Cancer Alliance Research Articles

STING signalling compensates for low tumour mutation burden to drive anti-tumour immunity

While mutation-derived neoantigens are well recognized in generating anti-tumour T cell response, increasing evidences highlight the complex association between tumour mutation burden (TMB) and tumour infiltrating lymphocytes (TILs). The exploration of non-TMB determinants of active immune response could improve the prognosis prediction and provide guidance for current immunotherapy. The transcriptomic and whole exome sequence data in The Cancer Genome Atlas were used to examine the relationship between TMB and exhausted CD8+ T cells (Tex), as an indicator of tumour antigen-specific T cells across nine major cancer types. Computational clustering analysis was performed on 4510 tumours to identify different immune profiles. NanoString gene expression analysis and single cell RNA-seq analysis using fresh human breast cancer were performed for finding validation. TMB was found to be poorly correlated with active immune response in various cancer types. Patient clustering analysis revealed a group of tumours with abundant Tex but low TMB. In those tumours, we observed significantly higher expression of the stimulator of interferon genes (STING) signalling. Dendritic cells, particularly those of BATF3+ lineage, were also found to be essential for accumulation of Tex within tumours. Mechanistically, loss of genomic and cellular integrity, marked by decreased DNA damage repair, defective replication stress response, and increased apoptosis were shown to drive STING activation. These results highlight that TMB alone does not fully predict tumour immune profiles, with STING signalling compensating for low TMB in non-hypermutated tumours to enhance anti-tumour immunity. Translating these results, STING agonists may benefit patients with non-hypermutated tumours. STING activation may serve as an additional biomarker to predict response to immune checkpoint blockades alongside TMB. Our research also unravelled the interplay between genomic instability and STING activation, informing potential combined chemotherapy targeting the axis of genomic integrity and immunotherapy. City of Hope Christopher Family Endowed Innovation Fund for Alzheimer's Disease and Breast Cancer Research in honor of Vineta Christopher; Breast Cancer Alliance Early Career Investigator Award; National Cancer Institute of the National Institutes of Health under award number R01CA256989 and R01CA240392.

Breast Radiologists' Perceptions on the Detection and Management of Invasive Lobular Carcinoma: Most Agree Imaging Beyond Mammography Is Warranted.

To determine breast radiologists' confidence in detecting invasive lobular carcinoma (ILC) on mammography and the perceived need for additional imaging in screening and preoperative settings. A 16-item anonymized survey was developed, and IRB exemption obtained, by the Society of Breast Imaging (SBI) Patient Care and Delivery Committee and the Lobular Breast Cancer Alliance. The survey was emailed to 2946 radiologist SBI members on February 15, 2023. The survey recorded demographics, perceived modality-specific sensitivity for ILC to the nearest decile, and opinions on diagnosing ILC in screening and staging imaging. Five-point Likert scales were used (1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree, 5 = strongly agree). Response rate was 12.4% (366/2946). Perceived median (interquartile range) modality-specific sensitivities for ILC were MRI 90% (80-90), contrast-enhanced mammography 80% (70-90), molecular breast imaging 80% (60-90), digital breast tomosynthesis 70% (60-80), US 60% (50-80), and 2D mammography 50% (30-60). Only 25% (85/340) respondents were confident in detecting ILC on screening mammography in dense breasts, while 67% (229/343) were confident if breasts were nondense. Most agreed that supplemental screening is needed to detect ILC in women with dense breasts (272/344, 79%) or a personal history of ILC (248/341, 73%), with 34% (118/334) indicating that supplemental screening would also benefit women with nondense breasts. Most agreed that additional imaging is needed to evaluate extent of disease in women with newly diagnosed ILC, regardless of breast density (dense 320/329, 97%; nondense 263/329, 80%). Most breast radiologists felt that additional imaging beyond mammography is needed to more confidently screen for and stage ILC.

Chinese expert consensus: multidisciplinary diagnosis and treatment of multiple ground-glass nodule like lung cancer (2024 edition)

Multiple ground glass nodules (GGN) like lung cancer is a special type of synchronous multiple primary lung cancer, with two or more lesions present simultaneously. It has characteristics such as"indolent"development, less lymph node or distant metastasis, identical or different pathological stages, differential driving gene mutations, diverse imaging manifestations, and good prognosis. In order to standardize the diagnosis and treatment behavior of multiple GGN-like lung cancer, reduce issues such as over diagnosis and insufficient treatment, relevant domestic experts are organized by The Lung Cancer Medical Education Committee of the Chinese Medical Education Association, Lung Cancer Alliance of Chinese Thoracic Surgery, the Society of Tumor Ablation Therapy of the Chinese Anti-Cancer Association, the Tumor Ablation Expert Committee of the Chinese Society of Clinical Oncology, the Tumor Ablation Expert Group of the Chinese College of Interventionalists, The Chinese Expert Consensus:Multidisciplinary Diagnosis and Treatment of Multiple Ground-Glass Nodule Like Lung Cancer (2024 Edition) was discussed and formulated. The main content includes: follow-up strategies, differential diagnosis, diagnosis and staging, treatment methods, and post treatment follow-up for multiple GGN-like lung cancer.

