Cancer Care Coordination Research Articles

A TED Talk style patient video education intervention to improve care coordination for rural patients with early-stage cancer: A feasibility study.

236 Background: Effective care coordination is a key component of high-quality, patient-centered cancer care. However, cancer patients residing in rural areas often experience substantial barriers to care and suboptimal care coordination. To date, there is a paucity of interventions to improve care coordination for rural cancer patients. In this pilot trial, we assessed the feasibility and preliminary efficacy of a remote, tablet-based patient video education intervention focused on cancer care coordination among rural patients in Hawaii. Methods: We conducted a single-arm pilot study to assess the preliminary effects of a novel, TED-talk style patient video education intervention presented by clinicians and a patient advocate. Video content focused on cancer basics, care coordination, and self-advocacy. Eligible participants were newly diagnosed with early-stage cancer (I-III), within one month of starting adjuvant chemotherapy, able to speak/read English, and residing in rural areas (defined as RUCA ≥ 4). We assessed the feasibility and patient-reports of acceptability and satisfaction using semi-structured interviews. Validated instruments were administered at baseline and post-intervention and used to assess the preliminary effects of the intervention on patients’ perceptions of care coordination (CCI; Care Coordination Instrument) and self-advocacy (adapted Cancer Self-Advocacy Scale; Hagan et al. 2018). Descriptive statistics were used to assess study outcomes. Results: From 01/2022 to 12/2022, 19 patients enrolled on the study (21 approached); 74% were female, 42.1% identified as two or more races, 26.3% Asian, and 21.1% White. Mean age was 52.2. The majority of participants were receiving treatment for breast cancer. Five patients became ineligible after enrolling on the study (disease progression, relocation). 71.4% of eligible patients completed all assessments. No changes were observed in the overall perceptions of care coordination. Improved scores were observed for the CCI communication domain (+4.5; Cohen’s d = -0.76, 95% CI: -1.45, -0.03). For self-advocacy, there was an overall trend for improved scores for the informed decision making and connected strengths subscales. All participants reported high satisfaction with the intervention. Conclusions: Results support the preliminary feasibility, satisfaction, and acceptability of this intervention for rural patients. Although the effects on the overall perceptions of care coordination are unclear, preliminary data suggest that the intervention may improve communication aspects of care coordination and self-advocacy. Further study is needed to evaluate the intervention in other rural areas. Funding support: The HOPE Foundation for Cancer Research/SWOG. Clinical trial information: NCT05162404 .

Intra- and inter-facility experiences of coordinating care for patients with lung cancer in KwaZulu-Natal public health facilities: a qualitative study

Aim Despite evidence that effective cancer care coordination has yielded positive results in facilitating and supporting high-quality care, it remains a complex and challenging system to implement. South Africa’s mortality of lung cancer is reported at 13.4%, ranking highest among all cancers. Coordinating the care of cancer patients is complex and can last several months or years, with multiple consultations, rounds of treatment, and follow-up in various settings. With so many health professionals, services, and settings involved, the care of these patients can become fragmented and uncoordinated. This interface between primary and specialty care offers a valuable opportunity to appreciate the challenges of delivering well-coordinated cancer care. Consequently, this paper explores healthcare professionals’ perspectives on coordinating lung cancer care within and between healthcare services. Methods This study was conducted through virtual, telephonic, and face-to-face in-depth interviews with 26 purposively selected participants from primary to tertiary health professionals, using a semi-structured tool and drawing from grounded theory design. Data generation and analysis were conducted iteratively, followed by systematic thematic analysis to organise data, review, and interpret the findings. Findings The overall public health system challenges reported by participants involved service fragmentation, staff shortages, and communication problems. Drivers of lack of care coordination varied widely across healthcare professionals, with interoperability and communication challenges standing out as the most prominent themes. Consequently, better communication, interoperability, and improved care transitions between providers and health systems were proposed. This study provides pertinent information for policymakers and healthcare professionals to develop appropriate strategies for improving cancer care coordination interventions. Conclusions A fundamental change is required to shift the direction of the KwaZulu-Natal public health system towards responsive, patient-centred, comprehensive, and coordinated care. Enabling the primary healthcare level to play a substantial role in care coordination may provide a plausible intervention to circumvent healthcare complexities.

