QIM19-122: Quality Improvement Initiatives in the Second Year of an Adolescent and Young Adult Oncology Clinic

Abstract

Background: Adolescent and young adult (AYA) oncology patients have a distinctive set of needs that are often not addressed by primary providers in busy clinical practices. Genetic counseling, fertility preservation, clinical trial enrollment, and individualized psychosocial support are a few key issues to address in this group. The AYA Oncology Program was created in August 2016 to specifically address these issues and mitigate the disparity in care and outcomes often seen in the AYA population. After the first year, we identified several areas in our program that required improvement. These included increasing referrals to our clinic, increasing appropriate referrals to genetics and fertility specialists, and improving clinical trial enrollment. Several quality improvement initiatives were created to address these issues. Methods: The study assessed patients actively under treatment between ages 15–39 from September 1, 2016 to September 1, 2018 that were seen in the AYA clinic. Starting in year 2, patients seen in the AYA clinic as well as AYAs not seen in the AYA clinic were screened weekly by the AYA team for clinical trial eligibility. Additionally, a weekly email was sent to all physicians and nurse practitioners listing patients for the week that were eligible for AYA referral as well as the clinical trials they were eligible for. The research staff was also included on these emails to facilitate communication and enrollment. Results: In year 2 of the program, 66 patients were seen in the AYA clinic, a 16% increase from the prior year. 65% of patients were referred to genetics, increased from 61% the prior year. 39% of patients were referred to fertility, increased from 37% the prior year. Of patients seen in the AYA clinic, 22% were on a clinical trial in year 1, which increased to 28% in year 2. The AYA team screened all patients at the cancer center regardless of whether they were referred to AYA starting in year 2, and over this year, 17% of AYA patients throughout the cancer center were enrolled on a clinical trial. Conclusion: In our quality improvement initiative in year 2, we increased referrals to the AYA clinic, referrals to specialist services, and clinical trial enrollment. Screening AYA patients on a weekly basis is productive in increasing clinical trial referrals and enrollment. The use of a weekly reminder email to providers also increased AYA clinic referrals.