Community Cancer Centers Research Articles

Enhancing the utilization of healthy living interventions among cancer survivors in historically underserved populations and communities.

This study aimed to describe the clinical characteristics and wellness programming preferences of cancer survivors from Acres Homes, a historically Black neighborhood in Houston, Texas, with areas of persistent poverty. The goal of this study was to identify opportunities to increase cancer survivor utilization of healthy eating and active living interventions aligned to cancer center community outreach and engagement efforts. This multiple methods study included a retrospective review of electronic health record data (n = 413) and qualitative interviews with cancer survivors (n = 31) immediately preceding initiation of healthy eating, active living programming in Acres Homes. This study found Acres Homes survivors have high rates of co-occurrent cardiometabolic disease including obesity (45.0%), diabetes (30.8%), and other related risk factors as well as treatment-related symptoms. Four major concepts emerged from interviews: (1) Factors that influence survivors' ability to eat well and exercise, (2) Current usage of community resources, (3) Interest in relevant programming, and (4) Specific programming preferences. Opportunities for current and future health promotion programming for cancer survivors were explored. Strategically tailoring community resources for cancer survivors can provide a more robust network of support to promote healthy eating and active living in this population. This work informed community implementation of evidence-based health interventions in Acres Homes and may support future projects aiming to enhance community-led cancer prevention efforts in historically underserved communities.

Peer MD Coaching Partnership Outcomes Between an NCI-designated Cancer Center Genetics Service and a Community Cancer Network Hospital

Purpose Patients with cancer seen in rural and underserved areas disproportionately face barriers to access genetic services. Genetic testing is critical to inform treatment decisions, early detection of another cancer, and to identify at-risk family members who would benefit from screening and prevention. Methods We conducted a prospective cohort study to examine medical oncologist’s genetic testing ordering trends at Olympic Medical Cancer Center (OMCC), a community network hospital. Phase I focused on observation of clinic processes. Phase II incorporated peer coaching from cancer genetics experts from Fred Hutchinson Cancer Center (FHCC) for OMCC medical oncologists. Number of genetic testing tests ordered was compared between phases. Results Of the total patients with cancer, 29 out of 415 (7.0%) received genetic testing in phase I and 25 out of 219 (11.4%) in phase II. Although it did not reach statistical significance (p=0.057), uptake of genetic testing increased by 22% between phases. 4 out of 19 (21.1%) patients with pancreatic cancer and 6 out of 35 (17.1%) patients with ovarian cancer received testing when NCCN recommends offering genetic testing to 100% of these patients. Conclusion Peer coaching intervention from cancer genetics experts led to increased ordering of genetic testing by medical oncologists. Efforts made to 1) standardize gathering of personal and family history of cancer, 2) review biomarker data suggestive of a hereditary cancer syndrome, 3) facilitate ordering tumor and/or germline genetic testing every time NCCN criteria are met, 4) encourage data sharing between institutions, and 5) advocate for universal coverage for genetic testing will help realize the benefits of precision oncology for patients and their families seeking care at community cancer centers.

Outcomes of a Multidisciplinary Team in the Management of Patients with Early-Stage Breast Cancer Undergoing Neoadjuvant Chemotherapy at a Community Cancer Center.

Background: The utilization of neoadjuvant chemotherapy (NAC) remains highly variable in clinical practice. The implementation of NAC requires coordination of handoffs between a multidisciplinary team (MDT). This study aims to assess the outcomes of an MDT in the management of early-stage breast cancer patients undergoing neoadjuvant chemotherapy at a community cancer center. Methods: We conducted a retrospective case series on patients receiving NAC for early-stage operable or locally advanced breast cancer coordinated by an MDT. Outcomes of interest included the rate of downstaging of cancer in the breast and axilla, time from biopsy to NAC, time from completion of NAC to surgery, and time from surgery to radiation therapy (RT). Results: Ninety-four patients underwent NAC; 84% were White and mean age was 56.5 yrs. Of them, 87 (92.5%) had clinical stage II or III cancer, and 43 (45.8%) had positive lymph nodes. Thirty-nine patients (42.9%) were triple negative, 28 (30.8%) were human epidermal growth factor receptor (HER-2)+, and 24 (26.2%) were estrogen receptor (ER) +HER-2-. Of 91 patients, 23 (25.3%) achieved pCR; 84 patients (91.4%) had downstaging of the breast tumor, and 30 (33%) had axillary downstaging. The median time from diagnosis to NAC was 37.5 days, the time from completion of NAC to surgery was 29 days, and the time from surgery to RT was 49.5 days. Conclusions: Our MDT provided timely, coordinated, and consistent care for patients with early-stage breast cancer undergoing NAC as evidenced by time to treatment outcomes consistent with recommended national trends.