Barriers to identifying and addressing health-related social needs in cancer care: Patient and patient navigator perspectives

BackgroundThe study aimed to gain insight into the experiences of patients with cancer and survivors regarding the integration of social needs assessment into their care, while also gathering perspectives from patient navigators on the barriers to obtaining and utilizing social needs information during cancer care, which taken together may influence cancer care policies. By comparing the perspectives of patients and navigators, the study sought to inform best practices for integrating, identifying, and addressing social needs to improve patient experiences and outcomes. MethodsWe conducted qualitative interviews and self-report surveys involving patients with cancer, providers, and patient navigators or care coordinators, seeking their insights and firsthand experiences related to health-related social needs in cancer care. Interviews were transcribed, separated into memos of main themes based on deductive coding, and further analyzed for new emergent themes using inductive coding. ResultsThe present analysis focuses solely on the perspectives of 20 patient navigators and 21 patients. Qualitative analyses revealed two overarching themes: Theme 1: Personal and health system-related factors may create barriers for patients to disclose health-related social needs information during cancer care; and Theme 2: When social needs are identified, it is best practice to acknowledge and address social needs through referrals, resources, timely follow-up, and continued care coordination. Key barriers include individual beliefs and attitudes, concerns regarding privacy and sensitivity of questions, uncertainties about the outcomes of disclosing information, and patient-provider relationships and trust. ConclusionDrawing upon the perspectives of patients and patient navigators provided valuable insight into the challenges associated with acquiring information on social needs. Their viewpoints presented feasible solutions to overcome barriers through early acknowledgment of patient needs, timely resource provision, and maintaining consistent follow-up actions. Additionally, it enhanced understanding of the pivotal role patient navigators play in oncology, serving as crucial links between screening for health-related social needs and addressing individual patient requirements. Policy SummaryThe policies and policy improvements our paper seeks to impact include: inequalities in cancer care and health-related social needs of cancer.

Association of housing status and cancer diagnosis, care coordination and outcomes in a public hospital: a retrospective cohort study

ObjectivesCancer is a leading cause of death in unhoused adults. We sought to examine the association between housing status, stage at diagnosis and all-cause survival following cancer diagnosis at a...

Care coordination models for transition and long-term follow-up among childhood cancer survivors: a scoping review

ObjectivesChildhood cancer survivors may experience complex health issues during transition and long-term follow-up (LTFU); therefore, high-quality healthcare is warranted. Care coordination is one of the essential concepts in advanced healthcare....

In search of strategies to mitigate financial toxicity in survivorship care: A survey of 347 head and neck cancer survivors.

11060 Background: High costs of cancer treatment exert substantial financial toxicity for patients undergoing treatment. Growing literature suggests lasting financial toxicity (FT) after treatment completion. This calls for the development and integration of mitigating strategies in survivorship care to reduce FT; thereby improving the overall well-being of survivors. Methods: Cross-sectional survey data from 347 head and neck cancer survivors were analyzed to explore the relationship between FT and potential targets for intervention. We measured FT using the COmprehensive Score for financial Toxicity (COST, v1), and defined severe, moderate, and mild-to-no FT as having COST score ≤13, 14 to 25, and ≥26, respectively. The survey also collected information on demographics, quality of life, work and activity impairment, and cancer care coordination (CCC) communication and navigation subscales. We conducted logistic regression to examine which COST item is most predictive of severe FT, and mediation analysis using structural equation model to explore potential targets for interventions to reduce FT. Results: The average age of respondents was 65.5 yrs (SD=11.3). 334 completed COST; 6.3%, 22.2% reported severe and moderate FT, respectively. Study cohort included 20% diagnosed within 2 yrs, 45% 3-4 yrs and 35% ≥5 yrs; the proportion of patients reporting severe FT did not decrease by year since diagnosis (6%, 5.3%, and 7.7%, respectively, P=0.73). Of the 11 items in COST, financial stress was most predictive of severe FT. Survivors who rated financial stress as “very much” or “quite a bit” were 92.8 (P=0.02) times more likely to have severe FT. Higher financial stress was significantly associated with being < age 65, having higher comorbidity score, lower CCC-navigation score, higher activity impairment; navigation and activity impairment are potentially actionable. None of these four variables were statistically significantly associated with severe FT. Mediation analysis showed financial stress has strong mediation effect on severe FT, and survivors with low CCC-navigation scores and high activity impairment were 3.2 times (95% CI: 1.3 – 7.8; P=0.01) and 2.5 (95% CI: 1.1 – 5.2; P=0.02) more likely, respectively, to report high financial stress. Survivors with high financial stress were significantly more likely to be interested or very interested in receiving resources covering financial issues compared to those without (63.4% vs 17.8%, P<0.01). Conclusions: Survivorship care that incorporates interventions designed to improve coordination and navigation and decrease activity impairment can potentially mitigate FT for cancer survivors through reducing their financial stress. The Centers for Medicare and Medicaid Services began paying for navigation services in 2024, opening the opportunity to integrate these interventions into covered navigation services.