2026 Development of a novel 2-week wait oncogeriatric service: A GI Frailty Clinic

Abstract Introduction Over the last 12 months, a novel oncogeriatric clinic was successfully established to assess frail 2-week wait (2WW) patients referred with gastrointestinal (GI) symptoms. The clinic was initially funded by the West Yorkshire Cancer Alliance, enabling a weekly clinic, run by a geriatrician, clinical specialist nurse and an advance clinical practitioner. Methods A total of 350 patients were assessed (those with a clinical frailty score of ≥ 6 were eligible for referral); due to demand exceeding capacity, remaining patients were referred on through the default surgical or GI pathways. Patients were triaged by endoscopy nurses from ‘straight to test’ referrals after training provided to assess frailty scores using routinely available data. Results Only a third of patients referred remained on the 2WW pathway compared to surgical patients; this was due to patients being too frail or an alternative diagnosis being made through comprehensive geriatric assessment, and a shared decision-making process. The patient level information and costing system (PLICS) demonstrated that the oncogeriatric clinic was cost effective, costing approximately £190 less per patient than the default pathways of care. Feedback from patients demonstrated extremely high satisfaction rates with the service provided. One of the most significant interventions was medicines management, which has led to a pharmacist supporting the clinic through further innovation funding. Conclusion Lessons learned included developing a better understanding of cancer diagnosis and frailty, providing a ‘one stop centre’ for cancer care, and managing complex comorbid conditions in frail older people suspected of having cancer. As a result of this QI service development project, a Frailty Cancer Strategy for the Trust is currently being developed and will be presented to the executive team with the aim of developing a comprehensive oncogeriatric service for frail patients in Leeds, providing the right care, the right treatment, first time.

Colorectal Cancer Alliance: Promoting prevention and early detection with screening navigation and a personalized recommendation via a digital screening quiz tool for colorectal cancer.

71 Background: Evaluating the effectiveness of a Colorectal Cancer screening navigation model delivered in a digital platform offered by a patient advocacy organization. Designed as a digital screening quiz tool and live navigation to promote CRC screening, the Colorectal Cancer Alliance’s Screening Quiz is a risk stratification tool that connects respondents to live certified cancer care navigators delivering evidence-based interventions to increase CRC screening, education and patient and family support. The framework utilizes small and mass media, one-on-one education and patient navigation services to help address and reduce barriers to care. Critical interventions which research shows that on-time screening for CRC leads to better outcomes. Methods: The Screening Quiz has been promoted through social sharing, community outreach, media, including influencer campaigns to increase outreach to at-risk communities. Questions assess personal and family history, hereditary syndromes, and demographics to provide a CRC screening recommendation based on current USPSTF guidelines. Respondents overdue for screening who opt in, are triaged to the Alliance’s patient navigation team for follow-up. This interaction includes phone calls and emails for symptomatic individuals or at high risk for CRC, telephonic and email for average-risk uninsured, and emails for average-risk insured. At-risk individuals are connected to resources, such as financial assistance, free at-home screening tests, and colonoscopy scheduling services. Results: July 2022 to August 2023, the Screening Quiz provided over 30,000 screening recommendations. The median age of respondents was 48; 33% of the respondents were between the ages of 45 to 64. Of the respondents, 29% were male and 71% were female. Most were White (74.3%), but nearly half of those who opted into navigation identified as BIPOC, including 14.4% Black/AA, 17.8% Hispanic or Latino, 7.7% Asian, and 2.5% AI/AN. Most respondents were symptomatic (65.5%) but 7.3% were asymptomatic high-risk. These two groups represented 88% of 1,851 respondents triaged to patient navigation. Conclusions: This digital screening tool and live navigation framework may serve as a key solution in driving CRC screening compared to other interventions. Providing access to live navigation, educational resources, and support services for CRC screening and diagnosis.The Alliance is uniquely positioned with its national network of volunteers, partners, and community presence to effectively reach at-risk communities. Aligning with the science of evidence-based interventions, the Alliance will continue to leverage the Screening Quiz in partnership with healthcare and community stakeholders to close Colorectal Cancer screening gaps.

