Medical Oncology Visit Research Articles

Correlation of significant delays and ethnic disparities in the receipt of treatment, palliative care, and supportive care interventions in pancreatic adenocarcinoma.

e16355 Background: In patients with pancreatic adenocarcinoma (PDAC), immediate treatment initiation is preferred. Early palliative care initiation has also improved quality of life and symptom burden. However, the timing of real-world treatment and palliative care initiation and possible ethnic disparities are not well understood. The objective of this study was to evaluate the timing of care initiation in a mainly Hispanic population of PDAC patients. Methods: We conducted a retrospective cohort study that included patients diagnosed with PDAC from 2014 to 2023 at Loma Linda University Health (the only tertiary care center for two large Hispanic-majority counties with large rural populations). Data were obtained on the presence and timing of appropriate provider referrals, care establishment, treatment, advanced care planning, and hospital admissions. We used a Wilcoxon rank-sum test to compare Hispanic and non-Hispanic patients regarding the time to treatment initiation and palliative care initiation. Results: 263 PDAC patients were identified (mean age 66, 57% female, 47% Hispanic, 67% head tumor, 78% stage III/IV). After diagnosis, 93% of patients were referred to medical oncology, 82% to surgical oncology, 61% to palliative care, and 30% to genetic testing. An advanced directive or physician orders for life-sustaining treatment was completed for 24% of patients. The time to care initiation is as follows: a median of 23 days (IQR 14, 54) from diagnosis to the first medical oncology visit, 13 days (IQR 6, 37) to the first surgical oncology visit, 73 days (IQR 24, 132) to the first palliative care visit and 133 days (IQR 47, 329) to hospice referral. 64% of hospice referrals were placed within the last two weeks of life. Hispanic patients had a significantly longer time to treatment initiation (68 days vs. 48 days, p= 0.008) but similar times to palliative care initiation (73 vs 74 days, p= 0.64). Hispanics also had a lower rate of completing genetic testing (45% to 66%, p= 0.07). Conclusions: In our retrospective cohort study, significant delays in establishing care with oncology, palliative care, and hospice initiation in patients with PDAC were noted. Low rates of advanced care planning were also noted despite guideline recommendations for early-focused symptomatic interventions and advanced care planning. Hispanic patients had significantly longer time to treatment initiation and lower rates of genetic testing. These results indicate a need for improved targeted patient care navigation for multidisciplinary PDAC management, particularly in Hispanic patients.

INUDGE: Integration of liquid biopsy based next generation gene sequencing in newly diagnosed NSCLC—A stepped wedge cluster randomized clinical trial.

TPS8664 Background: The development of targeted therapies has changed the treatment paradigm for non–small cell lung cancer (NSCLC). With the growing number of FDA approved targeted therapies, current NCCN guidelines recommend comprehensive molecular genotyping prior to first line (1L) therapy for all newly diagnosed patients with metastatic non-squamous (mNSq) NSCLC to enable the delivery of personalized therapy. Based on prior work that found improved detection of clinically actionable alterations through concurrent plasma (P) based next-generation gene sequencing (NGS) and tissue NGS, we piloted a behavioral economics (BE) informed electronic health record (EHR)-based “nudge” intervention designed to facilitate P NGS at the new patient medical oncology visit. After implementing across 3 practices within the University of Pennsylvania Health System (UPHS), our findings demonstrated that EHR-based nudges are feasible and can promote guideline concordant diagnostic testing at both community and academic sites (1). Methods: Design: NCT05853887 is a prospective stepped wedge cluster randomized trial that includes 3 “clusters”, representing 6 community-based cancer centers. The primary objective of this trial is to test the effectiveness of a BE informed EHR nudge intervention to increase availability of comprehensive molecular test results before 1L therapy by incorporating concurrent tissue and plasma-based molecular testing. Secondary objectives include evaluation of contextual mechanisms contributing to the adoption, reach, and effectiveness of EHR nudge interventions with a lens for health equity. Intervention: An EHR-based nudge that allows for default order placement of P NGS testing at the time of the first medical oncology visit will be implemented. Subsequently, results detected on the default P NGS order will be conveyed to providers in the form of an electronic clinical decision support notification. Statistical Methods:Sample size is based on estimates of the proportion of patients undergoing comprehensive molecular testing prior to 1L. A sample of 3 clusters in a complete stepped-wedge cluster-randomized design with 4 time periods (including the baseline), 3 steps, 1 cluster(s) switching from control to treatment at each step, and an average of 120 subjects per cluster with an average of 30 subjects per cluster per time period (for a total sample size of 360 subjects) will provide 80% power to detect a difference between proportions of 0.21701. Patients with histological, or cytological diagnosis of Stage IV mNSq NSCLC who have not yet received systemic treatment for metastatic disease are eligible for inclusion. Enrollment is ongoing: Cluster 1 began enrollment in June 2023, Cluster 2 in October 2023, and Cluster 3 is planned for February 2024. 1. Aggarwal C et al, JCO, Vol 40, Num 16, Suppl Jun 2022. Clinical trial information: NCT05853887 .

