bluuebunny/crossref_metadata_2025 huggingface dataset:
Implementation of care near home model (CNH) for cancer patients in response to COVID-19 pandemic.
Authors: Jazieh Abdul-Rahman , Al Mutairi Nashmia , Al Hadab Abdulrahman , Al Olayan Ashwaq , Al Hejazi Ayman , Al Qarni Abdullah , Al Zahrani Mohsen , Shehata Hussam , Al Shami Mona , Al Raizah Abdulrahman , Gadallah Azzah , Musumadi Luhanga , Al Rabeeah Fawaz , Alotaibi Thamer , Al Ajlan Abdulaziz
Published: October 2020

32

Background: Cancer care is heavily centered in health care facilities due to the requirements of providing complex multidisciplinary care with multiple testing and interventions. We describe our experience in implementing a new model of care to minimize cancer patients visit to health care facilities and to reduce the risk of infections and to decrease the pressure on the health care system. Methods: In response to the COVID-19 pandemic, we reengineered the cancer care process to reduce patients visit to the hospital by the implementation of a Care Near Home (CNH) Model, which comprises of four components: virtual clinic, laboratory testing near home, shipping medications and supplies, and involving local health care facilities. The effectiveness and acceptance of this new model has been assessed by the delivery of timely care successfully and assessing the satisfaction patients and healthcare providers. Results: On March 18, 2020, we launched the virtual clinics followed by different components of the model. The number of virtual clinic visits has increased significantly from 399 visits in March to 1107 in April 2020. More the 90% of physicians and patients who responded to the survey expressed their acceptance and satisfaction with the virtual clinic services. Medications were shipped to total of 603 patients. Of those, 578 (96%) patients received their medications (378 patients outside city, 200 patients inside city of which, 95% received medications within 24 hours). Only 25 (4%) patients did not receive their medications and we arrange for alternative solutions. Laboratories in various regions were set up to perform the tests for our patients and to communicate the results through our electronic healthcare records system. The process of ordering and performing the test were piloted with success and now we are at the scaling up phase. Conclusions: Although the implementation of CNH Model was driven by COVID-19 pandemic, it will be integrated in our work process and utilized as a long term approach to manage many of our patients because it is more convenient to them and more cost effective to the health care system.
Feasibility, delivery, and acceptance of a multidisciplinary survivorship care model based in an Asian national ambulatory cancer center: A six-month review.
Authors: Ke Yu , Neo Patricia Soek Hui , Loh Kiley , Yang Grace Meijuan , Ho Shirlynn , Tan Yee Pin , Ramalingam Mothi Babu , Quah Daniel , Chew Lita , Si Phebe , Tan Yung Ying , Tay Beng Choo , Koh Suzanne Poh Geok , Chan Alexandre
Published: October 2020

34

Background: Accessible Cancer Care to Enable Support for Cancer Survivors (ACCESS) is a multidisciplinary survivorship care model launched at the National Cancer Centre Singapore, the largest ambulatory cancer centre serving 70% of adult cancer patients in the public sector. ACCESS employs routine distress screening to triage patients with varying care needs and complexities. This study aims to examine the feasibility, delivery, and acceptance of ACCESS in providing appropriate service referrals to cancer patients in clinical settings. Methods: As part of an ongoing evaluation, we evaluated ACCESS for a 6-month implementation period between September 2019 and February 2020. Feasibility was assessed by proportions of (1) eligible breast and gynecological cancer patients who completed the locally adapted Distress Thermometer (DT) screening tool, (2) highly distressed patients, and (3) highly distressed patients requiring multidisciplinary meetings (MDM). Delivery was characterized by the mode and number of supportive care team (SCT) reviews required. Acceptance rates of SCT reviews by distressed patients and the uptake rate of service referrals recommended by the SCT were tabulated. Results: ACCESS screened 1074/1471 (73.0%) of all eligible patients within the 6-month period and identified 239/1074 (22.3%) as highly distressed for follow-up with the SCT. Eventually, 84.5% agreed to SCT review, with approximately one-fourth (26.7%) requiring MDM reviews. The majority (62.4%) of all distressed patients were identified at their first DT completion, whereas 19.8% and 7.4% were identified at their second and third completions respectively. The most common modes of follow-up were phone reviews (49.9%) and face-to-face in clinic waiting areas (48.6%). The SCT recommended 80 referrals to distressed patients for the following services: psychosocial (27.2%), cancer rehabilitation (5.9%), and home hospice (5.0%). The acceptance rates of the referrals for psychosocial, rehabilitation, and hospice services were 43.6%, 75.0%, and 80.0% respectively. Conclusions: ACCESS is a feasible model for triaging Asian cancer patients based on distress levels, and identifying complex patients requiring care personalization through MDM. The poorer acceptance rate of psychosocial services highlights patients’ preference for interventions targeting physical than psychosocial issues. Future studies should explore whether the uptake of psychosocial services is higher in the post-COVID era.
Addressing reproductive health needs of cancer patients: The pilot experience of pioneering oncofertility clinic in Saudi Arabia.
Authors: Alrabiah Hayat Ahmed , Abdelhafeiz Nafisa , Al Olayan Ashwaq , Jazieh Abdul-Rahman
Published: October 2020

