Multidisciplinary Cancer Program Research Articles

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

Opportunities for expanded nurse and nurse navigator involvement in design, implementation and management of remote patient monitoring programs.

564 Background: The use of remote patient monitoring (RPM) in oncology for timely reporting of adverse events to improve patient outcomes is well-documented; however, less is known about real-world implementation of RPM and its impact on workforce needs. To assess use and perceptions about RPM, including its role in patient reported outcomes (PROs), the Association of Community Cancer Centers (ACCC) surveyed U.S. cancer program staff. Methods: Developed by expert advisors and patient advocacy partners, a survey of cancer program staff was distributed between December 2022 and January 2023. The survey included 25 closed and open-ended questions. Results: 128 multidisciplinary cancer program staff completed the survey, of which 45% are actively planning/implementing RPM programs. 34 U.S. states were represented. The three largest roles represented were medical oncologists (n=54; 42%), cancer program administrators (n=18; 14%) and nurses/nurse navigators (n=14; 11%). Of all respondents, 82% viewed nursing teams as the most appropriate to review and triage RPM data. Nurses indicated less involvement with the design/development of RPM programs (0%) compared to administrators (33%) and oncologists (48%). Similarly, 3% of nurses reported involvement in monitoring or taking actions on RPM data, compared to 12% of administrators and 56% of oncologists. Notably, no nurses compared to 6% of administrators and 18% of oncologists strongly agreed that they had access to educational resources and training needed to support a RPM program. In qualitative responses, nurses indicated provider education as the greatest need for RPM to become standard of care in cancer programs. Conclusions: Despite a high perceived need for nursing involvement in all aspects of RPM programs, real-world data indicates that nurses, who are expected to monitor/triage RPM data by most of their peers, are less frequently involved in the design and implementation of RPM programs. Future research is needed to understand these workforce barriers, and to explore novel approaches to tailored provider education and engagement to ensure that RPM programs benefit from diverse workforce and patient involvement.

The Benefits of Cancer Genetic Panel Testing in At-Risk Women: A Single Institution Experience [24M

INTRODUCTION: The scope of panel testing for hereditary cancer syndromes is expanding rapidly. We sought to evaluate the role of panel testing in identifying actionable genetic mutations in high-risk or affected women, beyond BRCA-limited testing. METHODS: A retrospective chart review was conducted of all patients presenting to a multi-disciplinary cancer program at George Washington University for genetic counseling from 1/2015 and 12/2016. The results of testing and management implications, based on NCCN guidelines, were recorded. RESULTS: Of 673 patients that underwent single site, BRCA-limited, or panel testing, 17% (n=116) were found to have at least one deleterious mutation, of which 96% (n=111) had changes in clinical management. Over one half (65%, n=65) of patients who tested positive for a mutation had undergone panel testing and three-quarters (n=49) of those individuals were diagnosed with non-BRCA mutations. The latter group represents patient’s whose mutations would have been missed without a broader panel test. Ninety-six percent of those testing positive for a mutation (n=111) had significant increase in clinical surveillance and/or management. All of the true negative individuals (n=45) were able to decrease their surveillance and/or management. CONCLUSION: Despite concern that the results of panel testing do not translate into clinically impactful management of high-risk individuals, our data indicates that guideline-based management is frequently altered by such testing. Obstetrician-gynecologists should incorporate detailed family histories into their routine visits, and counsel patients on the availability and utility of genetic panel testing when appropriate.

Abstract P5-09-03: Education and integration of medical breast nurse practitioners in a multidisciplinary breast cancer program

