Cancer Center Sites Research Articles

Travel-time barriers to specialized cancer care for adolescents and young adults with acute lymphoblastic leukemia.

Prior studies demonstrate that 20%-50% of adolescents and young adults (age 15-39 years) with acute lymphoblastic leukemia (ALL) receive care at specialty cancer centers, yet a survival benefit has been observed for patients at these sites. Our objective was to identify patients at risk of severe geographic barriers to specialty cancer center-level care. We used data from the North American Association of Central Cancer Registries Cancer in North America database to identify adolescent and young adult ALL patients diagnosed between 2004 and 2016 across 43 US states. We calculated driving distance and travel time from counties where participants lived to the closest specialty cancer center sites. We then used multivariable logistic regression models to examine the relationship between sociodemographic characteristics of counties where adolescent and young adult ALL patients resided and the need to travel more than 1 hour to obtain care at a specialty cancer center. Among 11 813 adolescent and young adult ALL patients, 43.4% were aged 25-39 years, 65.5% were male, 32.9% were Hispanic, and 28.7% had public insurance. We found 23.6% of adolescent and young adult ALL patients from 60.8% of included US counties would be required to travel more than 1 hour one way to access a specialty cancer center. Multivariable models demonstrate that patients living in counties that are nonmetropolitan, with lower levels of educational attainment, with higher income inequality, with lower internet access, located in primary care physician shortage areas, and with fewer hospitals providing chemotherapy services are more likely to travel more than 1 hour to access a specialty cancer center. Substantial travel-related barriers exist to accessing care at specialty cancer centers across the United States, particularly for patients living in areas with greater concentrations of historically marginalized communities.

Impact of targeted education on adverse drug reaction documentation in cancer center sites.

395 Background: Allergic and infusion-related reactions represent a significant portion of reported adverse drug reactions (ADRs) at The University of Kansas Health System (TUKHS) Cancer Center sites. According to the TUKHS Allergy Documentation policy, all observed reactions are required to be documented in the electronic health record (EHR) and reported to the responsible provider. Insufficient documentation may result in preventable patient harm due to continued exposure to medications after known ADRs. An audit of patient EHRs demonstrated notable variability in documentation practices, which served as the impetus to implement a standardized ADR documentation workflow at Cancer Center sites. Methods: This multi-center, retrospective study included patients with ADRs submitted via safety reports from July 1st, 2022 to April 1st, 2023. Categorical data was analyzed using the chi-squared test. Duplicate reports and ADRs identified as side-effects were not included in the final analysis. Targeted education was provided via two online video modules, a workflow tips sheet, and an educational infographic. The primary outcome was frequency of allergy lists updated following submission of a safety event report. Secondary outcomes included frequency of standardized progress note writing, note routing, and accurate reaction type differentiation. Results: Targeted education significantly improved allergy list updating from 34.2% to 84.0% (P < 0.001), use of a standardized progress note from 47.4% to 64.2% (P = .008), and correct differentiation of reaction type from 57.7% to 76.4% (P = .02). Progress notes were routed to the responsible provider 58.5% of the time. Smaller community-based Cancer Center sites were significantly less likely to update allergy lists (7.5% vs. 24.5%, P = .017) and more likely to document incorrect reaction types (35.0% vs. 14.3%, P = .022). Conclusions: Targeted education for a standardized documentation workflow increased adherence to ADR documentation, ensuring future treatment plans are updated for patients with a history of reaction and the EHR accurately reflects ADR history. There is an opportunity to strengthen targeted education surrounding ADR documentation workflows for smaller community-based sites.

Differences in real-world pembrolizumab dosing patterns (every 3 weeks versus every 6 weeks) across a large cancer center network.