37

Background: Fertility and reproductive health issues are commonly encountered in cancer patients and survivors and unfortunately, they are not systematically addressed in many cancer care centers. We are reporting the initial experience in our dedicated Oncofertility Clinic that was established to address all reproductive and fertility issues for all oncology patients at our cancer center. Methods: We launched the first dedicated oncofertility clinic in the region on April 2018, staffed by a consultant of obstetrics and gynecology with the help of a team from in vitro fertilization (IVF) unit and a medical oncologist. It is held on a weekly basis and receives referral from medical oncology, hematology, stem cell transplant and radiation oncology. Eligible patients are males and premenopausal females going for chemotherapy or radiation therapy aiming for fertility preservation or cancer survivors who completed treatment and complaining of infertility problems. The clinic provides fertility preservation through the following procedures: Oocytes freezing (OF), in-vitro fertilization (IVF), sperm freezing, and ovarian transposition. Oncofertility care also includes management of sexual and hormonal dysfunction, and contraception methods. We are capturing the demographic, clinical data of all patients who were served in the clinic and the number of interventions and procedures that they underwent. Results: Between April 2018 and April of 2020, the clinic served 100 patients 60% were female, Median age was 35 years (16 -39). Diagnoses were distributed between breast cancer (36%), lymphoma (10%), and sickle cell anemia patients undergoing hematopoietic stem cell transplant (10%). The table depicts the types and number of procedures performed on these patients. Conclusions: Our pilot experience revealed the critical need of such clinic to help patients in fertility preservation, management of symptoms of gonadal toxicity. Future plans include implementation of systematic screening approach cancer populations who will benefit from the services and monitor the long- term impact of the clinic on the served patients. [Table: see text]
Multiple myeloma (MM) therapy within a Medicare-insured patient population: Role of care setting and oncologist sub-specialization in hematologic malignancies.
Authors: Davidoff Amy J. , Long Jessica B. , Huntington Scott F.
Published: October 2020

38

Background: Dramatic increases in oncology practice consolidation with hospitals may affect care setting and whether patients see oncologists that specialize in their cancer, with downstream effects on treatment patterns. This may be particularly true for MM, where approval of new immunomodulatory drugs (IMiDs) and proteasome inhibitors (PIs), coupled with evidence supporting PI-IMiD combinations, maintenance (MT), and stem cell transplant (SCT) among fit patients, have expanded options, complexity and lines of therapy (LOT). Methods: We selected adults with MM diagnosis (dx) between 07/07-12/15 from the SEER-Medicare linked database. We required continuous Medicare Parts A and B enrollment and no HMO/PPO coverage from 12 months prior to dx (1 month prior for Part D) through death or end of study (12/16) and MM therapy initiation w/in 12 months post dx. Outcomes including LOT1 PI-IMiD combination, SCT, MT, and any LOT2, 3 or 4 were constructed using claims indicators for oral and IV drugs and receipt dates. Provider setting was assigned as academic and/or NCI cancer center, non-teaching hospital, or community (non-hospital) based on the most recent oncologist E and M visit prior to LOT1 initiation. Percentage of patient panel with hematologic malignancies (Heme%) was calculated for each oncologist, using a pooled sample of 11 major cancer sites reported in SEER-Medicare. Multivariable logistic regressions included care setting, %Heme, with controls for demographics, health status, and diagnosis year. Results: The cohort (n = 4930) was 14% Black, and 51% age ≥75 years. Care setting was 23% academic, 14% non-teaching hospital, and 63% community; community setting decreased from 72 to 58% during observation period (2007 to 2015). Mean Heme% (31% overall) was higher in academic hospitals (44%) compared with community practices (27%; p < .001). LOT1 PI-IMiD, LOT 2, 3 and 4 were received by 21%, 55%, 31% and 18% respectively, with 53% MT, and 7% SCT. Higher %Heme was associated with increased likelihood of LOT1 PI-IMiD, SCT, LOT3, and LOT4. Relative to academic/NCI, community care was associated with higher adjusted odds for LOT1 PI-IMiD: aOR 1.33, p < .001; but lower odds for any LOT4: aOR .67, p = .001). Conclusions: Using a novel measure of oncologist sub-specialization in hematologic malignancies, we found positive associations with receipt of initial PI-IMiD therapy and ongoing LOTs in a Medicare insured population treated for MM. Surprisingly, care in a community setting was associated with recommended initial PI-IMiD therapy, but fewer LOTs.
Testicular cancer management: Population-wide, rapid case ascertainment to drive early expert engagement and reduced practice variation.
Authors: Harzstark Andrea , Herrinton Lisa J. , Walker Lauren C. , Liu Liyan , Kolevska Tatjana , St. Lezin Mark , Nichols Craig R. , Daneshmand Siamak , Presti Joseph
Published: October 2020

