Academic Comprehensive Cancer Center Research Articles

Bridging the Gap: Standardizing Orientation to Improve Vacancy and Turnover Rates of Ambulatory Oncology Nurses.

This article describes standardizing ambulatory oncology nursing orientation within an academic comprehensive cancer center to reduce turnover rates. The nursing professional development specialist created a standardized orie.

Patient Characteristics and Outcomes of Nodular Lymphocyte Predominant Hodgkin Lymphoma at a Safety-Net System Compared to an Academic Comprehensive Cancer Center

Purpose: Nodular lymphocyte predominant Hodgkin's lymphoma (NLPHL) is a rare subtype of Hodgkin lymphoma that often follows an indolent course although carries a risk of late recurrence and transformation. Given its rarity, there is significant variability in the treatment patterns at various healthcare centers. The aim of this study was to compare the patient characteristics and outcomes of NLPHL treated at a safety-net system compared to those treated at an academic comprehensive cancer center. Materials and Methods: Parkland Health (PH) is the safety-net system for uninsured/underinsured patients in Dallas County and is affiliated with the UT Southwestern NCI-designated Harold C. Simmons Comprehensive Cancer Center (SCCC). Electronic records of adult patients (age > 18) diagnosed with NLPHL between January 1st, 2007, and December 31st, 2022, at the two centers were reviewed and data on demographics, disease characteristics, treatments, and outcomes were collected. Results: A total of 53 patients were included in the study (25 at PH vs 28 at SCCC). The median age at diagnosis was 42 (IQR 32-54.5) and was not significantly different between the institutions (41.7 at PH vs 46.5 at SCCC). There was a trend towards male predominance at SCCC compared to PH, but this was not statistically significant. PH patients were more likely to belong to racial/ethnic minority groups (Black non-Hispanic 84% at PH vs 32% at SCCC; Hispanic 16% at PH vs 0% at SCCC, p <0.01) and to be uninsured (60% at PH vs 0% at SCCC, p <0.01). Overall, 38% of patients presented at a late stage (stage III-IV) and this was not different based on site of care (11 at PH vs 9 at SCCC; p=0.37). Patients were managed by observation alone (n=4), radiation only (n=11), combination chemotherapy and/or rituximab only (n= 22), or combined modality (n=12). Site of care (PH vs SCCC) or race/ethnicity did not impact the treatment choice. At a median follow up of 60 months (IQR 21-83), 6 recurrences and 5 transformations were noted. Only 3 deaths occurred during the follow up period, for an overall median survival of 62 months (IQR 21.5-84.5). Conclusion: Despite health inequities that typically impact safety-net patients, we did not observe any differences in treatment patterns or outcomes of Nodular lymphocyte predominant Hodgkin lymphoma between patients treated at Parkland Health compared to Simmons Comprehensive Cancer Center.

Real-World Toxicity of Conventional Versus Hypofractionated Definitive Prostate Radiotherapy across a Large, Diverse, Academic and Community-Based Enterprise.

Over the past 10-15 years there has been increasing adoption of moderate hypofractionation (HF) for definitive prostate radiotherapy as compared to conventional fractionation (CF). Based on several randomized trials hypofractionation results in equivalent treatment efficacy with similar rates of long-term toxicity. However, some studies suggest higher acute GI toxicity with moderate hypofractionation. We sought to compare the rates of toxicity between these two groups across our enterprise including 16 community-based practices and one academic NCI-designated comprehensive cancer center. We retrospectively extracted radiation treatment intent from our network-wide clinical pathways for patients diagnosed with prostate cancer between 3/2019 and 10/2022. Patients treated after prostatectomy and those treated with brachytherapy or SBRT were excluded. For the remaining 1529 patients treated with either conventional fractionation or moderate hypofractionation, we identified and merged physician-graded toxicity data using CTCAE version 5.0 recorded in their electronic medical record at each weekly on-treatment visit and follow-up. A total of 1051 patients had toxicity data available. Rates of toxicities were then compared between the cohort of patients who received CF and those who HF using the Chi-square test. Of the 1051 patients, 450 (43%) received CF and 601 (57%) received HF. These patients were treated by 40 different radiation oncologists (median patients per physician = 18, interquartile range = 7-35). Median age in the CF and HF cohorts was 71 (IQR: 66-76) and 71 (IQR: 66-77; p = 0.51), respectively. The CF cohort had more patients with Gleason 8+ disease (39% vs 19%; p<0.01), PSA >20 (26% vs 11%; p<0.01), or T3a+ (18% vs 8%; p<0.01). Rates of any grade 2+ toxicity were significantly higher in patients who received HF at 45.8% vs 39.6% for those treated with CF (p = 0.04). However, the respective rates of any grade 3+ toxicity were no different at 2.0% vs. 1.8% (p = 0.80). The difference in grade 2 toxicities appeared to be primarily driven by the rates of urinary frequency at 27.1% vs. 17.8% (p<0.01) and prostatic obstruction 14.8% vs. 10.2%, p = 0.03). Rates of grade 2 diarrhea were worse with MF at 5.3% vs. 2.8% for CF (p = 0.04). There were no significant differences between HF and CF in the rates of grade 2 dysuria (6% vs 5.2%), urinary urgency (6.5% vs. 4.2%), proctitis (3.0% vs. 3.6%), urinary incontinence (0.5% vs. 1.3%), rectal bleeding (0.3% vs. 0%), hematuria (0% vs. 0.4%), and fatigue (14.1% vs. 15.1%). In this large network-wide analysis, toxicity was slightly increased among patients with prostate cancer treated with HF compared to CF, consistent with published randomized data. However, the increased toxicity appeared to be primarily GU rather than GI. This study demonstrates the feasibility of analyzing impacts of treatment decisions on a large scale using real-world data through an integrated network of practices.