Fractionated external-beam radiation therapy in elderly patients.

e13764 Background: To review the outcome of elderly patients treated with fractionated external-beam radiation therapy (RT) at a privately-owned, multi-disciplinary cancer center. Methods: From January 7, 2019, to August 22, 2023, 63 elderly patients were treated with fractionated RT at California Cancer Associates for Research and Excellence (“cCARE”), a privately-owned, multi-disciplinary cancer center in Fresno, California. The median age at the time of RT was 90 y/o (range, 85-98 y/o). Twenty-three patients were female and 40 were male. Forty-six patients identified as white and 17 as non-white. Treatment sites/histologies included primary lung 10, non-melanomatous skin 6, bone metastases 6, breast 5, esophagus 5, H&N 5, prostate 4, primary CNS 3, brain metastases 3, rectum 3, bladder 2, Merkel tumor 2, sarcoma 2, anus 1, liver 1, melanoma 1, multiple myeloma 1, NHL 1, pancreas 1 and stomach 1. Results: Thirty-two of the patients (51%) were treated with curative intent. The remaining 31 patients were treated for palliation. All patients were treated with fractionated RT. However, 4 patients also received a separate course of single-fraction RT. Twenty-seven patients received more than one course of RT. The median RT course was 10 fractions (range, 1-35 fractions). Most patients had previously been treated with systemic therapy. Nearly one third (31%) received systemic therapy concurrent with their RT. The majority of the patients (73%) completed their prescribed course(s) of RT. Many patients (61%) required one or more treatment breaks. The median duration of a treatment break was 1 day (range, 1-29 days). There were no grade 3 or higher RT toxicities recorded. The median follow-up since RT was 5 months (range, 1-59 months). Twenty-four patients have expired. The mediation duration from RT to death was 5 months (range, 1-32 months ). Of the remaining 39 patients, 92% were scored as clinically stable at the time of their last f/u visit. Conclusions: In our experience at cCARE, fractionated RT was administered to elderly patients and the majority completed their prescribed treatment courses. None of the patients in our review experienced clinically significant side effects (Grade 3 or higher) during their RT even in the cohort (31%) who were treated with concurrent systemic therapy. Clearly, careful patient selection and state-of-the-art RT administration is paramount. It is also highly advantageous for patients to be treated in a multi-disciplinary setting such as cCARE where seamless coordination of cancer care among radiation oncologists, medical oncologists and surgeons excels. A companion study is in process comparing the outcome of similarly matched elderly patients from our center who were treated with systemic therapy alone. We anxiously await the outcome of this vital comparison review.

Rural comprehensive cancer care: Qualitative analysis of current challenges and opportunities.

