Impact of an Electronic Patient-Reported Outcome-Informed Clinical Decision Support Tool on Clinical Discussions With Head and Neck Cancer Survivors: Findings From the HN-STAR Randomized Controlled Trial (WF-1805CD).

509 Background: ASCO guidelines for care of post-treatment head and neck cancer (HNC) survivors recommend comprehensive management of late effects, comorbidities, health behaviors, and cancer risks. We developed HN-STAR: a clinical decision support tool based on electronic patient-reported outcomes (ePROs) to improve implementation of HNC survivorship guidelines. Methods: We conducted a site-randomized controlled trial of oncology practices in the Wake Forest NCI Community Oncology Research Program (NCORP) Research Base (NCT04208490) comparing HN-STAR to usual care during a routine clinic visit. Eligible disease-free survivors completed treatment for HNC <2 years prior. In both arms, prior to the visit, survivors completed validated ePROs for 25 concerns (symptoms, well-being, and health behaviors). Concerns were characterized as absent or mild vs. burdensome. The HN-STAR tool presented survivor’s burdensome concerns and tailored recommendations for clinician review during the visit. Clinicians selected management plans in HN-STAR for each concern. Post-visit, all survivors reported which concerns were discussed at the clinic visit (regardless of whether the concern was reported pre-visit). Comparisons between groups were made by mixed models adjusted for correlation within practices. We hypothesized that survivors in the HN-STAR arm would report 1) more concerns discussed, 2) more of their burdensome concerns discussed, and 3) a greater proportion of their burdensome concerns discussed, compared to survivors receiving usual care. Results: 335 survivors (mean age 64 years, 23% Hispanic or Non-White, 26% non-metropolitan) at 26 practices reported a mean of 7.7 burdensome concerns (standard deviation [sd] 4.6) pre-visit, most commonly dry mouth (71%), altered taste (54%), neck or shoulder stiffness (48%), and fatigue (40%). In adjusted models, survivors in the HN-STAR arm had a greater proportion of burdensome concerns discussed at the visit than survivors in the usual care arm (60% vs. 44%, p=0.01) (Table). Conclusions: In a large, national, diverse, and symptomatic sample of HNC survivors at community oncology practices, using an ePRO-informed clinical decision support tool increased the likelihood that burdensome concerns were discussed in clinic. Alerting providers to burdensome concerns and presenting guideline-concordant management options has promise for improving provider-survivor interactions. Clinical trial information: NCT04208490 . HN-STARN=136 Usual careN=199 p-value # concerns discussed, median (interquartile range [IQR]) 7.0 (4.0, 10.0) 5.0 (2.0, 9.0) 0.25 # burdensome concerns discussed, median (IQR) 4.0 (2.0, 7.0) 3.0 (1.0, 5.0) 0.10 Proportion of burdensome concerns discussed, mean (sd) 0.60 (0.32) 0.44 (0.32) 0.01

The Head and Neck Survivorship Tool (HN-STAR) Trial (WF-1805CD): A protocol for a cluster-randomized, hybrid effectiveness-implementation, pragmatic trial to improve the follow-up care of head and neck cancer survivors

Drug shortages represent a challenge in oncology care, with potential repercussions including suboptimal treatment options, treatment delays, and medication errors. However, there is scant evidence on how drug shortages interrupt cancer care delivery (CCD) nationally and specifically across National Cancer Institute (NCI) Community Oncology Research Program (NCORP) community oncology practices. Between December 2020 and July 2024, 96 NCORP community oncology practices were enrolled. NCORP practice study staff completed the Drug Shortage Baseline Survey and Pharmacy Baseline Survey. The primary outcome was proportion of practices seriously affected by drug shortages (ie, encountered CCD problems [change to less effective treatments, adoption of more toxic alternatives, treatment delays, or an increase in medication errors or near misses]) in the past 3 months. Secondary outcomes included CCD problems among practices (eg, ethical dilemmas) and strategies used by practices (eg, use of alternative drugs, stockpiling). Finally, we described differences between seriously affected and nonaffected practices. Nearly 54% of NCORP practices were seriously affected by drug shortages in the past 3 months, with 23 drugs (including carboplatin [24.7%], leucovorin [22.6%], and cisplatin [19.4%]). Seriously affected practices were more likely to report lack of suitable alternatives (34.7% v 13.6%), substantial resources spent (70.8% v 50.0%), and change to alternative administration (73.5% v 52.3%) and were less likely to hire staff to address shortages (16.3% v 36.4%). Strategies to address shortages included using alternative drugs (91.5%), stockpiling (87.2%), and developing action plans (84.0%). Most (50.5%) practices reported experiencing an ethical dilemma related to a drug shortage. Drug shortages influenced CCD among NCORP practices. This study underscores the need for robust strategies and policies to mitigate these effects and enhance the resilience of oncology practices.

