Delivery Of High-quality Cancer Care Research Articles

Addressing social needs in oncology care: another research-to-practice gap.

Social determinants of health and unmet social needs are directly related to cancer outcomes, from diagnosis to survivorship. If identified, unmet social needs can be addressed in oncology care by changing care plans in collaboration with patients' preferences and accounting for clinical practice guidelines (eg, reducing the frequency of appointments, switching treatment modalities) and connecting patients to resources within healthcare organizations (eg, social work support, patient navigation) and with community organizations (eg, food banks, housing assistance programs). Screening for social needs is the first step to identifying those who need additional support and is increasingly recognized as a necessary component of high-quality cancer care delivery. Despite evidence about the relationship between social needs and cancer outcomes and the abundance of screening tools, the implementation of social needs screening remains a challenge, and little is known regarding the adoption, reach, and sustainability of social needs screening in routine clinical practice. We present data on the adoption and implementation of social needs screening at two large academic cancer centers and discuss three challenges associated with implementing evidence-based social needs screening in clinical practice: (1) identifying an optimal approach for administering social needs screening in oncology care, (2) adequately addressing identified unmet needs with resources and support, and (3) coordinating social needs screening between oncology and primary care.

Patient-centered collaborative research: Exploring perspectives on clinical meaningfulness in metastatic breast cancer with clinicians, patients, and caregivers.

338 Background: In metastatic breast cancer (mBC), treatment decision-making is informed by many factors including patient values, preferences, and care goals. Important to treatment decision-making is clinical meaningfulness, or the degree to which a treatment for mBC results in a meaningful change in the patient’s daily life, and clinically meaningful outcomes that are relevant to patients (e.g., survival, quality of life). However, patient and clinician perspectives and alignment on these concepts have not been well elucidated. Engaging patients and other key stakeholders as research collaborators is vital to guiding the delivery of high-quality cancer care focused on outcomes that patients considered meaningful. The aim of this work is to describe the implementation of an innovative multi-collaborator engagement with patient advocates and professional oncology societies to support a study examining perspectives on clinical meaningfulness in mBC treatment among clinicians, patients, and caregivers in the United States. Methods: This mixed-methods study utilizes qualitative semi-structured in-person and virtual focus groups to inform the development of collaborator-specific surveys on clinical meaningfulness in mBC. A multi-collaborator engagement approach was selected to support the conception, implementation, and completion of this study. Specifically, we have convened a collaboration with patient advocacy groups and professional membership organizations to engage researchers, patients, caregivers, and clinicians. The collaboration is designed to: i) facilitate the development of study protocols and key data collection documents; ii) review and reflect on findings and salience for relevant populations; and iii) participate in dissemination activities whereby collaborators co-create, co-present and discuss findings and their impact on clinical practice. Results: To date, we have partnered with four breast cancer patient advocacy groups representing sociodemographic diverse constituencies throughout the US and three oncology professional membership organizations. By describing how to implement these partnerships, we seek to present a collaboration roadmap that can be replicated and adapted to similar studies in oncology care delivery. Such a comprehensive and rigorous approach aims to enhance the quality of data collection and interpretation, generating evidence that will optimally improve patient-centered mBC care delivery and meaningful patient outcomes. Conclusions: Engaging patients and other key collaborators in research is important to generate clinically meaningful evidence to those involved in mBC treatment decision-making. This study offers a robust methodological approach for gaining insights into the delivery of patient-centered cancer care.

Integrated oncology operational dashboard for clinical and operational quality improvement.