2592 Background: Pembrolizumab (pembro) is an intravenous immune checkpoint inhibitor used for anti-cancer treatment, with equivalent monotherapy dosing options of 200 mg every 3 weeks (Q3W) or 400 mg every 6 weeks (Q6W). Pembro Q6W dosing was approved for use in April 2020 after the Q3W dose had already been established. As pembro dosing patterns in real-world practice are not well-described, we evaluated this in a large cancer center network consisting of a central site (CS) and 36 community network sites (NS). Methods: We retrospectively reviewed the charts of all patients who received pembro monotherapy for cancer treatment between 4/2020 – 4/2022 at UPMC Hillman Cancer Center sites across the state of Pennsylvania, as well as sites in New York and Ohio. We performed statistical comparisons using the Fisher’s exact test and Wilcoxon rank-sum test. Results: We identified 1,640 patients who received pembro monotherapy, including 377 patients at the CS and 1,263 patients in the NS, with characteristics displayed. Pembro Q6W dosing was significantly more common at the CS than in the NS (42% vs. 15%, p<0.0001). When analyzed by tumor type, pembro Q6W dosing was significantly more common at the CS than in the NS for head & neck (53% vs. 11%, p<0.0001), thoracic (49% vs. 15%, p<0.0001), skin (60% vs. 19%, p<0.0001), and genitourinary (30% vs. 16%, p=0.015) cancers, but not for other tumor types. Within the NS, 30% (11/36) of sites only utilized pembro Q3W dosing and never administered Q6W dosing to patients. Of note, some patients who received pembro Q6W dosing received pembro Q3W dosing initially, either as part of a pembro-containing multidrug regimen or as monotherapy. Excluding patients initially treated with a multidrug regimen to reduce confounding factors, we found that of the patients who received pembro Q6W dosing, 47% (65/137) at the CS and 28% (48/169) in the NS were initially treated with pembro Q3W monotherapy before transitioning to Q6W monotherapy (p=0.0008). Conclusions: In our large cancer center network, pembro Q6W dosing was significantly more common at the CS than in the NS. Switching from pembro Q3W to Q6W dosing was also significantly more common at the CS. Further work is needed to clarify the patient, provider, and institutional factors influencing differences in pembro dosing patterns in real-world practice, as well as the impact of dosing patterns on care delivery outcomes such as cost and accessibility. [Table: see text]

Implementing patient navigation programs: Considerations and lessons learned from the Alliance to Advance Patient-Centered Cancer Care.

Six multidisciplinary cancer centers were selected and funded by the Merck Foundation (2017-2021) to collaborate in the Alliance to Advance Patient-Centered Cancer Care ("Alliance"), an initiative to improve patient access, minimize health disparities, and enhance the quality of patient-centered cancer care. These sites share their insights on implementation and expansion of their patient navigation efforts. Patient navigation represents an evidence-based health care intervention designed to enhance patient-centered care and care coordination. Investigators at 6 National Cancer Institute-designated cancer centers outline their approaches to reducing health care disparities and synthesize their efforts to ensure sustainability and successful transferability in the management of patients with cancer and their families in real-world health care settings. Insights are outlined within the context of patient navigation program effectiveness and supported by examples from Alliance cancer center sites: 1) understand the patient populations, particularly underserved and high-risk patients; 2) capitalize on the existing infrastructure and institutional commitment to support and sustain patient navigation; and 3) build capacity by mobilizing community support outside of the cancer center. This process-level article reflects the importance of collaboration and the usefulness of partnering with other cancer centers to share interdisciplinary insights while undergoing intervention development, implementation, and expansion. These collective insights may be useful to staff at other cancer centers that look to implement, enhance, or evaluate the effectiveness of their patient navigation interventions.

Understanding interest, barriers, and preferences related to yoga practice among cancer survivors.

Despite growing evidence supporting the benefits of yoga for cancer-related symptom management, yoga usage among cancer survivors is low. To translate the evidence of yoga benefits into community practice, it is critical to understand interest in yoga as well as barriers and preferences that influence yoga usage among cancer survivors. We conducted a cross-sectional survey study among cancer survivors, 18 years or older, with a primary diagnosis of cancer, and receiving treatment or follow-up care at outpatient clinics at five regional academic cancer center sites. We collected data and performed bivariate and multivariable analyses on self-reported yoga usage and interest in and barriers to practicing yoga, as well as preferred location and time for yoga practice. Of 857 participants, 70.0% had never practiced yoga and 52.3% were interested in practicing yoga. Among those interested, 52.5% had never practiced yoga. Lower interest was independently associated with being male (odds ratio [OR] = 0.30, 95% confidence interval [CI] = 0.20-0.44, p < 0.001), unemployed (OR = 0.60, 95% CI = 0.39-0.91, p = 0.016), and white (OR = 0.42, 95% CI = 0.23-0.78, p = 0.005). Commonly cited barriers among those who were interested but had never practiced were not aware of yoga benefits (36.3%), difficulty motivating (28.7%), experiencing symptoms (22.9%), and not enough time (22.0%). Participants indicated "on-site and at a studio near home" (41.5%) as preferred location and evenings (3-8 pm, 34.0%) as preferred time for yoga practice. Although more than 50% of patients indicated interest in practicing yoga, use of yoga is low among cancer survivors. Barriers and patient preferences for yoga practice need to be addressed to design effective yoga programs for this population.