First impressions: A prospective evaluation of patient-physician concordance and satisfaction following the initial medical oncology consultation.

An especially significant event in the patient-oncologist relationship is the initial consultation, where many complex topics-diagnosis, treatment intent, and often, prognosis-are discussed in a relatively short period of time. This study aimed to measure patients' understanding of the information discussed during their first medical oncology visit and their satisfaction with the communication from medical oncologists. Between January and August 2021, patients without prior systemic treatment of their gastrointestinal malignancy (GI) attending the Princess Margaret Cancer Centre (PMCC) were approached within 24 h of their initial consultation to complete a paper-based questionnaire assessing understanding of their disease (diagnosis, treatment plan/intent, and prognosis) and satisfaction with the consultation. Medical oncology physicians simultaneously completed a similar questionnaire about the information discussed at the initial visit. Matched patient-physician responses were compared to assess the degree of concordance. A total of 184 matched patient-physician surveys were completed. The concordance rates for understanding of diagnosis, treatment plan, treatment intent, and prognosis were 92.9%, 59.2%, 66.8%, and 59.8%, respectively. After adjusting for patient and physician variables, patients who reported treatment intent to be unclear at the time of the consultation were independently associated with lower satisfaction scores (global p = 0.014). There was no statistically significant association between patient satisfaction and whether prognosis was disclosed (p = 0.08). An in-depth conversation as to what treatment intent and prognosis means is reasonable during the initial medical oncology consultation to ensure patients and caregivers have a better understanding about their cancer.

2124P The impact of NUTRItional status at first medical oncology visit ON Clinical Outcomes: The NUTRIONCO study

2124P The impact of NUTRItional status at first medical oncology visit ON Clinical Outcomes: The NUTRIONCO study

The Impact of NUTRItional Status at First Medical Oncology Visit on Clinical Outcomes: The NUTRIONCO Study.

Malnutrition affects up to 75% of cancer patients and results from a combination of anorexia and metabolic dysregulation. Metabolic and nutritional abnormalities in cancer patients can lead to cachexia, a multifactorial syndrome characterized by involuntary loss of skeletal muscle mass, systemic inflammation and increased protein catabolism. Cancer cachexia negatively affects patients' outcomes, response to anticancer treatments, quality of life, and survival. However, risk of malnutrition, and cachexia are still under-recognized in cancer patients. The Prevalence of Malnutrition in Oncology (PreMiO) study revealed that 51% of patients already had nutritional deficiencies at their first medical oncology visit. Here, we report the results of the subsequent retrospective, observational NUTRItional status at first medical oncology visit ON Clinical Outcomes (NUTRIONCO) study, aimed at assessing the impact of baseline nutritional and non-nutritional variables collected in the PreMiO study on the clinical outcomes of the same patients followed up from August 2019 to October 2021. We have highlighted a statistically significant association between baseline variables and patient death, rehospitalization, treatment toxicity, and disease progression at follow-up. We found a higher overall survival probability in the well-nourished general study population vs. malnourished patients (p < 0.001). Of major interest is the fact that patient stratification revealed that malnutrition decreased survival probability in non-metastatic patients but not in metastatic patients (p < 0.001). Multivariate analysis confirmed that baseline malnutrition (p = 0.004) and VAS score for appetite loss (p = 0.0104), in addition to albumin < 35 g/L (p < 0.0001) and neutrophil/lymphocyte ratio > 3 (p = 0.0007), were independently associated with the death of non-metastatic patients at follow-up. These findings highlight the importance of proactive, early management of malnutrition and cachexia in cancer patients, and in particular, in non-metastatic patients, from the perspective of a substantial improvement of their clinical outcomes.

