Association Of Community Cancer Centers Research Articles

Evaluating enrollment processes and eligibility criteria of manufacturer free-drug patient assistance programs for oral anticancer agents used in hematologic malignancies.

117 Background: Increasing costs of oral anticancer agents (OAAs) pose a major barrier to patient adherence and consequently treatment effectiveness. While patient assistance programs (PAPs) may help cover costs, eligibility requirements for these programs are anecdotally reported to be non-transparent and enrollment processes burdensome, limiting their accessibility to patients. Thus, we evaluated the eligibility criteria and enrollment processes of manufacturer free-drug PAPs. Methods: A prospective review of manufacturer free-drug PAPs available for OAAs used in hematologic malignancies was conducted between October 2023 and February 2024. Available PAPs were identified using three online databases: RxAssist, NeedyMeds, and Association of Community Cancer Centers . Financial support program websites were assessed to gather information on eligibility requirements, enrollment processes, and other PAP characteristics. Results: For the 45 OAAs evaluated, 23 manufacturer free-drug PAPs were identified. All PAPs had insurance and income eligibility requirements which varied between programs. Uninsured patients were eligible for all programs, with 4% of programs restricting eligibility to only uninsured patients. The most common income eligibility threshold was 500% federal poverty limit, and requirement details were unavailable for 43.5% of programs. Enrollment could be initiated online, via downloadable form, and by phone-call, with 61% of programs having all three methods of enrollment initiation available to providers (17% to patients), 35% having two to providers (22% to patients), and 4% having only one to providers (52% to patients). Of note, 9% of programs offered no way for patients to independently initiate enrollment. Enrollment for all programs required both patient and provider inputs, and submission methods for some or all enrollment documentation included fax, online portal, email, and mail, with 4% of programs having four methods of submission available, 26% having three, 52% having two, and 17% having only one. Conclusions: The pathways for patients or providers to enroll in Patient Assistance Programs (PAPs) are complex and inconsistent across different programs, often requiring more action from providers than patients. Additionally, there is frequently a lack of transparency in the eligibility requirements for manufacturer free-drug PAPs.

Identifying and mitigating racial/ethnic disparities in clinical trials with screening data.

63 Background: ASCO and Association of Community Cancer Centers (ACCC) released a statement on increasing racial/ethnic equity, diversity, and inclusion (EDI) in cancer trials (1). It included recommendations for clinical practices and research sites to 1) screen every patient for trial eligibility; and 2) routinely collect and analyze screening and enrollment data by patient demographic characteristics, including race/ethnicity. Most of the 62 sites that completed a 2021 pilot study reported that screening data were not readily available by patient race/ethnicity (2). ASCO conducted a follow-up study about challenges, resource needs, and effective strategies for collecting and analyzing these data. Methods: Semi-structured interviews were conducted with research team members from sites that completed the 2021 pilot study. Sites were purposefully selected based on pilot study data quality and insights, diversity of patient population, and site type, size, and region. Sites completed a pre-interview questionnaire on site characteristics and screening and enrollment processes before participating in a 1-hour interview focused on challenges and effective strategies for collecting and analyzing screening and enrollment data, by race/ethnicity. Anticipated themes and relationships, stemming from the pilot study findings, informed a conceptual framework. Up to 20 interviews were planned and halted sooner when there was theme saturation. Results: Thirteen research sites participated in the study, representing academic centers (62%) and community-based practices/health systems (38%) with racially/ethnically diverse patient populations (median 31% non-white; range 11% to 63%). 53 research team members participated in the interviews (typically 4 per site), including investigators (23%), directors/managers (56%), and coordinators (21%). Aggregated responses were interpreted through content analysis and concepts were quantified for both frequency and extensiveness. Several barriers to patient screening, data collection, and analysis were cited, including lack of standardized procedures and documentation, dedicated staff and time, quality and/or accessible data on race/ethnicity and/or screening, and integrated technology that facilitates screening and documentation. Conclusions: Collecting and analyzing screening and enrollment data are critical to identifying and mitigating racial/ethnic disparities in trial access and EDI. Many sites do not systematically screen every patient for a trial and/or document outcomes. Lack of resources, including dedicated staff and time and integrated technology, make it difficult for them to do so in systematic and reliable ways. Greater investment in resources will help to facilitate routine screening of every patient and ensure underrepresented populations are not being overlooked for trials. 1. Oyer et al, JCO, 2022 . 2. Pressman et al, JCO, 2022 .

