Development of a novel cancer diagnostic center to facilitate care coordination for patients with new or suspected diagnoses of cancer.
Authors: Murphy Jacob , Balasubramaniyan Kumar , Parma Mitchell , Guo Matthew , Reeb Kristen , Zhang Xinyi , Wang Zheyu , Feliciano Josephine Louella 
Published: September 2024

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Background:
Navigating a cancer diagnosis is a multifaceted challenge, characterized by intricate care coordination that creates potential for workup and treatment delays, lapses in care, and potentially negatively affecting clinical outcomes. We have developed a novel physician and advanced practitioner-led cancer diagnostic program (CDP) to help navigate patients with a suspected cancer through the diagnostic and staging workup, discussion of results, and linkage to oncologic care. Patients are referred to the CDP, an administrative intake coordinator creates a medical chart, verifies insurance, gathers records, and schedules appointments. An intake nurse reaches out within 24 hours to obtain clinical information and review of systems. Patients are offered an in-person or video visit with the advanced practitioner for history and physical, labs, and further coordination of testing. Here, we aim to describe the demographic and clinical patterns of referral and clinical outcomes of patients who were referred to a CDP over one calendar year.
Methods:
We retrospectively analyzed 154 patients with a new cancer diagnosis to have at least 1 encounter at the Johns Hopkins CDP between January 1, 2022, and December 31, 2022. Data were retrospectively collected from medical records and stored within Johns Hopkins REDCap. Descriptive analyses were used to describe the data.
Results:
Among the 154 total patients included in this analysis, 65.6% were White, 24.7% were Black, 3.2% were Asian, and 1.9% were of Hispanic, Latino, or Spanish origin. Insurance coverage was most frequently (46.8%), Medicare (40.3%), and Medicaid (8.4%). Referral distribution shows 50 inpatient and 104 outpatient referrals. Primary cancer diagnoses were most often gastrointestinal (39.6%), upper airway and lung (26.6%), and genitourinary (9.1%).
Conclusions:
The Johns Hopkins CDP exemplifies the potential for dedicated diagnostic and treatment initiation programs to improve oncologic care, particularly for vulnerable populations. The center facilitates expedited diagnostic resolution, to increased ease of workup for patients and providers, and potentially improve clinical outcomes such as linkage to care and time to treatment. Accepting referrals from inpatient and outpatient settings captures a broad patient pool, including those who may otherwise experience lapses in care owing to complex care navigation needs. In conclusion, we describe a novel care delivery model to potentially optimize healthcare delivery in oncologic care.

Inpatient Referral
Outpatient Referral

Percent minority populations
34%
23.1%

Stage 4 at diagnosis
74%
52.9%

Patients initiating treatment with curative intent
42.3%
30%

Median length of hospitalization
7 days
N/A

Median time from pathology results to discharge
-2.5 days
N/A

Median time from pathology results to treatment initiation
20 days
16.5 days