Using an Adapted Tumor Board Evaluation Tool for Quality Assessment of a Thoracic Multidisciplinary Cancer Conference: A Pilot Study.

Multidisciplinary cancer conferences (MCCs) are crucial for the management of complex oncology patients. Tools to evaluate MCC performance are needed. The aim of this pilot study was to assess the applicability of an existing validated performance assessment tool to evaluate the quality of thoracic MCCs (T-MCCs). Data were collected from weekly T-MCCs over a 5-week period using the MCC Performance Assessment Tool and a self-assessment survey. Audio recordings were used to supplement observation notes. Case presentation, discussion duration, decision making contribution, recommendations, and consensus were captured. Quality of information and contribution were rated on a 1-5 scale. The data were analyzed using descriptive statistics to calculate means and composite scores representing overall MCC performance. A total of 44 cases were observed at the T-MCC with the mean presentation and discussion time of 6 minutes and 22 seconds. Quality of case history, radiologic and pathological information, and reason for case discussion were rated above average (>3), whereas inclusion of comorbidities and patient views were rated below average. Surgical oncologists had a higher discussion contribution compared with medical and radiation oncologists (3.6 v 2.9 and 2.4, respectively). The overall mean composite score was 55.9 (deemed average) with no cases categorized as poor or excellent. Radiologists and pathologists had mean preparation times of 81.7 and 144.0 minutes, respectively. This study demonstrated the applicability of a previously validated tool to assess the quality of a T-MCC at an academic comprehensive cancer center. The tool was found to be useful in identifying elements of the T-MCC process that needed improvement.

Trends of opioid prescription in cancer patients utilizing telemedicine: a retrospective study.

Aim: Prescribing patterns among healthcare practitioners remain a recurring theme of interest in the opioid crisis. This study aims to provide insight on opioid prescribing patterns for cancer pain in telemedicine and in-person encounters during COVID-19. Materials & methods: A retrospective chart review of 1000 encounters (500 telemedicine and 500 in-person) at an academic tertiary care comprehensive cancer center. Results: On average, overall, significantly higher narcotics (in morphine milligram equivalents [MME]) prescribed for patients receiving telemedicine services. In-person encounters had a significantly higher proportion of narcotic (in MME) increases in subsequent visits. Conclusion: Our institution continues to adapt telehealth services as an additional care venue and deeper insight helps mitigate development of maladaptive opioid prescribing patterns.

Gut Microbiome in Patients With Early-Stage and Late-Stage Melanoma

The gut microbiome modulates the immune system and responses to immunotherapy in patients with late-stage melanoma. It is unknown whether fecal microbiota profiles differ between healthy individuals and patients with melanoma or if microbiota profiles differ among patients with different stages of melanoma. Defining gut microbiota profiles in individuals without melanoma and those with early-stage and late-stage melanoma may reveal features associated with disease progression. To characterize and compare gut microbiota profiles between healthy volunteers and patients with melanoma and between patients with early-stage and late-stage melanoma. This single-site case-control study took place at an academic comprehensive cancer center. Fecal samples were collected from systemic treatment-naive patients with stage I to IV melanoma from June 1, 2015, to January 31, 2019, and from healthy volunteers from June 1, 2021, to January 31, 2022. Patients were followed up for disease recurrence until November 30, 2021. Fecal microbiota was profiled by 16S ribosomal RNA sequencing. Clinical and pathologic characteristics, treatment, and disease recurrence were extracted from electronic medical records. Fecal microbiome diversity, taxonomic profiles and inferred functional profiles were compared between groups. A total of 228 participants were enrolled (126 men [55.3%]; median age, 59 [range, 21-90] years), including 49 volunteers without melanoma, 38 patients with early-stage melanoma (29 with stage I or melanoma in situ and 9 with stage II), and 141 with late-stage melanoma (66 with stage III and 75 with stage IV). Community differences were observed between patients with melanoma and volunteers. Patients with melanoma had a higher relative abundance of Fusobacterium compared with controls on univariate analysis (0.19% vs 0.003%; P < .001), but this association was attenuated when adjusted for covariates (log2 fold change of 5.18 vs controls; P = .09). Microbiomes were distinct between patients with early-stage and late-stage melanoma. Early-stage melanoma had a higher alpha diversity (Inverse Simpson Index 14.6 [IQR, 9.8-23.0] vs 10.8 [IQR, 7.2-16.8]; P = .003), and a higher abundance of the genus Roseburia on univariate analysis (2.4% vs 1.2%; P < .001) though statistical significance was lost with covariate adjustment (log2 fold change of 0.86 vs controls; P = .13). Multiple functional pathways were differentially enriched between groups. No associations were observed between the microbial taxa and disease recurrence in patients with stage III melanoma treated with adjuvant immunotherapy. The findings of this case-control study suggest that fecal microbiota profiles were significantly different among patients with melanoma and controls and between patients with early-stage and late-stage melanoma. Prospective investigations of the gut microbiome and changes that occur with disease progression may identify future microbial targets for intervention.

