Designated Cancer Centers Research Articles

Access to National Cancer Institute-Designated Cancer Centers Among Native American Cancer Patients

Introduction/Purpose Native Americans (NAs) are subject to high cancer mortality rates in the USA. Despite that, they face significant geographic barriers to access to cancer care. This study aims to estimate the travel distance to a National Cancer Institute (NCI)-designated cancer center for NA patients in Utah and the continental USA. Methods This IRB-approved study utilized retrospective data on genitourinary cancer patients from both NAs and white populations from February 2013 to January 2023. The distance of their geographical location to the Huntsman Cancer Institute (HCI) at the University of Utah was calculated using their home zip code and a GeoData ZIP Code Distance Calculations Matrix Template. A shapefile containing NCI-designated cancer centers was used alongside the Area Deprivation Index (ADI), matched to block groups from the 2020 census, to serve as a national control group. All geographic data was visualized in ArcGIS 10.7 by using the coordinates and a 5-digit zip code tabulation area to map locations. Results A total of 468 NA patients were eligible and included. The median travel distance for NA patients vs. white patients to HCI was 190.6 miles (range: 1.1-596.4 miles) vs. 21.6 miles (range: 1.1-269 miles, p<0.0001). In the continental US, the median travel distance from NA reservations vs. ADI-matched block groups to the nearest NCI-designated cancer centers was 186.5 miles (range 77.8-629 miles) vs. 159 miles (range 1.9-671.3 miles, p<0.01). Conclusion The travel distance to NCI-designated cancer center for NA cancer patients in Utah was around nine times longer than that of white cancer patients. This study highlights the significant disparity in cancer care accessibility faced by NA communities.

Determinants of Outcomes for Acute Myeloid Leukemia Patients Treated in a Community-Based Specialized Versus Non-Specialized Hospital Setting.

The treatment setting influences acute myeloid leukemia (AML) outcomes. Most cancer patients receive care in the community, yet few studies have evaluated the effectiveness of clinical programs outside of academic or National Cancer Institute (NCI)-designated cancer centers. This was a multi-level, case-controlled study of real-world outcomes for initial AML treatment in a community-based network for 1,391 patients with AML between 2011 and 2018. We benchmarked survival within our network against the Surveillance, Epidemiology, and End Results (SEER) database. Coarsened exact matching was performed against 17,186 chemotherapy-treated patients in the SEER database. Cox proportional and accelerated failure time multivariable modeling were performed to identify patient, disease, therapy and center characteristics associated with the risk of AML mortality. Within the network, 799 patients were treated at six specialized blood cancer centers and 592 at 63 other hospitals. Patients receiving high-intensity induction at specialized centers had improved median survivals of 31 months versus 18 months [P<0.001] at non-specialized centers. Median survivals were 13 for non-specialized centers versus 10 months for SEER [P<0.001], and 18 for the entire network versus 10 months for SEER [P<0.001]. Multivariable modeling showed significant impacts from age (HR = 1.025), high-intensity induction therapy (HR= .695), diagnosis year (HR= .937), neighborhood income (HR = .997; P<0.01), higher acuity (HR = 1.002) and Charlson comorbidity score (HR = 1.117). AML treatment may be effectively delivered in the community hospital setting, with specialized centers producing better outcomes for higher intensity treatments.

Screening log: Challenges in community patient recruitment for gynecologic oncology clinical trials

BackgroundClinical trial participation can improve overall survival and mitigate healthcare disparities for gynecologic cancer patients in low-volume community centers. This study aimed to assess the effectiveness of a centrally regulated but administratively decentralized electronic screening log system to identify eligible patients across a large catchment area for a National Cancer Institute (NCI)-designated cancer center's open clinical trials. MethodsElectronic screening log data collected between 2014 and 2021 from ten community partner sites in a single NCI-designated cancer center's catchment area were reviewed retrospectively. Clinical factors assessed included cancer site, primary versus recurrent disease status, and histology. Identification efficiency (the ratio of patients screened identified with an available trial) was calculated. Identification inefficiencies (failures to identify patients with a potentially relevant trial) were assessed, and etiologies were characterized. ResultsAcross ten community partner sites, 492 gynecologic cancer patients were screened for seven open clinical trials during the study period. This included 170 (34.5 %) ovarian cancer patients, 156 (31.7 %) endometrial cancer patients, and 119 (24.2 %) cervical cancer patients. Over 40 % had advanced stage disease, and 10.6 % had recurrent disease. Only three patients were identified as having a relevant open trial; none ultimately enrolled due to not meeting trial eligibility criteria. An additional 2–52 patients were retrospectively found to have a relevant trial available despite not being identified as such within the electronic screening log system. Up to 14.4 % of patients had one or more missing minimum data elements that hindered full evaluation of clinical trial availability. Re-screening patients when new trials open may identify 12-15 additional patients per recurrent disease trial. ConclusionsAn electronic screening log system can increase awareness of gynecologic oncology clinical trials at a NCI-designated cancer center's community partner sites. However, it is inadequate as a single intervention to increase clinical trial enrollment. Providing adequate support staff, documenting clinical factors consistently, re-screening patients at relevant intervals, and coordinating with central study personnel may increase its utility.