Are NCI Cancer Centers Providing Adolescents and Young Adults With Cancer Focused Clinical Services? A National Survey.

This study sought to evaluate the current services and delivery models of adolescent and young adult oncology (AYAO)-specific programs at NCI-designated Cancer Centers (NCI-CCs). NCI, academic, and community cancer centers were electronically sent surveys from October to December 2020 and administered via REDCap. Survey responses were received from 50 of 64 (78%) NCI-CCs, primarily completed by pediatric oncologists (53%), adult oncologists (11%), and social workers (11%). Half (51%) reported an existing AYAO program, with most (66%) started within the past 5 years. Although most programs combined medical and pediatric oncology (59%), 24% were embedded within pediatrics alone. Most programs saw patients aged 15 (55%) to 39 years (66%) mainly via outpatient clinic consultation (93%). Most centers reported access to a range of medical oncology and supportive services, but dedicated services specifically for adolescent and young adults (AYAs) were available at a much lower extent, such as social work (98% vs 58%) and psychology (95% vs 54%). Although fertility preservation was offered by all programs (100%), only two-thirds of NCI centers (64%) reported providing sexual health services to AYAs. Most NCI-CCs (98%) were affiliated with a research consortium, and a lesser extent (73%) reported collaboration between adult and pediatric researchers. Nearly two-thirds (60%) reported that AYA oncology care was important/very important to their respective institution and reported providing good/excellent care to AYAs with cancer (59%), but to a lesser extent reported good/excellent research (36%), sexual health (23%), and education of staff (21%). Results of this first-ever national survey to assess AYAO programs showed that only half of NCI-CCs report having a dedicated AYAO program, and that areas of improvement include staff education, research, and sexual health services for patients.

Racial Disparities in Brachytherapy Treatment among Women with Cervical and Endometrial Cancer in the United States.

Brachytherapy improves clinical outcomes among women diagnosed with cervical and endometrial cancers. Recent evidence demonstrates that declining brachytherapy boosts for women with cervical cancer were associated with higher mortality. In this retrospective cohort study, women diagnosed with endometrial or cervical cancer in the United States between 2004 and 2017 were selected from the National Cancer Database for evaluation. Women ≥18 years of age were included for high intermediate risk (PORTEC-2 and GOG-99 definition) or FIGO Stage II-IVA endometrial cancers and FIGO Stage IA-IVA-non-surgically treated cervical cancers. The aims were to (1) evaluate brachytherapy treatment practice patterns for cervical and endometrial cancers in the United States; (2) calculate rates of brachytherapy treatment by race; and (3) determine factors associated with not receiving brachytherapy. Treatment practice patterns were evaluated over time and by race. Multivariable logistic regression assessed predictors of brachytherapy. The data show increasing rates of brachytherapy for endometrial cancers. Compared to non-Hispanic White women; Native Hawaiian and other Pacific Islander (NHPI) women with endometrial cancer and Black women with cervical cancer were significantly less likely to receive brachytherapy. For both NHPI and Black women, treatment at community cancer centers was associated with a decreased likelihood of brachytherapy. The data suggest racial disparities among Black women with cervical cancer and NHPI women with endometrial cancer and emphasize an unmet need for brachytherapy access within community hospitals.

Hospital facility characteristics and socioeconomic factors on outcomes and treatment in patients with multiple myeloma: National Cancer Database analysis.

Previous studies have shown that socioeconomic factors play an important role in multiple myeloma (MM) health outcomes. We postulated that the type of treatment facilities and their volume of cases also affect overall survival, utilization of various therapies including palliative care services in newly diagnosed MM. Using the National Cancer Database (NCDB), we analyzed 174,551 newly diagnosed MM participants from across the country. We found that at high volume facility centers (over 90th percentile of new patient volume from 2004 to 2016), the median overall survival (OS) was 62.3 months versus 35.3 months at lower volume facilities (p <0.001). Similarly, high volume academic cancer centers had an improved median OS of 66.4 months (65.3-67.4 CI) versus 39.2 months (37.9-40.4 months CI) in lower volume academic centers (p <0.001). The odds of utilizing chemotherapy, immunotherapy, and autologous transplants were higher in academic cancer centers compared to community cancer centers, after adjusting for demographic and socioeconomic factors (OR 1.10, 1.23, and 2.06 respectively, all with p<0.001). There was significantly decreased odds of receiving palliative care (OR 0.89, 95% CI 0.85-0.93) in high volume facilities compared to low volume. Palliative care services were more frequently utilized at integrated network cancers and comprehensive community cancer centers compared to community cancer centers, with similar odds of receiving palliative care between community and academic facility types. Our results likely reflect increased provider experience and resources in higher volume and academic facilities. This highlights the need to integrate resources and improve access to community programs.

