing of a Health-Coaching Intervention to Enhance Cancer Survivorship Follow-up in Primary Care. \u003cem\u003eJournal of cancer education : the official journal of the American Association for Cancer Education, 37(3), 788\u0026ndash;797. https://doi.org/10.1007/s13187-020-01883-2\u0026nbsp;\u003c/em\u003e\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSzuhany, K. L., Malgaroli, M., Riley, G., Miron, C. D., Suzuki, R., Park, J. H., Rosenthal, J., Chachoua, A., Meyers, M., \u0026amp; Simon, N. M. (2021). Barriers and engagement in breast cancer survivorship wellness activities. \u003cem\u003eBreast cancer research and treatment\u003c/em\u003e, \u003cem\u003e188\u003c/em\u003e(1), 317\u0026ndash;325. https://doi.org/10.1007/s10549-021-06279-4\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eCoughlin, S. S., Yoo, W., Whitehead, M. S., \u0026amp; Smith, S. A. (2015). Advancing breast cancer survivorship among African-American women. \u003cem\u003eBreast cancer research and treatment\u003c/em\u003e, \u003cem\u003e153\u003c/em\u003e(2), 253\u0026ndash;261. https://doi.org/10.1007/s10549-015-3548-3.\u003c/li\u003e\n \u003cli\u003eHaynes-Maslow, L., M. Allicock, and L.S. Johnson, \u003cem\u003eCancer Support Needs for African American Breast Cancer Survivors and Caregivers.\u003c/em\u003e J Cancer Educ, 2016. \u003cstrong\u003e31\u003c/strong\u003e(1): p. 166-71\u003c/li\u003e\n \u003cli\u003ePalmer, N.R.A., Weaver, K.E., Hauser, S.P. \u003cem\u003eet al.\u003c/em\u003e Disparities in barriers to follow-up care between African American and White breast cancer survivors. \u003cem\u003eSupport Care Cancer\u003c/em\u003e \u003cstrong\u003e23\u003c/strong\u003e, 3201\u0026ndash;3209 (2015).\u003c/li\u003e\n \u003cli\u003eBinkley JM, Gabram S, Finley J, Fowler D, VanHoose L, McCullough LE. Racial disparity in breast cancer survivorship: themes from a series of four national healthcare provider live virtual forums. J Cancer Surviv. 2023 Aug;17(4):1008-1016. doi: 10.1007/s11764-023-01373-6. Epub 2023 Apr 11. Erratum in: J Cancer Surviv. 2023 Jul 22. doi: 10.1007/s11764-023-01393-2. PMID: 37040001.\u003c/li\u003e\n \u003cli\u003ePinheiro LC, Samuel CA, Reeder-Hayes KE, Wheeler SB, Olshan AF, Reeve BB. Understanding racial differences in health-related quality of life in a population-based cohort of breast cancer survivors. Breast Cancer Res Treat. 2016 Oct;159(3):535-43. doi: 10.1007/s10549-016-3965-y. Epub 2016 Sep 1. PMID: 27585477; PMCID: PMC5031495 https://doi.org/10.1007/s00520-015-2706-9 \u0026nbsp;\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eOppong, B.A., et al. Utilization of cancer survivorship services during the COVID-19 pandemic in a tertiary referral center. J Cancer Surviv 17, 1708\u0026ndash;1714 (2023)\u003c/li\u003e\n\u003c/ol\u003e\n\u003col start=\"15\"\u003e\n \u003cli\u003eBiancuzzi, H., et al., \u003cem\u003ePost-breast\u003c/em\u003e\u003cem\u003e\u0026nbsp;cancer coaching: the synergy between health and fitness through co-production.\u003c/em\u003e Ig Sanita Pubbl, 2019. \u003cstrong\u003e75\u003c/strong\u003e(3): p. 181-187.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eSamuel CA, Pinheiro LC, Reeder-Hayes KE, et al. To be young, Black, and living with breast cancer: a systematic review of health-related quality of life in young Black breast cancer survivors. Breast Cancer Res Treat. 2016; 160(1): 1-15. doi:10.1007/s10549-016-3963-0\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eKo NY, Fikre TG, Buck AK, Restrepo E, Warner ET. Breast cancer survivorship experiences among Black women. Cancer. 2023;129(S19):3087-3101. doi:10.1002/cncr.34634\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eErica M. Stringer-Reasor et al., Disparities in Breast Cancer Associated With African American Identity. Am Soc Clin Oncol Educ Book 41, e29-e46(2021).DOI:10.1200/EDBK_319929,\u003c/li\u003e\n \u003cli\u003eRichardson, L.C., et al., Patterns and Trends in Age-Specific Black-White Differences in Breast Cancer Incidence and Mortality - United States, 1999-2014. MMWR Morb Mortal Wkly Rep, 2016. 65(40): p. 1093-1098.\u003c/li\u003e\n \u003cli\u003eAbdel-Razeq H, Abu Rous F, Abuhijla F, Abdel-Razeq N, Edaily S. Breast Cancer in Geriatric Patients: Current Landscape and Future Prospects. Clin Interv Aging. 2022 Sep 28;17:1445-1460. doi: 10.2147/CIA.S365497. PMID: 36199974; PMCID: PMC9527811.\u003c/li\u003e\n \u003cli\u003eMohile SG, Hurria A, Cohen HJ, et al. Improving the quality of survivorship for older adults with cancer. Cancer. 2016;122(16): 2459-2568. \u0026nbsp;\u003c/li\u003e\n \u003cli\u003eFaul LA, Luta G, Sheppard V, et al. Associations among survivorship care plans, experiences of survivorship care, and functioning in older breast cancer survivors: CALGB/Alliance 369901. J Cancer Surviv. 2014;8(4):627\u0026ndash;637.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eKrok-Schoen JL, Naughton MJ, Noonan AM, Pisegna J, DeSalvo J, Lustberg MB. Perspectives of Survivorship Care Plans Among Older Breast Cancer Survivors: A Pilot Study. Cancer Control. 2020 Jan-Dec;27(1):1073274820917208. doi: 10.1177/1073274820917208. PMID: 32233798; PMCID: PMC7143997.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eOppong BA. Rumano R, Paskett ED. Expanding the Use of Patient Navigation: Health Coaching-Based Navigation as a Novel Approach to Addressing Deficits in Breast Cancer Survivorship Support. Breast Cancer Res Treat, 2024 Jan 25. doi: 10.1007/s10549-023-07213-6. Online ahead of print. PMID: 38273216\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eCoughlin, S.S., et al., \u003cem\u003eAdvancing breast cancer survivorship among African-American women.