Masking Policies at National Cancer Institute–Designated Cancer Centers During Winter 2023 to 2024 COVID-19 Surge

This cross-sectional study examines variation in masking policies at National Cancer Institute (NCI)–designated cancer centers during the winter 2023-2024 COVID-19 surge.

PP01.38 A Missed Opportunity, The Lack of Lung Cancer Clinical Trial Promotion on Instagram by NCI Designated Cancer Centers

PP01.38 A Missed Opportunity, The Lack of Lung Cancer Clinical Trial Promotion on Instagram by NCI Designated Cancer Centers

Clinician-to-clinician connectedness and access to gastric cancer surgery at National Cancer Institute-designated cancer centers

BackgroundFor patients with gastric cancer, the pathway from primary care (PC) clinician to gastroenterologist to cancer specialist (medical oncologist or surgeons) is referral dependent. The impact of clinician connectedness on disparities in quality gastric cancer care, such as at National Cancer Institute–designated cancer centers (NCI-CC), remains underexplored. This study evaluated how clinician connectedness influences access to gastrectomy at NCI-CC. MethodsMaryland’s All-Payer Claims Database was used to evaluate 667 patients who underwent gastrectomy for cancer from 2013 to 2018. Two separate referral linkages, defined as ≥9 shared patients, were examined: (1) PC clinicians to gastroenterologists at NCI-CC and (2) gastroenterologists to cancer specialists at NCI-CC. Multiple logistic regression models determined associations between referral linkages and odds of undergoing gastrectomy at NCI-CC. ResultsOnly 15% of gastrectomies were performed at NCI-CC. Patients of gastroenterologists with referral links to cancer specialists at NCI-CC were more likely to be <65 years, male, White, and privately insured. Every additional referral link between PC clinician and gastroenterologist at NCI-CC and between gastroenterologist and cancer specialist at NCI-CC increased the odds of gastrectomy at NCI-CC by 71% and 26%, respectively. Black patients had half the odds as White patients in receiving gastrectomy at NCI-CC; however, adjusting for covariates including clinician-to-clinician connectedness attenuated this observation. ConclusionPatients of clinicians with low connectedness and Black patients are less likely to receive gastrectomy at NCI-CC. Enhancing clinician connectedness is necessary to address disparities in cancer care. These results are relevant to policy makers, clinicians, and patient advocates striving for health equity.

The evolution of catchment areas for national cancer institute designated cancer centers

The evolution of catchment areas for national cancer institute designated cancer centers

Access to cancer center information for patients with limited English proficiency from NCI Cancer Center websites.

e23124 Background: Patients with Limited English Proficiency (LEP) can experience health disparities in cancer care and clinical trial participation. This study sought to assess the availability of information on interpreter services, clinical trials, and second opinions from National Cancer Institute – Designated Cancer Center (NCI-DCC) websites for patients with LEP. Methods: The public facing websites of all 65 adult NCI-DCCs were reviewed from January 1, 2023 to May 15, 2023 to assess availability of English and translated, non-English information on interpreter services, second opinion programs, and clinical trials. Data abstraction was conducted through predefined criteria for website inspection and search bars. Three authors independently abstracted websites for content, with constant comparison until consensus was achieved. Chi-square tests were used to ascertain any significant association between the proportion of LEP populations served by the centers ( &gt; 5%) and their likelihood to provide translated information. Results: 92.3% of NCI-DCCs and their affiliated flagships hospitals provide information on interpreter services for patients with LEP. This information was translated into a non-English language approximately half of the time. All NCI-DCC center webpages provide information on clinical trials and 38.5% provide information regarding second opinions. There was no difference in the availability of translated information on interpreter services or second opinion programs based on percentage of LEP population. However, there was an association between higher LEP population and the provision of translated clinical trial pages. Conclusions: The majority of NCI-DCCs provide information on their webpages related to interpreter services and clinical trials. Half of these centers provide this information in a non-English language and there was an association between higher percentage of LEP populations in the NCI-DCC state and translated clinical trial pages. Future work should identify optimal methods to provide cancer related information to patients with LEP with the goal of improving clinical trial participation for LEP populations. [Table: see text]

