Central Infusion Research Articles

A Statewide Telemedicine Referral System for Regional Monoclonal Antibody Infusion Centers.

Background: Regional infusion centers (RICs) played an integral role in treating high-risk patients with COVID-19, with mild to moderate symptoms, who did not need acute hospitalization, with monoclonal antibodies. While any medical provider could place a RIC referral, it was recognized that many people face challenges with accessing care. A dedicated medical team was created to provide telemedical evaluation of patients and place appropriate referrals to RICs. The objective of this work was to assess patient populations who utilized a telemedicine referral system for COVID-19 antibody infusions. Methods: Providers used Pulsara, a Health Insurance Portability and Accountability Act-compliant video chat platform, to remotely screen patients and refer them to regional monoclonal antibody infusion centers if they met criteria. Basic demographic data were collected anonymously on all patients referred to the RICs, and medically underserved populations were determined using the uniform data system mapper. Results: A total of 6,031 patients were referred to RICs through Pulsara. Of these, 1,723 (29%) lived in medically underserved areas and 1,042 (17%) lived in mixed zones. In the second half of the program, 36 providers virtually screened 3,531 patients with 1,890 patients (53.5%) receiving an infusion. Conclusions: The successful implementation of a telehealth referral system facilitated the decentralization of monoclonal antibody infusion therapy from emergency departments to RICs. This system reached a significant number of people living within medically underserved areas.

P-545. Feasibility, Fidelity, and Effectiveness of Administering CABENUVA in Infusion Centers

Abstract Background Administering intramuscular CABENUVA at infusion centers (ICs) offers a convenient alternative for patients to receive treatment. Giving Long Acting CABENUVA in Infusion centERs (GLACIER) examined feasibility and fidelity of delivering monthly and every 2-monthly CABENUVA at ICs from the perspective of patient study participants (PSP) over 8 months. Methods Study data includes clinical data and questionnaires to examine PSPs experiences receiving CABENUVA in IC routine care. Quantitative questionnaires include the Feasibility of Intervention Measure (FIM), the Acceptability of Intervention Measure (AIM), and implementation questions. Qualitative interviews were completed with a subset of PSPs. Results Enrolled participants (n=44) had a mean age of 46.8, 20.5% female at birth, and 51.2% had not previously received CABENUVA. 96.4% (187/194) of injections were within the treatment window. No study withdrawal or treatment discontinuation were due to AEs. There were 16 ISR AEs in 12 participants and 19 treatment related AE in 13 participants; most were mild (Grade 1) or moderate (Grade 2). Injection site discomfort (14%) and pain (14%) were cited most frequently. No SAEs were reported. At Month 8, IC administration was highly feasible (FIM: M=4.41) and acceptable (AIM: M=4.51). Advantages of ICs included ease of parking, convenient location, ease of scheduling/rescheduling, privacy, others not knowing what medication they received, and reduced stigma (Table 1). At Month 8, 94.6% of PSPs reported being very or extremely satisfied with the ICs care. Qualitative interviews highlighted positive views of IC administration, including staff relationships and continuity in care as key acceptability factors. Conclusion CABENUVA administration at ICs was safe, effective, and convenient. High levels of adherence to the treatment window, acceptability, and feasibility were reported. Rapport with IC staff, continuity in care, reduction in logistical barriers and the perception of decreased stigma highlight that ICs can be a valuable alternative site of care for CAEBNUVA administration. ICs should be considered to improve convenience of treatment administration and when HCP offices have limited capacity. Disclosures Cassidy Gutner, PhD, GSK: Stocks/Bonds (Public Company)|ViiV Healthcare: Employee Conn M. Harrington, BA, GSK: Stocks/Bonds (Public Company)|ViiV Healthcare: Employee Gilda Bontempo, MD, GSK: Stocks/Bonds (Public Company)|ViiV Healthcare: Employee Sivakumar Pazhamalai, BPharm, GSK: Employee Abhishek Kumar, MSc, GSK: Employee|GSK: Stocks/Bonds (Public Company) Kelly Rimler, MS, GSK: Employee Karen Davis, MS, RN, GSK: Stocks/Bonds (Public Company)|ViiV Healthcare: Employee Will Williams, n/a, GSK: Employee|GSK: Stocks/Bonds (Public Company) Deanna Merrill, PharmD, MBA, AAHIVP, GSK: Stocks/Bonds (Public Company)|ViiV Healthcare: Employee Lisa Petty, MT(ASCP), GSK: Stocks/Bonds (Public Company)|ViiV Healthcare: Employee Cindy Garris, MS, GSK: Stocks/Bonds (Public Company)|ViiV Healthcare: Employee Supriya Sarkar, PhD, MPH, GSK: Stocks/Bonds (Public Company)|ViiV Healthcare: Full time employee Patrick Daniele, MS, GSK: Advisor/Consultant|ViiV Healthcare: Advisor/Consultant Bridget Gaglio, PhD, MPH, Thermo Fisher Scientific: Stocks/Bonds (Public Company) Maggie Czarnogorski, MD MPH, GSK: Stocks/Bonds (Public Company)|ViiV Healthcare: Employee