An Analysis and Comparison of Survival and Functional Outcomes in Oropharyngeal Squamous Cell Carcinoma Patients Treated with Concurrent Chemoradiation Therapy within City of Hope Cancer Center Sites.

Oropharyngeal squamous cell carcinoma (OPSCC) is a subset of head and neck cancers that can arise due to human papillomavirus (HPV) infection. We designed a retrospective analysis to determine differences in outcomes of OPSCC patients treated at City of Hope (COH) Cancer Center’s main campus versus selected satellite sites with COH-associated faculty and facilities. Patients diagnosed with OPSCC and treated with concurrent chemoradiation therapy (n = 94) were identified and included in the study. Patients underwent treatment at the COH main campus site (n = 50) or satellite sites (n = 44). The majority of patients were Caucasian, male, and diagnosed with p16 positive stage IV locally advanced OPSCC by AJCC 7th edition. Most patients completed their prescribed cumulative radiation therapy dose and had a complete response to treatment. No significant difference in overall survival and progression-free survival was observed between the main campus and the satellite sites. Our study demonstrates successful treatment completion rates as well as comparable recurrence rates between the main campus and COH-associated satellite sites. A trend toward significant difference in feeding tube dependency at 6-months was observed. Differences in feeding tube placement and dependency rates could be addressed by the establishment of on-site supportive services in satellite sites.

Abstract B26: Analysis and comparison of survival and functional outcomes in oropharyngeal squamous cell carcinoma patients within City of Hope Cancer Center sites

Abstract Introduction: Oropharyngeal squamous cell (OPSCC) is a subset of head and neck cancers and is known to be associated with human papillomavirus (HPV). We designed a retrospective analysis to determine differences in survival and functional outcomes of OPSCC patients treated at City of Hope (COH) Cancer Center’s main campus versus selected satellite sites with COH-associated faculty and facilities. Methods and Materials: A retrospective analysis was done on patients diagnosed with OPSCC and treated with concurrent chemoradiation therapy from May 2009 to February 2017 at COH main campus or satellite sites. Eligible patients (N=94) had available demographic data, treatment data, survival and functional outcomes, and recent follow-up at a COH site. Results: 50 patients underwent treatment at the COH main campus and 44 at its satellite sites. Majority of patients were Caucasian (38 patients at main campus, 32 patients at satellite sites), male (40 at main campus, 39 at satellite sites), diagnosed with stage IV locally advanced OPSCC by AJCC 7th edition (43 vs. 32 patients), and p16 positive (42 vs. 30 patients). There was an equal smoking history distribution within our cohort (50% never smokers, 50% former/current smokers at both sites). A small subset of patients at both sites underwent surgical resection prior to concurrent chemoradiation (N=23, 25%). Chemotherapy agents chosen for treatment included cisplatin, carboplatin, cetuximab, and platinum/paclitaxel. Cisplatin was highly favored at the main campus (N=39, 78%); cisplatin (N=21, 48%) and cetuximab (N=21, 48%) use was equally distributed at the satellite sites. Of the 60 cisplatin-treated patients, 58 (98%) received the recommended total minimum dose of 200 mg/m2. Majority of patients completed their prescribed cumulative radiation therapy dose (50-70 Gray) (49 [98%] at main campus, 43 [98%] at satellite sites) and had a complete response to treatment (35 [70%] at main campus, 37 [84%] at satellite sites). There were few hospitalizations during the course of treatment (6 at the main campus, 4 at the satellite sites). 12 patients (24%) at the main campus and 19 patients (43%) at the satellite sites underwent feeding tube placement. A trend toward significant difference in feeding tube dependency at 6 months was observed between the main campus (N=2) and satellite sites (N=11) (17% vs. 58%, p=0.08). No significant difference in the 2-year recurrence rate was observed between the main campus (N=5) and the satellite sites (N=7) (10% vs. 16%, p&amp;gt;0.05). Conclusion: Our retrospective analysis highlights comparable recurrence rates between a major tertiary cancer center and selected satellite sites with dedicated radiation and medical oncology faculty and facilities. Discrepancies in the feeding tube dependency rates could be potentially overcome by integration of supportive services between satellites and main campus. This study also highlights the importance of telehealth services in major institutions. Citation Format: Rebecca R. Pharaon, Ellie Maghami, Arya Amini, Atish Mohanty, Nayana Vora, Sue Chang, Thomas Gernon, Robert Kang, Lalit Vora, Samuel Chung, Sagus Sampath, Erminia Massarelli. Analysis and comparison of survival and functional outcomes in oropharyngeal squamous cell carcinoma patients within City of Hope Cancer Center sites [abstract]. In: Proceedings of the AACR-AHNS Head and Neck Cancer Conference: Optimizing Survival and Quality of Life through Basic, Clinical, and Translational Research; 2019 Apr 29-30; Austin, TX. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(12_Suppl_2):Abstract nr B26.