39

Background: Research priorities in germ cell tumor (GCT) management have moved sharply from therapeutic improvements to cancer care delivery research and biomarker-based decision making. Early intervention with centralized decision support and oversight by expert teams result in best therapeutic outcomes and survivorship with decreased resource utilization. We describe Kaiser Permanente Northern California’s (KPNC) re-organization of care delivery through rapid case ascertainment and early expert input, as well as early results of reduction in practice variation and system-wide practice change. Methods: In 2016, KPNC reorganized oncology from a distributed generalist model to a model led by a centralized multidisciplinary expert team to share in initial and ongoing care delivery for all GCT patients in the system. Central to the re-organization was rapid ascertainment of the entire population of patients with GCT within the system and early expert engagement in treatment decision-making. Results: Between May 2016 and June 2018, 274 GCT patients were recorded in the tumor registry, of whom 69% were < 40 years of age, 16% were non-white, 56% had seminoma and 63% had stage 1 disease. Rapid case ascertainment identified 89% (95% CI, 86-93%) of the cases, increasing from 79% in 2016 to 97% in 2018 as false negatives were identified and used to improve the case finding algorithm. The overall positive predictive value was 57% (52-62%) and number needed to detect was 1.75 (1.62-1.91). Of the 274 cases, 92% (89-95%) were engaged by the expert team. In addition, the team reviewed 61 testicular cancer patients who had recurrences or metastatic cancers. Among 177 patients with stage I seminoma, the preferred use of active surveillance over adjuvant chemotherapy or radiation therapy rose from 48% (95% CI, 35-62%) in 2015 to 87% (75-99%) in 2018 (p = 0.0005). For patients with nonseminoma, the rate of the preferred option of retroperitoneal lymphadenectomies being performed by a high volume urologic surgeon increased markedly from 62% in 2015 to 95% in 2018. Conclusions: To our knowledge, the KPNC re-organization of GCT care delivery with comprehensive rapid case ascertainment is unique for integrated health care delivery systems in the USA. While early, KPNC has a working platform for early, expert multidisciplinary review and bidirectional communication with local care teams for population-based care. Early evidence points to system-wide reductions in practice variation and improvements in practice.
Assessing burnout among oncologists in Ontario, Canada.
Authors: Singh Simron , Farrelly Ashley C , Chan Catherine , Nazeri-Rad Narges , Nicholls Brett , Bauman Glenn , Bellicoso Daniela , Eisen Andrea , Falkson Conrad B , Fox Colleen , Holloway Claire MB , Kennedy Erin , McLeod Robin , Rothenberger David A. , Trudeau Maureen E. , Shanafelt Tait D.
Published: October 2020

41

Background: Provider experience and physician burnout has been recognized as a critical issue in medicine. Ontario, Canada has a single payer cancer system run by Ontario Health (Cancer Care Ontario) with a mandate covering system level planning and delivery of cancer services, funding, and quality improvement. As part of a larger provincial initiative to address clinician burnout, we examined the prevalence and drivers of burnout in practicing physician oncologists in Ontario. Methods: In November-December 2019, surgical, medical, hematological, and radiation oncologists in Ontario were invited to complete an anonymous online survey to assess burnout and its drivers. Burnout prevalence was assessed through the Maslach Burnout Inventory – Human Services Survey for Medical Personnel (MBI-HSS MP). Data on demographic, workplace, engagement, and practice profiles were collected. Logistic regression modeling was conducted to assess key variables associated with “high” burnout using a common definition of high scores on the MBI subscales of emotional exhaustion (EE) (> 27) and/or depersonalization (DP) (>10). Results: Response rate to the survey was 44% (n=418) with 72% reporting high levels of burnout. Mean scores for EE (30.7, SD 12.1) and DP (9.9, SD 6.7) were consistent with high burnout. Participants endorsed known drivers of burnout including: 1) a poor culture of wellness at work (e.g., not comfortable talking to leadership (72%), 2) inefficiencies of practice (e.g. feeling insufficient documentation time (67%)) and 3) personal resilience (e.g. not feeling they are contributing professionally in ways they value (21%)). Age (<45yrs) (OR: 2.15), poor/marginal control over workload (OR: 4.42), feeling used/unappreciated (OR: 2.63), working atmosphere that feels hectic/chaotic (OR: 2.68), and insufficient time for documentation requirements (OR: 2.52) significantly impacted the odds of high burnout in the regression model (p<0.05). Conclusions: The high rate of burnout among oncology physicians in a single payer public cancer system in Ontario is concerning for the wellbeing of providers, patients and system sustainability. Drivers important for maintaining a culture of wellness and efficiency of practice will require local, regional and provincial health policy to improve. Next steps will include raising awareness with provincial initiatives/policy to address key burnout drivers, and examining the impact of working under pandemic conditions (Covid-19) on oncologist burnout.
The effect of COVID-19 on revenue cycle staff.
Authors: Poole Stacey L , Blakely Johnetta , Crouse Cheryl , Colangelo Pam , Dickson Natalie R.
Published: October 2020