Predicting Survivorship Appointment Nonattendance in a Community Cancer Center: A Machine-Learning Approach.

Understanding and predicting cancer survivors' health care utilization is critical to promote quality care. The consultative system of survivorship care uses a onetime consultative appointment to transition patients from active treatment into survivorship follow-up care. Knowledge of attributes associated with nonattendance at this essential appointment is needed. An ability to predict patients with a likelihood of nonattendance would be of value to practitioners. Unfortunately, traditional data modeling techniques may not be useful in working with large numbers of variables from electronic medical record platforms. A variety of machine-learning algorithms were used to develop a model for predicting 843 survivors' nonattendance at a comprehensive community cancer center in the southeastern United States. A parsimonious model resulted in a k-fold classification accuracy of 67.3% and included three variables. Practitioners may be able to increase utilization of follow-up care among survivors by knowing which patient groups are more likely to be survivorship appointment nonattenders.

Outcomes of Older Adults With AML Treated in Community Versus Academic Centers: An Analysis of Alliance Trials.

Clinical trials are important for managing older patients with AML. We investigated differences in outcomes of older patients with AML on the basis of whether patients participated in intensive chemotherapy trials at community versus academic cancer centers. We used data from the Alliance for Clinical Trials in Oncology phase III trials that enrolled patients age ≥ 60 years with newly diagnosed AML between 1998 and 2002 in the Cancer and Leukemia Group B (CALGB) 9720 trial and between 2004 and 2006 in the CALGB 10201 trial. Centers funded by the NCI Community Oncology Research Program were identified as community cancer centers; others were designated as academic cancer centers. Logistic regression models and Cox proportional hazards models were used to compare 1-month mortality and overall survival (OS) by center type. Seventeen percent of the 1,170 patients were enrolled in clinical trials in community cancer centers. The study results demonstrated comparable rates of grade ≥3 adverse events (97% v 93%), 1-month mortality (19.1% v 16.1%), and OS (43.9% v 35.7% at 1 year) between community versus academic cancer centers, respectively. After adjusting for covariates, 1-month mortality (odds ratio, 1.40; 95% CI, 0.92 to 2.12; P = .11) and OS (hazard ratio, 1.04; 95% CI, 0.88 to 1.22; P = .67) were not statistically different among patients treated in community versus academic cancer centers. An older patient population, who have complex health care needs, can be successfully treated on intensive chemotherapy trials in select community cancer centers with outcomes comparable with that achieved at academic cancer centers.

Abstract 1059: Precision medicine in a community cancer center: pan-cancer DNA/RNA sequencing of tumors reveals clinically relevant gene fusions

Abstract Background: Gene fusions occur when two independent genes form a hybrid gene through genomic rearrangements, which often leads to abnormal expression and function of the encoded proteins. In hematological and solid cancers, oncogenic fusions may be prognostic, diagnostic, or therapeutic biomarkers. Improved detection and understanding of the functional implications of such fusions may be beneficial for patient care. Herein, we report gene fusions in different solid tumors seen in a community cancer center. Method: We retrospectively analyzed our internal genomic cancer center-specific cBioPortal database for gene fusions identified by DNA and RNA sequencing of solid tumors through a CLIA/CAP commercial lab from 2016-2022. We divided the identified fusions into two groups: 1) known oncogenic fusions; and 2) unclassified fusions. Results: We identified 420 known oncogenic fusions in 4,415 tumors. Oncogenic fusions occurred most often in ovarian adenocarcinoma (N=62/420; 14.8%), followed by non-small cell lung cancer (NSCLC) (N=55/420; 13.1%), prostate cancer (N=48/420; 11.4%), breast cancer (N=46/420; 10.1%), glioblastoma (N=35/420; 8.3%), and colorectal cancer (N=22/420; 5.2%). We identified EML4-ALK fusions in 13 tumor samples and KIF5B-RET fusions in 9 tumors, all in NSCLC. We identified 18 fusions in soft tissue sarcomas, including the fusions that are the hallmark of synovial sarcomas, such as SS18-SSX1 and SS18-SSX2. In addition, we identified 25 unclassified fusions (Table). Conclusions: 9.5% of our tumors have oncogenic fusions that may be clinically relevant, which suggests patients with advanced cancers should have comprehensive molecular profiling that includes RNA sequencing. Additional studies are needed to determine the function of the identified unclassified gene fusions to assess potential clinical significance. Table- Unclassified Fusions (number per total unclassified fusions) Tumor Type (Total Number of Samples Profiled) Fusion Positive samples Unclassified Fusions Prostate adenocarcinoma (89) 8 (32%) BMPR1B-PDLIM5 (2 patients), CDC13-SUGCT, NIPBL-RAI14, TTC6-MIPOL1, NFIB-UBE3B, GALNT7-SPOCK3, TBCA-AP3B1 Breast cancer (224) 8 (32%) NIPBL-PIEZO1, ETV6-RINT1, PAK1-TEX14, PAK1-MMP20, PAK1-LOC101928896, TTC6-MIPOL1, BMPR1B-PDLIM5, CMTM8-OSBPL10 Non-small cell lung cancer (751) 4 (16%) PANX1-PRPF19 (2 patients), TTC6-MIPOL1, GALNT7-SMIM8 Head and neck cancer (177) 2 (8%) ETV6-DNAH14, TP53BP1-SND1 Salivary gland tumor (22) 1 (4%) NFIB-CHCHD7 Pancreatic adenocarcinoma (186) 1 (4%) CMTM8-GPD1L Ovarian cancer (362) 1 (4%) NIPBL-SLC1A3 Total Number of Fusions 25 Citation Format: Sourat Darabi, David R. Braxton, Carlos E. Zuazo, Burton L. Eisenberg, Michael J. Demeure. Precision medicine in a community cancer center: pan-cancer DNA/RNA sequencing of tumors reveals clinically relevant gene fusions [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1059.