\u003c/em\u003e Breast Cancer Res Treat, 2015. \u003cstrong\u003e153\u003c/strong\u003e(2): p. 253-61.\u003c/li\u003e\n \u003cli\u003eRobinson-White, S., et al., Patient navigation in breast cancer: a systematic review. Cancer Nurs, 2010. 33(2): p. 127-40.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eChan, R. J., Milch, V. E., Crawford-Williams, F., Agbejule, O. A., Joseph, R., Johal, J., Dick, N., Wallen, M. P., Ratcliffe, J., Agarwal, A., Nekhlyudov, L., Tieu, M., Al-Momani, M., Turnbull, S., Sathiaraj, R., Keefe, D., \u0026amp; Hart, N. H. (2023). Patient navigation across the cancer care continuum: An overview of systematic reviews and emerging literature. CA: A Cancer Journal for Clinicians, 73(6), 565\u0026ndash;589. https://doi.org/10.3322/caac.21788\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eBaik SH, Gallo LC, Wells KJ. Patient Navigation in Breast Cancer Treatment and Survivorship: A Systematic Review. J Clin Oncol. 2016 Oct 20;34(30):3686-3696. doi: 10.1200/JCO.2016.67.5454. PMID: 27458298; PMCID: PMC5065113.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003ePratt-Chapman, M., et al., \u003cem\u003eSurvivorship navigation outcome measures: a report from the ACS patient navigation working group on survivorship navigation.\u003c/em\u003e Cancer, 2011. \u003cstrong\u003e117\u003c/strong\u003e(15 Suppl): p. 3575-84.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eDixit N, Sarkar U, Trejo E, et al. Catalyzing Navigation for Breast Cancer Survivorship (CaNBCS) in Safety-Net Settings: A Mixed Methods Study. Cancer Control. 2021;28. doi:10.1177/10732748211038734\u003c/li\u003e\n \u003cli\u003eRamirez, A.G., et al., \u003cem\u003eQuality of life outcomes from a randomized controlled trial of patient navigation in Latina breast cancer survivors.\u003c/em\u003e Cancer Med, 2020. \u003cstrong\u003e9\u003c/strong\u003e(21): p. 7837-7848.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1.\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eJames\u003cem\u003eCare\u003c/em\u003e for \u003cem\u003eLife\u003c/em\u003e Attendance by Program Area:\u003c/strong\u003e Total Number of Participant Attendees in Calendar Years 2019-2022\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"759\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21.3439%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProgram Area\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.7628%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal Breast Cancer Participants \u0026ndash; CY2019\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.7628%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal Breast Cancer Participants \u0026ndash; CY2020\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.7628%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal Breast Cancer Participants \u0026ndash; CY2021\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.3676%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal Breast Cancer Participants - CY2022\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.3439%;\"\u003e\n \u003cp\u003eArt\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7628%;\"\u003e\n \u003cp\u003e24(5.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7628%;\"\u003e\n \u003cp\u003e24(4.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7628%;\"\u003e\n \u003cp\u003e16(2.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.3676%;\"\u003e\n \u003cp\u003e14(2.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.3439%;\"\u003e\n \u003cp\u003eAsk the Expert \u0026ndash; Living Well with Advanced Breast Cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.7628%;\"\u003e\n \u003cp\u003e13(3.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.7628%;\"\u003e\n \u003cp\u003e29(5.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.7628%;\"\u003e\n \u003cp\u003eNA \u0026ndash; Program on Hold\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.3676%;\"\u003e\n \u003cp\u003e18(3.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.3439%;\"\u003e\n \u003cp\u003eBreast Cancer Survivorship Conference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.7628%;\"\u003e\n \u003cp\u003e78(18.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.7628%;\"\u003e\n \u003cp\u003e61(11.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.7628%;\"\u003e\n \u003cp\u003e41(6.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.3676%;\"\u003e\n \u003cp\u003e44(8.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.3439%;\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7628%;\"\u003e\n \u003cp\u003e41(9.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7628%;\"\u003e\n \u003cp\u003e41(8.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7628%;\"\u003e\n \u003cp\u003e59(9.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.3676%;\"\u003e\n \u003cp\u003e55(10.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.3439%;\"\u003e\n \u003cp\u003eExercise\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7628%;\"\u003e\n \u003cp\u003e57(13.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7628%;\"\u003e\n \u003cp\u003e168(32.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7628%;\"\u003e\n \u003cp\u003e227(37.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.3676%;\"\u003e\n \u003cp\u003e122(22.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.3439%;\"\u003e\n \u003cp\u003eFamily, Teens, Children\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7628%;\"\u003e\n \u003cp\u003e13(3.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7628%;\"\u003e\n \u003cp\u003e4(0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7628%;\"\u003e\n \u003cp\u003e5(0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.3676%;\"\u003e\n \u003cp\u003e1(0.