Abstract PO5-06-10: Evaluating Disparities in Access to Quality Cancer Care for Black Women with Triple Negative Breast Cancer in the US: A Provider Perspective

Abstract Introduction: Triple-negative breast cancer (TNBC) presents unique challenges due to its aggressive nature and limited treatment options. Black women are disproportionately affected by TNBC, experiencing higher incidence rates and poorer outcomes compared to other racial/ethnic groups. This study aims to evaluate disparities in access to quality cancer care for Black women with TNBC from the perspective of oncology healthcare providers. Methods: From December 2022 to February 2023, the Association of Community Cancer Centers conducted a survey of 84 multidisciplinary care team members who provided care to Black patients with TNBC. The online survey captured quantitative and qualitative data on challenges related to accessing timely TNBC diagnosis and treatment services, care coordination for work-up and biomarker testing, confidence in TNBC treatment, clinical trial enrollment, supportive care services, and related referrals. Additionally, a follow-up focus group was conducted in May 2023 to further interpret select survey data, with a focus on shared decision-making, patient-provider communication, and ways to support cancer programs in improving screening, biomarker testing, and care coordination for individuals with TNBC. Results: Respondents reported several barriers to accessing timely diagnosis and treatment services for Black women with TNBC, including challenges in coordinating care for work-up and biomarker testing, providers' confidence in providing guideline-concordant comprehensive cancer care services for this patient population, enrolling patients in clinical trials, and making referrals for supportive care services. The survey revealed that community cancer programs treated an average of 21-50 patients with TNBC annually, with 31% of them being Black. Perceived patient-level factors contributing to challenges in accessing TNBC diagnosis and treatment included geographic distance to care facilities (14%), health literacy (18%), and insurance-related factors (21%). Practice-level barriers included limited accessibility of practice location (19%), capacity to accommodate new patients (27%), and insurance-related factors (34%). Additional findings highlighted slightly lower provider confidence in areas such as tobacco cessation (only 54% very confident), breast reconstruction (59% very confident), fertility counseling (52% very confident), and coordinating care across a fragmented healthcare system (52% very confident). Respondents identified the most commonly offered comprehensive cancer care services as palliative care (82%), nutrition support (77%), telemedicine (68%), psychological counseling (68%), and financial advocacy (68%). Less commonly offered services include recreational therapy (21%), legal aid (17%), and childcare (16%). Conclusion: This study highlighted the barriers faced by providers in delivering quality cancer care to Black women with TNBC. The findings underscore the importance of addressing challenges related to timely diagnosis and treatment services, care coordination, confidence in treatment options, clinical trial enrollment, and referrals for supportive care services. Insights from the focus group discussions further highlight the need for shared decision-making, improved patient-provider communication, and identification of opportunities to support cancer programs in addressing the specific needs of Black women with TNBC. To advance equity in cancer care, targeted interventions should focus on enhancing provider education, improving care coordination systems, and promoting cultural sensitivity. Efforts should also be made to overcome barriers related to limited accessibility of practice location, and insurance-related factors. By addressing these gaps, providers can play a crucial role in reducing disparities and improving outcomes for Black women with TNBC. Citation Format: Doreen Effange, Niharika Dixit, Ruth O'Regan, Ogori Kalu, Ryann Norcereto, Richard Simonds, Elizabeth Valencia, LaToya Bolds-Johnson, Aubrey Van Kirk Villalobos, Christie Mangir, Elana Plotkin, Karen Tacka, Leigh Boehmer. Evaluating Disparities in Access to Quality Cancer Care for Black Women with Triple Negative Breast Cancer in the US: A Provider Perspective [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-06-10.

Barriers to Clinical Trial Implementation Among Community Care Centers

While an overwhelming majority of patients diagnosed with cancer express willingness to participate in clinical trials, only a fraction will enroll onto a research protocol. To identify critical barriers to trial enrollment to translate findings into actionable practice changes that increase cancer clinical trial enrollment. This survey study included designated site contacts at oncology practices with teams who were highly involved with the Association of Community Cancer Centers (ACCC) Community Oncology Research Institute (ACORI) clinical trials activities, all American Society of Clinical Oncology (ASCO)-ACCC collaboration pilot sites, and/or sites providing care to at least 25% African American and Hispanic residents. To determine participation trends among health care practices in oncology-focused research, identify barriers to clinical trial implementation and operation, and establish unmet needs for cancer clinics interested in trial participation, a 34-question survey was designed. Survey questions were defined within 3 categories: cancer center demographic characteristics, clinical trial characteristics, and referral practices. The survey was distributed through email and was open from June 20 through October 5, 2022. Participation in and barriers to conducting oncology trials in different community oncology settings. The survey was distributed to 100 cancer centers, with completion by 58 centers (58%) across 25 states. Fifty-two centers (88%) reported that they conduct therapeutic clinical trials, of which 33 (63%) were from urban settings, 11 (21%) were from suburban settings, and 8 (15%) were from rural settings. Only 25% of rural practices (2 of 8) offered phase 1 trials, compared with 67% of urban practices (22 of 33) (P = .01). Respondents noted challenges in conducting research, including patient recruitment (27 respondents [52%]), limited staffing (27 [52%]), and nonrelevant trials for their patient population (25 [48%]). Among sites not offering therapeutic trials, barriers to research conduct included limited infrastructure, funding, and staffing. Most centers (46 of 58 [79%]) referred patients to outside centers for clinical trial enrollment, particularly in the context of late-stage disease and/or disease progression. Only 17 of these sites (37%) had established protocols for patient follow-up subsequent to outside referral. In this national survey study of barriers to clinical trial implementation, most sites offered therapeutic trials, but there were significant disparities in trial availability across care settings. Furthermore, fundamental deficiencies in trial support infrastructure limited research activity, including within programs currently conducting research as well as at sites interested in future clinical research opportunities. These results identify crucial unmet needs for oncology clinics to effectively offer clinical trials to patients seeking care.