42

Background: The COVID-19 pandemic caused a public health emergency declaration in March 2020. A safer at home order was issued by the Tennessee governor on March 12 urging non-essential employees to stay at home. The decision was made to offer telecommuting to employees at Tennessee Oncology (TO) who could effectively work from home. 90% of the revenue cycle staff (RCS) began working remotely within a week of the decision. Methods: TO had been conducting a telecommuting pilot involving 20 RCS. This pilot was expanded within a week to accommodate 130 RCS including billing, credentialing, collections, financial counseling, analysts, authorization and benefit specialists. Employees signed telecommuting agreements and provided equipment based on IT recommendations. IT installed software which allowed secure connection through a Citrix gateway. Surveys were later conducted to measure work-from-home satisfaction. Less than 10 RCS remained onsite to perform essential duties. Results: Compared to the prior year there was an 80% reduction in turnover and an 82% reduction in unscheduled absences for telecommuting employees vs in-office employees. 92% reported an improved work/life balance. Productivity metrics by team are displayed below: Key financial metrics including payer turnaround, days in AR and patient payments improved over prior months. Payer turnaround dropped by 3 days and days in AR decreased by 3.9 compared to February. Patient payments were up 14% compared to the prior year. Conclusions: COVID-19 has been a challenging time in healthcare but it has taught us some valuable lessons. Telecommuting could be the wave of the future showing positive financial return in the form of employee retention, reduction of non-productive time (including unplanned absences) and increased employee satisfaction. Data shows these factors lead to higher producing team members who yield superior results. [Table: see text]
Emotional impact of COVID-19 preparations on metro and regional cancer workforces in Queensland Australia: "We are all in this together".
Authors: Roberts Natasha Anne , Chan Bryan , Ahern Elizabeth Stephanie , Gasper Harry Michael , Kennedy Glen , Hughes Brett Gordon Maxwell , Wyld David , Eastgate Melissa A. , Lwin Zarnie
Published: October 2020

44

Background: Australia has achieved a “flattening of the curve” with a sustained COVID-19 roadmap to recovery in place. We explored the emotional impact of COVID-19 on our cancer workforce, during the preparation phase of the pandemic. Methods: We developed and pilot-tested an online survey to capture the emotional impact on cancer care staff during the COVID-19 health system response. Two large cancer centres were identified for study sample, one metropolitan and one regional, in Queensland, Australia. All cancer care staff with patient-facing roles were invited via all-staff email to participate on a weekly basis, uniquely also including ancillary and administrative workers. The final survey questionnaire included qualitative domains with open text responses for reflections on difficult decisions and subsequent emotional impacts. At the same time, a prospective diary of organizational developments was independently maintained by two investigators in order to contextualize changing survey responses over time. Qualitative data analyses by four investigators included independent, multiple cross-coding, memos, dataset review and member-checking to ensure methodological rigour. Data were synthesised into key themes utilising the Framework Method (Gale, 2013). Results: 117 metropolitan and 59 regional staff were surveyed over a 6-week period. Participants were medical, nursing, allied health, administrative and ancillary staff, working across inpatient and outpatient oncology services. Four key themes were emergent across the trajectory of the COVID preparation phase; ‘Strategies for protection’ (self-isolation, using PPE, protecting patients, families and each other), ‘Navigating rules and keeping up’ (compliance, exceptions, conflict and complex decision fatigue), ‘Tempered optimism’ (this is grief, strategies for coping, pride in one’s place), and ‘Framing the new normal’ (using new technology, second wave, uncertainty). At different time points, one theme dominated more than others. Conclusions: Despite rapid adaptations to system changes, staff responses highlight that it was their sense of connectedness that had the greatest influence on their reflections during the COVID-19 pandemic, but also underpinned the humanistic aspects of their responses. Staff perceptions of feeling supported and prepared, permeated through the duration of the survey. Results from the recovery phase are awaited.
Oncology treatments during COVID-19 pandemic in Israel: ONCOR study.
Authors: Wolf Ido , Hirsh-Yechezkel Galit , Chetrit Angela , Ben-Avraham Sivan
Published: October 2020

50

Background: The SARS-CoV-2 pandemic outbreak declared by the World Health Organization in March 2020 challenged health systems in affected countries and raised concerns for its potential direct and indirect impact on cancer patients. Cancer patients are at high risk for COVID-19 infections and complications due to factors related to their underlying condition and treatments. We aimed to evaluate the impact of COVID-19 on clinical activity of the oncology departments in Israel, and to assess the implementation of measures aimed at containment of COVID-19 diffusion, while allowing continuation of quality cancer care. Methods: A national survey among 18 of 19 oncology departments in Israel was conducted on April 2020 focusing on the institute's preparedness for treatment of their cancer patients during the COVID-19 pandemic. Results: Prevention measures against COVID-19 spread were taken prior to patients' arrival and at arrival or while staying at the departments. most participants reported employing a quick triage of patients and caregivers, prior to their entrance to the oncology units. Most departments limited the entrance of caregivers; one third not allowing entrance of any caregivers and more than half allowing entrance of only one caregiver. Some differences between large and small/medium sized medical centers were observed, with less strict measures taken by the smaller hospitals. Most departments implemented steps aimed at reducing unnecessary visits to the clinic. These included a shift to telephone interactions or telemedicine (78%) and switching to oral therapies, rather than intravenous ones, when possible. This approach was taken mostly by the medium/small hospitals compared to large hospitals (60% vs. 92%, p = 0.1). Conclusions: Oncology departments in Israel were able to prepare and adapt their services to guidelines and requirements related to the COVID-19 pandemic with little harm to their treatment capacity. However, some differences between large and small hospitals were noted. These findings call for either better allocation of resources in case of an epidemic.
Oncologist- versus hospitalist-led service: Differences in hospital utilization for solid tumor patients.
Authors: Wu Lesley , Aslanova Minira , Theroux Haley Hines , Huang Hsin-hui , Smith Cardinale B.
Published: October 2020