P-1102. Real-World Effectiveness of Dalbavancin for Invasive Gram-Positive Bacterial Infections

Abstract Background Emerging data suggest dalbavancin (DAL) may be used in complicated infections including bacteremia, prosthetic joints, osteomyelitis, and endovascular infections. The purpose of this study was to evaluate the real-world effectiveness of DAL for the treatment of invasive gram-positive infections (GPIs). Methods This multicenter, retrospective cohort study included adult patients receiving DAL for treatment of confirmed/presumed invasive GPI between February 2021 and December 2023. Invasive infections included those requiring ≥ 4 weeks of therapy. Patients were excluded if they received DAL for chronic suppression. The intention to treat (ITT) population included patients who received ≥ 1 DAL dose; the per protocol (PP) population received ≥ 2 doses within 7 days of expected administration dates. The primary outcome was clinical failure in the PP group at 90 days post-treatment. Secondary outcomes were logistical failures, clinical failures, and treatment-emergent adverse events in the ITT group at 90 days post-treatment. Results The ITT population included 150 patients (mean age 50.2 years, 65% male, 35% obese, 41% illicit drug use); the PP population included 107 patients. The most common infectious syndrome was osteomyelitis (63.3%, 95/150); the most common pathogens were MRSA (38%, 57/150) and MSSA (37%, 44/150). The most common dosing regimen was 1500 mg on day 1, followed by 1500 mg on day 8 (90%, 96/150). Among the PP population with follow-up, 22% (19/87) experienced clinical failure at 90 days post-treatment. No factors were significantly associated with clinical failure. Logistical failure occurred in 17% (26/150). Results of univariate regression analyses showed receipt of first dose at an infusion center vs. inpatient setting significantly increased logistical failure (OR 4.53, 95% CI 1.62 – 16.17; P = 0.008) while blood-based infectious syndromes significantly decreased logistical failure (OR 0.26, 95% CI 0.06 – 0.82; P = 0.038). Receipt of vancomycin within 6 weeks of DAL significantly increased risk of acute kidney injury (OR 4.12, 95% CI 1.20 – 14.68; P = 0.024). Conclusion Dalbavancin is a safe and effective treatment option for invasive GPIs; however there are modifiable risk factors associated with secondary outcomes of logistical failure and toxicity. Disclosures Julie Ann Justo, PharmD, MS, FIDSA, BCPS, Shionogi: Advisor/Consultant Bruce M. Jones, Pharm.D., FIDSA, BCPS, AbbVie: Advisor/Consultant|AbbVie: Honoraria|Ferring: Honoraria|Innoviva: Honoraria|Paratek: Honoraria Bryan White, PharmD, BCPS, BCIDP, Melinta: Advisor/Consultant|Shionogi: Grant/Research Support Joseph Sassine, MD, Ansun BioPharma: Grant/Research Support|Cidara Therapeutics: Grant/Research Support|Community Infusion Solutions: Grant/Research Support|F2G: Grant/Research Support|Shionogi: Grant/Research Support

P-1870. Clinical Outcomes of Self-Administered Outpatient Parenteral Antimicrobial Therapy over 12 Years in a Safety Net Hospital

Abstract Background Outpatient Parenteral Antimicrobial Therapy (OPAT) is safe and effective for medically stable patients requiring intravenous (IV) antibiotics.1 OPAT is most commonly administered in a healthcare setting (H-OPAT), utilizing home health services, infusion centers, nursing homes, or hemodialysis centers. However, patients without health insurance are often unable to afford H-OPAT services, leading to lengthy hospital stays and potentially avoidable healthcare costs. Self-administered OPAT (S-OPAT) is relatively uncommon. At our safety net hospital, we established a S-OPAT clinic for uninsured patients in 2009. Data published from the first four years of our S-OPAT program in 2015 demonstrated a decreased risk of 30-day readmission among S-OPAT compared to H-OPAT with no significant difference in 1-year mortality.1. A registry of all patients discharged on OPAT has since been developed.Table 1:Patient Demographics Methods Data from 7335 OPAT discharges between October 2012 and December 2023 were analyzed. We assessed both H-OPAT and S-OPAT groups for blood stream infections secondary to vascular access sites in the ambulatory setting, 30-day readmission rates, and total number of S-OPAT days as an estimate for prevented inpatient days.Table 2.Clinical Outcomes for S-OPAT versus H-OPAT Results Of the 7,335 OPAT discharges from 2012 to 2023, 49.9% were discharged to H-OPAT and 50.1% to S-OPAT (Table 1). There was no difference between 30-day readmissions (OR 1.01 [CI 1.000 - 1.029) for S-OPAT as compared to H-OPAT (Table 2). There were a total of 47 blood stream infections over this 12-year period. 35 occurred in H-OPAT patients and 12 in S-OPAT patients (p < .01). A total of 54,733 days of S-OPAT were prescribed, preventing an estimated same number of inpatient days. Conclusion S-OPAT was designed to provide an alternative to prolonged hospital stays for uninsured patients requiring prolonged IV antibiotics. There is always a concern about the safety of discharging patients with vascular access, especially in patients with limited access to healthcare. Our data demonstrates that the safety of S-OPAT is as good, if not better, than the standard of care, H-OPAT, while allowing for more effective utilization of and improving health equity for our uninsured patients in our safety net hospital. Disclosures All Authors: No reported disclosures