Cohort study to assess geographical variation in cholangiocarcinoma treatment in England.

Outcomes for cholangiocarcinoma (CCA) are extremely poor owing to the complexities in diagnosing and managing a rare disease with heterogenous sub-types. Beyond curative surgery, which is only an option for a minority of patients diagnosed at an early stage, few systemic therapy options are currently recommended to relieve symptoms and prolong life. Stent insertion to manage disease complications requires highly specialised expertise. Evidence is lacking as to how CCA patients are managed in a real-world setting and whether there is any variation in treatments received by CCA patients. To assess geographic variation in treatments received amongst CCA patients in England. Data used in this cohort study were drawn from the National Cancer Registration Dataset (NCRD), Hospital Episode Statistics and the Systemic Anti-Cancer Therapy Dataset. A cohort of 8853 CCA patients diagnosed between 2014-2017 in the National Health Service in England was identified from the NCRD. Potentially curative surgery for all patients and systemic therapy and stent insertion for 7751 individuals who did not receive surgery were identified as three end-points of interest. Linear probability models assessed variation in each of the three treatment modalities according to Cancer Alliance of residence at diagnosis, and for socio-demographic and clinical characteristics at diagnosis. Of 8853 CCA patients, 1102 (12.4%) received potentially curative surgery. The mean [95% confidence interval (CI)] percentage-point difference from the population average ranged from -3.96 (-6.34 to -1.59)% to 3.77 (0.54 to 6.99)% across Cancer Alliances in England after adjustment for patient sociodemographic and clinical characteristics, showing statistically significant variation. Amongst 7751 who did not receive surgery, 1542 (19.9%) received systemic therapy, with mean [95%CI] percentage-point difference from the population average between -3.84 (-8.04 to 0.35)% to 9.28 (1.76 to 16.80)% across Cancer Alliances after adjustment, again showing the presence of statistically significant variation for some regions. Stent insertion was received by 2156 (27.8%), with mean [95%CI] percentage-point difference from the population average between -10.54 (-12.88 to -8.20)% to 13.64 (9.22 to 18.06)% across Cancer Alliances after adjustment, showing wide and statistically significant variation from the population average. Half of 8853 patients (n = 4468) received no treatment with either surgery, systemic therapy or stent insertion. Substantial regional variation in treatments received by CCA patients was observed in England. Such variation could be due to differences in case-mix, clinical practice or access to specialist expertise.

P017 Cancer alliance initial feasibility study for potential drivers for improvements in QOMS measures and cancer care

P017 Cancer alliance initial feasibility study for potential drivers for improvements in QOMS measures and cancer care

Community driven support platform BlueHQ: An innovative solution to address the needs of patients with colorectal cancer.

330 Background: Colorectal cancer (CRC) is the third-most commonly diagnosed cancer and the second-leading cause of cancer death in men and women combined in the United States. In efforts to manage the disease, patients and caregivers turn to various tools and resources for financial assistance, information dissemination, emotional and peer support, and treatment planning, among other critical issues and needs they face. The Colorectal Cancer Alliance (the Alliance) created BlueHQ to provide patients and caregivers with a resource solution that encompasses all potential areas of need. Methods: A survey aimed at understanding needs, barriers, and quality improvement opportunities was disseminated via the Alliance's Blue Hope Nation community for two weeks and by email. One hundred sixty-seven colorectal cancer patients and forty caregivers of colorectal cancer patients completed the survey. Results: Patients and caregiver respondents report reliance on external tools and resources to manage disease and support information. Of the support methods, patient respondents reported using social media (46.11%); notebooks, journals, and planners (45.41%); online articles (44.91%); the Blue Hope Nation Facebook group (41.32%); cancer discussion boards (35.33%); and spiritual or religious advice (29.94%). To minimize diagnosis-related stressors, patients reported seeking financial assistance, local peer support and groups, and mental health help. To provide more efficient care and limit stress, the community suggested financial help, communication and support from other patients and caregivers, and informational resources. Conclusions: These survey results are consistent with other published learnings about patient and caregiver reliance on support tools and highlight the myriad resources that patients and caregivers currently use for managing CRC. BlueHQ is a support solution that provides patients and caregivers with access to information and resources tailored to users’ specified profiles, including molecular characteristics of the tumor. Users can also store documents and information from healthcare encounters, creating a longitudinal record and tracking disease progression. In the age of precision oncology, BlueHQ ensures patients and users are presented with personalized educational materials and multimedia resources to help manage their disease and bridge the gaps in patient support. BlueHQ was explicitly designed to connect the CRC community to the latest therapeutic and clinical research resources to improve outcomes and quality of life for all CRC patients.