Pilot study of a Spanish language measure of financial toxicity in underserved Hispanic cancer patients with low English proficiency.

Financial toxicity (FT) reflects multi-dimensional personal economic hardships borne by cancer patients. It is unknown whether measures of FT-to date derived largely from English-speakers-adequately capture economic experiences and financial hardships of medically underserved low English proficiency US Hispanic cancer patients. We piloted a Spanish language FT instrument in this population. We piloted a Spanish version of the Economic Strain and Resilience in Cancer (ENRICh) FT measure using qualitative cognitive interviews and surveys in un-/under-insured or medically underserved, low English proficiency, Spanish-speaking Hispanics (UN-Spanish, n = 23) receiving ambulatory oncology care at a public healthcare safety net hospital in the Houston metropolitan area. Exploratory analyses compared ENRICh FT scores amongst the UN-Spanish group to: (1) un-/under-insured English-speaking Hispanics (UN-English, n = 23) from the same public facility and (2) insured English-speaking Hispanics (INS-English, n = 31) from an academic comprehensive cancer center. Multivariable logistic models compared the outcome of severe FT (score > 6). UN-Spanish Hispanic participants reported high acceptability of the instrument (only 0% responded that the instrument was "very difficult to answer" and 4% that it was "very difficult to understand the questions"; 8% responded that it was "very difficult to remember resources used" and 8% that it was "very difficult to remember the burdens experienced"; and 4% responded that it was "very uncomfortable to respond"). Internal consistency of the FT measure was high (Cronbach's α = 0.906). In qualitative responses, UN-Spanish Hispanics frequently identified a total lack of credit, savings, or income and food insecurity as aspects contributing to FT. UN-Spanish and UN-English Hispanic patients were younger, had lower education and income, resided in socioeconomically deprived neighborhoods and had more advanced cancer vs. INS-English Hispanics. There was a higher likelihood of severe FT in UN-Spanish (OR = 2.73, 95% CI 0.77-9.70; p = 0.12) and UN-English (OR = 4.13, 95% CI 1.13-15.12; p = 0.03) vs. INS-English Hispanics. A higher likelihood of severely depleted FT coping resources occurred in UN-Spanish (OR = 4.00, 95% CI 1.07-14.92; p = 0.04) and UN-English (OR = 5.73, 95% CI 1.49-22.1; p = 0.01) vs. INS-English. The likelihood of FT did not differ between UN-Spanish and UN-English in both models (p = 0.59 and p = 0.62 respectively). In medically underserved, uninsured Hispanic patients with cancer, comprehensive Spanish-language FT assessment in low English proficiency participants was feasible, acceptable, and internally consistent. Future studies employing tailored FT assessment and intervention should encompass the key privations and hardships in this population.

Study protocol for a randomized trial of a supportive care mobile application to improve symptoms, coping, and quality of life in patients with advanced non-small cell lung cancer.