P-1873. Telavancin Outcomes in Infections Treated with Outpatient Parenteral Antibiotic Therapy (OPAT)

Abstract Background Telavancin (TLV) is a lipoglycopeptide approved for the treatment of complicated skin and skin structure infection (cSSSI) and hospital acquired and ventilator associated bacterial pneumonia caused by susceptible Gram-positive bacteria. Data is lacking for published outcomes in OPAT. This study evaluated the use and treatment outcomes of TLV in patients receiving OPAT. Methods Medical records of adult patients who received TLV during 2021-2023 in OPAT were queried. Demographics, diagnosis, therapy characteristics, laboratory and microbiologic data, adverse events (AEs), and clinical outcomes were collected. Patients were categorized at the completion of OPAT as clinical success (complete or partial resolution of signs and symptoms of infection without need for escalation of antimicrobials), non-success (persistent infection or discontinuation of TLV due to non-improvement), or non-evaluable (unable to determine clinical response to TLV). The microbiologically evaluable group (presence of Gram-positive bacterial culture data) was evaluated for microbiologic success (clearance of Gram-positive organism or improvement/resolution of infection) or microbiologic failure (persistent growth of a Gram-positive organism or non-improvement of infection). Descriptive statistics were used. Results A total of 126 patients from 33 infusion centers were included. Median age was 57 (IQR: 47-64) years and 65% were male. Median TLV daily dose was 750 mg (8mg/kg/dose) and median duration of treatment was 28 days (IQR: 14-40). Gram-positive pathogens were documented in 74 (59%) of patients. Predominant infections included bone and joint (73%) and cSSSI (15%). Early TLV discontinuation occurred in 40 (32%) patients. Overall, 22% prematurely ended TLV due to an AE, most commonly nausea/vomiting (4%) and rash (4%). Of 100 patients evaluable for outcome, clinical success was achieved in 96 (96%) and non-success in 4 (4%). The clinical outcomes for each infection type are shown in Figure 1. Microbiologic success was achieved in 63 (95%) and 3 (5%) experienced microbiologic failure. Conclusion TLV use in OPAT was associated with a high clinical success rate. TLV presents an effective option for treatment of Gram-positive infections of multiple etiologies in OPAT. Disclosures Brian S. Metzger, MD, MPH, Cumberland Pharmaceuticals: Advisor/Consultant|Ferring Pharmaceuticals: Advisor/Consultant Nikhil K. Bhayani, MD, FIDSA, CorMedix: Advisor/Consultant|Cumberland Pharmaceuticals: Advisor/Consultant|Melinta: Advisor/Consultant|Paratek Pharmaceuticals: Advisor/Consultant Richard L. Hengel, MD, Gilead: Grant/Research Support Theresa L. Human, PharmD, Cumberland Pharmaceuticals: Employee Emily A. Durr, PharmD, Cumberland Pharmaceuticals: Employee Jason M. Makii, PharmD, Cumberland Pharmaceuticals: Employee Lucinda J. Van Anglen, PharmD, Cumberland Pharmaceuticals: Grant/Research Support|Ferring Pharmaceuticals: Grant/Research Support|Novartis Pharmaceuticals: Grant/Research Support|Takeda Pharmaceuticals: Grant/Research Support

Infusion line contamination in preterm neonates: impact of infusion line design, length, and use duration: the multicenter ChronoBIOline study

IntroductionCentral venous catheters are critical in preterm neonatal care but increase the risk of central line-associated bloodstream infections (CLABSIs). The incidence of S. haemolyticus-associated CLABSIs in French neonates is increasing, but the mechanisms underlying this trend remain unclear.MethodsWe examined microorganisms in 108 central line infusion sets used in preterm infants across 12 neonatal intensive care units, and collected at the time of removal.ResultsThe infusion sets varied widely in type (28 types; 1-6 parts) and length (10-180 cm, mean 52.9 cm). Contamination was detected in 24 infusion sets (22.2%), mainly by coagulase-negative Staphylococci (50.0%) and Bacillus species (41.7%). Higher contamination rates were linked to longer infusion lines (> 50 cm; p < 0.001), usage beyond 7 days (p = 0.002), and multi-line infusion systems (p < 0.001).DiscussionOur findings are fully consistent with guidelines, which recommend simpler designs and a 4 or 7-day use of infusion sets, emphasizing the importance of adhering to these guidelines to reduce the risk of CLABSIs. Additionally, our findings raise concerns regarding the use of multi-line infusion systems. These devices, which combine extended infusion line length, manufacturer-authorized use of up to 21 days, and intermittent use of certain infusion lines, are easily contaminated during use, creating a high-risk situation for central line contamination.