Improving Access to Early Palliative Care Delivery for Patients With an Advanced Thoracic Malignancy Through an Embedded Oncopalliative Clinic Model.

Early integration of palliative care (PC) with standard oncology care is driving the development of innovative PC delivery models. This was a single-institution retrospective study of outpatient PC before and after the opening of an embedded thoracic oncology-palliative clinic at The Ohio State University. Patients included in the preintervention (October 2017-July 2018) and postintervention (October 2018-July 2019) cohorts had a diagnosis of any non-small-cell lung cancer (stages I-IV) or small-cell lung cancer (limited or extensive stage) and were newly established in the thoracic medical oncology clinic during the study time periods. All patients in the preintervention cohort had access to outpatient PC through a freestanding clinic, while the postintervention cohort had access to both freestanding and embedded clinics. Using time-to-event analyses, we evaluated differences in time intervals from first medical oncology visit to PC referral and first PC visit between cohorts. The majority of patients in both cohorts had metastatic disease at diagnosis. In the postintervention cohort, 20.9% of patients were referred to outpatient PC compared with 9.2% in the preintervention cohort (P < .01). PC referrals for patients outside of Franklin and adjacent counties increased from 4.0% to 14.2% after opening the embedded clinic (P < .01). Completion percentages of PC referrals increased from 57.6% to 76.0% in the preintervention versus postintervention cohorts (P = .048). Median time from palliative referral order to first PC visit decreased from 29 to 20 days (P = .047). Similarly, median time from the first oncology visit to PC referral completion decreased from 103 to 41 days (P = .08). Implementation of an embedded PC model was associated with increased access to early PC among patients with thoracic malignancies.

The impact of the 4R Oncology model on OncotypeDx turnaround time.

531 Background: The OncotypeDx genomic assay has been widely used to predict recurrence in those with early-stage ER positive breast cancer to determine whether adjuvant chemotherapy is beneficial. Receiving OncotypeDx results in a timely manner prior to medical oncology appointment is critical to inform adjuvant therapy decisions. In this quality improvement project, we implemented a care delivery optimization for patients with breast cancer receiving OncotypeDx assays in an integrated healthcare system. The optimization was conducted as part of implementing the 4R Oncology model (Right Info / Right Care / Right Patient / Right Time), a novel care model that aims to optimize patient-centric care planning, team-based delivery and patient self-management. Herein, we assess the impact of implementing this model on improving OncotypeDx turnaround time. Methods: We examined two patient groups with newly diagnosed early-stage ER positive breast cancer who attended a multidisciplinary clinic and underwent surgery at a single medical center. The historical control (HC) group received care pre-4R implementation, from January 2019 through June 2020, while the 4R Intervention group received care from July 2020 to December 2021. The OncotypeDx-related care optimization was a team effort of 5 medical specialties that involved establishing an OncotypeDx reflex testing practice, updating workflows, working with a testing company to streamline the process and implementing a method to align result timing with scheduling medical oncology appointments. Bivariate analyses were used to compare the HC and 4R groups on demographic characteristics and OncotypeDx turnaround time. Results: Within the 4R group (N = 208), 72 (34.6%) patients received OncotypeDx and 89 (32.5%) patients from the HC cohort (N = 274) received OncotypeDx. The groups were balanced by median age at time of multidisciplinary clinic visit (HC: 59 years vs 4R: 60 years), female gender (HC: 99.6% vs 4R: 99.5%), race, combined race and ethnicity, language spoken, Charlson Comorbidity Index and tumor characteristics. The average turnaround time from surgery date to delivery of OncotypeDx results was significantly reduced in the 4R cohort (19.4 days) compared to that of the HC cohort (23.1 days), a difference of 3.8 days, p = 0.004. The availability of OncotypeDx results by the first medical oncology visit after surgery increased from 40% in the HC cohort to 69% in the 4R cohort, p = 0.0003, helping optimize the transition to adjuvant therapy for the appropriate population. Conclusions: The implementation of the 4R Oncology model within an integrated healthcare system significantly reduced turnaround time for patients with breast cancer awaiting OncotypeDx results, improving patient-centric care and enabling informed discussions at medical oncology visits. The 4R Oncology model is an effective method to optimize delivery of time-sensitive care.