Effect of mail-in sperm cryopreservation solution on access to cryopreservation: A national demographic analysis.

e13524 Background: There are many circumstances under which someone may choose to bank their sperm, but forthcoming cancer treatment is among the most common. The advent of services offering mail-in semen analysis and cryopreservation has expanded access to sperm banking, especially for those living in rural areas, far away from traditional andrology labs. This study summarized demographic characteristics and reasons for cryopreservation among those using one such US-based mail-in service, with a focus on patients banking sperm prior to cancer treatment. Methods: Patients &gt;18 years who banked sperm using a mail-in cryopreservation solution developed by Fellow Health, Inc. from March 2021 to January 2024 were included. Test kits sold for research purposes were excluded. To categorize each patient by reason for cryopreservation, we made use of a patient-provided reason, supplied during test kit registration, where available. For the remaining patients, reason was inferred using several data sources including medical history, medications, and clinic and physician information. Patients who could not be reliably classified were omitted from this portion of the analysis. Descriptive statistics of key demographics and reason for cryopreservation were reported under an IRB-approved protocol. Results: 2,154 patients met our inclusion criteria and 725 (33.7%) provided demographic information. Average age was 34.7 (SD=9.2) years and 11.9% identified as a trans female. The majority of the population identified as white (79.5%) and non-Hispanic (84.8%). Over half of the population had a college degree or greater (59.3%), was married/partnered (57.1%), and had private insurance (84.9%). Among the 756 patients whose reason for cryopreservation was discernible, the majority, 450 (59.5%), were doing so in the context of fertility treatment, with only 46 (6.1%) indicating cancer treatment. Other reasons included pre-vasectomy storage (n=137, 18.4%) and gender affirming hormone therapy (n=90, 11.9%). Of the patients who indicated cancer treatment as their reason for cryopreservation, 50.0% lived greater than a 25-mile drive of the nearest National Cancer Institute (NCI)-designated Cancer Center. Conclusions: Surprisingly, few patients utilizing a mail-in service for cryopreservation did so prior to beginning cancer treatment, with most originating from the fertility or pre-vasectomy context. Use was disproportionately high among trans women initiating hormone replacement therapy (HRT), perhaps demonstrating their preference for at-home sample collection to avoid the unique challenges they encounter in a clinical setting. Especially for oncology patients who are admitted to a hospital and cannot leave for fertility preservation, there is an opportunity to further integrate mail-in cryopreservation services within oncology to improve access and reduce time costs.

The structure of academic cancer service lines: Results of an Association of American Cancer Institutes survey.

e13566 Background: An integrated cancer service line (CSL) in academic medical centers provides a patient-centered approach with the goals of improving the patient experience and clinical outcomes; managing financial operations; increasing access to clinical research; and decreasing health disparities. The Association of American Cancer Institutes (AACI) Physician Clinical Leadership Initiative Steering Committee sought to evaluate the current state of cancer services lines among the membership of AACI to identify common areas of organizational structure and function and potential areas for enhancing integration. Methods: A 29-question, mixed-methods, descriptive survey with multiple choice and short answer questions addressing the characteristics of the center’s CSL, was sent electronically to the cancer center directors and administrators at 107 academic centers on July 31, 2023, and again on August 24, 2023. Descriptive statistics were used to summarize the survey data. Results: Of 107 centers, 75 (70%) responded to the survey. Of the 68 respondents with clinical services, 58 centers (85%) had a defined CSL. Twenty-three centers (40%) noted that they did not have a formal charter defining governance and structure; 11 (48%) of the 23 are National Cancer Institute (NCI)-Designated Cancer Centers. Twenty-six (45%) reported a defined funds flow. Fifty (86%) cancer centers have a physician as a primary leader and the majority have a leadership team of two or more individuals (55, 95%). While hematology and medical oncology, radiation oncology, and surgical specialties were part of every CSL, pathology (31, 53%) and radiology (28, 48%) were included in only half of the centers. Center respondents noted that quality and safety were a primary focus (48, 83%), with regional growth (45, 78%), ambulatory operations (44, 76%), and budgeting and margin management (43, 74%) as additional responsibilities. Key performance metrics tracked by the CSL included the number of new patients (57, 98%), time to first appointment (55, 95%), and accrual to clinical trials (47, 81%), while 48% (28) tracked palliative care referrals within 90 days of death. Most CSL services, inclusive of records collection (86%), billing (86%), and coding (81%) are centralized within the center’s health system. Conclusions: There is widespread variability in the structure of academic CSLs with 40% and 55% of respondents not having a formal charter or funds flow, respectively. Leadership, key responsibilities, and metrics differed across centers. These results can serve as a tool for centers to refine their existing CSL or as a guide for CSL development. Our survey highlights a potential to evaluate CSL structures, which are inclusive of a broader series of departments and services, to determine the optimal approach for a multidisciplinary patient-centered care model. Efforts to obtain outcome data on CSL structures are warranted.