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.3439%;\"\u003e\n \u003cp\u003eMind, Body, Spirit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7628%;\"\u003e\n \u003cp\u003e41(9.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7628%;\"\u003e\n \u003cp\u003e65(12.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7628%;\"\u003e\n \u003cp\u003e103(17.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.3676%;\"\u003e\n \u003cp\u003e66(12.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.3439%;\"\u003e\n \u003cp\u003eMusic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7628%;\"\u003e\n \u003cp\u003e7(1.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7628%;\"\u003e\n \u003cp\u003e4(0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7628%;\"\u003e\n \u003cp\u003e4(0.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.3676%;\"\u003e\n \u003cp\u003e5(0.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.3439%;\"\u003e\n \u003cp\u003eNutrition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7628%;\"\u003e\n \u003cp\u003e135(32.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7628%;\"\u003e\n \u003cp\u003e121(23.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7628%;\"\u003e\n \u003cp\u003e142(23.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.3676%;\"\u003e\n \u003cp\u003e216(39.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.3439%;\"\u003e\n \u003cp\u003eYoung Survivors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7628%;\"\u003e\n \u003cp\u003e6(1.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7628%;\"\u003e\n \u003cp\u003e6(1.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.7628%;\"\u003e\n \u003cp\u003e5(0.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.3676%;\"\u003e\n \u003cp\u003e0(0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u0026nbsp;\u003c/strong\u003e \u003cstrong\u003eJames\u003cem\u003eCare\u003c/em\u003e for \u003cem\u003eLife\u003c/em\u003e Attendance by Participant Race/Ethnicity:\u0026nbsp;\u003c/strong\u003eTotal Number of Participant Attendees in Calendar Years 2019-2022\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"750\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20.8%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProgram Participant Race/Ethnicity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal Breast Cancer Participants \u0026ndash; CY2019\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal Breast Cancer Participants \u0026ndash; CY2020\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 19.2%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal Breast Cancer Participants - CY2021\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal Breast Cancer Participants \u0026ndash; CY 2022\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8%;\"\u003e\n \u003cp\u003eAfrican American/Black\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003e41(9.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003e43(8.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.2%;\"\u003e\n \u003cp\u003e40(6.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003e31(5.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8%;\"\u003e\n \u003cp\u003eAmerican Indian\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003e4(1.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003e0(0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.2%;\"\u003e\n \u003cp\u003e1(0.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003e1(0.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8%;\"\u003e\n \u003cp\u003eAsian/Pacific Islander\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003e18(4.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003e39(7.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.2%;\"\u003e\n \u003cp\u003e84(14.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003e47(8.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8%;\"\u003e\n \u003cp\u003eCaucasian/White\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003e307(74.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003e409(78.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.2%;\"\u003e\n \u003cp\u003e448(74.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003e445(82.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8%;\"\u003e\n \u003cp\u003eHispanic/Latino\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003e7(1.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003e5(1.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.2%;\"\u003e\n \u003cp\u003e0(0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003e4(0.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8%;\"\u003e\n \u003cp\u003eMulti-racial\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003e14(3.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003e10(1.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.2%;\"\u003e\n \u003cp\u003e6(1.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003e6(1.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8%;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003e19(4.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003e15(2.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.2%;\"\u003e\n \u003cp\u003e23(3.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003e2(0.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 20.8%;\"\u003e\n \u003cp\u003eDid not answer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003e5(12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003e3(0.