Disparities in medical oncology visit adherence among African American (AA) men with prostate cancer (pCa).

e18671 Background: AA patients (pts) with pCa tend to have worse outcomes when compared to Caucasians. Disparities in access to healthcare among AA pts with pCa is a significant barrier to improvement in outcomes. Medical oncology visit attendance among this population has not been thoroughly investigated. Methods: Pts with a diagnosis (dx) of pCa scheduled to see a provider (MD or advanced practice provider) at a single academic institution medical oncology clinic between January 2022 and December 2022 were retrospectively identified. Pts were categorized by self-identified race. The total number of scheduled clinic visits was recorded, and each visit was categorized by visit status; completed, cancelled, no-show, or left clinic. The reason for visit cancellation was assessed and cancelled visits for non-pt driven reasons (ie. scheduling error) were removed. The data were summarized using descriptive statistics. Z-test and Chi-square analysis were utilized to compare proportions of visits between AA and Caucasian pts and the association of race with visit status. Results: A total of 992 pts were selected, 80% (n = 792) were Caucasian and 16% (n = 162) were AA, representing 4231 clinic visits during the study period. AA pts accounted 18% (n = 763) of the total scheduled visits. 94% of visits (n = 3962) were follow up and 6% (n = 269) were new pt visits. 86% of all scheduled visits were completed and 10 % (n = 436) were cancelled for pt driven reasons. Roughly 3% (n = 135) of visits were no-show. AA pts had fewer completed visits compared to Caucasian pts, 78% vs 88% (p &lt; 0.001) and a higher no-show rate of 10% vs 1.5% (p &lt; 0.001). The cancellation rate was similar between AA and Caucasian pts, 11% vs 10% (p = 0.33). The combined no-show and cancellation rate for AA pts was 22% vs 12% for Caucasian pts (p &lt; 0.001). There was a significant association between AA race and no-show visit status (p &lt; 0.001). Conclusions: AA men with pCa have much poorer visit adherence to scheduled medical oncology visits compared to their Caucasian counterparts. Identifying reasons for no-show and visit cancellations and targeted interventions to improve access to care are needed to improve outcomes. [Table: see text]

Examining the treatment journey of patients diagnosed with hepatocellular carcinoma (HCC) using retrospective real-world data in British Columbia, Canada.

e16111 Background: Hepatocellular carcinoma (HCC) is a complex disease with treatments that may include locoregional therapy (LRT), systemic therapy and liver transplant. Using retrospective real-world data from a tertiary care hospital in British Columbia (BC). We examined characteristics, treatment pathways, survival and relevant healthcare costs of HCC patients. Methods: This was a retrospective, real-world data study using data from two existing chart review studies (called MOTION and HCC) and the BC Transplant database. The Canadian province of British Columbia has a population of 5.0 million who receive medical coverage under the Medical Services Plan. “MOTION” collected data on patients who received LRTs between 2004 and 2017, while “HCC” collected data on patients who received systemic therapies between 2000 and 2019. MOTION and HCC and Transplant data were linked and patients were assigned a unique study number and personal health information (PHI) was removed. Start and stop dates for LRT and systemic therapies were used to determine treatment patterns. Treatment costs were provided by BC Cancer’s Pharmacy department, medical oncology visits were assumed to be monthly while patients were on systemic treatment, LRT costs were based on departmental expenditures, and the cost of a liver transplant was provided by the regional health authority. Analyses used descriptive statistics for baseline characteristics, duration and costs (in 2021 Canadian dollars) and Kaplan-Meier curves for survival. Results: There were 417 and 413 patients from the HCC and MOTION databases respectively, in which 63 patients were in both (referred to as the “common” group). Median age (years) at diagnosis was 64, 62 and 62 for HCC, MOTION and common groups respectively, while the proportion who were female was 17.5%, 18.2% and 15.9%. Median overall survival (mOS) from diagnosis was 21, 33 and 28 months for the HCC, MOTION and common groups, respectively. From start of systemic treatment, mOS was 9 months for the HCC group, 29 months from first LRT for patients in the MOTION group, and 26 months for the common group from first treatment. Treatment and cost results were based only on the common group: mean length of follow-up from diagnosis was 34.6 ± 26.2 months and mean time from diagnosis to first treatment was 4.7 ± 4.2 months. DEB-TACE was most frequently the first LRT, often received 3 rounds of LRT before starting systemic treatment, in which sorafenib was given mostly as first line systemic therapy. When including only costs related to LRTs, systemic therapies, medical oncology visits and liver transplants, the mean cost per patient was $94,419, resulting in $51,649 mean cost per patient per year. Conclusions: The linkage of HCC-related LRT, systemic and transplant databases provided detailed results related to the treatment patterns, survival and costs of HCC patients in Canada.