Impact of messaging informed by behavioural science on uptake of targeted lung health checks: a service evaluation

BackgroundLung cancer is the most common cause of cancer death in the UK, and incidence is strongly associated with increasing age. Screening can improve survival by detecting cancer earlier. Targeted Lung Health Check (TLHC) programme is a lung cancer screening pilot offered to smokers or ex-smokers aged 55–74 years in certain areas of England. However, uptake remains as low as 20% in London. We did a service evaluation to assess the effect of adding messaging informed by behaviour science to invitation letters on TLHC uptake. MethodsThe intervention involved adding to the standard invitation letter a box with a two-sentence behavioural message targeted at mitigating fatalistic beliefs and low risk perception, as well as promoting clinician endorsement and the value of early detection. Allocation to receive either standard or intervention letters was done at West London GP practice level, with approximate pairing between practices. From Sept 22, 2022, to Nov 28, 2022, 9464 invitations were sent to eligible individuals (4842 standard and 4622 intervention) covering 20 GP practices. The primary outcome (uptake) was a booked appointment date within 4 months of the invitation letter being sent. TIDieR checklist was used for methodology and reporting guidelines. We used χ2 analysis to test for significant differences in uptake, and mixed-effects logistic regression to control for demographic covariates. FindingsDemographic characteristics were similar in the control and intervention groups, with mean ages of 63·3 and 63·0 years, average index of multiple deprivation (IMD) deciles of 6·33 and 5·53, and percentage of female participants 42·1% (n=2038) and 43·7% (n=2022), respectively. Uptake of TLHC was significantly higher in the intervention group (25·8%, n=1192) than in the control group (20·4%, n=987; χ2(1)=38·762, p<0·0001). A logistic regression model estimated likelihood of uptake was 37·5% (95% CI 12·1–63·2) higher in the intervention group (p=0·004). Patients aged 60–64, 65–69 and 70–75 years were 23·5% (10·7–36·3, p=0·0003), 28·3% (14·5–42·0, p<0·0001), and 32·6% (18·3–47·0, p<0·0001) more likely to attend than those aged 55–59 years. The likelihood of attendance decreased on the basis of deprivation (IMD decile; b=0·060, 95% CI 0·035–0·087, p<0·0001), female gender (b=0·156, 0·057–0·254, p=0·002), and for ex-smokers compared with smokers (b=0·580, 0·467–0·693, p<0·0001). InterpretationThis simple, no-cost addition of behavioural messaging to invitation letters can significantly improve screening uptake and is recommended for wider rollout. These findings are consistent with other studies. However, a limitation is that the allocation to study arm was at GP practice level and the study was not randomised. FundingRM Partners, the West London Cancer Alliance.

Novel diagrammatical analyses of turnover of patients with cancer

Background/Aims The Inverted Nomogramma di Gandy is a diagrammatical method for evaluating staff turnover in large organisations. This exploratory research investigated whether it could be applied to cohorts of ‘active’ patients with cancer (those within the first 5 years of diagnosis) and provide additional insights into the underlying dynamics of cancer incidence and prevalence. Methods The Inverted Nomogramma di Gandy method was applied using relevant data for all clinical commissioning groups in England in 2017. This article details the data and results for breast and lung cancer. To evaluate the method's usefulness to healthcare practitioners, a report was circulated throughout the Cheshire and Merseyside Cancer Alliance, with readers asked to respond to a 15-item survey about their perceptions of the method and its usefulness. Results were analysed using descriptive statistics. Results There were wide variations in incidence and prevalence of breast and lung cancer across England. The diagram showed dispersed patterns for cancer alliances and identified the locations of individual outliers, revealing the underlying dynamics. The patterns for breast cancer and lung cancer were very different; even within the Cheshire and Merseyside Cancer Alliance there were some marked variations between locations. Survey respondents were generally neutral or positive about the method. Conclusions This diagrammatical method provided useful analyses that were complementary to incidence and prevalence data, and potentially useful for practitioners. Because the method uses existing available data, it could be rapidly introduced to services.