A framework and process for community-engaged, mixed-methods cancer needs assessments

PurposeCommunity health needs assessments are required for most state and local public health agencies and non-profit hospitals. Typically based on community health improvement planning models, these assessments encompass overall community health and multiple diseases to inform program planning. National Cancer Institute (NCI)-designated Cancer Centers and community-based cancer-focused programs share the goal of reducing cancer burden in the catchment areas they serve. However, to date, no published models exist to guide cancer-specific needs assessments for a determined geographic area that can inform both public health and research initiatives. The purpose of this article is to outline a cancer needs assessment (CNA) framework and community-engaged, mixed-methods process, along with a case study of how we applied it in Kentucky.MethodsWe convened a steering committee of key organizational partners to provide input throughout the process. We developed a conceptual framework of multi-level determinants affecting cancer-related outcomes. We incorporated both quantitative and qualitative data gathered through a variety of means, including a novel application of group concept mapping to guide definition of priorities.ResultsThe resulting CNA has helped guide strategic planning and priorities for Kentucky’s Cancer Action Plan, Markey Cancer Center, state agencies, and community-based organizations.ConclusionThis framework and process can be used collaboratively by cancer center Community Outreach and Engagement offices, public health agencies, oncology programs, and community partners to plan impactful cancer control programs and research in their catchment areas. Universities can also use them to inform the planning of community engagement and health equity research efforts.

Executing plans to enhance diversity across cancer centers in the United States: opportunities and challenges.

Lack of diversity in the cancer research workforce persists, which the new requirement for all National Cancer Institute (NCI)-designated cancer centers to have a Plan to Enhance Diversity (PED) seeks to address. However, it is not well understood how different cancer centers are approaching the development and execution of these plans. Our objective was to assess how cancer centers are establishing and pursuing their PED. We conducted a cross-sectional survey of members of the Cancer Center Diversity, Equity and Inclusion Network, which includes all NCI-designated cancer centers and several emerging centers. A total of 62 cancer centers (75% of those invited), including 58 NCI-designated cancer centers (81% of those with this designation), participated and completed a questionnaire that assessed PED leadership, major challenges, implementation strategies, and approach to evaluate PED progress. The most common PED challenge identified is recruiting diverse faculty (68% of centers), and the most common strategy currently used to address this is reviewing and revising faculty recruitment practices (67%). The most common approach centers are using to measure PED progress is shifts in demographics (68%), and data on the demographics of faculty, leadership, and trainees are available at 79%, 81%, and 75% of centers, respectively. Almost all centers have established a PED leadership structure, however, there is considerable variation in the approaches used to realize PED goals and in the resources provided to support PED work. Realizing opportunities to share and implement common best practices and exemplar programs has the potential to elevate the impact of PED efforts nationally.

Upper gastrointestinal and hepatopancreaticobiliary surgery in New Zealand: Balancing the volume-outcome relationship with accessibility in a surgically low volume country.