While limited resources can make high-quality, comprehensive, coordinated cancer care provision challenging in rural settings, rural cancer patients often rely on local hospitals for care. To develop resources and strategies to support high-quality local cancer care, it is critical to understand the current experiences of rural cancer care physicians, including perceived strengths and challenges of providing cancer care in rural areas. METHODS: Semi-structured interviews were conducted with 13 cancer providers associated with all 12 non-metropolitan/rural Iowa hospitals that diagnose or treat >100 cancer patients annually. Iterative thematic analysiswas conducted to develop domains. Participants identified geographic proximity and sense of community as strengths of local care. They described decision-making processes and challenges related to referring patients to larger centers for complex procedures, including a lack of dedicated navigators to facilitate and track transfers between institutions and occasional lack of respect from academic physicians. Participants reported a desire for strengthening collaborations with larger urban/academic cancer centers, including access to educational opportunities, shared resources and strategies to collect and monitor data on quality, and clinical trials. Rural cancer care providers are dedicated to providing high-quality care close to home for their patients and would welcome opportunities to increase collaboration with larger centers to improve coordination and comprehensiveness of care, collect and monitor data on quality of care, and access continuing education opportunities. Further research is needed to develop implementation approaches that will extend resources, services, and expertise to rural providers to facilitate high-quality cancer care for all cancer patients.

The impact of brain cancer care coordinators on healthcare utilization and outcomes in patients with glioblastoma.

Cancer care coordinators (CCCs) are recognized as having an important role in patients' and carers' cancer journey. However, there are no studies investigating the impact of CCCs on quantitative outcomes. We performed a retrospective cohort study investigating the impact of brain cancer care coordinators (BCCCs) on health service resource use and survival in patients with glioblastoma. All patients diagnosed with glioblastoma between 2012 and 2019 in Hunter New England Local Health District, Australia (HNELHD) were included and the patients were divided into 2 cohorts: before and after the introduction of the BCCC. Any patient diagnosed in 2016, during the introduction of the BCCC, were excluded. The main outcomes assessed were overall survival, health service resource use, odds of being admitted to hospital after the emergency presentation, and cost-offset analysis to examine the economic implications of BCCCs. A total of 187 patients were included. There were no significant differences in overall survival between the 2 groups (mOS 12.0 vs 11.16 months, HR 0.95). However, there was a reduction in the number of ED presentations and admissions. This was associated with a 24% reduction in aggregate length of stay with the BCCC. There was no statistically significant difference in mean patient costs, however our hospital may have saved over AUD$500 000 with BCCCs. The introduction of BCCC did not improve survival but appeared to be associated with reduced health resource utilization. This study provides economic justification, in addition to the established quality of life improvements, to support the presence of BCCCs.

Cancer care coordination in rural Hawaii: a focus group study

BackgroundRural populations consistently experience a disproportionate burden of cancer, including higher incidence and mortality rates, compared to the urban populations. Factors that are thought to contribute to these disparities include limited or lack of access to care and challenges with care coordination (CC). In Hawaii, many patients residing in rural areas experience unique challenges with CC as they require inter-island travel for their cancer treatment. In this focus group study, we explored the specific challenges and positive experiences that impact the CC in rural Hawaii cancer patients.MethodsWe conducted two semi-structured focus group interviews with cancer patients receiving active treatment for any type of cancer (n = 8). The participants were recruited from the rural areas of Hawaii, specifically the Hawaii county and Kauai. Rural was defined using the Rural-Urban Commuting Area Codes (RUCA; rural ≥ 4). The focus group discussions were facilitated using open-ended questions to explore patients’ experiences with CC.ResultsContent analysis revealed that 47% of the discussions were related to CC-related challenges, including access to care (27.3%), insurance (9.1%), inter-island travel (6.1%), and medical literacy (4.5%). Other major themes from the discussions focused on facilitators of CC (30.3%), including the use of electronic patient portal (12.1%), team-based approach (9.1%), family caregiver support (4.5%), and local clinic staff (4.5%).ConclusionOur findings indicate that there are notable challenges in rural patients’ experiences regarding their cancer care coordination. Specific factors such as the lack of oncologist and oncology services, fragmented system, and the lack of local general medical providers contribute to problems with access to care. However, there are also positive factors found through the help of facilitators of CC, notability the use of electronic patient portal, team-based approach, family caregiver support, and local clinic staff. These findings highlight potential targets of interventions to improve cancer care delivery for rural patients.Trial RegistrationNot required.