Management of Severe Hypertriglyceridemia in Pregnancy With Niacin: Reevaluating Safety and Therapeutic Benefits

Background: Severe hypertriglyceridemia (triglycerides (TGs) >1000 mg/dL, >11.3 mmol/L) is a rare but potentially morbid condition in pregnancy. Physiological changes in pregnancy may unmask or exacerbate an underlying defect in TG metabolism. When conventional therapies are ineffective in controlling TG levels, a personalized management approach is needed. We present a case of severe hypertriglyceridemic pancreatitis successfully managed with niacin, a treatment that has seen limited use in pregnancy due to the paucity of available data.Case Presentation: A 29‐year‐old pregnant woman with a history of cholecystectomy and a prepregnancy BMI of 30.6 kg/m2 presented at 12 weeks’ gestation with acute pancreatitis and severe hypertriglyceridemia (6900 mg/dL, 77.9 mmol/L). After initial management with intravenous (IV) fluids, insulin infusion, and a low‐fat diet, her TG levels improved. However, she was readmitted at 23 weeks’ gestation with recurrent hypertriglyceridemia (2872 mg/dL, 32.4 mmol/L), requiring a more aggressive insulin regimen. Despite various interventions, including omega‐3 fatty acids (O3FAs), fenofibrate, and central venous catheter insulin infusion, her TG levels remained elevated, necessitating early delivery at 34 weeks’ gestation. Her postpartum recovery included continued TG management with fenofibrate and O3FAs. Four years later, during a second pregnancy, she presented with similar hypertriglyceridemia, managed with diet, metformin, fenofibrate, and insulin. Due to persistent hypertriglyceridemia (>3000 mg/dL, 33.9 mmol/L), niacin was added as an additional therapy and titrated to 2000 mg/day, which successfully sustained TG levels below 1000 mg/dL (11.3 mmol/L) through the remainder of her pregnancy. She delivered her second child via cesarean section at 35 weeks’ gestation due to preeclampsia. Both children had developmental issues, with her first child diagnosed with attention‐deficient hyperactivity disorder (ADHD) and her second child with autism spectrum disorder and motor delays. The patient was encouraged to remain on long‐term management for her metabolic condition.Conclusions: Managing severe hypertriglyceridemia during pregnancy is challenging due to uncertainties about treatment efficacy and safety. Timely reduction of maternal TGs is essential to prevent complications and requires adjustments throughout pregnancy. This case demonstrates the effectiveness and safety of niacin, often underutilized due to perceived side effects, in managing severe hypertriglyceridemia in pregnancy when other treatments were inadequate.

The increasing role of the allergist in the management of infusion reactions at the Oncology Infusion Center.

Hypersensitivity reactions to chemotherapy disrupt treatment schedules and compromise patient outcomes. Rapid Drug Desensitization (RDD) enables patients to tolerate future treatments after an allergy workup. However, Same-Day Desensitization (SDD) is a novel approach that capitalizes on RDD to allow the continuation of chemotherapy on the same day as the index reaction, preventing treatment delays. To evaluate the safety and efficacy of SDD in managing hypersensitivity reactions during chemotherapy and emphasize the essential role of allergists in the Oncology Infusion Center (OIC) for accurate drugs hypersensitivity reactions (DHRs) phenotyping and management. This retrospective cohort included patients experiencing DHRs during chemotherapy. Under allergist supervision, SDD was performed once the index reaction was controlled. At a later date, clinical phenotypes and endotypes of DHRs were assessed through clinical history, skin tests, serum biomarkers (including tryptase and IL-6 levels), and drug provocation testing (DPT) to reach an accurate diagnosis. SDD was successful in 35 cases, even for patients with severe initial reactions. Only 14% experienced breakthrough reactions, all mild. Same-day assessment by allergists ensured a 92% correlation between initial and final diagnoses, optimizing DHR management. Early engagement with Allergy allowed 86% of reactive patients to continue treatment through RDD or after ruling out an allergy. SDD is a safe and effective procedure that ensures that patients don't miss their oncology treatment on the day of a reaction. The presence of an allergist in the OIC is crucial for rapid access to accurate DHR phenotyping and optimal management, supporting personalized precision medicine in oncology.

Lessons from the Use of Monoclonal Antibodies to SARS-CoV-2 Spike Protein During the COVID-19 Pandemic.

Monoclonal antibodies (mAbs) targeting the SARS-CoV-2 Spike protein were deployed during the COVID-19 pandemic. While all of the clinically authorized mAbs were eventually defeated by SARS-CoV-2 variants, they were highly effective in preventing disease progression when given early in the course of the disease. The experience with mAbs to SARS-CoV-2 offers important lessons for the use of mAbs in future infectious disease emergencies, such as choosing mAbs that target conserved epitopes and designing cocktails to reduce the emergence of escape variants. Planning for future use must include the creation of infusion centers and the development of strategies to minimize the emergence of escape variants.