Patients with advanced non-small cell lung cancer (NSCLC) often experience burdensome symptoms, emotional distress, and poor quality of life (QOL). While national guidelines recommend early palliative care to address these supportive care needs, most patients with advanced NSCLC lack access to such comprehensive care. Our aim in the current study is to test a novel model of palliative care delivery and use of innovative technology to evaluate the feasibility, acceptability, and preliminary efficacy of a supportive care mobile application (app) for improving symptom management and adaptive coping in patients with advanced NSCLC. We will enroll 120 patients with unresectable Stage III or IV NSCLC diagnosed within the past 12 weeks receiving care with palliative intent at a major academic comprehensive cancer center and its community affiliates. The study will take place in two phases, the first of which will be dedicated to adapting an evidence-based, early palliative care treatment guide and prior supportive care mobile app intervention to address the specific symptom management and coping needs of patients with advanced NSCLC. The second phase of the study will be a two-group, randomized controlled trial. Study patients will complete baseline self-report measures of symptoms, mood, coping skills, and QOL, after which they will be randomized to receive either the mobile app intervention combined with usual oncology care or usual oncology care alone. Intervention patients will use a tablet computer to self-administer the mobile app, which consists of six modules that teach evidence-based skills for managing burdensome symptoms and coping effectively with advanced cancer and its treatment. At 12 weeks follow up, patients in both groups will repeat the same self-report measures. We will use descriptive statistics to determine feasibility metrics of enrollment and retention rates. For secondary self-report measures, we will use linear regression controlling for baseline values. The results of the present study will contribute to a growing body of evidence regarding the supportive care needs of patients with advanced cancer and will have implications for how best to use innovative technology to widely disseminate comprehensive supportive care services to all patients who may benefit. Clinical Trial Registration: [www.ClinicalTrials.gov], identifier[NCT04629300].

Risk Factors for Immune Checkpoint Inhibitor Immunotherapy Toxicity Among Older Adults with Cancer.

Immune checkpoint inhibitor immunotherapy (IO) is revolutionizing cancer care but can lead to significant toxicity. This study seeks to describe potential risk factors for immune-related adverse events (irAEs) specifically among older adults. This was a retrospective study at a single academic comprehensive cancer center based on chart review data abstracted by physicians. For patients aged ≥70 years, frequency, type, and grade of irAEs and their association with baseline patient demographics, comorbidities, mobility, and functional status were characterized using bivariate analysis. Based on those results, multivariable logistic regressions were constructed to model the association between these characteristics with any grade and grade 3 or higher irAEs. Data were analyzed for 238 patients aged ≥70 years who received IO for mostly (≥90%) advanced cancer between 2011 and 2018. Thirty-nine percent of older adults experienced an irAE and 13% experienced one that was grade 3 or higher. In the multivariable analysis, depression was associated with an increased incidence of any grade irAE, while decreased life-space mobility was associated with an increased incidence of grade ≥3 irAEs. Most characteristics of special interest among older adults, include fall risk, weight loss, cognitive limitations, and hearing loss, were not associated with irAEs in our study. However, decreased life-space mobility and depression are potential risk factors for IO toxicity among older adults with advanced cancer. Interventions designed to evaluate and mitigate modifiable risk factors for treatment-related toxicity are needed, and the results of this study may be useful for guiding those efforts.

Supporting Advanced Practice Fellowship During COVID-19.

With the aging population and increasing number of cancer survivors contributing to a projected provider shortage, one solution is the specialization of nurse practitioners and physician assistants (part of the advanced practice provider [APP] workforce) in oncology. However, a lack of preparation in caring for the patient with cancer has led to burnout and stress in these groups. The authors studied an APP fellowship program to describe resilience, stress, and compassion in a transition-to-practice program and explore the experience of intentional, facilitated conversations. During 2019 and 2020, 18 APP fellows at a large, academic comprehensive cancer center participated in this descriptive study. The fellowship started in-person but changed to a virtual setting due to the COVID-19 pandemic. Resilience was measured through the Connor Davidson Resilience Scale 10, the Perceived Stress Scale, and the Professional Quality of Life Scale at four points in time: baseline, 6 months, 12 months, and 18 months. The experience of intentional, facilitated conversations was captured through simple theme collection as part of a standard program evaluation. Resilience, perceived stress, and compassion showed no statistical significance over the course of the fellowship. Evaluations of an intentional, facilitated conversation program found focal areas that included challenges, fatigue, empathy, relationships, role, self-awareness, and self-care. Despite the challenges of the pandemic on the health-care provider, the retention rate of APPs remained steady during the fellowship. The findings from this study suggested there was a benefit in an oncology fellowship for advanced practice and that intentional, facilitated conversations provide reflection and support during this experience.

The Impact of Receiving Radiation Treatment on Financial Toxicity in Underserved Hispanic Cancer Patients with Limited English Proficiency