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19.2%;\"\u003e\n \u003cp\u003e0(0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20%;\"\u003e\n \u003cp\u003e5(0.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eJames\u003cem\u003eCare\u003c/em\u003e for \u003cem\u003eLife\u003c/em\u003e Attendance by Participant Age:\u0026nbsp;\u003c/strong\u003eTotal Number of Participant Attendees in Calendar Years 2019-2022\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"714\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16.8067%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProgram Participant Age\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.0084%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal Breast Cancer Participants \u0026ndash; CY2019\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.0084%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal Breast Cancer Participants \u0026ndash; CY2020\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20.1681%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal Breast Cancer Participants - CY2021\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.0084%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal Breast Cancer\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eParticipants \u0026ndash; CY 2022\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16.8067%;\"\u003e\n \u003cp\u003e18-39 years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.0084%;\"\u003e\n \u003cp\u003e25(6.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.0084%;\"\u003e\n \u003cp\u003e17(3.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.1681%;\"\u003e\n \u003cp\u003e15(2.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.0084%;\"\u003e\n \u003cp\u003e20(3.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16.8067%;\"\u003e\n \u003cp\u003e40-49 years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.0084%;\"\u003e\n \u003cp\u003e53(12.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.0084%;\"\u003e\n \u003cp\u003e47(9.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.1681%;\"\u003e\n \u003cp\u003e65(10.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.0084%;\"\u003e\n \u003cp\u003e35(6.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16.8067%;\"\u003e\n \u003cp\u003e50-59 years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.0084%;\"\u003e\n \u003cp\u003e79(19.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.0084%;\"\u003e\n \u003cp\u003e99(18.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.1681%;\"\u003e\n \u003cp\u003e88(14.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.0084%;\"\u003e\n \u003cp\u003e87(16.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16.8067%;\"\u003e\n \u003cp\u003e60-69 years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.0084%;\"\u003e\n \u003cp\u003e190(45.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.0084%;\"\u003e\n \u003cp\u003e315(60.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.1681%;\"\u003e\n \u003cp\u003e324(53.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.0084%;\"\u003e\n \u003cp\u003e262(48.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16.8067%;\"\u003e\n \u003cp\u003e70+ years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.0084%;\"\u003e\n \u003cp\u003e39(9.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.0084%;\"\u003e\n \u003cp\u003e32(6.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.1681%;\"\u003e\n \u003cp\u003e82(13.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.0084%;\"\u003e\n \u003cp\u003e98(18.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 16.8067%;\"\u003e\n \u003cp\u003eDid not answer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.0084%;\"\u003e\n \u003cp\u003e29(7.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.0084%;\"\u003e\n \u003cp\u003e14(2.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 20.1681%;\"\u003e\n \u003cp\u003e28(4.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.0084%;\"\u003e\n \u003cp\u003e39(7.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4. Clinical Resource Referrals by Race\u003c/strong\u003e: Total Number of Participants Referred to Clinical Resources in Calendar Years 2019 and 2022 \u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"733\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eClinical Resource\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"10\" style=\"width: 629px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2019\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eTotal Referrals\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompleted Referrals\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e%\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 210px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eRace\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 222px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthnicity\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eBlack\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eWhite\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eAsian\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eOther\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eNot Hispanic or Latino\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eLatino/ Hispanic Other\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eUnknown\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eAYA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e97%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eFertility