Capacity for cancer care delivery research in gynecologic oncology within the National Cancer Institute Community Oncology Research Program (NCORP)

Community research has been an integral and influential component of the National Research Program since the late 1970s. Institutionalization of community research in the Community Clinical Oncology Program (CCOP) has resulted in successful collaborations, meaningful accrual, achievement of quality standards, and translation of research into clinical practice. Although the national clinical trial system is undergoing modernization and improvement, the success of the CCOP and minority-based CCOP in cancer treatment, prevention, and control research is being extended to include cancer care delivery research in the newly created National Cancer Institute (NCI) Community Oncology Research Program. This article briefly presents a historic perspective of community involvement in federally sponsored clinical trials and introduces the continued involvement in the newly created NCI program.

Lung Cancer Screening in the National Cancer Institute Community Oncology Research Program: Availability and Service Organization

Adolescents and young adults (AYAs, age 15-39 years) with cancer are vulnerable to the harmful effects of cancer-related financial hardship. Our objective was to describe financial distress screening and financial navigation across National Cancer Institute Community Oncology Research Program (NCORP) practices treating AYAs with cancer. The 2022 NCORP Landscape Assessment was developed and refined by an expert committee to assess infrastructure and capacity to conduct oncology research. Survey items specific to financial distress screening and cancer-specific financial navigation were compared on the basis of practice and patient characteristics among practices treating AYAs. A total of 271 NCORP practices (45 of 46 NCORP sites; 517 of 1,000+ discrete clinics) responded to the survey April through June 2022. One-hundred practices (37.0%) were characterized as treating AYAs. Most practices reported routinely screening for financial distress (82.0%) via social worker evaluation (57.0%). Financial concerns were addressed via social workers (81.0%), cancer-specific financial navigation (47.0%), billing staff (46.0%), general financial navigation (35.0%), or outside case management (31.0%). A lower proportion of practices with access to cancer-specific financial navigation reported having a dedicated AYA program (10.6% v 28.3%, odds ratio [OR], 0.30 [95% CI, 0.10 to 0.91]; P = .028) or treating >30% of patients insured by Medicaid (6.4% v 26.4%, OR, 0.19 [95% CI, 0.05 to 0.71]; P = .008) compared with those without cancer-specific financial navigation. Although most NCORP practices treating AYAs reported routinely screening for financial distress, only one half of practices offer cancer-specific financial navigation. Practices treating a higher percentage of patients at greatest risk for financial hardship have less access to cancer-specific financial navigation. Further research is needed to support expansion of financial navigation services among community oncology practices that treat AYAs.

BackgroundNational cancer organizations recommend provision of nutrition, physical activity, and mental health supportive services to cancer survivors. However, the availability of these services across diverse community oncology settings remains unclear.MethodsThe National Cancer Institute Community Oncology Research Program (NCORP) is a national network of community oncology practices engaged in cancer research. The 2022 NCORP Landscape Assessment (5UG1CA189824) assessed individual practices’ establishment of survivorship clinics and nutrition, physical activity, and mental health services, resources, and/or referrals. Descriptive statistics summarized and logistic regression quantified the association between services, practice, and patient characteristics.ResultsOf 46 NCORP community sites, 45 (98%) responded to the survey, representing 259 adult practice groups. A total of 41% had a survivorship clinic; 96% offered mental health, 94% nutrition, and 53% physical activity services, resources, and/or referrals. All 3 services were offered in various formats (eg, in-house, referrals, education) by 51% and in-house only by 25% of practices. Practices with advanced practice providers were more likely to have a survivorship clinic (odds ratio [OR] = 3.19, 95% confidence interval [CI] = 1.04 to 9.76). Practices with at least 30% Medicare patients (OR = 2.54, 95% CI = 1.39 to 4.66) and more oncology providers (OR = 1.02, 95% CI = 1.01 to 1.04) were more likely to have all 3 services in any format. Practices with at least 30% Medicare patients (OR = 3.41, 95% CI = 1.50 to 7.77) and a survivorship clinic (OR = 2.84, 95% CI = 1.57 to 5.14) were more likely to have all 3 services in-house.ConclusionsLarger oncology practices and those caring for more survivors on Medicare provided more supportive services, resources, and/or referrals. Smaller practices and those without survivorship clinics may need strategies to address potential gaps in supportive services.