Outcomes of Universal Point-of-Care Genetic Testing in Diverse Patients With Pancreatic Ductal Adenocarcinoma.

Guidelines recommend all patients with pancreatic ductal adenocarcinoma (PDAC) undergo germline genetic testing (GT). Rates of recommendation and completion of GT among diverse patients with PDAC are not known. The aim was to determine rates of recommendation and completion of point-of-care GT in diverse patients with PDAC. A retrospective review of patients with PDAC seen at an academic center between April 2019 and December 2020 was performed. Recommendation, completion and results of point-of-care GT, and demographic and clinical factors were recorded. Univariate and multivariate analyses of GT were performed using the chi-square test and logistic regression. In total, 579 patients with PDAC were included. The median age at diagnosis was 67 years; 52% were male; 63% were non-Hispanic White (NHW) patients, and 20% were African American (AA) patients. GT was performed in 216 (37%) patients. Of those tested, 47 (22%) had a pathogenic/likely pathogenic variant identified of which 25 (12%) were in PDAC-associated genes. On multivariate analysis, age, NHW race, personal and family cancer history, medical oncology visit, and number of visits were independent predictors of GT completion. AA patients had significantly lower rates of recommendation and completion of GT compared with NHW patients. Point-of-care GT in patients with PDAC is unacceptably low, especially among AA patients. Testing disparity might be due to lack of provider recommendation more than patient uptake. Lack of testing leads to missed opportunities for potential targeted therapies, improved outcomes, and identification of at-risk family members who could potentially benefit from surveillance.

Racial and ethnic disparities in adherence and reported symptoms during routine collection of patient-reported outcomes (PROs).

6510 Background: Routine collection of PROs for patients with cancer is an evidence-based practice and critical component of high-quality cancer care, but real-world adherence and reporting patterns are poorly understood. We examined differences in PRO adherence and reported symptoms by race and ethnicity. Methods: We conducted a retrospective cross-sectional study using de-identified electronic health record data from a National Cancer Institute Comprehensive Cancer Center. Participants included adults seen in follow-up at one of two medical oncology practices (1 academic, 1 community) from June 2019 to February 2020, during which two validated PRO instruments (NCI PRO-CTCAE and PROMIS Global v1.2) were routinely administered electronically via portal or tablet at return visits. Adherence was defined for each participant as the proportion of visits in which a PRO questionnaire was completed within 30 days. Using ordinary least squares regression, we modeled patient adherence as a function of race/ethnicity and adjusted for age, sex, insurance, median area income, ECOG performance status, cancer type, cancer stage, visit site, and number of visits during the study. Among study participants completing at least one PRO questionnaire, we modeled reported symptoms from the first questionnaire using a similar approach. Results: From June 2019 to February 2020, there were 29,726 patients (mean [SD] age 60.8 [15.1] years; 18,045 [60.7%] female) seen across 111,262 medical oncology visits. Of these patients, 19,971 (67.2%) completed at least one PRO questionnaire. Adjusted mean PRO adherence and reported symptoms varied by race/ethnicity, with Black and Hispanic patients reporting significantly higher symptom burden than White patients (Table). Conclusions: In this large cohort reflecting real-world PRO collection patterns, Black and Hispanic patients were less likely than White patients to complete PRO questionnaires, but more likely to report more severe symptoms. There is urgent need to ensure equitable PRO access and implementation and to address greater reported symptom burden among minority patients. [Table: see text]

Turnaround Times in Melanoma BRAF Testing and the Impact on the Initiation of Systemic Therapy at a Single Tertiary Care Cancer Center.