114 The role of the Patient Cancer Care Coordinator in the Lung Cancer Pathway – reducing health inequalities and optimising patient access

114 The role of the Patient Cancer Care Coordinator in the Lung Cancer Pathway – reducing health inequalities and optimising patient access

Carrying on with life as a lung cancer survivor: a qualitative study of Australian survivors' employment, finances, relationships, and healthcare experiences.

With novel therapies, more individuals are living longer with lung cancer (LC). This study aimed to understand the impacts of LC on life domains such as employment, finances, relationships, and healthcare needs. Individuals 18+, diagnosed with LC, 6-24 months post-treatment were recruited through an Australian LC cohort study (Embedding Research and Evidence in Cancer Healthcare-EnRICH). Demographic, clinical, quality-of-life and distress data were obtained through the EnRICH study database. Participants completed telephone interviews. Qualitative data were analysed via Framework methods. Twenty interviews (10 females) were conducted. Most participants were diagnosed with advanced LC (Stage III =8, Stage IV =6), and were on average 17 (range, 10-24) months post-diagnosis. Four themes related to "carrying on with life" as a LC survivor were identified: (I) the winding path back to work: those working pre-diagnosis discussed challenges of maintaining/returning to employment, and the meaning and satisfaction derived from work. (II) Vulnerability versus protection: managing the financial impacts of LC: wide variations in financial impacts, some described lost income and high healthcare expenses, others felt financially protected. (III) Connection and loneliness: navigating relationships as a survivor: some experienced lost friendships due to their diagnosis, others noted more meaningful connections. (IV) Still under the umbrella: healthcare during survivorship: participants noted the importance of ongoing oncology team connection and the vital role of cancer care coordinators. Many individuals living with LC want to "carry on" with life. Participants spoke of challenges and opportunities across life domains of relationships, work, and finances, and noted the importance of continued specialist healthcare throughout survivorship.

Patient Perceptions of Care Coordination during Neoadjuvant Therapy for Gastrointestinal Cancers: A Mixed Methods Analysis

PurposeEffective cancer care coordination (CCC) is an integral component of health care delivery and critical to achieving optimal oncologic outcomes. Neoadjuvant therapy (NT), the delivery of multimodality therapy prior to surgery, is inherently complex and multidisciplinary, but CCC during NT is poorly understood. The objective of this study was to characterize patient perceptions of CCC during NT using a mixed methods approach. MethodsThis study is a cross-sectional analysis of patients with gastrointestinal cancers receiving NT who participated in a prospective longitudinal cohort study evaluating their real-time experience using a customized smartphone application. Patients completed the Cancer Care Coordination Questionnaire for Patients (CCCQ-P), a 20-item validated measure of care coordination quality, six weeks after initiating NT. Items were scored on a 5-point Likert scale, and subsections on communication (13 questions) and navigation (7 questions) were calculated with higher scores signifying better CCC. Univariate linear regression was used to calculate the impact of fragmented care and other factors on perceived CCC. Semi-structured interviews were conducted among a convenience sample of patients (n = 5); transcribed interviews were then coded using an inductive approach.ResultsAmong 82 participants, mean age was 61 years old, 68% were male, and mean number of comorbidities was 1.68. Overall (mean 76.6 out of 100), communication subsection (48.6 out of 65), and navigation subsection (28.0 out of 35) CCCQ-P scores suggested overall positive perceptions of care coordination. Qualitative analysis of patient interviews highlighted the need for coordination among physicians before communicating the plan to patients as well as the importance of providers communicating plans in verbal and written form.ConclusionsSuccessful completion of NT requires significant care coordination between patients and healthcare professionals. Yet, in this cross-sectional analysis of patients on a prospective cohort study, patient perceptions of CCC during NT were overall positive. Future research should focus on optimizing other aspects of care delivery in order to improve outcomes of NT.