Health-related social needs (HRSNs) are associated with adverse cancer health outcomes. We assessed the processes for screening and responding to both HRSNs and financial distress and described the methods used across National Cancer Institute Community Oncology Research Program (NCORP) practices. The NCORP 2022 Landscape Assessment survey focused on services to screen for and respond to HRSNs and financial distress within a national network of community oncology practices. We calculated the proportions of oncology practices that screened for and responded to HRSNs and financial distress, separately, and described the staff, tools, and methods used for each process. Multivariable logistic regression models estimated the associations between oncology practice characteristics and screening for HRSNs and financial distress. The majority of community oncology practices reported screening for HRSNs (79%), and of those, most inquired about transportation (96%), family and social support (93%), housing (80%), and food security (80%). Most oncology practices reported screening for financial distress (78%). Social worker evaluation was the most common method used to screen for both HRSNs (77%) and financial distress (65%). Most oncology practices reported social work referral as the method for responding to HRSNs (89%) and financial distress (96%). Oncology practice characteristics such as having a survivorship clinic and geographic region were associated with screening for HRSNs and financial distress. Research is needed to understand the impact of different HRSN screening and referral approaches on care delivery, clinic costs, care quality, and health outcomes of patients with cancer. These efforts are critical to generate evidence to inform best practices, clinical guidelines, and novel interventions aimed to improve cancer health equity.

219 Background: Understanding experiences of community oncology practices in recruiting informal (unpaid/family) caregivers into research studies can inform resources and strategies to improve their enrollment. In this study, we aimed to describe the recruitment of informal caregivers for research studies in community oncology practices. Methods: The 2022 cross-sectional Landscape Assessment of National Cancer Institute Community Oncology Research Program (NCORP) assessed research capacity among network oncology practices. The University of Rochester Cancer Center (URCC) NCORP Research Base used these data to examine factors associated with the recruitment of informal caregivers into research studies in community oncology practices, adjusting for region of the country, practice ownership type, and total number of oncologists in logistic regression analyses. Results: Information was available from 517 discrete practices representing 271 practice groups. After excluding those serving pediatric patients exclusively (n=12) and missing information on recruitment of informal caregivers (n=1), 258 practice groups were included in final analyses. The practice groups had on average 20 oncologists [standard deviation (SD) 28.8]. Over 70% of practice groups (190/258) had advanced practice providers (APPs) involved in clinical research activities. Less than one third of practice groups (30%, 78/258) had experience recruiting informal caregivers of oncology patients for research studies. Informal caregivers were recruited in the following settings: medical oncology (97%, 76/78), radiation oncology (24%, 19/78), survivorship clinic (14%, 11/78), and surgical oncology (10%, 8/78). On multivariable analysis, having a greater number of oncologists [odds ratio (OR) 2.40, 95% Confidence Interval (95% CI) 1.23 - 4.67] and having APPs involved in clinical research activities (OR 2.32, 95% CI 1.13 - 4.76) were positively associated with experience recruiting informal caregivers for research studies. Conclusions: Most community oncology practices did not have experience recruiting informal caregivers of oncology patients, which may reflect limited research in this area. Future research should explore barriers for recruiting informal caregivers into research studies, especially in practices that may have fewer resources such as small community oncology practices or those without APPs involved in research activities.

Capacity for Cancer Care Delivery Research in National Cancer Institute Community Oncology Research Program Community Practices: Availability of Radiology and Primary Care Research Partners

Cancer-related financial hardship is associated with poor quality of life, risk of household material hardship, and psychological distress for families affected by pediatric cancer. Current processes on financial distress screening and financial navigation across the pediatric National Cancer Institute Community Oncology Research Program (NCORP) network remain unknown. Financial distress screening and financial navigation services among NCORP practices were assessed using two survey items from the 2022 NCORP Landscape Assessment Survey. Practices answering yes to providing oncology care for pediatric patients were included. Univariable models were used to test associations between practice characteristics and financial screening and financial navigation. Of the 53 NCORP practices serving pediatric patients with cancer that responded to the survey, 44 (83%) reported routinely conducting financial distress screening. Most of the practices reported that financial screening is completed by social workers (n = 40/44, 91%). One third of practices reported financial screening using a survey completed by patients/caregivers (n = 14/44, 32%). Almost all practices (n = 51/53, 96%) reported responding to financial needs through a social worker. One third of the practices reported having a cancer-specific financial navigator (n = 17/53, 32%) or a nondedicated (not cancer-specific) financial navigator (n = 19/53, 36%). Practices that served a proportion of new patients with cancer at or above the national average of Hispanic individuals in the United States were as likely to screen for financial distress as practices below the national average (odds ratio, 2.42 [95% CI, 0.45 to 13.03]; P = .30). Most pediatric NCORP practices report screening for financial distress. Fewer groups offer dedicated cancer-specific financial navigation, and practices vary. Further research is needed to explore the development and implementation of standardized financial distress measures and financial navigation interventions within pediatric cancer care.