588 Background: MaineHealth Cancer Care Network, comprised of nine member and two affiliate cancer centers, provides care to more than 70% of analytic cancer cases in largely rural south-central Maine and eastern New Hampshire. To drive high quality and performance and harmonize care across the network, an integrated operational dashboard was created. Methods: A team of clinicians, operational leaders and business intelligence analysts identified improvement goals across clinical and operational domains. Using a Microsoft Power BI platform, an integrated dashboard with extracts from various non-interoperable data sources were migrated together to illustrate all relevant metrics. Divided into five pages, the Summary page allowed for a high level visualization of financial improvement metrics across the service line. The Growth page included trends of template utilization, provider access, encounter and financial statistics. The Service Excellence page measured diagnosis to treatment times, new patient volumes, timely chart completion rates and provider net promoter scores. Lastly, the Innovation and Transformation page measured clinical trial accruals, use of Epic TNM staging (Epic Systems, Verona, WI), Clinical Pathways (Elsevier, Amsterdam, NL) and use of NCCN distress thermometer for patient assessment. All data was searchable based on chosen fiscal years, practice locations and provider names with automated monthly data refreshes. Dashboard access to clinical and operational staff with monthly reviews drove performance improvement. Results: Since creation in January 2023, dashboard has been leveraged to improve structured Epic TNM staging by medical oncology providers from 46.9% in FY22 to 53.4% in FY23. Time to treatment data has helped identify process bottlenecks. Provider productivity metrics have been used to launch a compensation reform program incorporating production based incentives and improve patient access. Information transparency has improved team engagement and ownership. Conclusions: High quality cancer care delivery requires equal attention to clinical and operational metrics. In most organizations, this data is siloed across disparate software platforms with limited visibility and access to care team members, impeding quality initiatives. Implementation of the system-wide integrated quality dashboard has led to tangible improvements in care delivery and provider engagement. Additional work to incorporate provider well-being data is underway.

Proximity to Radiotherapy Center, Population, Average Income, and Health Insurance Status as Predictors of Cancer Mortality at the County Level in the United States.

Sufficient radiotherapy (RT) capacity is essential to delivery of high-quality cancer care. However, despite sufficient capacity, universal access is not always possible in high-income countries because of factors beyond the commonly used parameter of machines per million people. This study assesses the barriers to RT in a high-income country and how these affect cancer mortality. This cross-sectional study used US county-level data obtained from Center for Disease Control and Prevention and the International Atomic Energy Agency Directory of Radiotherapy Centres. RT facilities in the United States were mapped using Geographic Information Systems software. Univariate analysis was used to identify whether distance to a RT center or various socioeconomic factors were predictive of all-cancer mortality-to-incidence ratio (MIR). Significant variables (P ≤ .05) on univariate analysis were included in a step-wise backward elimination method of multiple regression analysis. Thirty-one percent of US counties have at least one RT facility and 8.3% have five or more. The median linear distance from a county's centroid to the nearest RT center was 36 km, and the median county all-cancer MIR was 0.37. The amount of RT centers, linear accelerators, and brachytherapy units per 1 million people were associated with all-cancer MIR (P < .05). Greater distance to RT facilities, lower county population, lower average income per county, and higher proportion of patients without health insurance were associated with increased all-cancer MIR (R-squared, 0.2113; F, 94.22; P < .001). This analysis used unique high-quality data sets to identify significant barriers to RT access that correspond to higher cancer mortality at the county level. Geographic access, personal income, and insurance status all contribute to these concerning disparities. Efforts to address these barriers are needed.

Model for Achieving a Coordinated Access to Lung Cancer Care in Selected Public Health Facilities in KwaZulu-Natal, South Africa: Protocol for a Qualitative Study.

Timely delivery of high-quality cancer care to all patients is barely achieved in South Africa and many other low- and middle-income countries, mainly due to poor care coordination and access to care services. After health care visits, many patients leave facilities confused about their diagnosis, prognosis, options for treatment, and the next steps in their care continuum. They often find the health care system disempowering and inaccessible, thereby making access to health care services inequitable, with the resultant outcome of increased cancer mortality rates. The aim of this study is to propose a model for cancer care coordination interventions that can be used to guide and achieve coordinated access to lung cancer care in the selected public health care facilities in KwaZulu-Natal. This study will be conducted through a grounded theory design and an activity-based costing approach that will include health care providers, patients, and their caregivers. The study participants will be purposively selected, and a nonprobability sample will be selected based on characteristics, experiences of the health care providers, and the objectives of the study. With the study's objectives in mind, communities in Durban and Pietermaritzburg were selected as study sites, for the study along with the 3 public health facilities that provide cancer diagnosis, treatment, and care in the province. The study involves a range of data collection techniques, namely, in-depth interviews, evidence synthesis reviews, and focus group discussions. A thematic and cost-benefit analysis will be used. This study receives support from the Multinational Lung Cancer Control Program. The study obtained ethics approval and gatekeeper permission from the University's Ethics Committee and the KwaZulu-Natal Provincial Department of Health, as it is being conducted in health facilities in KwaZulu-Natal province. As of January 2023, we had enrolled 50 participants, both health care providers and patients. Dissemination activities will involve community and stakeholder dissemination meetings, publications in peer-reviewed journals, and presentations at regional and international conferences. This study will provide comprehensive data to inform and empower patients, professionals, policy architects, and related decision makers to manage and improve cancer care coordination. This unique intervention or model will address the multifactorial problem of cancer health disparities. If successful, this study will affect the design and implementation of coordination programs to promote optimal cancer care for underserved patients. DERR1-10.2196/34341.