Impact of Virtual Navigation on the Education and Access of Patients with Cancer: A National Mixed Methods Investigation.

Despite growing evidence of efficacy, oncology patient navigation is not ubiquitously offered. Navigation may reduce barriers to cancer care, yet geographic location may limit patient access. To overcome geographical barriers and increase patient education in oncology, our medical center developed a virtual navigation program. To examine the efficacy of the Virtual Navigation Program designed to increase patient access and education across local and national contexts. In this mixed-methods study, a total of 105 individuals completed an online survey administered nationally to oncology patients who used the navigation program. Clinical and demographic data were collected. Nonparametric tests were used for group comparisons (Wilcoxon Signed-Ranks test). Virtual navigation increased access as the majority of patients utilized the Virtual Navigation Program beyond the local area; 42% of patients were local; 58% were patients located across the US. 55 (52%) were female; 25% were non-White. Pancreatic cancer was the largest tumor type: 51 (49%). Patients agreed the virtual cancer education helped them make critical health choices (mean 4.89 SD = 84); understand their diagnosis (mean 4.44 SD = .77); were able to make informed decisions (mean 4.43 SD = .83), and empowered to manage their cancer care (mean 4.58 SD = .82). Post navigation, the user experience survey revealed significant increases in a subset of patients' cancer knowledge (P < 0.001), access to quality cancer education (P = 0.045), decision-making in cancer care (P < 0.05), and coordinated cancer care (P = 0.03). This study explores a unique role that virtual navigation may play in helping accommodate healthcare for many cancer patients in underserved areas. The use of innovative aspects of research and education in virtual navigation may be successful in promoting patient empowerment in the cancer continuum. Internet-strategies are needed to inform sustainable patient navigation in low-resource contexts.

Patient reports of cancer care coordination in rural Hawaii.

Rural residents experience disproportionate burdens of cancer, and poorer cancer health outcomes in rural populations are partly attributed to care delivery challenges. Cancer patients in rural areas often experience unique challenges with care coordination. In this study, we explored patient reports of care coordination among rural Hawaii patients with cancer and compared rural and urban patients' perceptions of cancer care coordination. 80 patients receiving active treatment for cancer from rural Hawaii participated in a care coordination study in 2020-2021. Participants completed the Care Coordination Instrument, a validated oncology patient questionnaire. Mean age of rural cancer patients was 63.0 (SD = 12.1), and 57.7% were female. The most common cancer types were breast and GI. Overall, rural and urban patients' perceptions of care coordination were comparable (p > 0.05). There were statistically significant differences between rural and urban patients' perceptions in communication and navigation aspects of care coordination (p = 0.02 and 0.04, respectively). Specific differences included a second opinion consultation, clinical trial considerations, and after-hours care. 43% of rural patients reported traveling by air for part or all of their cancer treatment. Findings suggest that while overall perceptions of care coordination were similar between rural and urban patients, differential perceptions of specific care coordination areas between rural and urban patients may reflect limited access to care for rural patients. Improving access to cancer care may be a potential strategy to enhance care coordination for rural patients and ultimately address rural-urban cancer health disparities.

Exploring the experiences of cancer survivors and their caregivers accessing supportive care services in New Brunswick, Canada.

Supportive care services can reduce distress and improve quality of life for cancer survivors and their caregivers. However, people often struggle to access these services. With this issue in mind, the current study aimed to explore the experiences of cancer survivors and their caregivers in accessing supportive care services in New Brunswick, Canada, as well as their prospective interest in a provincial supportive care centre. Forty-four individuals participated in an online or mail survey designed to identify experiences accessing supportive care services and supportive care needs. Results indicated the supportive care services that are most important to participants (e.g., mental and emotional support). Many participants noted that they were unaware of the availability of follow-up services and methods of access. Participants had a variety of unmet care requirements including lack of informational support and care coordination. All participants reported that they would like to have a supportive care centre in New Brunswick. These findings offer important recommendations for improving the coordination and delivery of supportive cancer care for this population.