The Impact of Supervised, Individualized Exercise on Fatigue and Quality of Life during Adjuvant Radiotherapy for Breast Cancer

Adjuvant radiation therapy in treatment for breast cancer has been shown to improve patient outcomes and reduce mortality rates. However, many patients experience debilitating fatigue as a result. Currently, there are limited treatment options for fatigue in cancer survivors. Options include pharmaceutical agents, psychological interventions, or nutrition strategies, all of which have limited efficacy. Exercise is recommended in survivorship care plans, but it not widely implemented beyond the use of generalized statements or resource guides given to patients. Therefore, the purpose of this study was the examine the impact of an individualized exercise program on fatigue, quality of life, and physical functioning during radiation therapy for breast cancer. This multi-institutional prospective trial evaluated the effects of supervised, individualized exercise therapy in 422 patients undergoing adjuvant radiotherapy for breast cancer. Following a comprehensive fitness assessment and the completion of the Brief Fatigue Instrument (BFI) questionnaire, each participant participated in a 12-week individualized exercise program offered through Maple Tree Cancer Alliance. At its conclusion, the patients repeated the assessment and questionnaire. Individualized exercise had a positive impact on fitness parameters and severity of fatigue. Specifically, cardiovascular endurance, muscular strength, muscular endurance, and flexibility all significantly improved following the exercise intervention (p<0.05). On average, patients fatigue levels decreased by 31.1% (P<0.01). These results signify that fatigue levels are positively impacted by exercise among patients with breast cancer.

Geographical Variation in Underlying Social Deprivation, Cardiovascular and Other Comorbidities in Patients with Potentially Curable Cancers in England: Results from a National Registry Dataset Analysis

AimsTo describe the prevalence of cardiovascular disease (CVD), multiple comorbidities and social deprivation in patients with a potentially curable cancer in 20 English Cancer Alliances. Materials and methodsThis National Registry Dataset Analysis used national cancer registry data and CVD databases to describe rates of CVD, comorbidities and social deprivation in patients diagnosed with a potentially curable malignancy (stage I–III breast cancer, stage I–III colon cancer, stage I–III rectal cancer, stage I–III prostate cancer, stage I–IIIA non-small cell lung cancer, stage I–IV diffuse large B-cell lymphoma, stage I–IV Hodgkin lymphoma) between 2013 and 2018. Outcome measures included observation of CVD prevalence, other comorbidities (evaluated by the Charlson Comorbidity Index) and deprivation (using the Index of Multiple Deprivation) according to tumour site and allocation to Cancer Alliance. Patients were allocated to CVD prevalence tertiles (minimum: <33.3rd percentile; middle: 33.3rd to 66.6th percentile; maximum: >66.6th percentile). ResultsIn total, 634 240 patients with a potentially curable malignancy were eligible. The total CVD prevalence for all cancer sites varied between 13.4% (CVD n = 2058; 95% confidence interval 12.8, 13.9) and 19.6% (CVD n = 7818; 95% confidence interval 19.2, 20.0) between Cancer Alliances. CVD prevalence showed regional variation both for male (16–26%) and female patients (8–16%) towards higher CVD prevalence in northern Cancer Alliances. Similar variation was observed for social deprivation, with the proportion of cancer patients being identified as most deprived varying between 3.3% and 32.2%, depending on Cancer Alliance. The variation between Cancer Alliance for total comorbidities was much smaller. ConclusionSocial deprivation, CVD and other comorbidities in patients with a potentially curable malignancy in England show significant regional variations, which may partly contribute to differences observed in treatments and outcomes.

Survival outcomes of head and neck melanoma patients in Queensland, Australia from 2009 to 2018.

To compare survival outcomes for patients with cutaneous invasive head and neck melanoma (HNM) with those of patients with melanoma on other anatomical sites. Retrospective cohort study using patient data extracted from the Cancer Alliance Queensland's Oncology Analysis System (OASYS) over a 10-year period from 2009 to 2018. Melanoma-specific survival was compared between patients with HNM and non-HNM. Kaplan-Meier survival estimates were calculated at 5 and 10 years. Univariable and multivariable Cox proportional hazards regression analysis determined factors associated with survival. The 5- and 10-year survival probabilities were 90.7% and 89.1%, respectively for HNM, compared with 94.7% and 93.0%, respectively, for non-HNM melanoma. The 5- and 10-year survival probabilities for scalp melanoma were 77.8% and 75.5%, respectively. Patients with HNM died of melanoma at 1.22 times (HR 1.22, 95% CI 1.09-1.37) the rate of those with non-HNM, controlling for sex, age, socioeconomic status, remoteness, Breslow thickness, the presence of multiple invasion melanoma and ulceration. Patients with scalp melanoma died of melanoma at 1.57 times (HR 1.57, 95% CI 1.26-1.95) the rate of those with non-scalp HNM. There is a statistically significant survival difference between patients with HNM and non-HNM, and between patients with scalp melanoma and non-scalp HNM, even after adjusting for prognostic factors.