<h3>Purpose/Objective(s)</h3> Racial and ethnic minority cancer patients in the US are at high risk for financial toxicity (FT). Prior FT outcomes for Hispanic cancer patients is mixed, though risk factors including socioeconomic, insurance, and English language proficiency barriers may influence FT outcomes in this population, though available data are lacking for US Hispanic cancer patients with un/under-insurance and low English proficiency. Therefore, we examined factors associated with FT in Hispanic cancer patients treated with or without RT. We hypothesized that un/under-insured and Spanish-only speaking Hispanic cancer patients would have more severe FT and receipt of RT would increase FT. <h3>Materials/Methods</h3> We conducted a multi-institution survey of Hispanic cancer patients receiving ambulatory oncology care. Depending on reported language preference, respondents underwent a Spanish- or English-language version of the Economic Strain and Resilience in Cancer (ENRICh) FT measure. Respondents were categorized in 3 groups: 1) un/under-insured Spanish-only speaking Hispanics (UN-Spanish) recruited from a public hospital for medically underserved patients 2) un/under-insured English-speaking Hispanics (UN-English, n=23) from the same facility and 3) insured English-speaking Hispanics (INS-English, n=31) from an academic comprehensive cancer center. Any receipt of RT, either pre- or post-survey, was recorded. Groups were compared via Fisher exact or Mann-Whitney U tests. <h3>Results</h3> A higher likelihood of severe overall FT occurred in UN-Spanish (OR=2.73, 95% CI 0.77-9.70; borderline P=0.12) and UN-English (OR=4.13, 95% CI 1.13-15.12; P=0.03) vs. INS-English Hispanics. However, the likelihood of FT did not differ between UN-Spanish and UN-English Hispanics in both models (P=0.59 and P=0.62 respectively). UN-Spanish Hispanics frequently identified completely lacking credit, savings, or income and food insecurity as key aspects of FT. Of 77 patients, 47 (61.0%) received RT as part of their cancer treatment. UN-Spanish (9/23, 39.1%) and UN-English (13/23, 56.5%) respondents were less likely to receive radiation as part of their treatment when compared to INS-English patients (25/31, 80.7%; p = 0.007). Respondents who received radiation treatment had similar overall FT score (median 3.8) when compared to those who had not (median 5.55; p = 0.214). Respondents who had already received RT demonstrated similar overall FT score (median 3.27) when compared with those who went on to receive RT (median 4.87; p = 0.559). <h3>Conclusion</h3> In this pilot study focused on medically underserved, un/under-insured Hispanics with cancer, inadequate insurance was a key predictor of FT regardless of language. Receipt of RT did not appear to impact overall FT. However, un- and under-insured Hispanic cancer patients were less likely to receive radiation as part of their treatment course, which may reflect a disparity in access to care based on insurance status.

Feasibility of systematic screening for unmet social determinants of health (SDoH) needs and associated resource utilization in ambulatory oncology.

6535 Background: Addressing unmet SDoH needs may reduce interruptions to cancer care caused by ED visits and hospitalizations (EDH). We aimed to determine feasibility of systematic screening for unmet patient-reported SDoH needs within a large tertiary academic comprehensive cancer center and association of unmet needs with EDH. Methods: We conducted a cross-sectional analysis of SDoH needs among new oncology patient (pts) consults from 5/15-9/21 at Dana-Farber Cancer Institute (DCFI). Pts completed an intake questionnaire including demographics, disease, and SDoH needs of financial distress, health literacy/numeracy, social isolation on a dichotomous or 5-point Likert scale. We ran bivariate and multivariable models on the association between demographics, SDoH and EDH within 30 days of consult using robust generalized estimating equations controlling for clustering by consult provider. Results: 125,997 unique new consults were seen from 5/15 – 9/21 of which 20,913 completed the intake questionnaire and were alive at 30 days after consult. Respondents were age 40-64 (50%), female (60%), non-Hispanic (84%), White (90%) and English speaking (97%), and 7% had an EDH within 30 days of consult. The most reported SDoH need was limited health numeracy (26%). In bivariate analysis, factors associated with ED visits were: non-English language, lung or GU/GYN cancer, living &gt; 25 mi from DFCI and limited health literacy and numeracy (all p &lt; 0.05). Demographics associated with hospitalizations included: White race and English as a primary language (EPL) (both p &lt; 0.05). Multivariable analysis showed female gender (OR 1.53, p &lt; 0.01), lung (OR 3.22*) and GU/GYN (OR 2.21*) (p &lt; 0.05 for both) cancer, and living &gt; 25 mi from DFCI (OR 2.50, p &lt; 0.0001) were associated with increased likelihood of ED visit while EPL (OR 1.80, p &lt; 0.05) and GU/GYN (OR 1.65, p &lt; 0.01*) cancer were associated with increased likelihood of hospitalization. Conclusions: It is feasible to systematically screen for unmet SDoH which are associated with increased frequency of ED visits. Differences in characteristics associated with ED vs. hospitalization could indicate possible bias or suggest SDoH needs as a reason for avoidance of costly medical care. Further study will expand SDoH screening and measure impact of resource matching to reduce disruptions to cancer care. [Table: see text]

Impact of Referring Team Characteristics on Inpatient Palliative Care Consultation Rate at a Comprehensive Cancer Center.