OP7 Challenges in Treating PNH Patients in Brazil's Public Healthcare System Due to the Frequency of Eculizumab Administration and Patients' Distance from Infusion Centers

OP7 Challenges in Treating PNH Patients in Brazil's Public Healthcare System Due to the Frequency of Eculizumab Administration and Patients' Distance from Infusion Centers

The first year of amyloid immunotherapy in an academic dementia specialty practice

AbstractImplementation of amyloid‐lowering treatments in clinical care for early symptomatic Alzheimer disease (AD) raises many challenges. The Memory Diagnostic Center (MDC), the dementia specialty practice associated with Barnes‐Jewish Hospital/Washington University School of Medicine (BJH/WUSM), has 16 clinicians (12 physicians and 4 advanced practice providers) who see over 2,000 patients with memory disorders per year. BJH is the academic flagship of BJC HealthCare (BJC), an integrated health system in St. Louis, Missouri. Leadership of BJC/WUSM and MDC staff met regularly for two years in anticipation of amyloid‐lowering treatments becoming available. BJC/WUSM decided not to offer aducanumab (Aduhelm®) but did approve use of lecanemab (Leqembi®) after it received FDA approval in July 2023. Providing amyloid‐lowering treatments required coordination with BJC administration, neuroradiology, infusion centers and the clinical practice. Patients meeting appropriate use criteria were identified prior to approval of lecanemab. The requirement for AD biomarkers led to an increase in referrals to our lumbar puncture clinic prior to ∼30/month; there was less increase in referrals for AD blood tests or amyloid PET scans. The first patient received lecanemab within 6 weeks of FDA approval. Barriers to treatment included limited availability of appropriate MRI imaging, lack of reimbursement for AD blood tests and amyloid PET, limited capacity of infusion centers, and issues with private insurers. The MDC developed an on‐call system for response to infusion reactions and other adverse events and a tracking system for infusions and monitoring MRIs. We are developing registries and mechanisms in the electronic medical record to alert Emergency Department providers that patients on lecanemab being evaluated for stroke could be at increased risk of bleeding from thrombolytic therapies. Increasing capacity for patient assessments, biomarker testing, infusions, and follow‐up appointments has required adding advanced practice providers and office staff and presents challenges for reimbursement. As of January 2024, 80 MDC patients had received at least one lecanemab infusion and about 30 are undergoing evaluation to initiate treatment. Ongoing challenges include extending amyloid immunotherapy beyond the academic medical center, which will require training neurologists throughout the BJC system and developing sustainable staffing and billing models for management of amyloid‐lowering treatments.

Is the US infusion capacity sufficient for the expected demand with the emergence of disease‐modifying Alzheimer’s treatments?

AbstractBackgroundDisease‐modifying treatments for Alzheimer’s disease (AD) are becoming available. To date, all current treatments require intravenous infusion, and concerns have emerged that lack of infusion capacity may limit access to treatment. We predict supply and demand for infusions for AD treatment in the US under different assumptions over a 10‐year period.MethodWe use a Markov model to predict the number of individuals identified as eligible for AD treatment from 2023 to 2032, taking into account constrained capacity for AD specialist visits and confirmatory biomarker testing. We analyze chronic treatment starting at mild cognitive impairment (70% of patients) and mild dementia (30%) until transition to moderate dementia with infusions every two and four weeks for an estimated duration of 5.7 years, and time‐limited treatment every four weeks for 52 weeks as a lower bound estimate. National historic trends of infusion capacity were obtained from the CDC’s Ambulatory Health Care Data surveys and projected forward. Estimates for excess capacity and future growth of capacity for AD treatment were obtained from a survey covering 404 US infusion centers.ResultThe model predicts that 370,527 patients would be eligible to start treatment in 2023, increasing by 1% per year. Based on the CDC data, around 21 million infusions across therapeutic areas would be provided in 2023 with a projected annual growth rate of 3%. The survey of infusion centers suggests that 3% of capacity is currently devoted to AD with that share growing 1% per year, as well as up to 17% average unused capacity. Figure 1 shows the projected supply and demand. The solid lines show demand for the three types of treatment, the green and black dashed lines the projected supply and the maximum projected supply, if all unused capacity were devoted to AD infusions.ConclusionProjected US infusion capacity would be insufficient for all three treatment types, and even the maximum projected capacity would only be sufficient for time‐limited treatments. Expansion of capacity and introduction of treatments that do not require intravenous infusions will be necessary to ensure timely access to treatment.

QLTI-19. PEDIATRIC NEURO-ONCOLOGISTS NAVIGATING AN ADULT WORLD: A TALE OF TWO CENTERS

Abstract BACKGROUND Adolescent and Young Adult Neuro-Oncology(AYA-NO) patients are a distinct cohort with an overlap of tumors found in childhood and adulthood. For adult patients with pediatric-type Central Nervous System tumors, optimal work-flow to manage these patients is unclear. METHODS We examine the work-flow of pediatric neuro-oncologists starting AYA-NO clinics within two high volume adult institutions: the University of Miami(Florida, USA) and the Princess Margaret Cancer Centre(Toronto, Canada). RESULTS Over 18 months, the AYA-NO clinics managed 167 patients total with several key differences emerging in both institutions between the pediatric and adult work-flows. Adult providers commonly have neurology backgrounds, while pediatric providers mostly have hematology/oncology backgrounds. In pediatrics, providers typically meet the patient inpatient before pathology results, adult providers meet their patients in outpatient settings once histopathology results are available. Outpatient management in pediatric oncology centers typically includes labs, infusion centers, provider rooms, and social workers in one area while adults, due to the larger volume, have these services on separate units. Chemotherapy related differences included the primary provider for inpatient admissions and the emphasis of adult institutions on outpatient administration when feasible. Psychosocial factors such as the variety of caregivers, increased opportunity for patient autonomy in decision-making, and the increased fragmentation in care magnifies the importance of providers forming a strong rapport with AYA-NO patients. End of life care is vastly different including the inability for adult patients to receive palliative treatment in hospice care and the availability medically-assisted death. CONCLUSION Pediatric neuro-oncologists building AYA-NO workflows within adult settings can provide unique expertise for AYA-NO patients with pediatric-type tumors. Growing AYA-NO clinics can benefit from allocating AYA CNS specific resources such as chemotherapy/targeted therapy provider education, a dedicated hospital/clinic space, chemotherapy nursing, a care coordinator, and a social worker with experience treating this patient population.