Abstract Background: Work-up of patients with breast symptoms and radiographic abnormalities, risk management, and survivorship care are vital elements in a multidisciplinary breast cancer program. Breast surgeons have traditionally provided for these needs, but with intense clinical demands and with efforts to reduce treatment time, access for patients with these problems can be a challenge. The medical breast specialist (MBS) is defined as a primary care physician who has been provided with additional training in benign and malignant breast disease [Smedira, AIM 2008]. With increasing need for providers, a fellowship for training MBS was designed for board eligible or board certified internists, family practitioners, obstetricians/gynecologists, and has recently been expanded for board certified primary care nurse practitioners, one of the first of its kind in the country. In our practice, medical breast visits (MBV) are defined as clinical visits for evaluation or follow-up of patients with breast symptoms, high risk management, and/or survivorship. Methods: The MBS Program at our institution was established in 1997, with expansion involving a formalized training for Nurse Practitioners in 2013. The medical breast fellowship uses a defined curriculum and offers nurse practitioners a six month multidisciplinary program with multiple rotations including medical breast clinic, surgical breast clinic, breast imaging, medical oncology, radiation oncology, genetics, pathology, plastic surgery, physical therapy, and psych-oncology. We analyzed the impact of trained NPs on overall medical breast and breast center volumes and clinical workflow. Our prospectively maintained Electronic Medical Records (EMR) system, which allows the acquisition of volume and practice pattern data, was utilized for this analysis. Results: The number of MBV has significantly increased between 2008 and 2014 (p<0.05). MBV accounted for 54% of total visits seen within the breast surgery program in 2014. The total number of medical breast visits in 2014 was 7146 with 5543 (78%) seen by MBS and 1603 (22%) seen by surgeons. Of the medical breast visits seen by MBS, 37% are seen by medical breast staff physicians and 63% are seen by medical breast nurse practitioners. The recent completion of the medical breast fellowship by a NP resulted in the addition of 1654 MBV over the course of 1 year. Conclusions: Medical breast visits account for a large percentage of patients seen within a multidisciplinary breast cancer program. The development of a curriculum for training NP medical breast specialists enables the rapid incorporation of a NP into a multidisciplinary cancer program. The training of a NP within the fellowship can increase patient access, timeliness of care, and can facilitate streamlining of a breast cancer practice to optimize patient care. Citation Format: Iyer PH, Kline M, Oliphant D, Crowe J, Grobmyer S, Pederson H. Education and integration of medical breast nurse practitioners in a multidisciplinary breast cancer program. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-09-03.

Advance care planning as a shared endeavor: completion of ACP documents in a multidisciplinary cancer program.

We examined the roles of oncology providers in advance care planning (ACP) delivery in the context of a multidisciplinary cancer program. Semi-structured interviews were conducted with 200 women with recurrent and/or metastatic breast or gynecologic cancer. Participants were asked to name providers they deemed important in their cancer care and whether they had discussed and/or completed ACP documentation. Evidence of ACP documentation was obtained from chart reviews. Fifty percent of participants self-reported completing an advance directive (AD) and 48.5% had named a healthcare power of attorney (HPA), 38.5% had completed both, and 39.0% had completed neither document. Among women who self-reported completion of the documents, only 24.0% and 14.4% of women respectively had documentation of an AD and HPA in their chart. Completion of an AD was associated with number (adjusted odds ratio [AOR] = 1.49) and percentage (AOR = 6.58) of providers with whom the participant had a conversation about end-of-life decisions. Participants who named a social worker or nurse practitioner were more likely to report having completed an AD. Participants who named at least one provider in common (e.g., named the same oncologist) were more likely to have comparable behaviors related to naming a HPA (AOR = 1.13, p = 0.011) and completion of an AD (AOR = 1.06, p = 0.114). Despite the important role of physicians in facilitating ACP discussions, involvement of other staff was associated with a greater likelihood of completion of ACP documentation. Patients may benefit from opportunities to discuss ACP with multiple members of their cancer care team. Copyright © 2015 John Wiley & Sons, Ltd.

Measuring the impact of integrating palliative care into a multidisciplinary brain and spine oncology clinic.