Management of patients at the hepatopancreatobiliary unit of a London teaching hospital during the COVID-19 pandemic

To mitigate COVID-19-related shortage of treatment capacity, the hepatopancreatobiliary (HPB) unit of the Royal Free Hospital London (RFHL) transferred its practice to independent hospitals in Central London through the North Central London Cancer Alliance. The aim of this study was to critically assess this strategy and evaluate perioperative outcomes. Prospectively collected data were reviewed on all patients who were treated under the RFHL HPB unit in six hospitals between November 2020 and October 2021. A total of 1541 patients were included, as follows: 1246 (81%) at the RFHL, 41 (3%) at the Chase Farm Hospital, 23 (2%) at the Whittington Hospital, 207 (13%) at the Princess Grace Hospital, 12 (1%) at the Wellington Hospital and 12 (1%) at the Lister Hospital, Chelsea. Across all institutions, overall complication rate were 40%, major complication (Clavien–Dindo grade ≥ 3a) rate were 11% and mortality rates were 1.4%, respectively. In COVID-19-positive patients (n = 28), compared with negative patients, complication rate and mortality rates were increased tenfold. Outsourcing HPB patients, including their specialist care, to surrounding institutions was safe and ensured ongoing treatment with comparable outcomes among the institutions during the COVID-19 pandemic. Due to the lack of direct comparison with a non-pandemic cohort, these results can strictly only be applied within a pandemic setting.

From diagnosis of colorectal cancer to diagnosis of Lynch syndrome: The RM Partners quality improvement project.

The UK National Institute for Health and Care Excellence guideline DG27 recommends universal testing for Lynch syndrome (LS) in all newly diagnosed colorectal cancer (CRC) patients. However, DG27 guideline implementation varies significantly by geography. This quality improvement project (QIP) was developed to measure variation and deliver an effective diagnostic pathway from diagnosis of CRC to diagnosis of LS within the RM Partners (RMP) West London cancer alliance. RM Partners includes a population of 4 million people and incorporates nine CRC multidisciplinary teams (MDTs), overseen by a Pathway Group, and three regional genetic services, managing approximately 1500 new CRC cases annually. A responsible LS champion was nominated within each MDT. A regional project manager and nurse practitioner were appointed to support the LS champions, to develop online training packages and patient consultation workshops. MDTs were supported to develop an 'in-house' mainstreaming service to offer genetic testing in their routine oncology clinics. Baseline data were collected through completion of the LS pathway audit of the testing pathway in 30 consecutive CRC patients from each CRC MDT, with measurement of each step of the testing pathway. Areas for improvement in each MDT were identified, delivered by the local champion and supported by the project team. Overall, QIP measurables improved following the intervention. The Wilcoxon signed rank test revealed significant differences with strong effect sizes on the percentile of CRC cases undergoing mismatch repair (MMR) testing in endoscopic biopsies (p = 0.008), further testing with either methylation or BRAF V600E (p = 0/03) and in effective referral for genetic testing (from 10% to 74%; p = 0.02). During the QIP new mainstreaming services were developed, alongside the implementation of systematic and robust testing pathways. These pathways were tailored to the needs of each CRC team to ensure that patients with a diagnosis of CRC had access to testing for LS. Online training packages were produced which remain freely accessible for CRC teams across the UK. The LS project was completed by April 2022. We have implemented a systematic approach with workforce transformation to facilitate identification and 'mainstreamed' genetic diagnosis of LS. This work has contributed to the development of a National LS Transformation Project in England which recommends local leadership within cancer teams to ensure delivery of diagnosis of LS and integration of genomics into clinical practice.

The impact of 2weeks wait referral on survival of head and neck cancer patients.

This study aims to evaluate the association between 2weeks wait referral and survival in the head and neck cancer. Retrospective cohort study of consecutively discussed new head and neck cancer patients at large United Kingdom Cancer Alliance including two tertiary referral hospitals and two district general hospital. A total of 276 cancer patients were included for analysis. Patients referred under the 2weeks wait had were seen and diagnosed sooner from referral (p < 0.0001 and p < 0.0001 respectively). However, this did not translate into better survival outcomes. No survival differences were seen between those patients that were managed within the proposed cancer targets and those that were not. The 2weeks wait head and neck cancer pathway did not offer a survival advantage. Targeting the delay in referral as well as delay in treatment to prevent late-stage cancer presentation is paramount. Fulfilment of cancer time targets do not translate into better outcomes and should not be prioritised to clinical judgement.