INTEGRATING AGE-FRIENDLY CARE INTO THE ONCOLOGY CONTINUUM

Abstract The number of older adults diagnosed with cancer is steadily rising, and measures for equitable, high-quality care in oncology are relatively undefined. The Association of Community Cancer Centers (ACCC), in collaboration with the Institute for Healthcare Improvement (IHI), led the first oncology-focused cohort guided by the 4Ms Framework for Age-Friendly Health Systems. Representatives from 22 cancer programs across the United States participated in a learning and action period to collaborate on building a program that provides optimal care for the older adult population. The Action Community consisted of a six-part didactic webinar series led by subject matter experts in geriatric oncology to apply the 4Ms model: What Matters, Mobility, Mentation, and Medication. ACCC asked sites to evaluate their program’s alignment with current standards using the ACCC Geriatric Gap Assessment tool and IHI’s 4Ms Care Description. Throughout the webinar series, participating sites in hospital and ambulatory settings identified a multidisciplinary team to improve workflows. The respondents answered questions regarding the frequency of assessments, documentation, and addressing inequities in their cancer program. Through a webinar poll, 90% of the participants from the multidisciplinary cancer team stated that medication was the most challenging “M” to implement and that further guidance from faculty experts was needed. More than half of the sites are progressing to earn level one (participant) or level two (committed to care excellence) recognition in the Age-Friendly Health Systems movement. ACCC has provided and will continue to provide health systems with resources for scale-up in their Age-Friendly journey.

Exploring Regional Challenges and Solutions to Appropriate and Equitable Care for Patients with Chronic Lymphocytic Leukemia

Background: For patients with chronic lymphocytic leukemia (CLL)-the most common form of leukemia in older adults-equitable access to care is particularly challenging, as the disease is often diagnosed in community cancer centers encumbered by regional disparities. Therefore, identifying and understanding regional barriers to care is essential. In 2020, the Association of Community Cancer Centers (ACCC) developed a heat map detailing the incidence rate of CLL diagnoses across the country (Fig.1), overlayed with the locations of CLL “expert” providers, revealing the areas in the US most in need of additional CLL clinical expertise (Fig. 2). In 2022, these incidence rates were stratified by race, ethnicity, and metropolitan statistical area to identify disparities Building on these maps, ACCC set out to identify specific regional challenges to appropriate, equitable care for patients with CLL. Methods: As part of an independent education program, ACCC initiated conversations with providers about the regional barriers that patients with CLL face. Through 4 webinars in February 2023, participants from 4 regions-Northeast (New York and Maine), Northwest (Montana and Idaho), Midwest (Wisconsin, Illinois, and Iowa), and Southwest (Texas)-shared insights on challenges and exchanged ideas on strategies to improve care for patients with CLL. In addition, ACCC interviewed 3 regionally diverse cancer programs (from the US Northwest, South, and Southwest regions) that are effectively overcoming regional challenges to reach their patient populations and provide equitable care. These interviews highlighted barriers and challenges, showcased effective outreach campaigns, and explored how the outreach improved the patient journey. Findings: The following themes emerged as key challenges and potential solutions throughout all regions studied: (1) Comprehensive Diagnostic Work-up Before Treatment Initiation: A key component in caring for patients with CLL is identifying certain disease related criteria prior to formulating a treatment plan. This includes determining the disease burden, disease-related symptoms, and if the patient meets certain active disease criteria (eg, Binet Stage C or Rai Stage III or IV). Further, by utilizing genetic testing, such as the TP53 gene mutation and IGHV mutation tests, physicians can estimate time to treatment and choice of specific novel targeted therapies. (2) Understanding Patient Population Needs: Cancer programs must understand the needs of their unique patient populations to effectively address them. For example, in the Northwest, as mountainous passes can make travel dangerous at times, one local program utilizes near-campus housing/hotel space for patients for the duration of their intensive treatment. In the Southwest, addressing health insurance coverage, low health literacy, language barriers, patient-provider mistrust, and culturally competent care for undocumented individuals presents challenges to equitable care delivery. Therefore, cancer programs in this region have implemented protocols to utilize community and social services to help support these patients. (3) Developing Community Partnerships: As the median age of diagnosis with CLL is approximately 70 years old, barriers such as transportation availability, caregiver support and financial constraints could be magnified. Building trust, particularly among vulnerable communities, also presents a significant challenge. By partnering with community outreach organizations, programs can help address these issues through community resources such as ride share programs, transportation vouchers, and financial assistance programs. (4) Provider Education and Learning: Because many patients are diagnosed in community cancer programs and smaller practices where physicians do not often have experience with CLL, nationally available provider education on new developments in testing and treatments is key. Conclusions: ACCC identified regional challenges and solutions to appropriate and equitable care for patients with CLL, including the importance of comprehensive diagnostic work-up before treating, understanding the regional needs of patient populations (particularly underserved populations), building community partnerships, and engaging in targeted provider education.