New Zealand has a population of only 5.5 million meaning that for many surgical procedures the country qualifies as a "low-volume center." However, the health system is well developed and required to provide complex surgical procedures that benchmark internationally against comparable countries. This investigation was undertaken to review regional variation and volumes of complex resection and palliative upper gastrointestinal (UGI) surgical procedures within New Zealand. Data pertaining to patients undergoing complex resectional UGI procedures (esophagectomy, gastrectomy, pancreatectomy, and hepatectomies) and palliative UGI procedures (esophageal stenting, enteroenterostomy, biliary enteric anastomosis, and liver ablation) in a New Zealand hospital between January 1, 2000 and December 31, 2019 were obtained from the National Minimum Dataset. New Zealand is a low-volume center for UGI surgery (229 hepatectomies, 250 gastrectomies, 126 pancreatectomies, and 74 esophagectomies annually). Over 80% of patients undergoing hepatic resection/ablation, gastrectomy, esophagectomy, and pancreatectomy are treated in one of the six national cancer centers (Auckland, Waikato, Mid-Central, Capital Coast, Canterbury, or Southern). There is evidence of the decreasing frequency of these procedures in small centers with increasing frequency in large centers suggesting that some regionalization is occurring. Palliative procedures were more widely performed. Indigenous Māori were less likely to be treated in a nationally designated cancer center than non-Māori. The challenge for New Zealand and similarly sized countries is to develop and implement a system that optimizes the skills and pathways that come from a frequent performance of complex surgery while maintaining system resilience and ensuring equitable access for all patients.

National Estimates of the Participation of Patients With Cancer in Clinical Research Studies Based on Commission on Cancer Accreditation Data.

National estimates of cancer clinical trial participation are nearly two decades old and have focused solely on enrollment to treatment trials, which does not reflect the willingness of patients to contribute to other elements of clinical research. We determined inclusive, contemporary estimates of clinical trial participation for adults with cancer using a national sample of data from the Commission on Cancer (CoC). The data were obtained from accreditation information submitted by the 1,200 CoC programs, which represent more than 70% of all cancer cases diagnosed in the United States each year. Deidentified, institution-level aggregate counts of annual enrollment to treatment, biorepository, diagnostic, economic, genetic, prevention, quality-of-life (QOL), and registry studies were examined. Overall, study-type estimates for the period 2013-2017 were estimated. Multiple imputation by chained equations was used to account for missing data, with summary estimates calculated separately by type of program (eg, National Cancer Institute [NCI]-designated cancer centers) and pooled. The overall estimated patient participation rate to cancer treatment trials was 7.1%. Patients with cancer participated in a wide variety of other studies, including biorepository (12.9%), registry (7.3%), genetic (3.6%), QOL (2.8%), diagnostic (2.5%), and economic (2.4%) studies. Treatment trial enrollment was 21.6% at NCI-designated comprehensive cancer centers, 5.4% at academic (non-NCI-designated) comprehensive cancer programs, 5.7% at integrated network cancer programs, and 4.1% at community programs. One in five patients (21.9%) participated in one or more cancer clinical research studies. In a first-time use of national accreditation information from the CoC, enrollment to cancer treatment trials was 7.1%, higher than historical estimates of <5%. Patients participated in a diverse set of other study types. Contributions of adult patients with cancer to clinical research is more common than previously understood.

Payer-Negotiated Price Variation and Relationship to Surgical Outcomes for the Most Common Cancers at NCI-Designated Cancer Centers.

Federal rules mandate that hospitals publish payer-specific negotiated prices for all services. Little is known about variation in payer-negotiated prices for surgical oncology services or their relationship to clinical outcomes. We assessed variation in payer-negotiated prices associated with surgical care for common cancers at National Cancer Institute (NCI)-designated cancer centers and determined the effect of increasing payer-negotiated prices on the odds of morbidity and mortality. A cross-sectional analysis of 63 NCI-designated cancer center websites was employed to assess variation in payer-negotiated prices. A retrospective cohort study of 15,013 Medicare beneficiaries undergoing surgery for colon, pancreas, or lung cancers at an NCI-designated cancer center between 2014 and 2018 was conducted to determine the relationship between payer-negotiated prices and clinical outcomes. The primary outcome was the effect of median payer-negotiated price on odds of a composite outcome of 30 days mortality and serious postoperative complications for each cancer cohort. Within-center prices differed by up to 48.8-fold, and between-center prices differed by up to 675-fold after accounting for geographic variation in costs of providing care. Among the 15,013 patients discharged from 20 different NCI-designated cancer centers, the effect of normalized median payer-negotiated price on the composite outcome was clinically negligible, but statistically significantly positive for colon [aOR 1.0094 (95% CI 1.0051-1.0138)], lung [aOR 1.0145 (1.0083-1.0206)], and pancreas [aOR 1.0080 (1.0040-1.0120)] cancer cohorts. Payer-negotiated prices are statistically significantly but not clinically meaningfully related to morbidity and mortality for the surgical treatment of common cancers. Higher payer-negotiated prices are likely due to factors other than clinical quality.