Diagnosis, treatment, and survival from kidney cancer: real-world National Health Service England data between 2013 and 2019.

To report the NHS Digital (NHSD) data for patients diagnosed with kidney cancer (KC) in England. We explore the incidence, route to diagnosis (RTD), treatment, and survival patterns from 2013 to 2019. Data was extracted from the Cancer Data NHSD portal for International Classification of Diseases, 10th edition coded KC; this included Cancer Registry data, Hospital Episode Statistics, and cancer waiting times data. Registrations included 66 696 individuals with KC. Incidence of new KC diagnoses increased (8998 in 2013, to 10 232 in 2019), but the age-standardised rates were stable (18.7-19.4/100 000 population). Almost half of patients (30 340 [45.5%]) were aged 0-70 years and the cohort were most frequently diagnosed with Stage 1-2 KC (n = 26 297 [39.4%]). Most patients were diagnosed through non-urgent general practitioner referrals (n = 16 814 [30.4%]), followed by 2-week-wait (n = 15 472 [28.0%]) and emergency routes (n = 11 796 [21.3%]), with older patients (aged ≥70 years), Stage 4 KCs, and patients with non-specified renal cell carcinoma being significantly more likely to present through the emergency route (all P < 0.001). Invasive treatment (surgery or ablation), radiotherapy, or systemic anti-cancer therapy use varied with disease stage, patient factors, and treatment network (Cancer Alliance). Survival outcomes differed by Stage, histological subtype, and social deprivation class (P < 0.001). Age-standardised mortality rates did not change over the study duration, although immunotherapy usage is likely not captured in this study timeline. The NHSD resource provides useful insight about the incidence, diagnostic pathways, treatment, and survival of patients with KC in England and a useful benchmark for the upcoming commissioned National Kidney Cancer Audit. The RTD data may be limited by incidental diagnoses, which could confound the high proportion of 'emergency' diagnoses. Importantly, survival outcomes remained relatively unchanged.

How patient-clinician education can strengthen partnerships and promote tangible actions to improve clinical trial diversity in breast and lung cancer trials.

6510 Background: Some of the greatest disparities in cancer care are related to clinical trial access for our patients. To address the racial/ethnic disparities in breast and lung cancer clinical trials, a tethered educational initiative was designed to empower patients, assess current clinician perceptions/practices, and improve awareness of real-world perspectives of clinical trials. Methods: Two, one-hour online, interactive, video-based programs were designed for patients, caregivers, and providers. This patient/caregiver program was hosted on CancerCoachLive and MedLive in November, 2022, while the provider program was hosted on ClinicalSeriesLive in December, 2022 and will remain on-demand until December 2023. This initiative was conducted in collaboration with TOUCH, the Black Breast Cancer Alliance, BlackDoctors.org, Moffitt Cancer Center, CancerCare, and the Lung Cancer Research Foundation. Herein, we report on an analysis from patients and providers regarding clinical trial diversity, behavioral impact, and qualitative insights. Results: As of data cut-off (02/10/23), 1,425 participants have engaged across both educational programs. Of participating patients, 46% were non-White (non-Hispanic), 36% were in remission, 36% were not on active treatment, and 29% were newly diagnosed. Following the program 81% were motivated to take one or more actions over the next two months: the most common actions being to research clinical trials (38%) or discuss clinical trials with a clinician (19%). Post-activity, 79% were confident to very confident discussing clinical trials with a clinician. Critical data related to clinician preferences was assessed and demonstrated a 23% increase in confidence from pre- to post-activity in improving diversity in clinical trial participation with preferences observed in both breast and lung cancers to offer clinical trials for newly diagnosed and second recurrence settings. Of those who are being offered clinical trials in the community setting, there was a higher likelihood for patients to be offered a clinical trial if their subtype was HER2+ breast cancer subtype or NSCLC with an actionable mutation. Data collection continues as this initiative is ongoing. Qualitative data including clinician write-in examples of behavioral impact and patient perspectives from the interviews will be shared. Conclusions: The outcomes discussed herein reveal a willingness from patients/caregivers to engage in clinical trial discussions and participate in clinical trials, if eligible. These educational programs positively impacted clinician motivation to address barriers to enrollment and clinical trial eligibility with their patients. Real-world accounts of patient experiences provide different perspectives that can help improve approaches to improve clinical trial diversity.