Deficient state-supported cancer care: A source of deep concern

Deficient state-supported cancer care: A source of deep concern

National organization addresses multidisciplinary oncology team burnout and resiliency through multifaceted presidential theme education initiative.

e23017 Background: The 2021-2022 Association of Community Cancer Centers (ACCC) President’s Theme centered on strengthening a work culture that supports professional well-being and workforce resilience. To support this theme and help ensure sustainable high quality cancer care delivery, ACCC —an education and advocacy organization for the multidisciplinary oncology care team (MDT)—designed a multifaceted professional development initiative. Educational interventions were designed to address team member burnout and building resilience, critical issues facing members of today’s oncology workforce. Methods: ACCC designed a collaborative and bi-directional peer-support educational initiative to drive the mission of the 2021-2022 ACCC President’s Theme. Professional Development opportunities included: 1) Expert-led mindfulness meditation series of 10 guided exercises tailored to help MDT members manage through social, emotional, physical, and mental health challenges. 2) Professional development themed virtual meetings, styled as “Coffee Chat Learning Sessions,” facilitated by the ACCC President, addressing emergent challenges and opportunities facing MDT members. 3) Podcast series featuring timely topics related to MDT well-being and resiliency amid the COVID-19 Pandemic. Podcast topics include a) The Business Case for Hiring Oncology Social Workers. b) Leading with Gratitude. c) Coping with Pandemic Grief. d) A Summer of Disconnect for Cancer Professionals. e) COVID-19 Self-Care. f) Real-World Lessons from COVID-19. Results: The education initiative reached a diverse cohort of oncology care community members. 76 unique professionals participated in the small group “Coffee Chat Learning Sessions” from 25 states and represented 72 unique cancer care programs, practices, and institutions. The meditation series engaged more than 1,100 users and the podcast series garnered 1,870 learners. The podcast episode titled “COVID-19 Self Care” was the third most accessed ACCC Podcast episode of all time with more than 680 views. Over 2,900 learners accessed and engaged with the ACCC President’s Theme resources across the dedicated webpage from March 2021-January 2022. Conclusions: Anecdotal learner feedback has been overwhelmingly positive regarding this professional development educational initiative. In a climate of high burnout and health care worker fatigue, the ACCC 2021-2022 President’s Theme Education program has served as a unique lifeline and resource to members of the oncology community to restore and develop resiliency, enhance well-being, and advance professional connections and peer-to-peer support to meet continued challenges. Lessons learned from these activities will guide and inform future professional development opportunities.

Clinical Research Professional Providing Care Coordination Support: A Study of Hawaii Minority/Underserved NCORP Community Site Trial Participants.

Although effective care coordination (CC) is recognized as a vital component of a patient-centered, high-quality cancer care delivery system, CC experiences of patients who enroll and receive treatment through clinical trials (CTs) are relatively unknown. Using mixed methods, we examined perceptions of CC among patients enrolled onto therapeutic CTs through the Hawaii Minority/Underserved National Cancer Institute Community Oncology Research Program. The Care Coordination Instrument, a validated instrument, was used to measure patients' perceptions of CC among CT participants (n = 45) and matched controls (n = 45). Paired t-tests were used to compare overall and three CC domain scores (Communication, Navigation, and Operational) between the groups. Semistructured focus group interviews were conducted virtually with 14 CT participants in 2020/2021. CT participants reported significantly higher total CC scores than non-CT participants (P = .0008). Similar trends were found for Navigation and Operational domain scores (P = .007 and .001, respectively). Twenty-nine percent of CT participants reported receiving high-intensity CC assistance from their clinical research professionals (CRPs). Content analysis of focus group discussions revealed that nearly half of the focus group discussions centered on CRPs (47%), including CC support provided by CRPs (26%). Other key themes included general CT experiences (22%) and CRP involvement as an additional benefit to CT participation (15%). Our results show that patients on CTs in this study had a more positive CC experience. This may be attributable in part to CC support provided by CRPs. These findings highlight both the improved experience of treatment for patients participating in a trial and the generally unrecognized yet integral role of CRPs as part of a cancer CT care team.