163 Background: Recent literature indicates that palliative care (PC) improves the outcomes of patients with cancer. Integration of PC providers into cancer centers is increasingly recognized to enhance symptom management with a beneficial effect on patient survival. In order to predict the impact of widespread PC integration, we hypothesized that a small pilot program may provide evidence supporting broader implementation. The current study endeavors to measure the result of adding a dedicated PC provider to a multidisciplinary brain and spine oncology program. Methods: Over the six month study period, a PC nurse practitioner was integrated into an existing weekly multidisciplinary brain and spine oncology conference and clinic. The provider participated in the multidisciplinary conference reviewing recent MRIs and discussing current disease status and treatment options. Following conference, the PC provider would consult on up to four of the clinic patients. Data were recorded regarding patient characteristics, goals of care, and changes in therapy. Results: The PC provider participated in 14 multidisciplinary clinics with a total of 180 subjects. Of those, 24 subjects met with the PC provider in formal consultation. The most common diagnoses were 41.6% with metastatic lung cancer and 25% with glioblastoma. For goals of care, an Advanced Directive discussion was documented in 100%. Do Not Resuscitate (DNR) orders were activated in 37.5% and documented in 54%. Medical Orders for Scope of Treatment (MOST) forms were introduced in 87.5% and completed in 25%. For changes in therapy, enrollment in hospice occurred in 33.3%. Pain medication was changed in 33.3%. Other symptoms including fatigue, weakness, anorexia, constipation, anxiety, lymphedema, dysphagia, depression, insomnia, and alopecia were managed in 87.5%. Conclusions: This study suggests that the integration of a PC provider into an existing multidisciplinary cancer program can produce a high rate of establishing goals of care and result in changes in treatment in a significant number of cases. Further study on the impact of integrating PC in cancer centers seems to be warranted.

A Multi-Disciplinary Cancer Program Enhances Hereditary Colorectal Cancer Detection

A Multi-Disciplinary Cancer Program Enhances Hereditary Colorectal Cancer Detection

How Sociodemographics, Presence of Oncology Specialists, and Hospital Cancer Programs Affect Accrual to Cancer Treatment Trials

We chose to examine the impact of socioeconomic factors on accrual to National Cancer Institute (NCI)-sponsored cancer treatment trials. We estimated the geographic and demographic cancer burden in the United States and then identified 24,332 patients accrued to NCI-sponsored cancer treatment trials during a 12-month period. Next, we examined accrual by age, sex, geographic residence, health insurance status, health maintenance organization market penetration, several proxy measures of socioeconomic status, the availability of an oncologist, and the presence of a hospital with an approved multidisciplinary cancer program. Pediatric patients were accrued to clinical trials at high levels, whereas after adolescence, only a small percentage of cancer patients were enrolled onto clinical trials. There were few differences by sex. Black males as well as Asian-American and Hispanic adults were accrued to clinical trials at lower rates than white cancer patients of the same age. Overall, the highest observed accrual was in suburban counties. Compared with the United States population, patients enrolled onto clinical trials were significantly less likely to be uninsured and more like to have Medicare health insurance. Geographic areas with higher socioeconomic levels had higher levels of clinical trial accruals. The number of oncologists and the presence of approved cancer programs both were significantly associated with increased accrual to clinical trials. We must work to increase the number of adults who enroll onto trials, especially among the elderly. Ongoing partnership with professional societies may be an effective approach to strengthen accrual to clinical trials.

Surgical oncology in university departments of surgery in the United States.

Data on surgical oncology and multidisciplinary cancer program activity were obtained from 124 of 126 university surgery departments in the United States. Most of these institutions have American College of Surgeons-approved cancer programs (84%) as well as divisions of medical (95%), radiation (94%), pediatric (76%), and gynecologic (79%) oncology. Only 47 departments (38%) have formal divisions of surgical oncology. There are no major staffing or activity differences in surgical departments with or without such divisions, but multidisciplinary cancer program activity is greater in those institutions with a surgical oncology focus. Peer-reviewed cancer research grants are more frequent in departments of surgery with a surgical oncology division (68% vs 47%). The activities of the existing 47 divisions of surgical oncology are mainly operative, with breast cancer, melanoma, and soft-tissue sarcomas being the major clinical responsibilities. Chemotherapy is also frequent (81%). Cancer education for undergraduate and postgraduate surgical trainees is a major responsibility of most divisions, but only a small proportion (28%) have postresidency surgical oncology training programs. In contrast to the growth of some oncologic specialties, the establishment of surgical oncology within university departments has been slow, and the manpower needs appear modest.