Colorectal Cancer Clinical Trial Summit: Devising solutions and interventions.

e15603 Background: Only 5% of adult cancer patients enroll in cancer clinical trials; however, approximately 70% are willing to participate. The numerous gaps between patient willingness and trial participation rates suggest that enrollment in clinical trials can be challenging. The Colorectal Cancer Alliance Clinical Trial Think Tank Summit brought together multidisciplinary voices to propose solutions and tailor interventions to increase participation in colorectal cancer (CRC) clinical trials and save lives. Methods: An expert advisory committee supported the planning of the Summit by collating existing knowledge and best practices from across the field. The Alliance collected patient perspectives through interviews and aligned around three critical themes for change in CRC clinical trials. The Summit created a forum for thoughtful and strategic discussions with expert speakers and sessions to explore thematic solutions. Results: The advisory committee’s research activities and discussion identified strategic solutions across the following themes: 1. Marketing &amp; Messaging Trust in Clinical Trials; 2. Fostering Readiness for Community-Based Cancer Research, and 3. Clinical Trial Patient Navigation. There was consensus that cancer patients and the public need to be educated on the importance of clinical trial access and dispel myths about clinical trials. Messaging must be culturally competent, creating quality standards for trial awareness and participation for utilization in a marketing campaign.&amp;nbsp; Summit participants discussed barriers to clinical trial enrollment at the institutional, structural, provider, and patient levels. Collaborations with industry sponsors and partnering with community oncology programs are necessary for designing and conducting research serving the understudied and underserved. &amp;nbsp; Participants identified that navigators are crucial for decentralized clinical trials and are a key element for improving clinical trial efficiency and the patient experience. Developing and launching a centralized clinical trial navigator pilot program is necessary to ensure that navigators are knowledgeable about recruiting CRC clinical trials nationally. Conclusions: Clinical trials are essential to advancing new treatments. To extend clinical research into the community, standardized messaging is needed that dispels myths about clinical trials and highlights positive trial outcomes. By improving our overall messaging, collaboration, education, and access to resources, we can accelerate CRC clinical trial participation to improve outcomes and research answers.

Colorectal cancer and digital/live screening navigation: Promoting prevention through personalized recommendations and access.

10566 Background: This project evaluates the effectiveness of an advocacy organization-led digital and live navigation framework aimed at colorectal cancer (CRC) screening completion. The Colorectal Cancer Alliance’s screening quiz guides patients to a clinically valid, personalized CRC screening recommendation with a handoff to live navigation for those at risk. The framework utilizes digital innovation, targeted awareness, and financial support to support populations experiencing the greatest disparities and increase screening intention, behavior, and further health equity in colorectal cancer. This simple intervention is critical due to existing research consistently indicating on-time screening for CRC leads to favorable outcomes. Methods: In July 2022, the Alliance launched an enhanced quiz to improve the CRC screening navigation experience and increase engagement. The new survey instrument was restructured to streamline time to completion while preserving clinically accurate risk stratification. The follow-up navigation protocol was reordered from digital-first to live-first to leverage high-touch strategies earlier in the screening journey and dynamic content was added to the recommendation page to create a more personalized resource. The Alliance also deployed social media and influencer campaigns to increase outreach to at-risk communities. Results: The enhanced quiz delivered over 8,300 CRC screening recommendations and improved the average monthly completion rate (33%) and contact capture rate (14.4%) compared to the previous quiz in 2022 (24%; 8%). The median age of respondents was 55, and 37.2% of the respondents were between the ages of 45 and 64. Of the respondents, 26.7% were male and 73.3% were female. The majority were White (77.1%), 7.3% identified as Black/African American, 5.5% were Hispanic or Latino, and 3% were Asian. Most respondents were symptomatic (67.8%) but 8.1% were asymptomatic high-risk. Respondents (1,078) were triaged to live Alliance patient navigation. Conclusions: This digital and live navigation framework may serve as a strong solution in driving colorectal cancer screening and supporting shared-decision making conversations compared to other available interventions. The framework provides users with robust access to live navigation, educational resources, and support services for CRC screening and diagnosis. The Alliance is uniquely positioned to utilize its communications channels, social media and influencer campaigns to reach at-risk communities with credibility. Data attributed to specific campaigns are still being analyzed, and the Alliance will continue to optimize its navigation protocol and awareness efforts as quality improvement processes allow for a deeper understanding of more inclusive and impactful navigation experiences to close screening gaps among at-risk populations.