Clinical Evidence Generation During a Pandemic: Lessons Learned for Sustaining Progress.

Because of significant adaptations forced by the COVID-19 pandemic, resultant changes within health care delivery and clinical research introduced the potential for evaluation of novel evidence generation approaches in oncology. On July 26 and 27, 2021, the National Academies of Science, Engineering, and Medicine, National Cancer Policy Forum hosted a virtual workshop entitled “Cancer Care and Cancer Research in the Context of the COVID-19 Pandemic: A Workshop on Lessons Learned.” This workshop examined changes in cancer care and cancer research that occurred in response to the COVID-19 pandemic and considered lessons learned from that experience. The goal was to identify what changes could improve the delivery of high-quality cancer care and the conduct of cancer clinical trials in the postpandemic era, with an emphasis on health equity. How can we sustain the valuable lessons learned that might accelerate progress and enhance clinical evidence generation for patients and clinicians? In this overview, we discuss ways in which the COVID-19 experience has catalyzed research efficiencies as well as fostered a broader array of trial design and research methods that may facilitate improved cancer drug development during the pandemic and beyond.

Proposal for development of a guideline in maintaining quality cancer care during and post-covid-19 in an upper middle-income country with universal health coverage

BackgroundDuring periods of high community transmission of COVID-19, the public hospitals in Malaysia, an upper middle-income country, have been forced to scale down elective surgeries, prioritize cancer treatments based on treatment benefits, and postpone non-emergency imaging procedures. These inevitably led to disruptions in cancer care delivery within the public health care system. This study aims to explore the facilitators and barriers faced by healthcare providers and cancer survivors in cancer care, and to co-design a guideline to maintain the delivery of cancer care amid the disaster situations. MethodIn-depth interviews (IDIs) will be conducted with Malaysian healthcare providers and cancer survivors and findings will be analysed thematically. The insights will be used in a subsequent phase to co-design a guideline to maintain the delivery of quality cancer care in Malaysia via a three-round modified Delphi survey with a broad range of cancer stakeholders. Expected resultsFindings derived from IDIs and existing literature will be included for rating across three rounds by the expert panel. Feedback provided will be refined until consensus on the best practises for cancer care continuity during crises is achieved. ConclusionThe output of the present study is not only expected to ensure the continuity of delivery of high-quality cancer care in Malaysia during the ongoing pandemic but also to be adapted during unforeseen crises in the near future. Policy summary statementCollaborative work between policy makers, public health physicians, members of the multidisciplinary oncology team as well as cancer survivors is vital in developing an evidenced- based contingency plan for maintaining access to cancer care.

Improving the Delivery of High-Quality Cancer Care in Medically Underserved Communities: A Formative Evaluation Method.

In 2015, the American Society of Clinical Oncology launched a new program: Improving Quality of Care in Underserved Communities with the overarching aim of serving patients with cancer who have traditionally had difficulty accessing the care they need. Cancer care requires intense coordination of complex services to provide safe, effective, timely, and equitable care. If chemotherapy and/or radiation is needed, patients must navigate a complex system of care many times, a formidable challenge for many disadvantaged patients. Many practices believe that these patients face such significant issues that it is almost impossible to provide high-quality care. A grant from the Stavros Niarchos Foundation allowed us to select 4 oncology practices serving high proportions of racial minorities and persons of low socioeconomic status to participate in the new American Society of Clinical Oncology program. The program had 2 objectives: (1) to improve the capacity and capability of the participating practices to provide evidence-based, high-quality care; and (2) to identify and disseminate lessons learned for improving quality of care among oncology practices serving underserved patients. The program leveraged existing programs including the Quality Oncology Practice Initiative, which is a national performance measurement and improvement program that collects data about processes of care provided in the outpatient medical oncology setting, and the American Society of Clinical Oncology Quality Training Program, which provides training in how to apply the tools and methods of quality improvement in routine care settings. Training was provided in face-to-face and virtual meetings and participants were provided mentors throughout the program. At the conclusion, a formative evaluation method was used to assess whether the goals had been achieved. Objectives, activities, and desired outcomes were identified for each of the goals and thus became the framework for the evaluation. The program met the stated goals and objectives. The evaluation revealed many successes, some surprises, and a list of improvements that were incorporated in the next iteration of this program. Based on data from the evaluation, the Niarchos Foundation provided funds for an additional 10 practices to participate in a similar program in 2020. This article outlines the evaluation of a new program demonstrating that medical oncology practices can make improvements in the care of their underserved populations if provided with the proper tools, methods, and coaching. The use of formative evaluation methodology also identified opportunities for improvement and ultimately resulted in additional funding for more practices to participate in the program.