Abstract B110: Reducing cancer disparities through identification of linkages to care partners within GMaP Region 1 North

Abstract Introduction: The National Cancer Institute (NCI) Center to Reduce Cancer Health Disparities (CRCHD) supports two national networks within its Integrated Network Program (INP): the Geographic Management of Cancer Health Disparities Program (GMaP) and the National Outreach Network (NON). CRCHD strategically engages in facilitation efforts to integrate and disseminate efforts focused on reducing cancer health disparities among the scientific community and to the underserved communities they serve. The GMaP Region 1 North (R1N) hub is one of 7 regional GMaP hubs, led by Regional Coordinating Directors (RCDs) and inclusive of 8 NON CHES across 6 cancer center sites. The R1N hub is based at the Markey Cancer Center in Lexington, Kentucky. R1N has partnered with Johns Hopkins University's Sidney Kimmel Comprehensive Cancer Center, the University of South Carolina, and the University of Virginia Cancer Center to serve Delaware, Kentucky, West Virginia, Maryland, Maine, New Hampshire, Vermont, Virginia, and Washington, DC. RCDs and NON CHEs collaborate to enhance the capacity of regional cancer centers, academic and research partners and community partners to reduce regional cancer health disparities. Identification of preventative screening programs, or “linkages to care,” currently in place across our region and dissemination of this information to key partners was a strategy employed by R1N. Methods: RCDs conducted a web search of all R1N member institutions and organizations and of NON CHEs cancer outreach, education activities and cancer screening initiatives. Using key search terms such as “cancer screenings,” “cancer education,” “cancer awareness,” “clinical trials” for each cancer type (breast, colon, lung, prostate, cervical and ovarian), they searched within each state and DC as well as queried social media channels (Facebook, Google+, Twitter and YouTube) of each R1N member to reveal “linkages to care” data available for each. Results: While search engines provided results in response to our query methods described above, we noted that cancer-specific awareness months offer frequencies for NON CHE interactions through member institutions and for community members occur at least once a quarter in correlation with cancer-specific awareness months campaigns. Based on methods used, RCDs successfully developed, implemented, and disseminated the plan to identify Linkages to Care within R1N. Conclusions: RCDs recommend that R1N member institutions and organizations dedicate web pages to Linkages to Care and adopt social media accounts for their respective public health divisions and/or organizations sponsoring cancer education, outreach, screening initiatives and clinical trials recruitment. The goal is to increase visibility of collaborative efforts among regional cancer centers, academic partners, and minority serving institutions to coordinate Linkages to Care within an NCI CRCHD INP. Citation Format: Julia F. Houston, Heenali Fozdar, Marcela Blinka, Mark Cromo. Reducing cancer disparities through identification of linkages to care partners within GMaP Region 1 North [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B110.