Preservation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e74%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e99%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e99%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003ePalliative Care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e57%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e11%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e89%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e99%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003ePsychosocial Oncology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e379\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e190\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e50%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e11%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e84%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e99%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eSurvivorship (Survivorship, Sexual Health)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 71px;\"\u003e\n \u003cp\u003e797\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e546\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e69%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e9%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e85%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e98%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 78px;\"\u003e\n \u003cp\u003e1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"732\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eClinical Resource\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"10\" style=\"width: 630px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e2022\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eTotal Referrals\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompleted Referrals\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 43px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e%\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eRace\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width: 222px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthnicity\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eBlack\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eWhite\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eAsian\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eOther\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eNot Hispanic or Latino\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eLatino/ Hispanic Other\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eUnknown\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003eAYA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e116\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e52%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e13%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e83%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e96%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003eFertility Preservation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e80%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e13%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e68%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e19%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e94%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e6%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003ePalliative Care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e53%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e21%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e74%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e5%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e97%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003ePsychosocial Oncology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e401\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e212\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e53%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e17%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e76%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e3%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e98%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003eSurvivorship (Survivorship, Sexual Health)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e584\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e372\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e64%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e14%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e81%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 53px;\"\u003e\n \u003cp\u003e1%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e4%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e97%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 70px;\"\u003e\n \u003cp\u003e2%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e1%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5. Clinical Resource Referrals by Age:\u003c/strong\u003e Total Number of Participant Referred to Clinical Resources in Calendar Years 2019 and 2022\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"672\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\" valign=\"bottom\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCY 2019\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0298%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.6071%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e25-34\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.6071%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e35-44\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.5%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e45-54\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.5%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e55-64\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.5%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e65-74\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.6071%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e75+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.6488%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTOTALS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0298%;\"\u003e\n \u003cp\u003eAYA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.6071%;\"\u003e\n \u003cp\u003e\u0026nbsp;-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.6071%;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.5%;\"\u003e\n \u003cp\u003e-\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.5%;\"\u003e\n \u003cp\u003e-\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.5%;\"\u003e\n \u003cp\u003e-\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.6071%;\"\u003e\n \u003cp\u003e-\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.6488%;\"\u003e\n \u003cp\u003e-\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0298%;\"\u003e\n \u003cp\u003eFertility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.6071%;\"\u003e\n \u003cp\u003e2(11.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.6071%;\"\u003e\n \u003cp\u003e10(55.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.5%;\"\u003e\n \u003cp\u003e4(22.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.5%;\"\u003e\n \u003cp\u003e2(11.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.5%;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.6071%;\"\u003e\n \u003cp\u003e0(0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.6488%;\"\u003e\n \u003cp\u003e18(2.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0298%;\"\u003e\n \u003cp\u003ePalliative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.6071%;\"\u003e\n \u003cp\u003e1(2.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.6071%;\"\u003e\n \u003cp\u003e6(12.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.5%;\"\u003e\n \u003cp\u003e10(21.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.5%;\"\u003e\n \u003cp\u003e14(29.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.5%;\"\u003e\n \u003cp\u003e12(25.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.6071%;\"\u003e\n \u003cp\u003e4(8.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.6488%;\"\u003e\n \u003cp\u003e47(5.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0298%;\"\u003e\n \u003cp\u003ePSO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.6071%;\"\u003e\n \u003cp\u003e9(4.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.6071%;\"\u003e\n \u003cp\u003e24(12.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.5%;\"\u003e\n \u003cp\u003e59(31.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.5%;\"\u003e\n \u003cp\u003e53(27.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.5%;\"\u003e\n \u003cp\u003e34(17.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.6071%;\"\u003e\n \u003cp\u003e11(5.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.6488%;\"\u003e\n \u003cp\u003e190(23.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0298%;\"\u003e\n \u003cp\u003eSurvivorship\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.6071%;\"\u003e\n \u003cp\u003e5(0.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.6071%;\"\u003e\n \u003cp\u003e32(5.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.5%;\"\u003e\n \u003cp\u003e130(23.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.5%;\"\u003e\n \u003cp\u003e149(27.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.5%;\"\u003e\n \u003cp\u003e164(29.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.6071%;\"\u003e\n \u003cp\u003e70(12.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.6488%;\"\u003e\n \u003cp\u003e550(68.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\" valign=\"top\" style=\"width: 100%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCY 2022\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0298%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.6071%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e23-34\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.6071%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e35-44\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.5%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e45-54\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.5%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e55-64\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.5%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e65-74\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.6071%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e75+\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.6488%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTOTALS\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0298%;\"\u003e\n \u003cp\u003eAYA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.6071%;\"\u003e\n \u003cp\u003e21(31.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.6071%;\"\u003e\n \u003cp\u003e43(65.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.5%;\"\u003e\n \u003cp\u003e2(3.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.5%;\"\u003e\n \u003cp\u003e0(0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.5%;\"\u003e\n \u003cp\u003e0(0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.6071%;\"\u003e\n \u003cp\u003e0(0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.6488%;\"\u003e\n \u003cp\u003e66(8.