Analysing the attributes of Comprehensive Cancer Centres and Cancer Centres across Europe to identify key hallmarks.

There is a persistent variation in cancer outcomes among and within European countries suggesting (among other causes) inequalities in access to or delivery of high‐quality cancer care. European policy (EU Cancer Mission and Europe’s Beating Cancer Plan) is currently moving towards a mission‐oriented approach addressing these inequalities. In this study, we used the quantitative and qualitative data of the Organisation of European Cancer Institutes’ Accreditation and Designation Programme, relating to 40 large European cancer centres, to describe their current compliance with quality standards, to identify the hallmarks common to all centres and to show the distinctive features of Comprehensive Cancer Centres. All Comprehensive Cancer Centres and Cancer Centres accredited by the Organisation of European Cancer Institutes show good compliance with quality standards related to care, multidisciplinarity and patient centredness. However, Comprehensive Cancer Centres on average showed significantly better scores on indicators related to the volume, quality and integration of translational research, such as high‐impact publications, clinical trial activity (especially in phase I and phase IIa trials) and filing more patents as early indicators of innovation. However, irrespective of their size, centres show significant variability regarding effective governance when functioning as entities within larger hospitals.

An Optimal Care Coordination Model for Medicaid Patients with Lung Cancer: Rationale, Development, and Design

Patient-centered care that is accessible, affordable, evidence based, and well coordinated is integral to high-quality cancer care delivery.1 Medicaid and other socioeconomically disadvantaged pati...

American Society of Clinical Oncology Road to Recovery Report: Learning From the COVID-19 Experience to Improve Clinical Research and Cancer Care.

This report presents the American Society of Clinical Oncology's (ASCO's) evaluation of the adaptations in care delivery, research operations, and regulatory oversight made in response to the coronavirus pandemic and presents recommendations for moving forward as the pandemic recedes. ASCO organized its recommendations for clinical research around five goals to ensure lessons learned from the COVID-19 experience are used to craft a more equitable, accessible, and efficient clinical research system that protects patient safety, ensures scientific integrity, and maintains data quality. The specific goals are: (1) ensure that clinical research is accessible, affordable, and equitable; (2) design more pragmatic and efficient clinical trials; (3) minimize administrative and regulatory burdens on research sites; (4) recruit, retain, and support a well-trained clinical research workforce; and (5) promote appropriate oversight and review of clinical trial conduct and results. Similarly, ASCO also organized its recommendations regarding cancer care delivery around five goals: (1) promote and protect equitable access to high-quality cancer care; (2) support safe delivery of high-quality cancer care; (3) advance policies to ensure oncology providers have sufficient resources to provide high-quality patient care; (4) recognize and address threats to clinician, provider, and patient well-being; and (5) improve patient access to high-quality cancer care via telemedicine. ASCO will work at all levels to advance the recommendations made in this report.

Identifying Breast Cancer Care Quality Measures for a Cancer Facility in Rural Sub-Saharan Africa: Results of a Systematic Literature Review and Modified Delphi Process.