Abstract 5533: Providing culturally responsible health care to Pacific Islander communities: The creation of a cultural competency training for healthcare professionals

Abstract Cultural competency is the ability to respectfully engage, understand, and communicate through conscientious interaction, enabling effective work and meaningful relationships in cross-cultural situations. Cultural competency recognizes the importance for organizations of participants’ diverse social and cultural values, beliefs, and behaviors, and has gained attention because it can bridge health perspectives, understanding, and respect between health professionals and patients. There remains a need for cultural competency in healthcare as disparities persist across the U.S. in racial and ethnic minority groups who experience worse health outcomes and lower healthcare quality than the general public. Therefore, a cultural competency training curriculum was created using various resources to improve interactions between Pacific Islander patients and healthcare professionals. This training helps to reduce racial/ethnic disparities in healthcare by encouraging mutual understanding and improving patient satisfaction, adherence to medical instructions, and overall health outcomes by highlighting patient-centered care as a result of utilizing components of cultural competency. To improve patient experiences in Hawai’i, healthcare professionals need the tools to better interact with patients from different cultures, such as Pacific Islanders. This training provides healthcare professionals with culturally-based content for improving cultural competence techniques for interacting with Pacific Island patients. This training was pilot tested with key stakeholders from community organizations and Cancer Center faculty/staff. Local health clinics, providers, and practices will have the opportunity to participate in this training through a Zoom-based electronic training format and be provided with three continuing medical education credits. The initial delivery of the training was intended for in-person sessions; however, a virtual format was adapted due to the COVID-19 pandemic and subsequent social distancing regulations. Healthcare providers are provided pre-training resources, a pre- and post-test, and a course evaluation to determine the validity of training objectives. To date, two Federally Qualified Health Centers have been provided the training, n=60, as well as one Cancer Health Equity Partnerships’ Scientific Workshop, n=40. For attendees, the analysis of correct responses from the pretest to post-test showed a significant improvement on 6 of the 12 questions. Respondents also agreed that the training resources aligned with the course objectives. Improved patient interactions from this training can help support better patient outcomes, adherence to medical advice regarding cancer screenings, and many other aspects of improving health equity for Pacific Islanders. Citation Format: Mark Lee Willingham Jr., Kevin Cassel, Angela Sy, Munirih Taafaki, Tressa P. Diaz, Angelina G. Mummert. Providing culturally responsible health care to Pacific Islander communities: The creation of a cultural competency training for healthcare professionals. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5533.

The 17-Gene Genomic Prostate Score Assay Is Prognostic for Biochemical Failure in Men With Localized Prostate Cancer After Radiation Therapy at a Community Cancer Center