The identification of BRAF mutations in melanoma enables targeted therapy and improves patient outcomes. Barriers to BRAF molecular testing affect the quality of care and therapeutic options. This retrospective study mapped BRAF testing timelines in adult patients with melanoma at the Princess Margaret Cancer Centre to identify obstacles to timely BRAF reporting and its impact on the initiation of therapy. Sixty-six cases were included. The median time between BRAF request and result was 12 days (95% CI, 8 to 15) when the BRAF test was ordered by pathology, compared with 20 days (95% CI, 16 to 23) if the test was requested by another specialist (P < .001). When the BRAF test and biopsy were performed within the same institution, the BRAF median turnaround time (TAT) was 13 days (95% CI, 6 to 19) compared with 19 days (95% CI, 16 to 21) if the sample was transferred from another institution (P = .02). Forty-seven patients received systemic therapy, and 20 had metastatic disease. In the metastatic subgroup, if the BRAF result was available at the first medical oncology visit, the initiation of treatment was 20 days (95% CI, 9.6 to 30.3), but was delayed to 31 days (95% CI, 10.8 to 51.1) if the BRAF result was not available (P = .03). This study showed variations in BRAF test results in TAT. One factor affecting this timeline is the transfer time, which can be streamlined by pathology reflex testing. Delays in TAT affect the timing and type of therapeutic intervention, especially in patients with stage IV disease.

Protocol for a type 2 hybrid effectiveness-implementation study expanding, implementing and evaluating electronic health record-integrated patient-reported symptom monitoring in a multisite cancer centre

IntroductionCancer symptom monitoring and management interventions can address concerns that may otherwise go undertreated. However, such programmes and their evaluations remain largely limited to trials versus healthcare systemwide applications. We...

Prevalence of Malnutrition in Patients at First Medical Oncology Visit in a Single Center Study

Background: Malnutrition is associated to treatment toxicity, complications, reduced physical function, and lower survival in cancer patients. Malnutrition or associated risk was observed in the Prevalence of Malnutrition in Oncology (PreMiO) study among cancer patients visiting their first medical oncology appointment. Oncologists, not nutritionists, evaluated the nutrition status of the patients in this research, which was a first. Objective: The aim of the study was to evaluate the prevalence of malnutrition in patients at first medical oncology. Methods: PreMiO was a prospective, observational study conducted at Department of oncology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. For inclusion, adult patients (&gt;18 years) had a solid tumor diagnosis, were treatment-naive, and had a life expectancy &gt;3 months. Malnutrition was identified by the Mini Nutritional Assessment (MNA), appetite status with a visual analog scale (VAS), and appetite loss with a modified version of Anorexia-Cachexia Subscale (AC/S-12) of the Functional Assessment of Anorexia- Cachexia Therapy (FAACT). Results: Of patients enrolled (N=50), 51% had nutritional impairment; 9% were overtly malnourished, and 43% were at risk for malnutrition. Severity of malnutrition was positively correlated with the stage of cancer. Over 40% of patients were experiencing anorexia, as reported in the VAS and FAACT questionnaire. During the prior six months, 64% of patients lost weight (1–10 kg). Conclusion: Even on their first visit to a medical oncology center, malnutrition, anorexia, and weight loss are prevalent in cancer patients.

P59.21 Impact of Reflex Testing on Pathology Based Molecular Testing in Patients With Advanced Non-Squamous Non-Small Cell Lung Cancer (NSCLC)

Comprehensive molecular testing is essential to provide personalized and effective care for patients with metastatic non-squamous (non-Sq) NSCLC. Ordering of next-generation gene sequencing (NGS) is often delayed until the first medical oncology visit. To improve rates of timely comprehensive molecular profiling among newly diagnosed patients with advanced non-Sq NSCLC, we implemented a reflex, molecular testing pathway (NGS and RNA fusion panel) on tumor, nodal or metastatic specimens, initiated at the time of initial pathology review, that obviated the need for a separate specimen-specific order.