Transitioning adriamycin ifosfamide mesna (AIM) chemotherapy in sarcoma patients to the outpatient setting: Evaluation of outpatient chemotherapy in an oncology care model setting.

e19149 Background: The combination of doxorubicin, ifosfamide and mesna (AIM) significantly improves outcomes among patients with advanced soft tissue sarcomas. The rising cost of inpatient care, alternative payment model changes and patient preferences has prompted institutions to consider shifting therapy to the outpatient setting. However, the safety and feasibility of outpatient AIM chemotherapy is not well established. The University of Arizona Cancer Center developed an Outpatient Program (OP) to facilitate administration of traditional inpatient chemotherapy regimens in the outpatient setting. We transitioned AIM based chemotherapy to the outpatient setting based on selective criteria and caregiver support. The transition to outpatient treatment could lead to large cost-savings implications under the oncology care model. Methods: The current retrospective analysis evaluated the safety and efficacy of outpatient AIM chemotherapy for sarcoma administered in the outpatient setting. An economic study evaluated AIM in the outpatient setting, address, cost of labs, chemotherapy and bed days saved from transitioning chemotherapy from the inpatient setting. Results: Twenty-one patients with soft-tissue sarcoma were treated with outpatient AIM, for a total of 83 cycles. The median age was 60 (27-73) with 6 females and 15 males being evaluated. The median number of cycles per patient was 3.9 (range, 1-6), an average of 4.68 days of infusion days per cycle. Notable side effects included three patients ifosfamide-induced neurologic syndrome and 2 with hematuria. Acute grade 3 and 4 hematological toxicities were observed in 16 and 15 of patients, respectively with 11 occurrences of febrile neutropenia in 9 patients. Of the 21 patients, 15 patients (71%) were hospitalized at least once and 9 patients (43%) were hospitalized due to neutropenic fever. Total bed days saved by transitioning AIM outpatient was 390, for a total hospital cost savings of $1,043,250. Current costs savings for laboratory, chemotherapy and patient assistance access is still being tabulated. Conclusions: The combination of ifosfamide and mesna as a continuous outpatient infusion is feasible and well-tolerated using proper selection of patient and caregiver evaluation. This new model of administration provides an opportunity to decrease cost of care, improve patient satisfaction and reduce utilization of healthcare resource for community and academic cancer center sites.

Quality of prostate cancer screening information on the websites of nationally recognized cancer centers and health organizations

PurposeThe purpose of this study was to survey the accessibility and quality of prostate-specific antigen (PSA) screening information from National Cancer Institute (NCI) cancer center and public health organization Web sites. Methods and materialsWe surveyed the December 1, 2016, version of all 63 NCI-designated cancer center public Web sites and 5 major online clearinghouses from allied public/private organizations (cancer.gov, cancer.org, PCF.org, USPSTF.org, and CDC.gov). Web sites were analyzed according to a 50-item list of validated health care information quality measures. Web sites were graded by 2 blinded reviewers. Interrater agreement was confirmed by Cohen kappa coefficient. ResultsNinety percent of Web sites addressed PSA screening. Cancer center sites covered 45% of topics surveyed, whereas organization Web sites addressed 70%. All organizational Web pages addressed the possibility of false-positive screening results; 41% of cancer center Web pages did not. Forty percent of cancer center Web pages also did not discuss next steps if a PSA test was positive. Only 6% of cancer center Web pages were rated by our reviewers as "superior" (eg, addressing >75% of the surveyed topics) versus 20% of organizational Web pages. Interrater agreement between our reviewers was high (kappa coefficient = 0.602). ConclusionNCI-designated cancer center Web sites publish lower quality public information about PSA screening than sites run by major allied organizations. Nonetheless, information and communication deficiencies were observed across all surveyed sites. In an age of increasing patient consumerism, prospective prostate cancer patients would benefit from improved online PSA screening information from provider and advocacy organizations. Validated cancer patient Web educational standards remain an important, understudied priority.

Quality of Information Addressing Prostate Specific Antigen Screening on NCI Cancer Center and Public Health Organization Websites