53

Background: Hospitalists have been practicing alongside oncologists to provide high quality care for hospitalized cancer patients. We examined the differences in hospital utilization and outcomes among solid tumor patients admitted to oncologist-led teams (OT) versus hospitalist-led teams (HT). Methods: We performed a retrospective cohort study of patients with solid tumors admitted to the OT or HT at Mount Sinai Hospital from July to December 2019. We excluded patients less than 18 years of age, primary hematologic malignancies, or admission to intensive care or surgical units. We used the Activity Measure for Post Acute Care (AMPAC) and Charlson Comorbidity Index as a measure of functional ability and illness severity, respectively. We performed bivariate and multivariate analyses comparing differences in length of stay, ICU transfers, palliative care consults, healthcare proxy (HCP) decision, new DNR decision, readmission within 30 days and inpatient mortality by type of admitting service (OT vs HT). Results: A total of 544 patients were identified; 61% (334) admitted to HT. There were significant differences according to race and cancer type (p= 0.001 for both). HT patients had more functional impairment (p<0.0001) and poorer prognosis (p=0.0002). In bivariate analysis, HT had significantly more ICU transfers (OT, 2% vs HT, 8%; p=0.008), new DNR decisions (OT, 7% vs HT, 16%; p=0.002), and inpatient mortality (OT, 4% vs HT, 9%; p=0.02) while OT had significantly more palliative care consults (OT, 45% vs HT, 20%; p<0.0001). Multivariate analysis (Table) demonstrates HT had significantly more new DNR decisions (odds ratio [OR]: 0.46, 95% confidence interval [CI]: 0.23-0.93) and OT had significantly more palliative care consults (OR: 4.01, 95% CI: 2.51-6.43). Conclusions: At our academic hospital, inpatient cancer care led by hospitalists is comparable to that of oncologists despite HT caring for more severely ill oncology patients. From a value perspective, hospitalists facilitating care for hospitalized cancer patients will allow oncologists to maximize ambulatory time and focus on active cancer treatment. [Table: see text]
Process of the integration of patient advisors in oncology: Patient advisors' views.
Authors: Pomey Marie-Pascale , Vachon Marie-France , Charpentier Danielle , Côté Marie-Andrée , Desforges Mado , Bouchard Karine , Vialaron Cécile , Iliescu-Nelea Monica , Normandin Louise
Published: October 2020

54

Background: Since 2017, in Quebec (Canada), a research project is focusing on the feasibility, the processes, and the contribution of integrating patients who have already had cancer experiences (named patient advisors (PA)) in the oncology clinical team. In fact, the trained PA meet patients in health care settings in addition to the other health professionals in order to improve health care and partnership between professionals and patients. This presentation communicates the PA’s perception of their contribution and the factors influencing implementation of these programs in 4 establishments. Methods: Between April and May 2020, semi-structured virtual interviews lasting about 60 minutes were conducted on 12 patient advisors involved since 2017 in the elaboration of these support programs. The interviews were recorded and transcribed completely. The data analysis was done with content analysis using the QDA Miner 5.0 software, applying the qualitative analysis quality standards. Results: First of all, the 12 PAs have reported that the accompaniment of 67 patients have allowed them to share their experiential knowledge not only related to living with the illness but also about healthcare organization and the anticipation of treatments. They also highlighted their capacity to share situations that can be improved by healthcare professionals (example: wait times for exams; patients’ difficulty in understanding their illness, etc). However, they also highlighted 4 factors which limit the implementation: 1) organizational (the unclear and changing nature of the breast cancer consultation schedule, difficulty of access to consultation rooms and unsuitable schedules for the PA’s reality.; 2) leadership (lack of clinicians promoting the intervention; managers’ low involvement; lack of clarity of roles); 3) human (work overload and employee turnover); 4) PA’s status (lack of compensation and of recognition). Also, to optimize their integration, the PA’s suggest to work on a lasting bond of trust with the professionals, the creation of a status recognized by health establishments, the recognition of their role by the clinical team, to give them access to physical spaces, and an openness of the teams to their complementary knowledge. Conclusions: These first results suggest the importance during the implementation of such programs of working proactively with the PAs and the professionals on organization, leadership, resources, and status factors to allow the people dealing with cancer to benefit from experiential knowledge of other patients within their clinical team.
Support by peers in the clinical team in oncology: Perception of the contribution of patient advisors to improve the patient experience.
Authors: Pomey Marie-Pascale , Fortin Israël , Côté Marie-Andrée , Desforges Mado , Bouchard Karine , Vialaron Cécile , Iliescu-Nelea Monica , Normandin Louise
Published: October 2020