P60.13 MYLUNG Consortium: Molecularly Informed Lung Cancer Treatment in a Community Cancer Network. Pragmatic Prospective RWR Study

Recent improvements in lung cancer mortality can be ascribed to the discovery of molecular drivers, immunotherapy and utilization of drugs targeting these alterations. Despite national organizations endorsing comprehensive biomarker testing for patients with NSCLC, obstacles remain to routine testing and their use in driving therapeutic decisions. Engaging community practices within the US Oncology Network, we initiated a real world research program aimed to pragmatically identify and overcome barriers to timely and appropriate comprehensive biomarker testing in a large community-based diverse population of patients with lung cancer. Over the next 5 years, the MYLUNG program will evaluate biomarker testing workflows and algorithms, provider acceptance and use of biomarker results to inform treatment decisions, and appropriate adoption of new treatments as they become approved for use in patients with NSCLC. The program is comprised of three principal and integrated components: Protocol 1 was a retrospective cohort study (N=3474 patients) evaluating biomarker testing patterns, results, and initial treatment over a 2-year period that ended in March 31, 2020. Protocol 2 is a prospective, non-interventional cohort study (described below) studying the current testing practices of patients with newly diagnosed NSCLC who are candidates for systemic therapy. Protocol 3 is a platform of prospective interventional trials, engaging 20-30 resource and geographically diverse practices in The US Oncology Network, which will enroll approximately 7500 patients. Protocol 2 practices will serve as their own controls for subsequent interventional trials in Protocol 3. Protocol 2 is a prospective, non-interventional study that will enroll approximately 1000 patients with histologically or cytologically documented early stage, locally advanced, and advanced non-squamous NSCLC who are eligible for active systemic therapy across 10 community practices in The US Oncology Network. The primary objective is to examine the proportion of patients who receive biomarker testing results prior to initiating systemic therapy or death, as well as reasons for initiating systemic therapy without biomarker test results, in order to define the operational feasibility of comprehensive biomarker testing. Secondary objectives include determining the proportion of patients that receive appropriate biomarker-directed treatment, and reasons for not receiving appropriate treatment. We will also examine timelines for the patient journey from initial presentation to diagnosis, biomarker test order and results, first medical oncology visit, and treatment initiation. Additionally, we will examine single versus multi-gene biomarker testing, progression-free survival (PFS) and overall survival (OS) of patients with molecular targets who receive FDA-approved targeted therapy versus patients receiving systemic therapy without biomarker results. We will quantify differences in biomarker testing rates based on socioeconomic status, ethnic diversity, and practice resources. Enrollment began in January 2021 and is expected to enroll for 9-12 months. Information obtained from Protocol 2 will be used to identify an initial set of workflow and technology interventions to be tested in Protocol 3, which is targeted to begin enrollment in the fall of 2021. ▪▪▪ ▪▪▪

OA16.01 Plasma NGS At Time of Diagnostic Tissue Biopsy – Impact on Time to Treatment: Results From a Pilot Prospective Study

The expansion of targeted therapies has transformed the treatment landscape of advanced NSCLC, however the majority of patients do not receive guideline-recommended tumor genotyping. Molecular profiling for actionable mutations is often initiated at the first medical oncology visit leading to significant treatment delays and potentially inappropriate treatment assignments if therapeutic decisions are made prior to genomic results. The role of plasma-based genomic profiling performed simultaneously with diagnostic tissue biopsy in suspected advanced NSCLC has largely been unexplored.

CN63 Nutrition in people with cancer: Overview of reviews to summarise the evidence for cancer nursing practice

Malnutrition and other nutrition-related problems are very common in people with cancer and are frequently found at first medical oncology visit. People with cancer are still among the most malnourished of all patient groups. Early detection and treatment of malnutrition are of critical importance. Multidisciplinary interventions, based on collaborations between oncologist, nurses and dietitians, is key for success. Since cancer nurses are in frequent contact with patients, they are ideally placed to assess the risk and detect early signs of malnutrition and to refer, treat and regularly monitor nutrition-related issues.

BRAF testing timelines and impact on the starting of systemic treatment.