To survey accessibility and quality of prostate-specific antigen (PSA) screening information from National Cancer Institute (NCI) cancer center and public health organization websites. We surveyed the December 1, 2016 version of all 63 NCI-designated cancer center public websites and 5 major online clearinghouses from allied public/private organizations (Cancer.gov, Cancer.org, PCF.org, USPSTF.org, and CDC.gov). Websites were analyzed according to a 50-item list of validated healthcare information quality measures. Websites were graded by two blinded reviewers. Inter-rater agreement was confirmed by Cohen’s kappa coefficient. Ninety percent of websites addressed PSA screening. Cancer center sites covered 45% of topics surveyed, while organization websites addressed 70%. All organizational webpages addressed the possibility of false positive screening results; 41% of cancer center webpages did not. Forty percent of cancer center webpages also did not discuss next steps if a PSA test was positive. Only 6% of cancer center webpages were rated by our reviewers as “superior” (e.g. addressing > 75% of the surveyed topics), versus 20% of organizational webpages. Inter-rater agreement between our reviewers was high (kappa coefficient = 0.602). NCI-designated cancer center websites publish lower quality public information about PSA screening than sites run by major allied organizations. Nonetheless, information and communication deficiencies were observed across all surveyed sites. In an age of increasing patient consumerism, prospective prostate cancer patients would benefit from improved online PSA screening information from provider and advocacy organizations. Validated cancer patient web educational standards remain an important, understudied priority.

Quality of information addressing treatment options for women with breast cancer on NCI cancer center websites.

135 Background: The internet is increasingly utilized by cancer patients for information that may influence treatment decisions. National Cancer Institute (NCI)-designated cancer center websites and nationally recognized cancer research agencies are trusted sources of information, however little data exists regarding the quality of information on these sites. We evaluated the quality and accessibility of breast cancer treatment information on cancer center websites addressing therapeutic options. Methods: Websites of all NCI cancer centers, the NCI, and Susan G. Komen were reviewed. Quality was measured using 33 questions from three validated Breast Cancer Decision Quality Instruments (DQI). Two blinded reviewers determined if websites provided information to answer each question. Number of clicks to reach the breast-specific webpage, evaluation time, and Spanish and mobile accessibility were recorded. Kappa coefficient was used to measure inter-observer variability. Correlation between evaluation time and questions answered was measured using Pearson coefficient. Results: Of the 63 cancer center websites evaluated, 94% had breast cancer webpages reached in a median of 2 clicks. Average evaluation time was 11 minutes. 24% were Spanish accessible. 59% were mobile friendly. No site provided information that addressed all questions. The most informative cancer center site addressed 76% of questions. On average, 21% of questions were addressed per site. 16% of sites did not have sufficient information to answer any question. In comparison, the NCI and Komen sites covered higher proportions of questions than cancer center sites (85 and 88%). Inter-observer variability was fair to moderate (avg. Kappa 0.37). Evaluation time strongly correlated with number of questions answered (r = 0.75). Conclusions: NCI cancer center websites provided informative feedback for breast cancer patients across an average 21% of key knowledge points in a validated DQI. This information is less accessible to Spanish speaking patients and patients using mobile devices. Website improvements represent an opportunity to enhance knowledge that may improve shared decision making for women with breast cancer.

Obstacles and facilitators of conducting studies - the perspective of colorectal cancer centers' coordinators

Clinical trials and health services research are crucial pillars for improving patient care. This paper examines factors inhibiting and promoting the study activity and the knowledge and use of trial registries (e. g. DRKS, StudyBox) as an opportunity to learn about existing studies. The coordinators of 274 cancer center sites certified according to the requirements of the German Cancer Society were surveyed using a standardized online questionnaire. Data were analyzed using descriptive and bivariate statistics to identify associations with characteristics of the sites (e. g. patient volume, ownership, teaching status). 176 sites participated in the survey (64.2 %). The central obstacle to study participa-tion from the centers' view is the low number of existing studies. General knowledge of the population about studies was considered low. Trial registries are known to almost all respondents, but are rarely used. The results of the survey suggest that comprehensive measures are needed to sustainably increase the study activity. These include, for example, better information about studies, for example through appropriate databases, and (industry-independent) research funding. One possible way to sensitize patients for studies could be the comprehensive education of the population about the purpose of studies.