The objective of this study was to assess the association between the Oncotype DX Genomic Prostate Score (GPS) assay and long-term outcomes in men with localized prostate cancer (PCa) after radiation therapy (RT). We hypothesized that the GPS assay is prognostic for biochemical failure (BCF), along with distant metastasis (DM) and PCa-specific mortality in patients with PCa receiving RT. We retrospectively studied men with localized PCa treated with definitive RT at Georgia Urology from 2010 to 2016. The primary objective was to assess the association between GPS results and time to BCF per the Phoenix criteria; we also assessed time to DM and PCa-specific mortality. We used Cox proportional hazards regression models for all analyses, with clinicopathologic covariates determined a priori for multivariable modeling. A total of 450 patients (median age, 65 years; 35% Black) met eligibility criteria. There was a strong univariable association between GPS result and time to BCF (hazard ratio [HR] per 20-unit increase=3.08; 95% confidence interval [CI], 2.11-4.46; P < .001), which persisted after adjusting for clinicopathologic characteristics in multivariable analyses. We also observed this association for time to DM (HR=5.19; 95% CI, 3.06-8.77; P < .001) and PCa-specific mortality (HR=13.07; 95% CI, 4.42-49.39; P < .001). Race was not a predictor of time to BCF or DM, and the GPS assay was strongly prognostic for all endpoints in Black and White patients. In a community-based cohort, the GPS assay was strongly prognostic for time to BCF as well as long-term outcomes in men treated with RT for localized PCa.

Assessment of a Peer Physician Coaching Partnership Between a Designated Cancer Center Genetics Service and a Community Cancer Network Hospital

Patients with cancer seen in rural and underserved areas disproportionately face barriers to access genetic services. Genetic testing is critical to inform treatment decisions, for early detection of another cancer, and to identify at-risk family members who may benefit from screening and prevention. To examine medical oncologists' genetic testing ordering trends for patients with cancer. This prospective quality improvement study was performed in 2 phases over 6 months between August 1, 2020, and January 31, 2021, at a community network hospital. Phase 1 focused on observation of clinic processes. Phase 2 incorporated peer coaching from cancer genetics experts for medical oncologists at the community network hospital. The follow-up period lasted 9 months. The number of genetic tests ordered was compared between phases. The study included 634 patients (mean [SD] age, 71.0 [10.8] years [range, 39-90 years]; 409 women [64.5%]; 585 White [92.3%]); 353 (55.7%) had breast cancer, 184 (29.0%) had prostate cancer, and 218 (34.4%) had a family history of cancer. Of the 634 patients with cancer, 29 of 415 (7.0%) received genetic testing in phase 1, and 25 of 219 (11.4%) received genetic testing in phase 2. Of the 29 patients who received testing in phase 1, 20 (69.0%) had germline genetic testing; 23 of 25 patients (92.0%) had germline genetic testing in phase 2. Uptake of germline genetic testing increased by 23.0% between phases, but the difference was not statistically significant (P = .06). Uptake of germline genetic testing was highest among patients with pancreatic cancer (4 of 19 [21.1%]) and ovarian cancer (6 of 35 [17.1%]); the National Comprehensive Cancer Network (NCCN) recommends offering genetic testing to all patients with pancreatic cancer and ovarian cancer. This study suggests that peer coaching from cancer genetics experts was associated with an increase in ordering of genetic testing by medical oncologists. Efforts made to (1) standardize gathering of personal and family history of cancer, (2) review biomarker data suggestive of a hereditary cancer syndrome, (3) facilitate ordering tumor and/or germline genetic testing every time NCCN criteria are met, (4) encourage data sharing between institutions, and (5) advocate for universal coverage for genetic testing may help realize the benefits associated with precision oncology for patients and their families seeking care at community cancer centers.

Patient-reported outcomes for oral oncolytic therapy: A pilot study utilizing an electronic patient portal in a community cancer center.

A pilot project was initiated to determine the feasibility of using an electronic patient portal, MyChart, for documentation of patient-reported outcomes for those receiving treatment with an oral oncolytic. Documentation of patient-reported outcomes within the electronic medical record before and after implementing questionnaires through the use of MyChart was compared. Additional outcomes that were assessed included patient confidence and satisfaction, adherence rate, side effects, and documentation of provider interventions. Our findings indicate that the use of an electronic patient portal significantly increased the number of encounters documented within the electronic medical record from 1.8% (N = 19 patients; 1 out of 55 potential encounters; retrospective analysis) to 27.5% (N = 15 patients; 14 out of 51 potential encounters; prospective analysis) for those who utilized an electronic patient portal (p < 0.001). Patient confidence and satisfaction were high, the adherence rate was 100% at 4 months, and side effects were generally mild. Provider follow-up was documented in the electronic medical record in 6 out of 8 patients when a flagged response was identified. This pilot study indicates that the use of an electronic patient portal, MyChart, was feasible and improved documentation of patient-reported outcomes within the electronic medical record. Several information technologies and patient barriers were encountered throughout. Careful selection of patients who will embrace this technology is important.