Given the impact of cancer treatment on fertility among adolescents and young adults (AYAs: 15-39 years), it is important to ensure AYAs access to fertility preservation (FP). However, the availability of FP services for AYAs treated in community settings is unknown. We examined FP access at National Cancer Institute Community Oncology Research Program (NCORP) practice groups. The 2022 NCORP Landscape Assessment survey captured available resources and cancer care services including FP services at practice groups. We described FP services as accessible (on-site or off-site) versus not accessible by AYA-treating status (as previously defined). Univariable and multivariable analyses were used to evaluate associations between FP services and practice characteristics (NCORP classification [minority/underserved or community] and proportion of Medicaid or uninsured above/below the national average). Among 271 practice groups responding to the survey, 100 were categorized as AYA-treating, of which 32% had neither male nor female FP services available. Sperm banking was available at 59 AYA-treating practices, among which 43 (73%) referred for sperm banking off-site. Although approximately half of AYA-treating practices reported accessible female FP services (embryo = 54%, oocyte = 55%, ovarian tissue = 40%), most of them referred patients off-site (embryo = 72%, oocyte = 80%, ovarian tissue = 83%). The odds of access to male FP were lower at minority/underserved practices (odds ratio, 0.34 [95% CI, 0.13 to 0.88]; P = .026; ref = community); however, this same relationship was not seen for females. Despite guidelines surrounding FP discussions before cancer therapy, and strong consensus regarding the importance of FP access, many AYA-treating practices in community settings lack access to FP services. Understanding how to leverage available services and broadly expand access is urgently needed to facilitate guideline-concordant, high-quality cancer care for AYAs.

e23009 Background: The National Cancer Institute Community Oncology Research program (NCORP) is a network which brings cancer clinical trials and care to patients within their own communities. Currently, NCORP consists of 46 sites throughout the United States which receive grant funding through the NCI. We aim to describe the scope of social media use and NCORP dedicated websites. We also aim to describe the correlation between media usage and funding. Methods: We searched NCORP websites and online search engines to identify the social media presence of different NCORP sites. Facebook, Instagram, LinkedIn, and Twitter were the social media sites chosen. Additionally, we searched for NCORP dedicated websites that were separate and distinct from the host institution. We were able to gather public data outlining the total funding received by each site in a three-year span (2019-2021) using the NIH RePORTER. Data was summarized using descriptive statistics. Results: A total of 15 out of 46 sites were determined to have a social media presence, 11 out of 46 sites had NCORP dedicated websites, and 7 out of 46 had both a social media presence and a dedicated website. The social media sites used for the NCORPs were as follows Facebook 8, Twitter 5, LinkedIn 3, and Instagram 1. The content information within the 11 dedicated websites were as follows clinical trials 9, newsletters 2, and provider information 8. All 11 websites had the NCI watermark badge (100% of NCORP websites). The average three-year funding for NCORP sites utilizing social media was $5,371,610. The average three-year funding for NCORP sites without social media was $4,230,552. The average three-year funding for NCORP sites utilizing dedicated websites was $4,681,708. The average three-year funding for NCORP sites without dedicated websites was 4,584,321. There was no statistical significance between funding and websites or social media accounts. Conclusions: NCORPs have an opportunity to disseminate high quality reliable information about cancer clinical trials that meet the need of patients and clinical care providers. However, NCORP sites are rarely a distinct voice on social media or with dedicated websites. Sites may not have resources for this type of communication or may promote the work of NCORP through the communication channels of the host institution(s). Sites with websites or social media accounts had higher average funding. However, this was not significant. Whether social media and NCORP dedicated websites contribute meaningfully to the work of NCI clinical trials remains to be seen and is beyond the scope of this investigation.

Before treatment, cancer patients need information about side effects and prognosis, while after treatment they need information to transition to survivorship. Research documenting these needs is limited, especially among racial and ethnic minorities. This study evaluated cancer patients' needs according to race both before and after treatment. We compared white (n = 904) to black (n = 52) patients receiving treatment at 17 National Cancer Institute Community Oncology Research Program (NCORP) sites on their cancer-related concerns and need for information before and after cancer treatment. Two-sample t test and chi-squared analyses were used to assess group differences. Compared to white patients, black patients reported significantly higher concerns about diet (44.3 vs. 25.4%,) and exercise (40.4 vs. 19.7%,) during the course of treatment. Compared to whites, blacks also had significantly higher concern about treatment-related issues (white vs. black mean, 25.52 vs. 31.78), self-image issues (7.03 vs. 8.60), family-related issues (10.44 vs. 12.84), and financial concerns (6.42 vs. 8.90, all p < 0.05). Blacks, compared to whites, also had significantly greater post-treatment information needs regarding follow-up tests (8.17 vs. 9.44), stress management (4.12 vs. 4.89), and handling stigma after cancer treatment (4.21 vs. 4.89) [all p < 0.05]. Pre-treatment concerns and post-treatment information needs differed by race, with black patients reporting greater information needs and concerns. In clinical practice, tailored approaches may work particularly well in addressing the needs and concerns of black patients.