PURPOSEThe burden of cancer is growing in low- and middle-income countries (LMICs), including sub-Saharan Africa. Ensuring the delivery of high-quality cancer care in such regions is a pressing concern. There is a need for strategies to identify meaningful and relevant quality measures that are applicable to and usable for quality measurement and improvement in resource-constrained settings.METHODSTo identify quality measures for breast cancer care at Butaro Cancer Center of Excellence (BCCOE) in Rwanda, we used a modified Delphi process engaging two panels of experts, one with expertise in breast cancer evidence and measures used in high-income countries and one with expertise in cancer care delivery in Rwanda.RESULTSOur systematic review of the literature yielded no publications describing breast cancer quality measures developed in a low-income country, but it did provide 40 quality measures, which we adapted for relevance to our setting. After two surveys, one conference call, and one in-person meeting, 17 measures were identified as relevant to pathology, staging and treatment planning, surgery, chemotherapy, endocrine therapy, palliative care, and retention in care. Successes of the process included participation by a diverse set of global experts and engagement of the BCCOE community in quality measurement and improvement. Anticipated challenges include the need to continually refine these measures as resources, protocols, and measurement capacity rapidly evolve in Rwanda.CONCLUSIONA modified Delphi process engaging both global and local expertise was a promising strategy to identify quality measures for breast cancer in Rwanda. The process and resulting measures may also be relevant for other LMIC cancer facilities. Next steps include validation of these measures in a retrospective cohort of patients with breast cancer.

Choosing Wisely Africa: Ten Low-Value or Harmful Practices That Should Be Avoided in Cancer Care.

PURPOSEChoosing Wisely Africa (CWA) builds on Choosing Wisely (CW) in the United States, Canada, and India and aims to identify low-value, unnecessary, or harmful cancer practices that are frequently used on the African continent. The aim of this work was to use physicians and patient advocates to identify a short list of low-value practices that are frequently used in African low- and middle-income countries.METHODSThe CWA Task Force was convened by the African Organization for Research and Training in Cancer and included representatives from surgical, medical, and radiation oncology, the private and public sectors, and patient advocacy groups. Consensus was built through a modified Delphi process, shortening a long list of practices to a short list, and then to a final list. A voting threshold of ≥ 60% was used to include an individual practice on the short list. A consensus was reached after a series of teleconferences and voting processes.RESULTSOf the 10 practices on the final list, one is a new suggestion and 9 are revisions or adaptations of practices from previous CW campaign lists. One item relates to palliative care, 8 concern treatment, and one relates to surveillance.CONCLUSIONThe CWA initiative has identified 10 low-value, common interventions in Africa’s cancer practice. The success of this campaign will be measured by how the recommendations are implemented across sub-Saharan Africa and whether this improves the delivery of high-quality cancer care.

Choosing Wisely Africa: 10 low-value or harmful practices that should be avoided in cancer care.

e19213 Background: Choosing Wisely Africa, builds on Choosing Wisely (CW) in the USA, Canada and India, and aims to identify low-value, unnecessary, or harmful cancer practices that are frequently used on the African continent. Methods: The CWA Task Force was convened by African Organization for Research and Training in Cancer (AORTIC) and included representatives in surgical, medical and radiation oncology, the private and public sectors and patient advocacy group. Consensus was built through a modified Delphi process shortening a long list of practices to a short list then to a final list. Results: Of the 10 practices on the final list, one is a new suggestion, 9 are revisions or adaptations of practices from previous CW campaign lists. One item relates to palliative care, 8 concern treatment, and 1 relates to surveillance. Conclusions: The success of this campaign will be measured by how the list is implemented across sub-Saharan Africa and whether it improves the delivery of high-quality cancer care. [Table: see text]

Implementation of 11 system-wide, disease-specific, multidisciplinary tumor boards connecting 24 hospitals in an integrated health care system.

e19152 Background: Cancer treatment is becoming more complex, necessitating subspecialty expertise and multidisciplinary approaches to treatment planning. Simultaneously, there is increasing demand to provide care as close to home as possible. While tumor boards have long been an institutional backbone to providing high-quality multidisciplinary care in tertiary facilities, connecting several hospitals and dozens of cancer specialists in a large integrated healthcare system is unique and potentially transformational for smaller facilities and communities. Methods: Using highly-secure, network firewall-protected Cisco Telepresence and WebEx capabilities, 11 disease specific tumor boards (Breast, GI, Sarcoma, GU, Thoracic, Head/Neck, Melanoma, Neuro, Heme, Hepatobiliary, Gyn) were organized across Intermountain Healthcare’s 24 geographically and medically diverse hospitals spanning over 500 miles. Meetings for each of these disease-specific tumor boards have been held at least every 1-2 weeks, at set times and days since July 2019. Cases are submitted to the appropriate tumor board by individual providers from anywhere in the system. Submitted cases are reviewed by a designated subspeciality leader. Cases are either added to the system-wide agenda, or at times, the clinical decision can be resolved immediately. Included cases’ records including pathology, radiology and pertinent medical history are obtained for display and discussion. After each tumor board, recommendations and conclusions are recorded by nurse navigators for future review and consultation. Results: From July 2019 to February 2020, 1,598 patient cases were discussed. Just as relevant, 293 unique oncology providers (surgeons, medical oncologists, radiation oncologists, genetic counselors, nurse navigators, and therapists) participated in tumor board discussions. These deliberations provided insight, experience and recommendations directly related to patient care. Conclusions: Our system-wide, disease-specific, multi-disciplinary tumor boards are useful in connecting oncology providers and subspecialists. This effort has led to better collaboration, coordination and delivery of high-quality cancer care to patients throughout a large healthcare system that includes thousands of patients and dozens of cancer providers in smaller/rural communities. In addition, provider engagement has improved. Work is ongoing to prospectively evaluate the effects on treatment decisions and clinical outcomes.