Abstract P6-05-45: Providing Educational Resources during the Pandemic for Advanced Breast Cancer Patients

Abstract Significance and Background: Metastatic Breast Cancer (MBC) or Advanced Breast Cancer (ABC) is multifaceted and requires high levels of support and resource utilization. The ABC Program at MD Anderson Cancer Center began in 2014 with a goal to increase the quantity and quality of life for patients living with MBC. It offers emotional support, personalized visits with a nurse practitioner navigator, access to clinical trials, specialty clinics, tailored patient education and innovative care projects. Prior to COVID-19, the ABC Program held a 90-minute quarterly town hall series featuring 2-3 presenters and topics of patient interest. In response to COVID-19, it pivoted to a weekly virtual 60-minute educational series called “ABCs of Healthy Living in Challenging Times” that is for patients with breast cancer, caregivers, faculty, staff, community members and advocates. Purpose: To address COVID-19 social-distancing related isolation and changes to healthcare, build community, empower patients, and educate on diverse topics including patient services, treatment, symptom management and quality of life. Interventions and Evaluation: The series was facilitated by a nurse practitioner navigator via Zoom. A distribution list created from town hall meetings was the basis for the series’ notices and has grown by referrals, word of mouth and marketing opportunities; it began with less than 150 people and has grown to more than 550 people. The facilitator offered a format where the attendees and speakers could interact visually and verbally with each other. From 4/2020 to 6/2022, 104 webinars were held for 2,546 attendees for an average of 24 attendees each week. Topics covered were side effect management/quality of life/healthy lifestyle (26%), patient education/empowerment (18%), treatment (19%), clinical trials/research (11%), quality of life related to COVID-19 (8%), COVID-19 (7%), innovation projects (4%), palliative/end of life care (7%), and financial/disability concerns (3%). The series was evaluated using the Qualtrics survey software (n=53). Respondents said that the series has positively influenced their interactions with healthcare providers (65%), how patients with MBC think about their cancer experiences (65%) and provided an opportunity to connect with others like themselves (65%). Respondents stated actions taken based on the series: shared the information with family/friends (77%), joined or remained in a support group (34%), spoke with a provider for information and services (32%), requested an appointment with the ABC Program or other specialty clinics (26%), started a new healthy behavior (21%), joined a clinical trial (11%), or started using a patient reported outcome tool (9%). The series served mostly patients living with MBC (70%), established patients at MD Anderson (38%) or patients at MD Anderson as well as a community cancer center (17%). Most respondents indicated that they attended about half of the time, usually or always (60%) and are very or completely satisfied with the series (92%). Demographics of the respondents were White (77%), Black (13%), Asian (4%) and Hispanic (16%). Discussion: The ABC Program pivoted to COVID-19 by offering services virtually. The virtual series has allowed for more digestible patient education, varied presentations, and participation for those living outside of Houston, TX. Peer support and continuing education are imperative dynamics for patients to use their voice to impact their overall quality of life. The series has impacted attendees with a change in behavior when speaking with their clinical team, awareness and utilization of support resources, and starting healthy behaviors. While the series was created in response to demands of COVID-19, it effectively addressed psychosocial and educational needs and overall quality of life of MBC patients. The series was an easy intervention to initiate with lasting changes relative to the effort and resources required. Citation Format: Ginny T. Kirklin, Abbey Kaler, Debu Tripathy. Providing Educational Resources during the Pandemic for Advanced Breast Cancer Patients [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-45.

Abstract P4-02-17: Impact of low hormone receptor expression on neoadjuvant chemotherapy response and patterns of care in early-stage HER2-negative breast cancer: a US National Cancer Database analysis