57

Background: Since 2018, three establishments in Quebec have introduced patient advisors (PA) in their healthcare team in order to improve cancer patients’ experience. These PA, who have had a cancer experience, meet patients undergoing radiotherapy treatments or in oncogenetics for breast cancer on the healthcare site. They conduct consultations to complete the offer of services by bringing emotional, informational, and educational support. Methods: A longitudinal study of multiple cases was completed from January to June 2020. After each accompaniment, the PA filled out a logbook to document the main themes covered and the accompanied patient fill out a survey to evaluate their experience one week after the intervention. A qualitative analysis of the logbook content and descriptive statistics were conducted. The REDCAP platform was used for monitoring the process of data collection and to administer the surveys online. Results: In total, 67 patients were accompanied by 4 PA. 71 logbooks were completed by the PA. The logbooks show that 70.3% of accompaniments took place right before radiotherapy and 63.6% following the results of the genetic test in oncogenetics. 50% of meetings took place in person in the establishment (in a space dedicated to the PA or not) and 45.8% were by phone. The meetings lasted approximately 37 minutes (min: 15 minutes and max: 90 minutes). The majority only met once (93.1 %). The most common themes discussed are: the role of the PA (94.1%), returning to day life (57.6%) and dealing with stress and anxiety (52.2%). 96% of PA felt that they did not encounter any difficulties during the accompaniment. For the accompanied women, the partnership was most beneficial for their experience with the illness (sharing experiences of side-effects, on the impact of the illness on every day life, with their social circle). 79% of patients found that the accompaniment met their needs. 90% of patients estimate that these meetings are complimentary to the healthcare professionals’ interventions. Finally, 89.5% of accompanied patients think that it would be very important to develop these types of meetings on a larger scale. Concerning the adaptation of spaces for the meetings, 26.3% are very satisfied and 26.3% are rather satisfied (probably an area for improvement). Conclusions: Overall, the partnerships seem to answer the needs of the accompanied patients and the PA can share their experience inside the clinical team.
Fostering interspeciality learning in cancer survivorship care: Learning suite results.
Authors: Chaput Genevieve , Williams Tristan , Sussman Jonathan
Published: October 2020

59

Background: As survivorship provision declines within cancer centres, primary care providers are increasingly entrusted in the follow-up care of cancer survivors. Empowering specialists and primary care providers about survivorship through educational interventions is essential. Interspecialty education is poorly integrated into residency training, which may impede collaboration between different providers in practice. Interspecialty partnership can positively impact patient and resource- use outcomes. The aim of this study was to assess if a cancer survivorship learning suite (LS) impacts attitudes of family medicine, radiation oncology and medical oncology trainees towards interspecialty collaboration in Montreal, Canada. Methods: A survivorship (LS) developed by a Manitoba-based team under the sponsorship of a Canadian Partnership Against Cancer grant held by Cancer Care Ontario was delivered to 49 McGill University family medicine, radiation oncology, and medical oncology trainees. The LS comprised in-person delivery of a 3-hour case-based workshop, presented by a radiation oncologist and a family physician, both experienced in the field of survivorship. An adapted version of the Readiness for Interprofessional Learning Scale (RIPLS) was completed by participants before and after workshop delivery. Statistical analyses included Wilcoxon Signed-rank test comparisons. Results: Response rate was 63.2%, and included family medicine (65%), radiation oncology (26%), and medical oncology (10%) trainees, respectively. Following the workshop, participants were significantly more likely to agree that interspecialty learning in residency “would help physicians become better team workers”, (Z = 2.7, p < 0.008, n = 31), and “improves relationships between physicians of different specialties in independent practice afterwards”, (Z = 2.6, p < 0.009, n = 31). Participants were also significantly more likely to agree that “shared interspecialty learning < would > increase < their > ability to understand clinical problems”, (Z = 2.8, p < 0.005, n = 31). Conclusions: While much literature has focused on interprofessional collaboration at different levels of education and practice, few studies have assessed interspecialty collaboration of physicians of different specialties. This survivorship LS demonstrated favorable changes in attitudes towards interspecialty learning.
Practice patterns in bone modifying agent utilization: An analysis in patients with metastatic cancer and bone involvement at an NCI-designated center.
Authors: Manohar Poorni , Bastys Kyle , Tratt Micah , Gralow Julie , Eaton Keith D.
Published: October 2020

62

Background: Bone modifying agents (BMA) can reduce skeletal related events for patients with metastatic cancer and bone involvement. ASCO supports use of Zoledronic acid (ZA) and Denosumab (DB), with specific endorsement of both an every 3 to 4-week (Q1 month) and every 12-week (Q3 month) schedule for ZA in metastatic breast cancer. Trends in BMA utilization may identify areas to improve value in cancer care. Methods: We retrospectively reviewed utilization of BMAs at Seattle Cancer Care Alliance/University of Washington from fiscal year 2015-2019. We identified 1,286 patients who underwent 12,594 administrations. Data was categorized by BMA (ZA acid vs DB) and disease group. A 45-day cutoff defined interval of treatment (Q1 vs Q3). Whole-sale acquisition cost (WAC) and administration costs were estimated from CMS allowed charges. We calculated total costs spent during time period and projected potential savings for switching from Q1 to Q3 ZA administration. Results: A total of 904 patients received ZA (7201 administrations) and 473 patients received DB (5,393 administrations). The breast, myeloma, prostate, and kidney groups accounted for 81% of administrations. In breast, 427 patients received ZA (1,761 administrations) and 411 patients received DB (2,708 administrations). Among all patients, DM and ZA administrations remained constant over time, however, in breast, there was a trend towards less DB and more ZA administrations. The administration frequency (Q1 vs Q3) for both drugs stayed constant in the total cohort. Among ZA administrations in breast, there was a reversal in the trend for Q1 vs Q3, with Q1 being most common in 2015, and Q3 the most common in 2019 (crossover in 2018 fiscal year). In breast, 30 patients transitioned from Q1 to Q3, with majority occurring before 2017 ASCO update. Total costs on BMA utilization was estimated as $11,672,189,80, 90% attributable to DB. The projected savings for switching from Q1 to Q3 ZA administration was $1,223,961.08. Conclusions: BMA prescribing patterns from 2015-2019 show no change in ZA and DB utilization, though a trend towards increased ZA and decreased DB use in breast cancer was observed. There was a transition in practice patterns to adopt the Q3 ZA administration over time, however, the uptake of this has been incomplete. It is hoped that raising awareness of these practice patterns will lead to adoption of guideline-based decision making and promote value-based cancer care.
Linking reimbursement to patient-reported quality of life: Provider perspectives.
Authors: Feinberg Bruce A. , Jeune-Smith Yolaine , Fortier Stephanie , Yeh Ting-Chun , Kish Jonathan , Gajra Ajeet
Published: October 2020