Perceptions of Implementing Real-Time Electronic Patient-Reported Outcomes and Digital Analytics in a Majority-Minority Cancer Center.

Electronic patient-reported outcome (ePRO) tools are increasingly used to provide first-hand information on patient's symptoms and quality of life. This study explored how patients and health care providers (HCPs) perceive the use of a digital real-time ePRO tool, coupled with digital analytics at a cancer center located in a majority-minority county. Furthermore, we described the implementation barriers and facilitators identified from the participants' perspectives. We conducted a qualitative substudy as part of a larger implementation study conducted at University of California Irvine Chao Family Comprehensive Cancer Center. Patients and HCPs completed semistructured interviews and a focus group discussion. Thematic analysis was used to identify key themes regarding perceived impact of the intervention on patient's care and implementation factors. A total of 31 participants, comprising 15 patients (67% English-speaking, 33% Spanish-speaking) and 16 HCPs (43.8% pharmacists, 37.5% physicians, 18.8% nurses), were interviewed. The utilization of real-time ePRO was perceived to beneficially affect patient care, improve patient-provider communication, and increase symptom awareness. Implementation facilitators included ease of comprehension and completion within the infusion center. Barriers included the need to incorporate results in electronic medical records and create real-time referral pathways to address patient's needs. The use of real-time ePRO in a majority-minority population was perceived to enhance patient-centered oncology care, yet implementation barriers must be addressed for successful integration in clinical settings. The findings from this study may inform implementation strategies to reduce health disparities.

Evaluation of a Reiki Volunteer Program within Two Cancer Infusion Centers

Reiki is a biofield therapy from Japan currently used in many US hospitals. Evidence supports Reiki's effectiveness for addressing cancer and treatment-related symptoms such as pain and anxiety. However, no study to date has assessed changes in nausea following Reiki received during infusion treatments or assessed patients from multiple healthcare locations. To evaluate a Reiki program for outpatients with cancer and other chronic illnesses receiving infusion treatments (e.g., chemotherapy) at two University Hospitals infusion centers. Participants in the outpatient infusion clinics completed Edmonton Symptom Assessment System measures of pain, fatigue, anxiety, nausea, and well-being before and after receiving a 15-20-minute Reiki session during their infusion. Data analysis included means and 95% confidence intervals (CI) of single-session effects on measures where the pre-session score was ≥1 and analysis of post-session comments. Between March 2022 and February 2024, 392 Reiki sessions were provided to 268 unique patients (mean age 63.3 ± 13.9, 57.5% female, 71.6% White, 26.5% Black/African American). Participants reported clinically significant mean [95% CI] improvements (≥1 unit) in pain (-1.78 [-2.38, -1.18]), fatigue (-1.33 [-1.85, -0.82]), anxiety (-2.09 [-2.68, -1.50]), nausea (-2.30 [-2.95. -1.62), and wellbeing (1.37 [0.95, 1.79]). Participants also commented that the Reiki session was a positive experience helpful for promoting relaxation and symptom reduction. Outpatients receiving Reiki during infusion reported clinically significant improvements in all symptoms, high levels of satisfaction, and a qualitatively positive healing experience. More research is needed to assess long term changes following Reiki, including with an expanded program at additional healthcare locations.

Design of a Cancer Infusion Center: Results from a Pre- and Post-Occupancy Evaluation.

The current study performed a post-occupancy evaluation on a new cancer infusion center with pod-like layout and compared results to a pre-occupancy evaluation to investigate the impact of different cancer infusion center designs on staff efficiency and patient and staff satisfaction. The new cancer infusion center opened in October 2020 and replaced two previously existing infusion centers, in the same healthcare system. The study used a similar mixed-method approach as the pre-occupancy research, which included staff shadowing, medication delivery shadowing, and staff and patient questionnaires. The new infusion center improved staff efficiencies by reducing nurse travel time compared to pre-occupancy infusion centers. Results also showed an increase in satisfaction with different aspects of the new infusion center including patient privacy, by both patients and nurses. The pod design allowed for better audio and visual privacy for patients, provided a higher amount of worksurface and availability of workstations, reduced noise levels, and enhanced nurse concentration at workstations. Findings indicated that nurses who had prior experience working in the pre-occupancy infusion centers expressed significantly lower levels of satisfaction in the new infusion center, especially in the ability to connect with nurses in other pods. Although the new pod design had limitations in terms of collaborative opportunities across pods, it showed to provide a more efficient work environment for the staff and increase staff and patient satisfactions. The results also highlight the importance of effective change management strategies when nurses transition to a new work environment.