Abstract Background: Hormone receptor (HR) low (1-10%) HER2-negative breast cancer (BC) is emerging as a distinct subtype with similarities in clinical outcomes to triple-negative BC. However, there is a lack of consensus on treatment recommendations for chemo-immunotherapy and endocrine therapy in this subset. Here, we present results from a US National Cancer Database (NCDB) analyses of patients with HER2-negative BC evaluating response to neoadjuvant chemotherapy (NAC) and patterns of care by HR expression. Methods: Patients with stage I-III HER2-negative BC diagnosed in 2018 were identified in NCDB, a nationwide oncology outcomes database in the US. Quantitative HR expression was unavailable prior to 2018. Data were categorized into four groups by estrogen receptor (ER) and progesterone receptor (PR) expression: ER&amp;lt; 1% &amp; PR&amp;lt; 1% (HR-Neg), ER 1-10% and/or PR 1-10% (HR-Low), ER &amp;gt;11-30% and/or PR&amp;gt;11-30% (HR-Int), ER&amp;gt; 30% and/or PR &amp;gt; 30% (HR-High). Those with undocumented HR status (3%) or without curative intent surgery (5%) were excluded. The primary outcome was pathologic complete response (pCR) by HR expression in those undergoing neoadjuvant chemotherapy. Key secondary objectives included assessment of clinicopathologic characteristics and practice patterns. The categorical variables were compared between the four groups using a Chi-square test. Age was compared using a Kruskal-Wallis test. Results: Out of 104,205 incident cases, 2541 (2.4%) were HR-Low and 1241 (1.2%) were HR-Int. Significant differences were found between HR groups with higher grade, clinical stage, and Ki-67 in HR-Low vs. HR-Int or HR-High groups (Table 1). Patients with HR-Low and HR-Int BC were more likely to receive chemotherapy than HR-High (74%, 70% vs. 20%; p &amp;lt; 0.001) and the use of adjuvant endocrine therapy correlated with HR expression. Only half of patients in the HR-Low group received any endocrine therapy compared to higher rates in the HR-Int and HR-High groups (52% vs. 74%, 92%; p&amp;lt; 0.001). pCR rates in those receiving neoadjuvant chemotherapy were significantly different by HR status, with higher pCR rates in HR-Low vs. HR-High groups (p&amp;lt; 0.001) (Table 2). NAC utilization significantly differed between groups. A higher proportion of patients with HR-Low BC received NAC than other HR-positive groups (p &amp;lt; 0.001). Additionally, there was an increased use of NAC in patients with HR-Low BC treated at academic vs. community cancer centers (p&amp;lt; 0.001). Conclusions: This is one of the largest real-world analyses comparing key differences in biology and practice patterns of HR-Low, HER2-negative BC. Consistent with prior studies, we report HR-Low BC to be a rare and distinct subtype with higher pCR rates compared to HR-High BC. Practice patterns show wide variability in utilization of neoadjuvant chemotherapy and endocrine therapy for these patients. Future studies should address this disparity and enhance representation of patients with HR-Low BC in clinical trials to improve long-term outcomes. Table 1: Patient demographics Table 2: Neoadjuvant chemotherapy response amongst differing HR expression levels Citation Format: Dionisia Quiroga, Michael Grimm, Julie Stephens, Kai Johnson, Nicole Williams, Preeti K. Sudheendra, Mathew A. Cherian, Daniel Stover, Ashley C. Pariser, Margaret Gatti-Mays, Robert Wesolowski, Jose G. Bazan, Sasha Beyer, Ko Un Park, Bridget Oppong, Bhuvaneswari Ramaswamy, Julia White, Sachin R. Jhawar, Sagar Sardesai. Impact of low hormone receptor expression on neoadjuvant chemotherapy response and patterns of care in early-stage HER2-negative breast cancer: a US National Cancer Database analysis [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-02-17.

Adherence Disparities and Utilization Trends of Oncotype Dx Assay: A National Cancer Database Study

IntroductionOncotype Dx (ODX) is a genetic assay that analyzes tumor recurrence risk and provides chemotherapy recommendations for T1-T2 stage, hormone receptor-positive, human epidermal growth factor receptor-negative, and nodal-negative breast cancer patients. Despite its established validity, the utilization of this assay is suboptimal. The study aims to evaluate factors that are associated with adherence rate with the testing guidelines and examine changes in utilization trends. MethodsThis is a retrospective study, utilizing data from the National Cancer Database from 2010 to 2017. Patients who met the ODX testing guidelines were first evaluated for testing adherence. Secondly, all patients who underwent ODX testing were assessed to evaluate the trend in ODX utilization. ResultsA total of 429,648 patients met the criteria for ODX, and 43.4% of this population underwent testing. Advanced age, racial minorities, low-income status, well-differentiated tumor grade, uninsured status, and treatment at community cancer centers were associated with a decreased likelihood of receiving ODX in eligible patients. Additionally, a notable amount of testing was performed on patients who did not meet the ODX testing criteria. Among the 295,326 patients that underwent ODX testing, 16.6% of patients were node-positive and 1.8% had T3 or T4 stage tumors. ConclusionsA considerable number of patients who were eligible for ODX did not receive it, indicating potential barriers to care and disparities in breast cancer treatment. ODX usage has been expanded to broader patient populations, indicating more research is needed to validate the effectiveness of the assay in these patient groups.

Promoting multidisciplinary care for patients with unresectable hepatocellular carcinoma (HCC): Findings from a quality improvement initiative across two community cancer centers.