Overlapping cancer service areas: Delineation and implications

AbstractPrior research has defined cancer service areas (CSAs) anchored by major cancer centers in the U.S., such as members of the Association of American Cancer Institutes (AACI). Those CSAs have discrete boundaries and may not capture the increasingly interwoven cancer care markets. This is the first attempt to delineate possible overlapping CSAs. Specifically, we integrate the concept of shared memberships and other spatial attributes into the Speaker‐Listener Label Propagation (SLPA) algorithm, termed the spatially constrained SLPA (or ScSLPA), and apply it to six representative areas in the U.S. The results show that overlapping CSAs tend to form in areas that are more urbanized, with higher localization index (LI) values, larger populations, and shorter travel times than discrete CSAs. Two CSAs in Los Angeles and San Diego are consistent with the catchment areas (CAs) of the National Cancer Institute (NCI)‐designated cancer centers, and other CSAs are much smaller than the CAs of their anchoring cancer centers. The study has important implications for public health policy to advance cancer control and prevention efforts.

Rates of genetic consultation in high-grade serous ovarian cancer patients in the era of PARP inhibitor therapy: A population-based study.

The American Society of Clinical Oncology recommends all patients with high-grade serous ovarian carcinoma (HGSC) undergo germline genetic testing. Genetic consultation rates in Ontario, Canada, only reached 13.3% in 2011. In 2016, PARP inhibitor maintenance therapy became available in Ontario for BRCA-positive HGSC patients. Given expanding treatment options, we re-examined genetic consultation rates among HGSC patients. This retrospective cohort study identified patients diagnosed with HGSC between 2012 and 2019 using population-based administrative data from Ontario. Genetics consultations were identified using Ontario Health Insurance Plan billing codes. Consultation rates over time were analyzed using Cochran-Armitage trend test and segmental regression analysis. Multivariable analysis identified factors associated with attending genetics consultation. This study included 4645 HGSC patients. The mean age was 64.2 years (±SD 12.3); 56.3% had stage 3-4 disease. Overall, approximately 35% attended genetics consultations. The genetic consultation rate per year increased significantly from 21.6% to 42.6% (P < 0.001). Shorter times between diagnosis and genetics consult were observed after PARP inhibitors became available (68.1 vs 34.1 weeks, P < 0.001). Patients treated at designated cancer centers (odds ratio [OR] 2.11, P < 0.001), diagnosed in later years (OR 1.33, P < 0.001), and from higher income groups (P < 0.05) were more likely to attend genetics consultation; older patients were less likely (OR 0.98, P < 0.001). After PARP inhibitors became available, consultation rates plateaued (P < 0.001). Between 2012 and 2019, genetic consultation rates improved significantly among HGSC patients; however, a large proportion of patients never attended consultation. Further exploration of barriers to care is warranted to improve consultation rates and ensure equitable access to care.

Effect of Hospital Cancer Designation on use of Multimodal Therapy and Survival of Metastatic Colorectal Cancer: A State-Wide Analysis.

Stage IV colorectal cancer (CRC) often requires multidisciplinary approach. However, multimodal treatment options (receipt of >1 type of treatment) may not be uniformly delivered across health systems. We characterized the association between center-level cancer center designation and receipt of multimodal treatment and survival. The Texas Cancer Registry was used to identify patients diagnosed with stage IV CRC from 2004-2017. We identified those who received care at either: a National Cancer Institute-designated (NCI-D), an American College of Surgeons-Commission on Cancer-designated (ACS-D), or an undesignated facility. We used multivariable logistic regression and Cox regression for analysis to assess receipt of one or more treatment modality and 5-year overall survival. Of 19,355 patients with stage IV CRC, 2955 (15%) received care at an NCI-D facility and 5871 (30%) received multimodal therapy. Both NCI-D (odds ratio [OR] 1.64; 95% confidence interval [CI] 1.49-1.81) and ACS-D (OR 1.37; 95% CI 1.27-1.48) were associated with increased likelihood of multimodal therapy compared with undesignated centers. NCI-D also was associated with significantly improved survival (hazard ratio [HR] 0.74; 95% CI 0.70-0.78), although ACS-D was associated with a modest improvement in survival (HR 0.95; 95% CI 0.92-0.99). Receipt of multimodal therapy was strongly associated with improved survival (HR 0.61; 95% CI 0.59-0.63). In patients with stage IV CRC, treatment at ACS-D and NCI-D facilities was associated with increased use of multimodality therapy and improved survival. However, only a small proportion of patients have access to these specialized centers, highlighting a need for expanded access to multimodal therapies at other centers.