An evidence-based quality assessment tool for ovarian cancer care delivery.

384 Background: Ovarian cancer is the fifth leading cause of cancer death among women in the United States (US). Optimizing care for patients with ovarian cancer using a systematic, guideline-concordant approach improves outcomes. However, notable gaps persist for most patients with ovarian cancer in the US. Beginning in 2018, the Association of Community Cancer Centers (ACCC) implemented a quality improvement (QI) initiative in community and academic cancer centers to address care gaps. From this work, our expert steering committee published a quality document to inform evidence based ovarian cancer care delivery. Methods: In Phase II of this project we used the quality document to inform a qualitative baseline self-assessment and development of four six-month QI initiatives at cancer centers in the US. Based on this work, we developed a quality assessment tool to aid cancer centers in performing QI needs-assessments using the ovarian cancer quality document. The assessment tool applies evidence-based care recommendations in key areas identified by our multidisciplinary steering committee comprised of experts in ovarian cancer care. Results: The assessment tool includes a series of program-level questions and addresses seven key domains: 1. Care coordination and patient education, 2. Prevention and screening, 3. Diagnosis and initial management, 4. Treatment planning, 5. Disease surveillance, 6. Equity in care, and 7. Quality of life. Each domain has between two and seven key recommendations identified. Sites rate themselves on a four-point scale (1-unsatisfactory, 2-needs improvement, 3-acceptable, 4-good) for each key recommendation. Each key recommendation is given equal weight, and a combined score from 0-100 is calculated for each of the seven domains. The tool includes a macro-enabled spreadsheet that makes necessary calculations and provides an overall score, domain-specific sub-scores, and a list of key recommendations that received low ratings. The tool is to be used by clinical sites to self-assess the quality of ovarian cancer care currently provided at their cancer program and serves as a needs assessment. It is recommended that the site team performs the self-assessment in the context of a facilitated half-day multidisciplinary team meeting. After the self-assessment, sites are encouraged to develop QI initiatives to address the gaps identified using the format and structure we have previously described. Conclusions: The QI Assessment tool provides an important resource for cancer centers to conduct needs assessments in key areas of ovarian cancer care. The needs assessment can be used to inform the implementation of program-specific QI initiatives to elevate quality care delivery.

Differences in perception and use of remote patient monitoring among community and academic/NCI designated cancer programs.

563 Background: The benefits of remote patient monitoring (RPM) in oncology for reporting of adverse effects to improve patient outcomes are well-documented. To assess real-world use and perceptions of RPM, including its role with patient reported outcomes (PROs), the Association of Community Cancer Centers (ACCC) surveyed U.S. cancer program staff. Methods: Developed by expert advisors and patient advocacy partners, a survey of cancer program staff was distributed between December 2022 and January 2023. The survey included 25 closed and open-ended questions. Analysis was performed and responses compared using two-tailed Fisher’s exact test. Results: Of 128 staff respondents (52% MDs, 23% admin/managers, 22% other clinicians, 3% other cancer program staff), 40% worked in community, 38% academic/NCI-designated, and 20% private/physician practice settings. 34 U.S. states were represented. There was a high level of endorsement of RPM in the entire cohort; 86% of community and academic program staff agreed that RPM supplemented provider visits and informed clinical decision-making and patient/caregiver conversations. Among respondents using RPM (45%), 68% of community programs reported incorporating patient input into RPM program planning (vs 100% academic). (p=0.02). Compared to community programs, more academic programs reported planning/implementing RPM (57% vs 32%; p=0.02) and trended to have greater familiarity with RPM (80% vs 94%, p=0.07 NS). More community respondents (vs. academic) indicated concerns regarding patient comfort with RPM (80% vs 59%, p=0.05), access to a smartphone/computer (69% vs 45%, p=0.03), as well as barriers to RPM including securing funding (82% vs 57%, p=0.01) and EHR integration (61% vs 37%, p=0.02). In qualitative responses, 18% of community and 4% of academic staff described needs for provider education. Conclusions: Oncology staff across community and academic settings endorse the value of RPM to improve patient communication and clinical decision-making. There were more concerns and barriers to RPM planning and implementation reported by community programs. Nearly a third of community program staff indicated no incorporation of patient input to inform RPM planning. Further research into implementation barriers is needed, including funding/reimbursement strategies and tailoring patient/provider education to more equitably incorporate RPM across diverse cancer program settings.