Background: No prior study addresses the impact of admitting team characteristics on inpatient palliative care (PC) consultation rate in cancer patients. Understanding consultation rate differences among admitting service types may reveal PC access disparities for patients who would benefit from consultation. Aim: To determine the impact of admitting service characteristics (teaching vs. nonteaching and surgical vs. medical) on inpatient PC consultation rates. Methods: A six-month cross-sectional study was performed at an academic comprehensive cancer center. Inpatient PC consultations and follow-up visits were compared to total admissions by admitting service category. Results: Five thousand six hundred ninety-seven admissions resulted in 710 new PC consultations and 2494 follow-up visits. Patients admitted to medical services had highest odds of PC consultation, while data for teaching services were mixed. There was no difference in follow-up visits. Conclusions: Significant differences between medical and surgical service PC consultation rates may indicate specialty PC access disparities solely based on their admitting service.

A Sexual and Gender Minority Inclusive Tool to Identify and Reduce Psychological Distress Related to Vaginal Brachytherapy Treatment

Evidence has shown treatments for gynecologic cancers can pose a significant impact to quality of life (QoL) and psychosocial functioning for cancer patients and cancer survivors, with very limited understanding of the impact of such treatments on the lesbian, gay, bisexual, transgender and queer/questioning community, also referred to as sexual and gender minorities (SGM), a diverse and medically underserved population. Specifically, intracavitary vaginal brachytherapy (ICVBT) for endometrial cancers can cause a negative impact on QoL and can even result in PTSD after treatment. Thus, better understanding a patient's unique identity and chosen sexual preferences, as well as assessing underlying anxiety, psychosocial issues, and/or prior non-consensual sexual encounter(s) can potentially alleviate distress during and after this sensitive treatment. Here, we present an innovative, SGM-inclusive assessment tool to identify potential risk factors for physical and/or psychosocial distress that may occur in patients undergoing ICVBT.We combined two previously published, validated tools to assess for urinary, bowel, and sexual symptoms in patients undergoing ICVBT. Next, as part of the ongoing LGBTQ initiative at our academic comprehensive cancer center, our department's LGBTQ Task Force, which is composed of volunteer patients, physicians, nurses, physicists, dosimetrists, and support staff reviewed the questionnaire and provided critical feedback for inclusivity. We subsequently had the questionnaire reviewed for health literacy by our Patient Education Liaisons.The task force recommended inclusion of sexual orientation and gender identity (SOGI) demographic questions to the survey, and adjustment of previous questions for improved inclusivity of SGM-identifying patients, especially those who identify as transgender, gender non-binary, and/or who choose to not engage in penetrative vaginal intercourse. Additionally, it was recommended to include a question that screens for a history of non-consensual sexual encounters to reduce triggering past trauma. The task force felt these items were important for the practitioner to discuss with their patient prior to the procedure, with the goal to reduce acute anxiety and possibly prevent acute and long-term negative physical and/or emotional outcomes.Our ICVBT survey tool is designed to screen for "at-risk" patients, and provide a pathway for open dialogue between patients and physicians to potentially reduce undue harm during this important, yet sensitive treatment. To the best of our knowledge, this is the first such ICVBT survey tool to assess for a history of sexual trauma, and include SOGI and gender-inclusive questions. This adaptation has allowed our team to approach patients in a sensitive manner inclusive of their identity and prior experiences. Preliminary data is being collected and will be presented at the conference.

Gynecologic oncology patients are ready for telemedicine in routine care: Results from a pre-COVID survey

ObjectivesTo assess telemedicine readiness of gynecologic oncology patients, particularly those at risk for care access disparities (increased distance to care, rural populations.) MethodsPatients at all disease/treatment stages completed an anonymous survey during in-person outpatient appointments at an academic comprehensive cancer center from 1/6/2020 to 2/28/2020, conducted prior to the COVID-19 pandemic, before the introduction of telemedicine in this practice. ResultsOf 180 patients approached, 170 completed the survey (94.4%). Mean age was 59.6 years; 73.4% identified as White, 23.7% Black, and 2.9% other race. Ovarian cancer was most common (41.2%), followed by endometrial (27.1%), cervical (20.6%), and vaginal/vulvar (7.1%). Most patients traveled > 50 miles for appointments (63.8%); they were more likely from rural counties with significantly higher travel costs/visit ($60.77 vs $37.98, p = 0.026.) The majority expressed interest in using telemedicine (75.7%) or a smartphone app (87.5%) in their care. The majority of patients with difficulty attending appointments (88.9 vs 70.2%, p = 0.02) or from rural counties (88.7% vs 69.6%, p = 0.03) were interested in telemedicine; those with both characteristics reported 100% interest. The majority in both urban and rural counties had home internet access, and reported similarly high rates of daily use (79% vs 75%). Race and age were not associated with differences in internet access or use or telemedicine interest. ConclusionsTelemedicine is attractive to the majority of patients and may offer financial/logistical advantages. Patients have high internet use rates and comfort with using technology for healthcare. Telemedicine should be incorporated into standard practice beyond the COVID-19 pandemic to reduce healthcare access disparities.