528 Background: Evolving treatment paradigms in HCC are increasing the need for multidisciplinary coordination and a focus on patient-centered care. Identifying real-world challenges HCC care teams face in implementing these critical practices is necessary to inform educational interventions and optimize patient outcomes. Methods: In March–April 2021, 22 health care professionals (HCPs) who treat HCC at 2 US community oncology clinics completed surveys assessing practice patterns, challenges, and confidence related to multidisciplinary and patient-centered care in HCC and participated in interdisciplinary audit and feedback sessions. Patient charts evaluated pre- and post-intervention assessed changes in clinical practice. Inclusion criteria included confirmed HCC diagnosis, age ≥ 18 years, and ≥ 2 visits in the one-year chart abstraction period. Results: Participants represented the interprofessional HCC care team: medical oncologists (38%), gastroenterologists (8%), hepatologists (4%), internal medicine (17%), advanced practice professionals (4%), and nurses (29%). Baseline and follow-up patient charts included 50% and 47% Stage II-III HCC patients and 50% and 53% Stage IV HCC patients, respectively. Top reported barriers to multidisciplinary tumor board use were ineffective interdepartmental coordination/collaboration (43%) and low volume of referrals (38%). HCPs aimed to resolve these gaps through improved collaboration between multidisciplinary teams (33%) and earlier referrals to a medical oncologist (29%). Providing patient-centered supportive care was identified by 33% of HCPs as the top challenge in HCC patient care. Of HCPs surveyed, 77% estimated that ≤ 25% of patients are evaluated for/referred to distress/behavioral health services. Chart audits after educational intervention and action plan implementation showed improvements in supportive care utilization (see table). A critical component of patient-centered care, shared decision-making (SDM) was reported by 24% of HCPs. HCPs reported patient resistance to SDM (33%) and low patient health literacy (29%) as top barriers to SDM. Chart documentation of HCP participation in SDM increased post intervention (see table). Conclusions: In current real-world practice, HCC care teams report challenges in interdisciplinary collaboration and referrals, providing supportive care, and involving patients in SDM. These identified gaps represent key opportunities for future interventions to improve HCC care. [Table: see text]

Paving the Road for Chimeric Antigen Receptor T Cells: American Society for Transplantation and Cellular Therapy 80/20 Task Force Consensus on Challenges and Solutions to Improving Efficiency of Clinical Center Certification and Maintenance of Operations for Commercially Approved Immune Effector Cell Therapies

As the number and type of regulatory authority-approved cellular therapies grow, clinical treatment centers face a heavy burden of duplicative documentation around initial qualification, ongoing auditing, and reporting, with overlapping requirements from each manufacturer to ensure safe use of their specific product, which in the United States are stipulated under individual Food and Drug Administration (FDA) Biologic License Applications. The American Society for Transplantation and Cellular Therapy (ASTCT) convened the 80/20 Task Force to consider challenges and potential solutions to these issues. The Task Force proposed that 80% of manufacturers' requirements for onboarding and ongoing operations of commercially available products could be standardized and streamlined. Task Force members interviewed dozens of stakeholders, including clinicians at large academic medical centers already using commercial and investigational immune effector cell (IEC) products, regulators, members of accrediting bodies and professional cellular therapy societies, and manufacturers of IEC therapies for oncologic indications. In November 2021, the Task Force organized and led virtual discussions in a public forum and at a private ASTCT 80/20 Workshop at the online AcCELLerate Forum, a cellular-therapy stakeholders' meeting organized by the ASTCT, National Marrow Donor Program (NMDP), and Center for International Blood and Marrow Transplant Research (CIBMTR). At the workshop, approximately 60 stakeholders worked to identify and prioritize common challenges in onboarding and maintenance of operations at clinical sites for commercial FDA-approved and future IEC therapies and ways to streamline the process. It was agreed that standardization would improve efficiency of onboarding, allowing more cost-effective, sustainable growth of approved IEC therapies at treatment centers, and facilitate wider access while maintaining safety and clinical success. This early but extensive survey of stakeholders resulted in 5 overarching suggestions for both established and emerging treatment centers: (1) eliminate duplication in accreditation and auditing of clinical sites; (2) define expectations for the education about and management of CAR-T therapy toxicities to potentially replace product-specific REMS programs; (3) streamline current REMS education, testing, and data reporting; (4) standardize information technology (IT) platforms supporting enrollment, clinical site-manufacturer communication, and logistics of maintaining chain of identity/chain of custody across multiple transportation steps; and (5) encourage the use of universal nomenclature by cell therapy manufacturers. Future discussions need to engage a broader range of stakeholders, including administrators, pharmacists, nurses, data coordinators, surgeons, pathologists, and those developing promising cellular therapies for solid tumors, as well as teams from smaller academic or community cancer center settings. Continued collaboration with stakeholders outside of clinical sites will include accrediting bodies/auditors, established and emerging cell therapy companies, software developers, professional societies, and the patients who receive these therapies. Active dialog with government regulators remains essential. Such joint efforts are critical as the number of IEC therapies for myriad oncologic and nononcologic indications grows.

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

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

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

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