Developing consensus-based oncology financial advocacy services guidelines.

38 Background: Financial advocacy interventions help patients, and their families address financial hardship experienced through the cancer journey. However, how financial services are offered to patients varies greatly. Across the field of financial advocacy there is a lack of standardization of services, which is needed to accurately evaluate the impact of oncology financial advocacy. The Association of Community Cancer Centers (ACCC) Financial Advocacy Network (FAN) set out to revamp the Financial Advocacy Services Guidelines originally published in 2018, with the goal of providing cancer programs direction in implementing and improving financial advocacy services offered to patients with cancer. Methods: ACCC convened a task force of 7 multidisciplinary financial advocacy experts to guide the process of creating consensus-based financial advocacy services guidelines. The task force assembled a panel of 49 diverse oncology financial advocacy experts. A literature review and input from panelists was used to draft a list of guideline statements. Panelists went through 2 rounds of anonymous voting to inform revisions to the guideline statements. Consensus for the guideline statements was set at 75% agreement. The statements were rated as should not be a guideline, minimum guideline, or enhanced guideline. Cancer program staff completed a questionnaire upon downloading the guidelines. Results: After completion of the 2 rounds, the panel reached consensus that 43 statements should be guidelines. The guidelines are split into three main domains: financial advocacy services & functions; program management functions; and partner engagement functions. The updated Guidelines, which provide cancer organizations with the foundation to implement services to help reduce financial burdens of care, were published in March 2023 and are publicly available. From March 2023 until June 2023, it was downloaded by 93 cancer program staff members, of which 74% stated they will use it to assist in the development, implementation, and/or enhancement of a formal advocacy program at their organization and 58% responded that they have a financial advocacy program already implemented or have a financial advocate on staff. Conclusions: As financial advocacy grows more complex, interventions for patients with cancer are vital. The Guidelines provide expert-developed and consensus-based methods to assist cancer organizations with implementing financial intervention services. Importantly, the newly published guidelines will aid in closing existing gaps in delivery of oncology financial services as 48% of respondents stated they do not have a financial advocacy program or staff member. Further it will promote broader collaboration among partners to aid with assessment tools, creating valid measures and rigorous evaluation of the guidelines to improve cancer patients’ experience and reduce financial barriers to care.

Opportunities for expanded nurse and nurse navigator involvement in design, implementation and management of remote patient monitoring programs.

564 Background: The use of remote patient monitoring (RPM) in oncology for timely reporting of adverse events to improve patient outcomes is well-documented; however, less is known about real-world implementation of RPM and its impact on workforce needs. To assess use and perceptions about RPM, including its role in patient reported outcomes (PROs), the Association of Community Cancer Centers (ACCC) surveyed U.S. cancer program staff. Methods: Developed by expert advisors and patient advocacy partners, a survey of cancer program staff was distributed between December 2022 and January 2023. The survey included 25 closed and open-ended questions. Results: 128 multidisciplinary cancer program staff completed the survey, of which 45% are actively planning/implementing RPM programs. 34 U.S. states were represented. The three largest roles represented were medical oncologists (n=54; 42%), cancer program administrators (n=18; 14%) and nurses/nurse navigators (n=14; 11%). Of all respondents, 82% viewed nursing teams as the most appropriate to review and triage RPM data. Nurses indicated less involvement with the design/development of RPM programs (0%) compared to administrators (33%) and oncologists (48%). Similarly, 3% of nurses reported involvement in monitoring or taking actions on RPM data, compared to 12% of administrators and 56% of oncologists. Notably, no nurses compared to 6% of administrators and 18% of oncologists strongly agreed that they had access to educational resources and training needed to support a RPM program. In qualitative responses, nurses indicated provider education as the greatest need for RPM to become standard of care in cancer programs. Conclusions: Despite a high perceived need for nursing involvement in all aspects of RPM programs, real-world data indicates that nurses, who are expected to monitor/triage RPM data by most of their peers, are less frequently involved in the design and implementation of RPM programs. Future research is needed to understand these workforce barriers, and to explore novel approaches to tailored provider education and engagement to ensure that RPM programs benefit from diverse workforce and patient involvement.