Feasibility and preliminary effectiveness of a cancer survivorship care delivery intervention.

19 Background: A large and rapidly increasing number of US cancer survivors who have completed active treatment continue to seek oncology care. Low-risk survivors who continue to seek oncology care incur greater costs but experience worse care quality and outcomes than those who seek primary care. In this study, we assessed the feasibility and preliminary effectiveness of START (Supporting Transitions AfteR Treatment), a theory-driven, stakeholder-engaged intervention intended to improve the transition of low-risk survivors to primary care. Methods: To pilot START, beginning in August 2020, we engaged oncology providers (n = 5) and staff (n = 4) at a small community affiliate of our academic comprehensive cancer center. We worked with a nurse navigator, office manager, and physician champion to refine START’s content and delivery to accommodate the needs of a busy community cancer center. We queried electronic health records (EHRs) to assess the feasibility of identifying low-risk survivors and measuring key outcomes (i.e., receipt of recommended health maintenance services). In a formal meeting, we introduced providers to START and helped them to identify survivors whom they agreed should be transitioned to primary care. Front desk staff flagged these survivors to remind providers to transition them in upcoming appointments. Beginning in July 2021, we will conduct in-depth, semi-structured interviews with oncology providers and staff and survivors regarding their perspectives on START’s acceptability, appropriateness, and feasibility. Results: We successfully identified survivors using EHRs and engaged the nurse navigator and providers in identifying the subset of survivors whom they deemed eligible for transitioning to primary care. Preliminary results indicate that START helped providers to transition eligible survivors to primary care. We have successfully engaged cancer center data managers in measuring relevant outcomes using EHRs. Informal provider and staff feedback suggests that START is an acceptable, appropriate, and feasible approach to transitioning survivors. Conclusions: At the conference, we will report on oncology provider and staff and survivor perceptions of START’s acceptability, appropriateness, and feasibility for improving survivorship care delivery and preliminary findings regarding START’s effectiveness in increasing survivors’ receipt of recommended health maintenance services. Findings will be used to refine START and form the basis of a clinical trial to evaluate its effectiveness in improving survivorship outcomes.

Physical Activity: A Feasibility Study on Exercise in Men Newly Diagnosed With Prostate Cancer.

Physical activity (PA) has been shown to improve patient-centered care for cancer-related symptoms, treatment-related side effects, and health-related quality of life. This feasibility study aimed to explore PA preferences and changes in functional capacity and symptoms during a two-week self-prescribed PA intervention prior to treatment in men newly diagnosed with prostate cancer. Men newly diagnosed with prostate cancer were recruited from a community hospital, part of an academic comprehensive cancer center in the southeastern United States. An individualized PA intervention prescription was developed using baseline measures. Baseline and two-week measures consisted of functional capacity, PA participation, and symptom impact. Descriptive statistics and t tests were used. Thirteen men aged an average of 66.14 years (SD = 6.82) participated. Participants significantly improved functional capacity. Most common PAs were walking (n = 9) and yard work (n = 6).

Gynecologic oncology patients are ready for telemedicine in routine care: results from a pre-COVID survey

<h3>Objectives:</h3> We aimed to assess the telemedicine readiness and attitudes of gynecologic oncology patients with attention to groups at risk for difficulty in accessing care, such as increased distance to care and rural populations. <h3>Methods:</h3> Gynecologic oncology patients at all stages of disease and treatment (primary, recurrence, surveillance) were asked to complete an anonymous survey during in-person outpatient appointments at an academic comprehensive cancer center. Surveys were entered into RedCAP; SPSS was used for statistical analysis. This survey was conducted prior to the COVID-19 pandemic, before the introduction of telemedicine in this practice. <h3>Results:</h3> Of 180 patients approached, 170 completed the survey. Mean age was 59.6 years; 73.4% identified as White, 23.7% as Black, and 2.9% as other race. The majority of patients had ovarian cancer (41.2%), followed by endometrial (27.1%), cervical (20.6%), vaginal/vulvar (7.1%), and other (1.2%.) The majority of patients traveled greater than 50 miles for appointments (63.8%); these patients were more likely to be from rural counties and incurred a significantly higher cost for travel per visit ($60.77 vs $37.98, p=0.026.) The majority of patients expressed interest in using telemedicine appointments (75.7%) or a smartphone app (87.5%) as a component of their cancer care. Patients with difficulty attending appointments (88.9 vs 70.2%, p=0.02), or those from rural areas (88.7% vs 69.6%, p=0.03), were especially interested in telemedicine; those with both characteristics reported 100% interest in telemedicine. The majority of patients in both urban and rural counties had the ability to access the internet and telemedicine services from home, via smart phone or computer. Patients from rural and urban counties used the internet at similarly high rates (at least daily use, 79% vs 75%.) <h3>Conclusions:</h3> Telemedicine is acceptable and attractive to the majority of patients even prior to the COVID-19 pandemic, and may offer financial and logistical advantages for patients who live far from gynecologic oncology care. Overall, patients have high rates of internet use and express comfort with using technology for their healthcare. Disparities in cancer outcomes for rural patients, including survival and clinical trials enrollment, have been associated with increased distance to providers and difficulty accessing care. In our study, these patients were universally interested in telemedicine. Telemedicine should be incorporated into standard practice beyond the current COVID-19 pandemic to reduce healthcare disparities related to care access.