Survey of medical student knowledge in oncology and survivorship care in Nigeria: A pilot study.

e18106 Background: In low middle-income countries (LMICs), cancer patients present in later stages of disease for many reasons, including missed diagnoses. Due to high patient: physician ratios, generalists are taught broadly and prepared to treat diseases outside the scope of their interest in training. The delivery of high-quality cancer care requires an interdisciplinary team of physicians with excellent medical school training in oncology. To date, there has been no formal assessment of medical education for oncology in Nigeria. This study aims to assess the ability of the curriculum in Nigeria to prepare future doctors tasked with treating a growing number of patients with cancer. Methods: An anonymous survey was administered to final year medical students at Lagos State University and University of Ibadan, Nigeria. The survey assessed demographics, reports of experience during medical school with oncology, comfort ratings with different aspects of oncologic care (Likert scale, 1 = not at all, 5 = extremely), and included five clinical vignettes. Results: 146 graduating students in two medical schools responded (response rate = 36.6%). Twelve percent of students indicated that they planned to pursue a career in oncology. The majority of students reported exposure through lectures to medical oncology (85%), radiation oncology (82%), and surgical oncology (85%), but fewer reported exposure to lectures in hospice care (75%) and cancer survivorship care (52%). Most students (87%) have not attended a tumor board during medical school. In clinical vignettes, students performed worst on long-term chemotherapy toxicities, and best on surgical oncology risk. Overall, students indicated being “moderately comfortable” with topics in medical, radiation, surgical, and palliative care on a Likert scale, and “somewhat comfortable” with survivorship care. Conclusions: Although students in Nigeria report learning about disciplines in oncology care, they report varying comfort levels with specific oncology topics by the end of medical school. The results of this pilot study support the need to develop an interdisciplinary oncology curriculum in Nigeria.

Evaluating Barriers and Opportunities in Delivering High-Quality Oncology Care in a Resource-Limited Setting Using a Comprehensive Needs Assessment Tool.

PurposeDespite recognition of both the growing cancer burden in low- and middle-income countries and the disproportionately high mortality rates in these settings, delivery of high-quality cancer care remains a challenge. The disparities in cancer care outcomes for many geographic regions result from barriers that are likely complex and understudied. This study describes the development and use of a streamlined needs assessment questionnaire (NAQ) to understand the barriers to providing quality cancer care, identifies areas for improvement, and formulates recommendations for implementation.MethodsUsing a comprehensive NAQ, in-depth interviews were conducted with 17 hospital staff involved in cancer care at two teaching hospitals in Nigeria. Data were analyzed using content analysis and organized into a framework with preset codes and emergent codes, where applicable.ResultsData from the interviews were organized into six broad themes: staff, stuff, system, space, lack of palliative care, and provider bias, with key barriers within themes including: financial, infrastructural, lack of awareness, limited human capacity resources, lack of palliative care, and provider perspective on patient-related barriers to cancer care. Specific solutions based on ability to reasonably implement were subcategorized into short-, medium-, and long-term goals.ConclusionThis study provides a framework for a streamlined initial needs assessment and a unique discussion on the barriers to high-quality oncology care that are prevalent in resource-constrained settings. We report the feasibility of collecting and organizing data using a streamlined NAQ and provide a thorough and in-depth understanding of the challenges in this setting. Knowledge gained from the assessments will inform steps to improve oncology cancer in these settings.