Understanding Advanced Practitioner Prescriptive Privileges for Anticancer Therapies: A National Survey

Oncology advanced practitioners (APs) work in collaboration with physicians to provide high-quality, specialized oncology care. Data are lacking on individual AP function within different practice settings, specifically around the prescribing of anticancer therapies. Our primary aim was to conduct a prospective, national, web-based survey to understand AP roles in prescribing anticancer therapies and the related privileging process(es) in both academic and community oncology practice settings. A 38-question survey was developed based on a review of published oncology AP data sets, expert input, and cognitive interviews with key AP informants. Survey domains included basic respondent demographics, practice setting information, and prescribing and privileging practices. The survey was distributed by the Association of Community Cancer Centers (ACCC) and the Advanced Practitioner Society for Hematology and Oncology (APSHO) in late 2022. 180 individuals responded, and 135 oncology APs completed the survey. The majority of respondents practice in states that allow prescriptive privileging for anticancer therapies. Only half of those that have prescriptive privileging have an established privileging and competency process at their practice setting. Among the nurse practitioners and physician assistants practicing in primarily independent roles, only about half can prescribe both standard-of-care and investigational therapies. This national survey provides valuable insights into the prescribing practices of oncology APs. The findings highlight the need to further develop standardized privileging and competency strategies within the AP community. By addressing these gaps, APs can play a crucial role in addressing workforce shortages in oncology and optimizing patient outcomes.

Association of Community Cancer Centers: Examining Small Cell Lung Cancer Through Multiphase Effort

Association of Community Cancer Centers: Examining Small Cell Lung Cancer Through Multiphase Effort

The Association of Community Cancer Centers (ACCC) Honors Its 2023 Innovator Award Winners

The Association of Community Cancer Centers (ACCC) Honors Its 2023 Innovator Award Winners

Improving guideline-concordant biomarker testing through implementation of a precision cancer medicine steward.

e18706 Background: Gaps in guideline-concordant cancer biomarker testing exist in real-world clinical practice. Medically underserved populations, in particular, face significant challenges to accessing the latest advances in cancer diagnostics. As community cancer programs work to expand their approach to precision medicine, some have created a precision medicine “steward” who acts as a point person for removing barriers to biomarker testing. The Association of Community Cancer Centers (ACCC) explored the clinical utility, impact, and feasibility of having a precision medicine steward on the multidisciplinary cancer care team. Methods: ACCC held a series of focus groups and interviews with a diverse group of stakeholders to explore how cancer programs had justified, hired, trained, and utilized precision medicine stewards to improve guideline-concordant biomarker testing rates. ACCC examined select job descriptions, learned how stewards helped improve biomarker testing processes, and developed a framework for how a steward can fit into cancer care teams’ clinical and operational workflows. Results: Precision cancer medicine stewards can help improve biomarker test ordering processes. In one member program, turnaround time from test ordering to receipt of results decreased from an average of 24 days to 12 days and the quantity non-sufficient rate of testing decreased by five percent. Stewards also helped to improve the digitization of test orders, streamline prior authorizations, track tissue specimens, and notify oncologists when quantity of tissue was not adequate for testing. Stewards contributed to precision medicine workgroups that vetted reference laboratories, tracked key performance indicators around biomarker testing, and prioritized opportunities to reduce testing disparities. ACCC also collated examples of job titles, job descriptions, and role responsibilities of precision medicine stewards to share across member programs and practices. Conclusions: Guideline-concordant biomarker testing requires multiple complex steps and careful care coordination. Precision cancer medicine stewards have been shown to improve testing-related processes, decrease the time from ordering to receipt of results, and assist with prior authorizations. ACCC will work to further highlight their contributions on the multidisciplinary cancer care team and document more evidence of their return on investment for cancer programs and practices.

Oncology financial advocacy services guidelines: Results of a Delphi study.