Impact Of Umbilical Cord Unit Banking Conditions On Clinical Outcomes In Double Cord Transplant Recipients

▪ IntroductionUmbilical cord blood (UCB) transplantation yields survival comparable to adult stem cell transplantation, but there is significant variability among UCB products, in large part because of differences in processing conditions from collection to cryopreservation at cord banks. While impact of processing conditions on the actual UCB product has been reported, there is a little information regarding impact on patient-level outcomes. We report a retrospective exploratory analysis of processing performed at cord banks prior to freezing of UCB units and the impact on clinical outcomes such as engraftment, cord dominance, transplant-related mortality (TRM) and overall survival (OS) in 133 UCB recipients.MethodsAll adult recipients of unmanipulated double UCB transplantation (dUCBT) for hematologic malignancy from 2003 to 2011 at the 3 Harvard Cancer Center sites (Dana-Farber Cancer Institute, Massachusetts General Hospital, and Beth Israel Deaconess Medical Center) were included. All UCB units were thawed and washed prior to infusion. Multivariate analyses controlled for prognostic factors including age, malignancy, conditioning intensity, degree of HLA matching, presence of anti-HLA antibodies, order of cord infusion, TNC/kg, and CD34+/kg infused. Time to engraftment and treatment-related mortality were analyzed in the competing risks regression setting and survival was analyzed using proportional hazards models. Results98 recipients underwent reduced-intensity conditioning, primarily fludarabine, melphalan and anti-thymocyte globulin. 35 underwent myeloablative conditioning, primarily cyclophosphamide and total body irradiation. Of the 48 banks contributing cords to this study, 42% employed simple cryopreservation and 23% employed plasma/volume reduction only, at some point during operation. These 2 methods were considered “RBC replete”. Of the 34 banks sharing their current practices, simple cryopreservation is no longer practiced by any; 12% practice plasma/volume reduction alone. 88% of the banks now employ RBC depletion, of which 67% use hydroxyethyl starch for RBC sedimentation and 67% use automated processing systems. Engraftment – Neutrophil and platelet engraftment were not impacted by RBC depletion, sedimentation with hydroxyethyl starch, automated processing, HLA matching or CD34+/kg dose in multivariate analyses. An anti-HLA antibody against one or more cords (p<0.001), myeloablative conditioning (p=0.001) and lower TNC/kg doses (p=0.027) were associated with longer time to engraftment. Cord Dominance –Cord dominance was not significantly affected by RBC depletion, RBC sedimentation, use of an automated system, cord bank inventory or years in existence, time in storage, or viability less than 90% at infusion in a multivariate model. Transplant-related Mortality – None of the processing conditions had a significant effect on TRM at 100 days or 1 year. Overall Survival –Although recipient numbers were small, an interesting observation was the improved survival of the 17 recipients of 2 RBC replete units versus the 115 who received 1 or more RBC-depleted units. This was significant in univariate modeling (p=0.022, see Figure) and just significant in multivariate modeling (HR 3.20, p=0.049, 100day OS of 72% vs 100% and 1year OS of 47% vs 82%). Age over 50 and myeloablative conditioning were the only other cord or patient factors to correlate with increased TRM (p=0.033 and 0.001) and decreased overall survival (p=0.062 and 0.003). Conclusions1) UCB bank practices have changed with time and currently employ primarily RBC depletion by sedimentation via automated systems prior to cryopreservation. 2) Neutrophil and platelet engraftment and TRM were not significantly affected by processing conditions at the cord bank in our models. 3) Receipt of 1 or more RBC-depleted units seemed to be associated with inferior survival at 100 days and 1 year vs receipt of 2 RBC-replete cords in multivariate modeling. A clear limitation to our interpretation is sample size, with only 17 recipients receiving 2 RBC-replete cords. While our observations require validation in a larger population, processing conditions at the collection banks and their potential impact on clinical outcomes merit further investigation to determine which aspects of processing should be considered in UCB unit selection. [Display omitted] Disclosures:Koreth:Takeda Pharmaceuticals: Consultancy; Millennium pharmaceuticals: Research Funding.

Assessing patient values first: Creating a platform for advance care planning (ACP) in the adult oncology population.