e21575 Background: Targeted therapy with BRAF and MEK inhibitors constitute part of the standard treatment for BRAF V600 mutated melanoma. Timely detection of BRAF mutation is necessary for clinicians and patients to make treatment decisions. We aimed to map the BRAF testing timelines from the time of request until the reported result in order to assess obstacles to timely BRAF reporting in our community, and its impact on the initiation of systemic therapy. Methods: In this single-center retrospective study, we included adult patients referred to the Medical Oncology Department at the Princess Margaret Cancer Centre (PM) from January 2019 to August 2019 with histologically confirmed cutaneous or mucosal melanoma and BRAF molecular testing performed in 2019. The Log-Rank method was applied to detect differences in BRAF turnaround time and time to treatment initiation in specified subgroups. A p value &lt; 0.05 was considered statistically significant. Results: Sixty-six cases were identified. The median age was 64 (24-88), and 42 (64%) were male. At the time of BRAF request, 10 (15%) patients had stage II, 33 (50%) had stage III, and 23 (35%) had stage IV disease. Twenty-eight (43%) were positive for the BRAF V600E/K mutation by ARMS assay and 4 (6%) for other variants by NGS test. Thirty-three (50%) patients had the BRAF test available at their first PM Medical Oncology visit. Median time between BRAF request and result was 17 days; when a reflex BRAF test was ordered by the Pathology Department, the median turnaround time was 12 days (95% CI 8-15), compared to 20 days (95% CI 16-23) if the order was requested by another specialist ( p &lt; 0.001). Median time to transfer samples between institutions was 6 days. If the BRAF test was processed within the institution where the biopsy was performed, the BRAF median turnaround time was 13 days (95% CI 6-19) compared to 19 days (95% CI 16-21) if a sample was transferred to another institution ( p = 0.02). In total, 49 patients had systemic therapy. Median time between the first visit with Medical Oncology and treatment initiation was 29 days and was not statistically different if the BRAF result was available or not (28 vs. 34 days; p = 0.09). In the subgroup with stage IV disease (Table), 20 patients received systemic therapy; the median time to treatment initiation was 24 days and differed with BRAF result availability (20 vs. 31 days, p = 0.03). Conclusions: The current BRAF testing timeline at the PM varies from days to weeks. A major factor impacting this timeline is transfer time, which can be streamlined by pathology reflex testing. Delays in turnaround time appears to impact subsequent timing and type of therapeutic interventions, especially in patients with stage IV disease.[Table: see text]

Symptom identification and management in epithelial ovarian cancer.

5554 Background: A better understanding regarding the burden of treatment side effects in patients with gynecological malignancies could help guide symptom interventions and oncologic therapy decision-making. We aim to inform understanding of symptom burden in epithelial ovarian cancer (EOC) by analyzing patient-reported symptom data from patients treated for this condition over a 16-month period. Methods: Patients receiving medical oncology care at Mayo Clinic Rochester and at Midwest Mayo Clinic Health System community sites have received symptom-focused surveys prior to each medical oncology visit since March 28, 2019 through the Enhanced Electronic Health Record Facilitated Cancer Symptom Control Study (E2C2). These surveys, administered either through the electronic medical record portal or on a clinic tablet prior to each oncology office visit, no more frequently than every 2 weeks, include six linear analogue scales measuring sleep disturbance, pain, anxiety, emotional distress, and fatigue (SPADE), as well as physical dysfunction on a scale of 0 (none) to 10 (as bad as you can imagine). Scores of 0-3 were considered mild symptoms, 4-6 moderate symptoms, and 7-10 severe symptoms. We collected survey results from March 28, 2019 to July 20, 2020 for patients with EOC and reviewed the number of surveys per patient in addition to the average symptom scores. Results: From March 2019 to July 2020, for patients with EOC, there were 2974 encounter-based surveys from 762 patients. The number of surveys completed by each patient ranged from 1-20. The following number of patients returned the correlating number of surveys: 1 survey:240 patients; 2 surveys:145; 3 surveys:79; 4 surveys:56; 5 surveys:58; 6 surveys:45; 7 surveys:38; 8 surveys:27; 9 surveys:22; ≥10 surveys:52. The average score from all surveys for each symptom was: 2.41 for sleep disturbance, 2.03 for pain, 2.32 for anxiety, 1.97 for emotional distress, 3.26 for fatigue, and 2.50 for physical dysfunction. Please see the table for the proportion of surveys that reported symptoms as mild, moderate, or severe. Conclusions: Fatigue and physical dysfunction were reported most frequently in patients with EOC, while emotional distress and pain were reported least frequently. 20% of surveys reported moderate to severe emotional distress, while 40% reported moderate to severe fatigue. A targeted approach to symptom management is needed for patients undergoing EOC evaluation and treatment. Our next steps in this analysis include an assessment of potential predictors of greater symptom burden (e.g., specific treatments, age, and other clinical and sociodemographic characteristics). Clinical trial information: NCT03892967. [Table: see text]