Adverse Events in Patients with Cancer Treated with Direct Oral Anticoagulants and Cancer Therapy

IntroductionFour direct oral anticoagulants (DOAC) have been approved for the treatment of venous thromboembolism VTE and prevention of stroke in patients with non-valvular atrial fibrillation (NVAF) in the USA: rivaroxaban, apixaban, edoxaban and dabigatran. Data regarding efficacy and safety of DOAC in the cancer population however are currently limited to very small cohorts in the large randomized trials for treatment of VTE in which many cancer patients did not meet eligibility requirements, or to retrospective studies and quality improvement initiatives. Despite major consensus guidelines recommending low molecular weight heparin (LMWH) as the preferred treatment for cancer-associated VTE, DOAC are commonly prescribed for cancer patients in both community and academic settings. Data on the safety and efficacy of DOAC in patients getting active cancer treatment are lacking. We aimed to characterize the use of DOAC in patients managed at an academic comprehensive cancer center, to examine the incidence of thrombotic and bleeding events among patients receiving active cancer therapy during the study period.MethodsFollowing IRB approval, a retrospective chart review was performed in patients treated at an academic comprehensive cancer center. Patients >18 years old who had a prescription written for a DOAC between June 2015 and December 2016 were identified. Patients were included if they were receiving DOAC for NVAF, acute VTE, and secondary prevention and had active cancer. Patients were assessed for baseline demographics, indications for anticoagulation, DOAC management strategies, arterial and venous thrombotic events and bleeding complications during treatment with DOAC. Descriptive statistics were used to analyze study outcomes.ResultsOf the 721 patients screened, 392 were patients with cancer of which 241 s were actively being treated with chemotherapy while on DOAC. The other 151 patients were not actively receiving treatment. VTE was the most common indication for DOAC use in 75% of cancer patients (n=297), followed by NVAF in20% (n=78). There were 15 patients with history of both NVAF and VTE, and 2 patients with TIA. Apixaban was used in 48% of patients; rivaroxaban in 47%; dabigatran in 4%, and edoxaban < 1%.Of the 392 evaluated cancer patients, 15 (3.83%) experienced thrombotic events with 11/15 new or recurrent VTE, 3/15 stroke, and 1/15 myocardial infarction while on DOAC. The VTE rate was strikingly higher in those patients receiving active cancer treatment at 4.15% compared to 0.66% in those not getting treatment. The rate of major bleeding and clinically overt bleeding was not different between the 2 groups and was approximately 4.5%. (table 1)ConclusionWe found in our retrospective analysis of DOAC use in cancer patients, that patients getting active cancer treatment had higher rates of primarily venous and arterial thrombotic events while treated with DOAC compared to those patients not getting active cancer treatment. The rate of VTE at 4.14% compares favorably with published rates for VTE recurrence for LMWH and VKA in randomized controlled trials and is roughly 7 times higher than the rate in our patients with cancer treated with DOAC but not getting active cancer treatment. Despite differences in rates of thrombotic events, the bleeding rates were the same, and also comparable to published rates, confirming the known increased risk of bleeding in cancer patients. While our results are promising, dedicated randomized controlled trials comparing DOAC to LMWH are required to truly determine the efficacy and safety of DOAC in cancer patients simultaneously receiving cancer treatment. [Display omitted] DisclosuresConnors:BMS: Consultancy, Other: Scientific Advisory Board; Pfizer/BMS -Alliance: Other: Independent review committe; Unum Therapeutics: Other: Data Safety Monitoring Board; boehringer Ingelheim: Other: Scientific Advisory Board.

Duplicate Testing: Enhancing Transitions in Care Communication in the Infusion Center and Emergency Department Settings.

Two objectives of the American Board of Internal Medicine's Choosing Wisely® initiative include avoiding duplicate testing and choosing care that is free from harm. Oncology nurses in an academic comprehensive cancer center observed a pattern of testing duplication and related dissatisfaction among providers and patients. A quality improvement project was initiated to quantify the problem and reduce duplication by implementing collaborative solutions to improve interdepartmental communication during handoffs. Postimplementation data revealed a 35% decrease of testing duplication in the patient population.