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0298%;\"\u003e\n \u003cp\u003eFertility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.6071%;\"\u003e\n \u003cp\u003e10(47.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.6071%;\"\u003e\n \u003cp\u003e11(52.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.5%;\"\u003e\n \u003cp\u003e0(0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.5%;\"\u003e\n \u003cp\u003e0(0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.5%;\"\u003e\n \u003cp\u003e0(0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.6071%;\"\u003e\n \u003cp\u003e0(0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.6488%;\"\u003e\n \u003cp\u003e21(2.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0298%;\"\u003e\n \u003cp\u003ePalliative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.6071%;\"\u003e\n \u003cp\u003e2(2.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.6071%;\"\u003e\n \u003cp\u003e13(18.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.5%;\"\u003e\n \u003cp\u003e11(15.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.5%;\"\u003e\n \u003cp\u003e17(23.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.5%;\"\u003e\n \u003cp\u003e18(25.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.6071%;\"\u003e\n \u003cp\u003e11(15.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.6488%;\"\u003e\n \u003cp\u003e72(32.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0298%;\"\u003e\n \u003cp\u003ePSO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.6071%;\"\u003e\n \u003cp\u003e11(4.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.6071%;\"\u003e\n \u003cp\u003e44(17.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.5%;\"\u003e\n \u003cp\u003e75(30.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.5%;\"\u003e\n \u003cp\u003e60(24.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.5%;\"\u003e\n \u003cp\u003e46(18.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.6071%;\"\u003e\n \u003cp\u003e13(5.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.6488%;\"\u003e\n \u003cp\u003e249(32.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 15.0298%;\"\u003e\n \u003cp\u003eSurvivorship\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.6071%;\"\u003e\n \u003cp\u003e7(1.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.6071%;\"\u003e\n \u003cp\u003e42(11.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.5%;\"\u003e\n \u003cp\u003e75(20.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.5%;\"\u003e\n \u003cp\u003e111(30.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.5%;\"\u003e\n \u003cp\u003e101(28.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.6071%;\"\u003e\n \u003cp\u003e25(6.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 12.6488%;\"\u003e\n \u003cp\u003e361(46.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"breast cancer, survivorship, support services, race ","lastPublishedDoi":"10.21203/rs.3.rs-5312826/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5312826/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose:\u003c/strong\u003e With advancements in breast cancer treatment, survivorship has increased, leading to 3.8 million survivors in the US. These women have diverse supportive care needs, often addressed through Survivorship Programs (SPs), which provide clinical and non-clinical support services. SPs aim to deliver a holistic approach to comprehensive breast cancer treatment and recurrence prevention. Historically, disparities in SP utilization exist among minority and elderly women. This study aims to explore trends varying in SP participation by age and race within a single institution.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A retrospective analysis of breast cancer patients' survivorship needs at the James Comprehensive Cancer Center was conducted. Data were collected from JamesCare for Life programs (2019-2022), including demographics and referrals to clinical resources such as Adolescent/Young Adult care, Fertility preservation, Palliative care, Psychosocial support, and Survivorship. Participation in non-clinical areas, including Art, Education, Exercise, Mind-Body-Spirit, and Nutrition, was also evaluated. Descriptive statistics summarized patterns based on age, race, and ethnicity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e From 2019-2022, 2,198 patients attended SPs, with Nutrition and Exercise being the most popular. Most attendees were 60-69 years old and White. Black attendees declined from 9.9% (2019) to 5.7% (2022). Clinical resources showed the highest referral rate to survivorship clinics. Black patients saw an increase in palliative care referrals, rising from 11% to 21%.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Data reveal differences in clinical referrals by age and race, with fewer referrals for older women and more for Black patients. Participation in non-clinical SPs was similar across groups. Future program development will focus on inclusivity and equitable access.\u003c/p\u003e","manuscriptTitle":"Preferences for breast cancer survivorship programs among multiracial and ethnic women","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-09 15:45:53","doi":"10.21203/rs.3.rs-5312826/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0c52872d-c5ec-408d-ac4d-890594160a4f","owner":[],"postedDate":"December 9th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-01-17T17:08:39+00:00","versionOfRecord":[],"versionCreatedAt":"2024-12-09 15:45:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5312826","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5312826","identity":"rs-5312826","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}