75

Background: In the value-based era, policymakers have begun incorporating quality of life (QoL) components into payment models, such as the Merit-based Incentive Payment System (MIPs), Oncology Care Model (OCM), and Accountable Care Organization (ACO), to increase accountability. This qualitative research study sought to understand how providers address their patients’ QoL issues in a value-based environment. Methods: A live meeting in September 2019 brought together community oncology healthcare providers (HCPs) from across the United States. Participants submitted their demographic information via a web-based pre-meeting survey and their responses pertaining to patient QoL via an audience response system during the live meeting. Participant responses and their practice demographics were analyzed using descriptive statistics. Results: 71 HCPs participated in this live market research program: 51 medical oncologists/hematologists (herein referred to as physicians) and 20 nurse practitioners or physician assistants (herein referred to as APPs). 50% of physicians and 25% of APPs were from privately owned community practices. Half of HCPs indicated that their practices are collecting and reporting QoL data through value-based programs: 28% of physicians and 60% of APPs were in OCM-participating practices. Regarding accountability, over 80% of HCPs strongly agreed that they have a role in improving patients’ QoL. However, 32% of physicians and 25% of APPs agreed that their payment should be tied to patients’ QoL improvement. According to HCPs, the top factor impacting patients’ QoL was symptom and symptom burden (83%). To address QoL in their patients, HCPs reported addressing patients’ psychosocial needs (78%), implementing survivorship care planning (76%), and using nurse navigators (69%). 70% of physicians and 95% of APPs were confident that their patients have reliable resources for managing their QoL issues. Conclusions: HCPs recognize their role in improving patients’ QoL, and their practices have made several transformations to improve patients’ QoL; they are confident that their patients have resources for managing QoL issues. However, many HCPs disagree with linking QoL improvements to their payment. Further studies are needed to understand QoL from patients’ perspectives in the value-based environment.
Pharmacoeconomic savings associated with alternate dosing strategy of nivolumab and ipilimumab combination therapy.
Authors: Kupsh Allison , Alwan Laura , Segal Eve M. , Hammer Kathryn J. , Hall Evan Thomas
Published: October 2020

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Background: Nivolumab (NIVO) plus ipilimumab (IPI) is a commonly used therapy for advanced melanoma. Original weight-based dosing of NIVO 1 mg/kg plus IPI 3 mg/kg (NIVO1+IPI3) was approved in 2017. Recently, the CHECKMATE 511 trial demonstrated improved tolerability of NIVO 3 mg/kg plus IPI 1 mg/kg (NIVO3 + IPI1) compared to the original dosing regimen without observed differences in efficacy.Objective: To determine the pharmacoeconomic implications of NIVO1+IPI3 and NIVO3+IPI1 with a dose banding strategy applied. Methods: Patients with advanced melanoma (N = 21) who received IPI and NIVO in combination between 4/2019 – 7/2019 were evaluated via a single-center retrospective chart review. A total of 118 checkpoint inhibitor doses (59 NIVO, 59 IPI) were analyzed.Weapplied a dose banding strategy to both NIVO1+IPI3 and NIVO3+IPI1 regimens to examine pharmaceutical expenditures using the two dosing regimens, whichincluded our organization 10% dose-vial rounding policy. Pharmaceutical expenditure using average wholesale price (AWP), which was $32.42 per mg of NIVO and $180.03 per mg of IPI, was calculated for each dosing strategy (NIVO1+IPI3 and NIVO3+IPI1). Results: The anticipated cost savings of patients receiving NIVO3+IPI1 combination therapy compared to NIVO1+IPI3, (both with dose rounding strategy applied), was $1,459,473 or >$70,000 per patient, representing a 47.2% savings from the original NIVO1 +IPI3 regimen (Table). Conclusions: In addition to improved tolerability and comparable efficacy for NIVO3+IPI1 vs NIVO1+IPI3, our study shows that adoption of the NIVO3+IPI1 regimen results in significant savings in drug costs. Considerations should be made in future combination trials to compare NIVO3+IPI1 as a treatment arm to NIVO1+IPI3 to see if comparable clinical results can be obtained with less toxicity and decreased pharmaceutical spending. [Table: see text]
The COVID-19 pandemic impact on breast cancer care delivery at an academic center in New York City.
Authors: Satish Tejus , Raghunathan Rohit , Prigoff Jake , Wright Jason Dennis , Hillyer Grace , Trivedi Meghna S. , Kalinsky Kevin , Crew Katherine D. , Hershman Dawn L. , Accordino Melissa Kate
Published: October 2020