e18606 Background: At least half of people with cancer experience financial toxicity1 but financial advocacy has emerged as a promising intervention to mitigate it. How cancer programs and practices screen for financial toxicity among patients and the types of services they offer vary greatly. Standardization is needed to evaluate the outcomes and impacts of financial advocacy. Therefore, the Association of Community Cancer Centers (ACCC) Financial Advocacy Network set out to develop Oncology Financial Advocacy Services Guidelines (hereafter “the Guidelines”) to address this gap. Methods: To conduct this original, non-clinical trial research, ACCC convened a task force of seven multidisciplinary experts in financial advocacy to oversee a modified Delphi study. The task force assembled a panel of 49 experts, who represented oncology financial advocacy staff, multidisciplinary cancer care team members, financial advocacy subject matter experts, as well as patients and patient advocates. Based on a literature review and qualitative input from panelists, the task force drafted a list of 44 potential guidelines. In early 2022, panelists completed two rounds of anonymous voting, determining if each statement should not be a guideline, be a minimum guideline, or be an enhanced guideline. Consensus was set at 75% agreement. Results: The panel reached consensus that 43 statements should be guidelines. One guideline was rated minimum, while another 17 trended toward being considered minimum (60%-74% agreement among panelists). The panel rated one guideline as enhanced, with two others trending toward being enhanced. Twenty-two guidelines did not reach consensus one way or another on being minimal vs. enhanced. Conclusions: The Guidelines are publicly available in a report that includes implementation considerations extracted from Delphi panelists’ comments and task force input. Half of guidelines did not reach consensus on whether they are minimum or enhanced, reflecting the diversity of current financial advocacy practice and a need to develop greater standardization in the field. ACCC is taking several next steps to advance research and quality practice using the Guidelines, including collaborative policy development, assessment tools, and the creation of valid metrics and accountability measures.

Assessing current diagnostic, staging, and treatment practices in community and academic centers for individuals with stage IB-IIIA non–small-cell lung cancer (NSCLC).

e20608 Background: The five-year survival for individuals with surgically resected, early-stage NSCLC is around 50%. Recent availability of biomarker driven therapy after surgery has the promise of improved outcomes. However, deficits in the quality of diagnostic evaluation, evidence-based treatment delivery, care coordination, and biomarker testing are still barriers to optimal outcomes. Methods: In 2022, the Association of Community Cancer Centers (ACCC) conducted a survey of NSCLC providers to assess current patterns in the diagnosis and treatment of patients with early-stage (IB-IIIA) NSCLC. The survey, which was distributed to ACCC members and their associated networks, collected information about each respondent and their cancer program processes around diagnosis, treatment planning, and care delivery. We administered it Qualtrics and analyzed results with SAS 9.4. Results: We had 124 survey respondents from 33 US states. Respondents’ institutions were 60% urban, 23% suburban, and 17% rural, 53% community cancer programs, 37% academic/NCI designated cancer programs, 9% private practice. On average, initial tissue biopsy was performed by interventional radiologists in 29% of cases, interventional pulmonologist in 22%, and thoracic surgeons in 16%. In stage IIA-IIIA, on average 49% typically perform invasive mediastinal staging before surgery, 17% during surgery, and 18% do not typically perform invasive mediastinal staging. The most frequent barriers to optimal staging and diagnosis included scheduling (73%), cost (51%), tissue quality (46%), limited access to tests or procedures (42%), and missed appointments (36%). Multidisciplinary tumor board use included 31% with a general cancer tumor board, 50% with a thoracic specific tumor board, and 14% have a dedicated molecular tumor board. Tumor board meetings were weekly in 57%, 2-3 times a month in 22%, and once a month in 11%. 66% have a standard biomarker testing protocol for resected NSCLC. 51% typically order EGFR and 31% regularly order PDL1 testing for patients with resected NSCLC. The largest barriers to optimal care included: scheduling (23%), patient refusal (19%), communication breakdowns (17%), inadequate staffing (15%), and limited access to subspecialties (14%). 83% agree their center has the staff and resources to help patients navigating the health system. However, only 45% typically assign a nurse navigator to individuals with early-stage NSCLC. Palliative care service referrals were made sometimes or often in 48% of sites, while 51% refer rarely or never. Conclusions: In this broad sample of oncology practices across the US, we identified several strengths and barriers to optimal care for persons with early-stage NSCLC. Improved care coordination and standardized staging and diagnosis practices could optimize care in this dynamic treatment landscape.

Differences in perceptions and use of remote patient monitoring technology in rural cancer programs.