99 Background: Patients, families and healthcare providers can be apprehensive about having end-of-life (EOL) conversations. However, asking patients about personal values regarding their healthcare goals may create a platform for more in depth conversations. A quantitative instrument to assess patient values and ACP readiness was developed and validated to complement a process for identifying patients appropriate for ACP. Methods: Recruitment was conducted at seven cancer center sites in The US Oncology Network over a 90-day pilot study period. Of 871 identified patients, 301 Texas Oncology patients engaged in ACP. A cross-sectional descriptive design was used in 301 metastatic cancer patients. Sixty-three participants completed the questionnaire. The 13-item instrument was created after an extensive literature review regarding EOL choices and interventions using a 5-point Likert scale. Descriptive statistics were examined, in addition to analysis of the relationships between items using Pearson’s r correlations. Results: Participants were primarily female (59%) and Caucasian (95%); with a mean age of 66 years. Sixty-eight percent reported it "Very Important" to be told they were dying. There was a significant association between willingness to discuss feelings about dying and being told by their physician when dying, (r= 0.373, p&lt;0.01). Sixty-two percent reported it "Very Important" to be able to choose their EOL care location. EOL care location and level of burden for caregivers were significantly associated (r= 0.315, p&lt;0.05). Also, 76% reported being able to select the person who makes EOL decisions for them as "Very Important." Conclusions: Recent studies have shown the importance of assessment of patient healthcare values in the metastatic oncology population. The values and readiness instrument allows healthcare providers to understand the patient’s wishes early in the course of care. ACP can be guided through review of the validated instrument in the adult metastatic population. This provides appropriate weight to both sides of the care equation and is a major step toward creating patient-centered care. Further development of the instrument is needed in this population.

Science of quality: Communication, decision making, and behavior.

22 Background: Addressing advance care planning (ACP) early in metastatic disease is a challenge for providers across oncology. Providing a systematic method to engage providers and patients in these discussions offers opportunities to improve end of life outcomes, improve patient quality of life and engage in shared decision making that supports effective transition to appropriate palliative care and hospice. Methods: A multidisciplinary group of oncology providers developed a framework for ACP which included defining a target population for early introduction, utilizing a standard patient-centered measurement tool (Values Assessment), reviewing practice workflow to schedule ACP conversations, and incorporating documentation elements embedded in the electronic health record. The model included physician referral of patients to a nurse practitioner or social worker who scheduled meetings with patients to assess values, assist patients with advance directives (AD), and explore patient end-of-life wishes based on disease. Seven cancer center sites of service engaged in the pilot study for a 90-day period to test tools, workflow and effectiveness of implementation methods. Documented values assessments, code status, and advance directives were pilot outcomes measures. Results: All sites in the pilot study implemented the framework and participated for 90 days. Workflows were validated to support scheduling of ACP conversations. Use of the values assessment tool was slow to be incorporated in ACP process as was physician referral for introduction. Conclusions: Engaging in a systematic approach to gather and assimilate information provides an opportunity to comparatively assess adoption of an ACP program. Providers are not inherently experienced in basic ACP introduction or deeper ACP discussions. Communications training, including conversations for values assessment and ACP, is in development for use with pilot and new practices engaging in the program, which supports program scalability. [Table: see text]

Systematic identification of metastatic population subsets for advance care planning (ACP) discussions: A scalable approach using electronic health record (EHR) technology.

243 Background: Comprehensive cancer care embraces the concept of having timely discussions with patients about end of life care preferences regarding treatment interventions. Physicians and healthcare teams are frequently challenged with identifying patients who are clinically appropriate for these discussions and subsequent management of ACP work within the context of clinic resource capacity. A data extraction process is needed to systematically identify cancer population subsets for ACP based on clinical data elements maintained within an EHR database. Methods: Seven cancer center sites of service participated in a 90-day pilot study for delivering ACP services to discrete patient populations who it was believed would most benefit from ACP. Electronic methodology was developed and tested through the pilot process to systematically identify those patients having documented evidence of designated clinical criteria, including metastatic disease status. Metastatic status was determined using five clinical data elements. EHR technology enabled further targeting by cancer diagnoses and allowed this program to be scalable to individual practice capacity. Additional filtering capability was incorporated to exclude non-applicable patient records. Results: On a weekly basis, each pilot site received a report of eligible patients based on clinical criteria and practice-specific diagnoses. During the 90-day pilot period, sites collectively identified an average of 871 patients per week who met clinically-based selection criteria. Once a patient was identified, physicians were able to determine if the patient was appropriate for ACP introduction. The systematic patient identification process allowed ACP to be easily integrated into mainstream practice workflow. Conclusions: EHR technology is invaluable for strategically identifying cancer patient population subsets for clinically appropriate delivery of ACP services. Automated notification of eligible patients and the ability to filter the population enabled practices to engage the ACP process wholly within the scope of comprehensive cancer care delivery.