Abstract A122: Enhanced Vulnerable Elders Navigation (EVEN) program: Increasing patient navigation capacity and sustainability

Abstract Background: The rapidly growing population of older adults and racial/ethnic minorities with cancer necessitates innovative patient navigation strategies to address their unique needs. Our Enhanced Vulnerable Elders Navigation (EVEN) Program aims to increase the capacity to deliver high-quality, evidence-based oncology patient navigation services at a comprehensive cancer center, with the goal of improving equity in cancer care delivery. Methods: Based on a comprehensive needs assessment, the EVEN Program comprises three main domains: health information technology infrastructure enhancements, navigation workflow standardization, and stakeholder engagement. The primary outcome measure is time to treatment initiation. A quasi-experimental design compares outcomes of older adults with cancer who receive enhanced navigation during the implementation period to outcomes of historical controls (matched by age, race, and ethnicity) who received standard navigation during the lead-in "pre-implementation" period. We hypothesize that the EVEN Program will improve the timeliness of cancer treatment initiation among vulnerable older adults. Univariate and multivariable analyses using cox regression models will adjust for patient and health system factors. Logistic regression will assess the likelihood of treatment delay between the standard navigation and EVEN groups. Process metrics across multiple domains will be analyzed at 6-month intervals over 2 years. Qualitative interviews with program stakeholders will provide nearly real-time feedback on program implementation. Baseline Data Approximately half of newly diagnosed cancer patients (N&amp;gt;3000) seen at our institution's main campus in 2021 received navigation services, and at least half of those patients are estimated to be 65+. Patient navigators addressed language/communication barriers (17% of navigated patients) and social determinants of health (15%); they facilitated communication and emotional support (45%) and routinely made referrals to clinical care team members (39%) and for resource coordination (37%), such as interpreters, social work, financial counseling, and external resources. Most navigator contacts were in person (61%), followed by phone calls (34%). We found wide variation in time to initial cancer treatment across cancers, suggesting opportunities for improvement in care coordination. Conclusion: Our multi-component enhanced patient navigation program is conceptually grounded, innovative, with the potential to reduce cancer disparities among older adults from vulnerable populations. Our multidisciplinary project team includes expertise in geriatric oncology, implementation of patient navigator programs, health equity, community partnerships, and patient navigators with over 30 years of experience in compassionate coordination of cancer care. If proven feasible and effective, the EVEN Program has the potential to scale to our entire enterprise, other health delivery systems nationally, and long-term, to improve equitable cancer care for underserved older adults with cancer. Citation Format: Ana Tergas, Annette Mercurio, Lauren Cai, Lorena Gaytan, Marianne Razavi, Deborah Lefkowitz, Chrissy Kim, Terry Hernandez, Steven Morales, William Dale, Narissa Nonzee. Enhanced Vulnerable Elders Navigation (EVEN) program: Increasing patient navigation capacity and sustainability [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A122.

Enhancing Symptom Management and Coordination of Breast Cancer Care at Secondary Hospitals in Saudi Arabia

The passage highlights the complexity of integrated breast cancer care and the importance of effective communication in ensuring treatment compliance, reducing errors and complications, and managing co-morbidities. It emphasizes the need for clarity in the role of the care director to prevent patients from getting lost across different departments. Digital tools are recognized as valuable resources for improving care communication, but their directives and integration within the care team need to be clearly defined. Multidisciplinary team meetings are essential for driving care planning, establishing directives, and collecting structured data. Nurse navigators play a pivotal role in ensuring care continuity and assuming the director's role in the complex landscape of breast cancer care. While AI-driven planning can facilitate their tasks, human intervention remains crucial for providing psychosocial support and addressing unexpected urgencies. The allocation of patients across different healthcare centers is often managed manually and through phone communication, resulting in time-consuming processes and discontinuous system solutions. Privacy rules and competition among providers further limit the effectiveness of current solutions. Additionally, the collection of comprehensive outcome information is currently limited to specific collaborative networks. To address these challenges, AI tools can play a role in facilitating care allocation and predicting risks by leveraging data continuity over time. This can help identify non-compliance issues caused by factors such as limited local resources, distance, and costs. However, it is essential to conduct applied research to bring AI modeling into clinical practice and promote well-coordinated, patient-centric cancer care within the complex healthcare landscape.