Coordinating expensive, difficult-to-obtain prophylactic medications before discharge: A quality improvement project in an academic stem cell transplant unit.

337 Background: Infections are a significant source of morbidity/mortality in allogeneic stem cell transplant (alloSCT) patients and antimicrobial prophylaxis has reduced deaths. Between July 2022 and July 2023, 21% of new alloSCT recipients were discharged from UVA Medical Center without posaconazole or isavuconazonium +/- letermovir in-hand at the time of hospital discharge necessitating daily oral drug administration at the infusion center until medication could be obtained. This led to excess cost for UVA, burden on clinic staff, missed doses, and patient frustration. We sought to decrease the number of new alloSCT recipients discharged without appropriate prophylaxis in-hand from 21% to 10% by November 2024. Methods: Per the 2023 ASCO Quality Training Program associated with this project, a Model for Improvement and Plan Do Study Act (PDSA) methodology was utilized. The population included alloSCT patients with new prescriptions (Rxs) for posaconazole or isavuconazonium +/- letermovir. The outcome measure was percentage of newly discharged alloSCT patients requiring oral prophylaxis at the infusion center. The process measure was Time to Affordable Medication (TAM) defined as days from Rx prior-authorization (PA) request to paid claim with an affordable copay (defined as a copay the patient was able/willing to pay, including free drug approvals or assistance programs). The counter measure consisted of initiating the Rx PA process 10 days prior to planned admission via a discharge test Rx order set instead of waiting until admission. This standardized process allowed for clearer communication and more time for pharmacy technicians to process the Rx for PA, copays, free drug applications, and pharmacy logistics. Upon admission, the official Rx was released to the discharge pharmacy. If Rx shipment was required, this was set up the week prior to discharge. An I-chart (3-sigma) statistical process control (SPC) chart was used to assess the intervention. Results: The baseline TAM was assessed retrospectively in 22 Rxs over 3 months prior to intervention for a mean of 7.5 days. PDSA cycle 1 was implemented Nov. 2023. TAM for the first 35 Rxs was 4.3 days and the SPC upper control limit decreased from 26.3 days to 13.3 days demonstrating overall markedly decreased variation despite data from early 2024 having greater variability due to new insurance deductibles. Rxs requiring 10 or more days were due to free drug application processes. Importantly, no newly discharged alloSCT patients have required drug administration at the infusion center. Conclusions: PDSA #1 resulted in a decrease in TAM of 3.2 days, decreased variation in the process, and no patients discharged without drug in hand. Since we have already surpassed our aim, next steps include demonstrating sustainability of the process and a survey requesting feedback to identify balance measures.

Integrating diabetes care into an oncology practice: A patient-centric model of care delivery at a safety-net health system.

2 Background: Oncologic treatments can disrupt glycemic control in people with diabetes and induce dysglycemia in individuals without diabetes through the use of steroids and/or targeted therapies. Severe hyperglycemia can result in delay/interruption of oncologic care and emergency department (ED) utilization. Here we report on an integrated model of diabetes care at a safety-net system, where patients commonly use the ED for their care. Methods: Parkland Health is an academic-affiliated safety-net system, primarily providing care for the un-/under-insured patients in Dallas County. An advanced nurse practitioner specializing in diabetes care (DM-ANP), supervised by an endocrinologist, was embedded in oncology clinics. Patients were referred to the DM-ANP by their oncology provider, or through an automated process if they had a recent hemoglobin A1c >8.0% or a random blood sugar > 250mg/dL. Patient education was provided by a trained nurse educator. Nutrition consult was available through an oncology dietitian. An acute hyperglycemia management protocol was developed to manage patients in the infusion center and prevent unnecessary ED visits. Results: Between March 2021 and March of 2024, the DM-ANP provided 4,276 visits to 797 distinct patients (average, 1425 visits per year). Breast cancer was the most common malignancy among patients seen in the integrated clinic. DM-ANP visits were coupled with oncology visits (clinic or infusion) or via telehealth, thereby increasing access and decreasing number of days patients had to come to clinic to receive care. Telehealth visit rate was highest in 2021 (27.5%) reflecting the impact of the pandemic, and subsequently dropped to 10.1% in 2023. Patients who were seen by the DM-ANP had an overall lower number of ED visits. Comparing prior vs post establishing care with the DM-ANP, the total number of ED visits by patients with diabetes significantly reduced in 2021-2022 (2021: 970 vs. 241, p <0.01; 2022: 796 vs. 501, p<0.01) before equilibrating in 2023-2024; (2023: 426 vs. 468, p=0.24). On average, patients had 1.2 less ED visits after receiving care from the DM-ANP. Since in-person visits were coupled with other oncology visits, the no-show rate for DM-ANP mirrored the rates for oncology clinics/infusion visits. Conclusions: Integrating diabetes/glycemic management into our oncology practice provided a patient-centric model of care delivery, improved visit adherence compared to an off-site model, reduced the time-toxicity by having fewer clinic visit days. Future directions include comparing oncologic outcomes in patients who had DM-ANP management to those who were managed by primary care.