Classical Hematology Referrals at an National Cancer Institute-Designated Cancer Center: Lessons Learned.

To understand the spectrum and volume of classical hematology (CH) referrals to hematology clinics at a National Cancer Institute (NCI)-designated cancer center (CC) to plan for the delivery of effective and equitable care for this population. One referral office at the Academic CC located in Bexar County, TX, handles all adult hematology referrals. From October 1, 2021, to September 30, 2022, all nonmalignant hematology (MH) referrals were triaged daily to define the category of CH problem. Declined referrals (confirmed at triage that no CH problem was evident) are included as part of this analysis. Electronic consultation (opinion rendered without patient seen) at our CC is available and is not part of this analysis. One thousand nine hundred forty-five CH referrals were received in the 12-month period. Seventy-six referrals (3.9%) were declined. During the study period, there were 2,289 medical oncology referrals and 779 referrals for MH. CH referrals therefore comprise 39% of all hematology-oncology referrals and 71% of all hematology referrals at the CC. Anemia and thrombotic disorders were the most common categories of the accepted CH referrals at 487 (26%) and 393 (21%), respectively. Video visits were used for 447 of all CH referrals (23%), and the rest were in person. Nearly 40% of all referrals to hematology and medical oncology at our NCI-designated CC are for CH. Effective management of the CH population of patients will allow ideal care for CH problems and also allow cancer-focused care to improve.

Abstract A124: NICRAT: The institute pioneering a new approach to cancer research and treatment in sub-Saharan Africa

Abstract Background: Cancer is a major public health challenge in several sub-Saharan African countries, and some of these nations have established their national cancer institutes as a focal point to address this threat. Similarly, the Nigerian government founded the National Institute for Cancer Research and Treatment (NICRAT) in 2017. The purpose of this report is to provide an understanding of the opportunities in establishing a new cancer institute in Nigeria, the most populous Black country in the world and the most populous country in Africa. We reviewed the history, mission and strategy of the National Institute for Cancer Research and Treatment (NICRAT). Methods: The data sources reviewed were publications in professional journals, government reports, news articles, and the NICRAT website. Results: Some of the concerns that justified the establishment and initiation of a national cancer institute in Nigeria include the lack of a coordinated effort to study and combat the disease in Nigeria. The NICRAT was created to centralize cancer research efforts, provide funding for cancer research, and coordinate research activities across the country. These institutes are a science-based governmental institutions dedicated to cancer research, prevention, and treatment. Accordingly, the institution will promote the fight against cancer, providing a centralized focus for cancer research and treatment efforts, and facilitating collaboration between researchers, healthcare providers, and patients, as well as guidance for cancer policy formulation and implementation for decision-makers. Modelled on the US National Cancer Institute (NCI), the NICRAT has institutionalised Nigeria’s capacity to coordinate research efforts to support the use of evidence-based practices in designated Cancer Centers to reduce the impact of cancer. The NICRAT is also the focal point for the implementation of the National Cancer Control Plan (NCCP), and will coordinate the National System of Cancer Registries and the Cancer Health Fund. Discussion: Cancer institutes in sub-Saharan Africa are currently in early stages of evolution. Over the next 5 years, NICRAT’s mission is to work in partnership with other arms of Government and partners to continue its efforts in advancing cancer research, prevention, and treatment. The NICRAT will also focus on improving cancer care delivery and access to care, enhancing cancer prevention and education efforts, and strengthening collaborations with international partners to address the cancer challenge. How successful the institute becomes in its mission will be determined by its capacity to develop the right partnerships, including with the private sector, adopting innovative approaches, and mobilising adequate resources. Building a national cancer institute requires strong commitment, planning and action. The experience of setting up the NICRAT can inform similar efforts in other African countries. Citation Format: Sani A. Malami, Usman M. Aliyu, Uchechukwu E. Nwokwu, Waziri U. Mohammed. NICRAT: The institute pioneering a new approach to cancer research and treatment in sub-Saharan Africa [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 A124.