Health care experiences of Black cancer survivors: A qualitative study exploring drivers of low and high Consumer Assessment of Healthcare Providers and Systems global ratings of care.

The purpose of this study was to understand the experiences of Black patients with cancer in health care by comparing drivers of high and low ratings. Semistructured in-depth interviews were conducted with 18 Black patients with cancer recruited from cancer survivorship support groups and Facebook between May 2019 and March 2020. Interviews were coded across all transcripts by using a thematic analysis approach before comparing low- and high-rating groups. There were three major themes that influenced whether patients rated their care as low or high, which included the patient-provider relationship, health care staff interactions, and cancer care coordination. For example, the high-rating group described good communication with the health care team as physicians listening to their needs, being responsive to their concerns, and providing recommendations on how to address side effects. In contrast, the low-rating group described poor communication with their health care team as their needs being dismissed and being excluded from decision-making processes. Additionally, there were two distinct themes that influenced patients' low ratings: insurance and financial toxicity issues and experiences of health care discrimination. In an effort to promote equitable cancer care experiences for Black patients, it is important that health systems work to prioritize patient interactions with health care providers and staff, comprehensive care management for patients with cancer, and reductions in the financial burden of caring for cancer.

Multidisciplinary prostate cancer consultation at home: Does the virtual visit platform adversely affect care for elderly patients or impact treatment recommendations?

1521 Background: Amidst the COVID-19 pandemic, Hartford Healthcare (HHC) implemented a multidisciplinary virtual visit prostate cancer clinic (MDVV) to allow patients to receive cancer consultations at home. This clinic has shown significant logistical advantages for provision of coordinated cancer care. To evaluate concerns regarding usability of the telehealth platform for elderly patients, and the absence of in person physical exam at initial consult, we evaluated the MDVV in terms of patient satisfaction based on age, as well as for differences in treatment recommendations after patients were seen in-person at a pre-treatment follow up visit. Methods: Patients with newly diagnosed or progressive prostate cancer were offered a MDVV consultation. Those who assented had sequential virtual consultations with a urologic surgeon, a radiation oncologist, and a medical oncologist, followed by a group conference with all 3 specialists, and were guided through the visit by a nurse navigator. Patients then completed a 7 item satisfaction survey using a 5 point Likert scale evaluating their perception of the efficacy, efficiency, coordination, and overall value of the clinic. Responses were stratified by age group and compared. Chart review determined the impact of subsequent in person office visit on treatment recommendations, and the proportion of patients who underwent staging imaging according to NCCN guidelines. This was compared with a cohort of consecutive patients who completed traditional consults with two high volume prostate cancer surgeons immediately before the pandemic. Results: A total of 161 patients with newly diagnosed or progressive prostate cancer received a MDVV consultation from August 2020 – February 2023. Patient age ranged from 47-84 years (9% &lt; 60 yrs, 52% 60-70 yrs, 34% 70-80 yrs, 5% &gt;80 yrs). The median score for patient satisfaction on all 7 domains was 1 (strongly agree), and did not differ between age groups. There were no instances of a change in treatment recommendation after follow up in person office visit. While 100% of the MDVV cohort received multidisciplinary consultation before treatment, only 14/50 traditional cohort patients (28%) ultimately received the same (p&lt;.001). 100% of MDVV patients underwent imaging according to NCCN guidelines, compared with 33/50 (66%) of traditional patients (p&lt;.001). Conclusions: A virtual format for a multidisciplinary prostate cancer clinic is a logistically advantageous, effective means of offering in-home consultation to prostate cancer patients, leading to high patient satisfaction, regardless of age. The absence of in-person physical examination at initial consultation did not ultimately impact treatment recommendations. This format also improved access to multidisciplinary consultation and increased adherence to imaging guidelines.