Frustrations with time spent on cancer care among patients with metastatic breast or advanced ovarian cancer.

235 Background: Individuals with cancer face substantial demands on their energy and time due to the complexity of cancer care. We sought to describe frustrations with time-consuming aspects of cancer care among individuals with advanced ovarian or breast cancer. We hypothesized that frustrations would be highest for time spent on administrative tasks, particularly for those who are younger, employed, and have dependents. Methods: We analyzed baseline survey data from an ongoing prospective study of the time burdens of cancer care among individuals receiving treatment for ovarian or metastatic breast cancer at the University of Minnesota and University of Alabama-Birmingham. The survey included questions about frustrations with the time needed for cancer-related activities such as travel time, finding transportation, care coordination, receiving treatment, and paperwork (0=Not at all, 10=Extremely frustrated). We summarized the data using descriptive statistics and made comparisons across demographic and clinical characteristics using Wilcoxon rank-sum and Kruskal-Wallis tests. Results: A total of 67 participants completed the baseline survey, 37 (55.2%) with metastatic breast cancer and 30 (44.8%) with ovarian cancer. About 1/4 of participants (26.9%) were under 50 years old, 34.3% had dependents, 39.1% were employed, and 57.6% lived 30+ miles from the cancer clinic; 73.1% were non-Hispanic (NH) White and 22.4% NH Black; 4.5% reported another race/ethnicity. Over half (58.2%) agreed minimizing time spent on cancer-related activities was important to them; those employed were significantly more likely to agree (76.0% vs. 48.7%, p=0.03). Activities with the highest reported frustrations were the number of trips, time for care-related travel or paperwork, and wait time. Younger participants reported higher frustration with wait time (p=0.04) and time at the infusion center than older participants (p=0.03). Employed participants reported significant frustration with having to take time off work (p<0.0001), and those with dependents reported frustration needing to organize dependent care (p=0.01). Participants living 30+ miles from the cancer clinic reported greater frustrations with travel time (p=0.01), time needed for care coordination (p=0.01) and waiting for the provider (p=0.02). Some (10.6%) participants reported lacking reliable transportation and, among those, reported high frustration with the time needed for numerous activities, including finding transportation, paperwork, care coordination, and making appointments (all p<0.05). Conclusions: Cancer-related time demands are frustrating for many patients. Those employed, younger, with dependents, living further from the cancer clinic, and without reliable transportation experience greatest frustrations about time lost, underscoring the need to address these often unrecognized aspects of care.

Access to patient assistance programs for rural cancer patients in an NCI designated comprehensive cancer center: A retrospective cohort study.

94 Background: 35% of Oregon’s and 14% of Washington’s populations live in rural/frontier communities. These populations often experience a higher incidence of cancer disparities across the care continuum and a disproportionate burden of the high costs associated with cancer care compared to urban populations. Methods: The Oregon Health & Science University (OHSU) Knight Cancer Institute (KCI) operates a multidisciplinary cancer program catering to Oregon and Southwest Washington from its Portland-based campuses. OHSU launched an enterprise Patient Assistance (PA) program partnership with Atlas Health which included an Artificial Intelligence (AI)-powered platform integrated with the electronic health record and 4 Patient Advocates who enrolled patients into matched PA programs. Rural patients receiving intravenous (IV) infusion therapy who benefited from PA programs were compared to the overall treated population at OHSU infusion centers to determine if rural patients who are at high risk for financial toxicity were identified and provided an effective intervention. Patient zip codes were used to designate residence in urban or rural/frontier counties. Results: A retrospective analysis reviewed unique patients treated in the OHSU KCI infusion centers, PA Enrolled, and PA Awarded patient cohorts. Conclusions: The Enterprise PA program partnership notably and proportionately benefited rural communities who are at high risk for financial toxicity and experience significant cost barriers to care. OHSU collected over 599,000 which reduced the risk of bad debt for the institution and cancer related medical debt for patients. Average PA award of 1,426 was significant due to 40% of Americans cannot afford a 1,000 emergency or unexpected medical bill. This underscores that an enterprise PA program may be considered a care delivery intervention to decrease health disparities. Further study is needed to determine if increasing rural cancer patients’ access to PA programs helps improve clinical access and treatment outcomes across the spectrum of cancer care services. Patient cohort comparison 12/15/2023-3/31/2024. Patient Cohort OHSU Infusion Center Cohort Patient Assistance Enrolled Cohort Patient Assistance Awarded Cohort Total Number of Patients 9,197 554 420 Total Number of Patients Residing in Oregon and Washington 9,064 552 418 Total Number of Patients Residing in Oregon and Washington Rural Counties 1,668 117 122 Percentage Rural Patients 18% 21% 29% Drug Manufacturer Co-Pay Programs - $ 590,785.70 $ 459,095.08 Charitable Co-Pay Assistance Programs - $ 96,024.70 $ 139,981.33 Total - $ 686,810.40 $ 599,076.41 Average Expected/Received Award Per Patient - $ 1,239.73 $ 1,426.37