88

Background: The coronavirus disease 2019 (COVID-19) pandemic has altered healthcare delivery. To save resources and reduce patient exposure, non-urgent care has been postponed. Previous work has focused on cancer patients with COVID-19, but little has been reported on the impact on patients without COVID-19. We aimed to characterize breast cancer (BC) patients without COVID-19 whose care was impacted by the COVID-19 pandemic at an academic center in New York City. Methods: We performed a retrospective cohort study of BC patients treated at a medical oncology practice between 2/1/2020-4/30/2020. Patients were included if they were scheduled to receive intravenous or injectable therapy or were scheduled as a new patient. Patients were excluded if they tested positive for COVID-19 or transferred care during the study period. Demographic and treatment information were obtained by chart review. Delays/changes in systemic therapy, imaging, interventional radiology procedures, radiation, and surgery were tracked. Delays were defined as postponements of scheduled care. Changes were defined as care alterations without postponements. Care impact was defined as any change/delay in any of the above oncologic care a patient was scheduled for. We conducted a univariate analysis to compare demographics and care impact using χ2 analyses. Results: Of 351 eligible patients, the majority had stage 0-III BC (71.9%) and hormone receptor-positive HER2-negative BC (69.5%). Less than half were Caucasian (43.9%). Care was impacted due to the pandemic in 149 (42.5%) of patients. Surgery changes/delays were most frequent (37 of 84 patients, 44.0%), followed by changes/delays in systemic therapy (90 of 351 patients, 25.6%) and imaging (58 of 282 patients, 20.6%). Patients of Asian, Black, and other non-reported races were more likely to experience a care impact vs. Caucasian patients (47.1% vs. 44.4% vs. 55.6% vs. 31.2%, p = 0.001). Hispanic patients were more frequently impacted vs. non-Hispanic patients (47.6% vs. 35.9%, p = 0.06). Medicaid and Medicare patients were also more frequently impacted vs. commercially insured patients (54.7% vs. 41.4% vs. 36.2%, p = 0.02). BC stage and hormone receptor status were not significantly associated with care impacts. Conclusions: We found that nearly half of our BC patients experienced a change/delay in workup or treatment during the COVID-19 pandemic. We also found significant racial and socioeconomic disparities in the likelihood of care impact. Ongoing studies will determine the impact of alterations in care on cancer outcomes.
The association between Medicaid insurance, biomarker testing, and outcomes in patients with advanced non-small cell lung cancer (aNSCLC).
Authors: Gross Cary Philip , Meyer Craig S. , Ogale Sarika , Kent Matthew , Wong William Bruce
Published: October 2020

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Background: Prior work suggests that patients (pts) with Medicaid experience lower quality cancer care and worse outcomes than pts with private insurance. It is unclear whether these disparities persist in the era of personalized medicine. We therefore examined the relation between Medicaid (vs private) insurance and receipt of biomarker testing, targeted therapy, and overall survival in a contemporary cohort of pts with aNSCLC. Methods: We conducted a retrospective study of pts with aNSCLC, diagnosed Jan 2011 through Sep 2019 using the nationwide US Flatiron Health EHR-derived de-identified databases comprising data from over 280 (largely community based) cancer clinics (~800 sites of care) and representing more than 2.4 million US cancer patients available for analysis. Eligible pts were 18-64 years old, had either Medicaid or Commercial insurance at the time of advanced diagnosis, and had a visit ≤120 days after advanced diagnosis. We assessed evidence of receipt of biomarker testing (ALK, EGFR, BRAF, ROS1, PDL1) according to year of diagnosis. The likelihood of testing, biomarker-driven therapy (immunotherapy (CIT) or tyrosine kinase inhibitor (TKI) treatment and mortality were compared by insurance type using Cox regression adjusted for baseline characteristics. Results: The sample included 6,145 commercially insured and 865 Medicaid pts. Compared with commercially insured pts, Medicaid beneficiaries were more likely to be Black (20% vs. 9.3%); P < 0.01) and less likely to have evidence of testing with any biomarkers (57% vs. 71%; P < 0.01). In the adjusted analysis, Medicaid pts were less likely to have evidence of testing (HR [95%CI]: 0.81 [0.74, 0.89], p < 0.01), any 1L treatment (HR [95%CI]: 0.72 [0.66, 0.79], p < 0.01) and 1L biomarker-driven therapy (HR [95%CI]: 0.70 [0.58, 0.84], p < 0.01). A higher risk of death was observed in Medicaid vs. commercially insured pts (HR [95%CI]: 1.23 [1.13, 1.34], p < 0.01) which was partially ameliorated after adjusting for testing and treatment (HR [95% CI: 1.15 [1.05, 1.25], p < 0.01). Among Medicaid pts, those who had no biomarker tests had a 27% higher risk of mortality compared to those who had at least one test (HR [95% CI: 1.27 [1.06, 1.53], p < 0.01). Conclusions: Medicaid pts with aNSCLC had a 23% higher risk of mortality than commercially insured pts. The increased risk of mortality was partially mediated by disparities in testing and treatment, and improved access to these resources may improve outcomes for Medicaid beneficiaries.