1582 Background: While the benefits and acceptability of remote patient monitoring (RPM) during cancer care are well documented, barriers to implementation and use of these digital technologies remain. Feasibility may be particularly restricted in rural settings. The Association of Community Cancer Centers (ACCC) surveyed U.S. cancer programs, patients with cancer and caregivers in various geographic settings to illuminate the current practice landscape and perceptions regarding the use of digital technologies to monitor patients for adverse events and collect patient reported outcomes (PROs). Methods: ACCC convened an expert advisory committee and patient advocacy partners to guide development of two surveys, one for cancer program staff and the other for patients/caregivers. Surveys were distributed between December 2022 and January 2023 and included 25 closed and open-ended questions. Exploratory analysis was performed and responses were compared between rural, suburban, and urban settings for both groups, with comparisons made by two tailed Fisher’s exact test. Results: There were 128 cancer program staff and 162 patient/caregiver responses. Of staff respondents (52% physicians, 20% other clinicians, 21% administrators/managers), 58% work in urban, 30% suburban, and 13% rural settings. Of the patient/caregiver respondents (56% patients, 44% caregivers), 28% live in urban, 51% suburban, and 21% rural areas. 56% of rural, 24% of urban, and 26% of suburban respondents indicated that their cancer programs have not implemented and are not considering implementing RPM. Of rural program staff, 44% indicated they have no experience/familiarity with RPM, compared to 7% for urban and 13% for suburban staff (p<.001, p=.03, respectively). Fewer rural programs, as compared to urban, use secure text messaging (6% vs. 42%; p=.008) or automated phone surveys (6% vs. 34%; p=.03). More rural patients/caregivers compared to their urban/suburban counterparts indicated concerns about privacy (47% vs 27%; p=.02), concerns about the need to pay (44% vs. 19%; p=.004), and lack of strong cell service (5% vs 21%; p=.007) as barriers to RPM technology use. Conclusions: RPM is gaining momentum in academic and community cancer program settings; however, significant gaps exist in RPM experience and implementation for rural cancer programs. In addition to well-documented disparities in access to internet and cellular service for rural patients, perceptions about privacy and cost pose additional barriers. Secure text messaging and automated surveys are often used as example solutions to bridge digital literacy and access gaps, yet cancer programs in rural areas are less likely to use these technologies. Tailored patient/provider education, funding/reimbursement strategies, and advocacy for policies expanding technology infrastructure may be needed for cancer programs to equitably provide RPM technologies.

Healthcare providers' experiences of continuing care for older adults with cancer during the COVID-19 pandemic.

The COVID-19 pandemic has caused great strain on older adults with cancer and their healthcare providers. This study explored healthcare providers' reported changes in cancer care, clinical barriers to care, patient questions, and the overall experiences of caring for older adults with cancer during the COVID-19 crisis. The Advocacy Committee of the Cancer and Aging Research Group and the Association of Community Cancer Centers developed a survey for healthcare providers of adults with cancer, inquiring about their experiences during the pandemic. Responses from the survey's four open-ended items were analyzed by four independent coders for identification of common themes using deductive and inductive methods. Participants (n = 137) represented a variety of demographic and clinical experiences. Six overall themes emerged, including (1) telehealth use, (2) concerns for patient mental health, (3) patient physical and social isolation, (4) patient fear of contracting COVID-19, (5) continued disruptions to cancer care, and (6) patients seeking guidance, particularly regarding COVID-19 vaccination. Questions fielded by providers focused on the COVID-19 vaccination's safety and efficacy during older adults' cancer treatment. Additional resources (e.g., technology support, established care guidelines, and sufficient staffing) are needed to support older adults with cancer and healthcare providers during the pandemic. Future research should explore universally effective in-person and virtual treatment strategies for older adults with cancer. Persistence of telehealth barriers, particularly a lack of infrastructure to support telehealth visits, social isolation, and restrictive visitor policies as a result of COVID-19, negatively impacted the mental health of older adults with cancer.

Increasing Racial and Ethnic Equity, Diversity, and Inclusion in Cancer Treatment Trials: Evaluation of an ASCO-Association of Community Cancer Centers Site Self-Assessment.

Clinical trial participants do not reflect the racial and ethnic diversity of people with cancer. ASCO and the Association of Community Cancer Centers collaborated on a quality improvement study to enhance racial and ethnic equity, diversity, and inclusion (EDI) in cancer clinical trials. The groups conducted a pilot study to examine the feasibility, utility, and face validity of a two-part clinical trial site self-assessment to enable diverse types of research sites in the United States to (1) review internal data to assess racial and ethnic disparities in screening and enrollment and (2) review their policies, programs, procedures to identify opportunities and strategies to improve EDI. Overall, 81% of 62 participating sites were satisfied with the assessment; 82% identified opportunities for improvement; and 63% identified specific strategies and 74% thought the assessment had potential to help their site increase EDI. The assessment increased awareness about performance (82%) and helped identify specific strategies (63%) to increase EDI in trials. Although most sites (65%) were able to provide some data on the number of patients that consented, only two sites were able to provide all requested trial screening, offering, and enrollment data by race and ethnicity. Documenting and evaluating such data are critical steps toward improving EDI and are key to identifying and addressing disparities more broadly. ASCO and Association of Community Cancer Centers will partner with sites to better understand their processes and the feasibility of collecting screening, offering, and enrollment data in systematic and automated ways.

Association of Community Cancer Centers: Exploring Current Perceptions of Multi-Cancer Early Detection Testing Among Healthcare Providers

Association of Community Cancer Centers: Exploring Current Perceptions of Multi-Cancer Early Detection Testing Among Healthcare Providers