Oncology Research Articles

The state of cancer care in Russia: malignant tumors of the skin (C44). Prevalence, quality of accounting, age characteristics, localization and histological structures (clinical and population study). Part 1.

This work represents a clinical-population study of the state of oncological care in Russia, focused on malignant skin neoplasms (C44). The study analyzes data on the prevalence of this disease, the quality of case accounting, age characteristics, and the localization and histological structure of tumors. The aim of this research is to continue the investigation into the patterns of prevalence of skin neoplasms (C44), assess the quality of primary accounting, and evaluate the impact of the coronavirus infection epidemic on analytical indicators of prevalence and patient survival. The conducted study confirmed the trend of increasing morbidity and decreasing mortality from skin neoplasms (C44) among the population of Russia and the Northwestern Federal District of the Russian Federation. A clear positive dynamics in the quality of accounting is observed. Special attention is given to the specifics of morbidity changes in neoplasms (C44) considering each age group of the population of Russia. At the population level, the age-specific mortality of patients is presented for each year of observation, analyzed in the context of five-year cohort groups. For the first time, a trend has been identified showing an increase in annual mortality from skin neoplasms (C44) after the sixth year of observation following the treatment of patients.

The state of cancer care in Russia: malignant tumors of the skin (C44). One- and five-years survival of patients, age characteristics. Part II.

In the first part of our study, we presented an analysis of the prevalence, quality of primary registration, annual mortality, and the peculiarities of changes in the localization and histological structure of malignant neoplasms (C44) of the skin. In the second part of our research, special attention will be focused on assessing the effectiveness of anti-cancer measures concerning observed and relative one-year and cumulative five-year survival rates in the Northwestern Federal District of Russia (NWFD). The database created in 2019 for the population cancer register (PCR) at the federal district level has significantly expanded the possibilities for conducting analytical research, including the potential to study rare tumors. In this work, we will pay special attention to the new opportunity to conduct an in-depth analysis of the dynamics of localization and histological structure. We will examine the survival of patients with skin neoplasms from any affected area (lips, ears, face, back, extremities, and other parts), which is not feasible when evaluating prevalence based on state reporting forms, not to mention calculating patient survival rates. The aim of this research is to study the patterns of one-year and five-year survival of patients with skin neoplasms (C44) taking into account the main parameters of the registration card. The conducted research revealed a positive trend in the one-year observed survival of patients with skin neoplasms (C44) in the Northwestern Federal District of the Russian Federation, which increased from 95.6% to 96.2% between 2000 and 2019, with higher rates for the female population at 96.3% and 96.9%, respectively. The specificity of the level and dynamics of individual age groups of patients was identified. For the first time, the one-year survival of patients with skin neoplasms was calculated based on detailed tumor localizations and the respective one-year survival rates, as well as the one-year survival calculated separately for each tumor histotype. The highest survival rate was observed for the histotype M-8090/3 at 97.4%, while the lowest was for M-8390/3 at 59.1%.

Surgical Treatment Intensity at the End of Life in Patients With Cancer: A Systematic Review

Objective: To synthesize evidence of surgical treatment intensity, defined as a measure of the quantity of invasive procedures, received by patients in patients with cancer within a defined time period around the ‘end of life’ (EoL). Background: Concern regarding overly ‘aggressive’ care or high health care utilization at the EoL, particularly in cancer, is growing. The contribution surgery makes to the quality and cost of EoL care in cancer has not yet been quantified. Methods: This PROSPERO registered systematic review used PRIMSA guidelines to search electronic databases for observational studies detailing surgical intensity at the EoL in adult cancer patients. Intensity was compared by disease, individual characteristics, geographical region, and palliative care involvement. A risk of bias tool assessed quality and a narrative synthesis of findings was completed. Results: In total, 39 papers were identified in this search. Up to 79% of patients underwent invasive procedures in the last month of life. Heterogeneity in patient groups, inclusion criteria, and EoL time periods lead to huge variation in results, with treatment intention often not identified. Patient, geographical, and pathological factors, alongside involvement of palliative/hospice care, were all identified as contributors to treatment intensity variation. Conclusions: A significant proportion of patients with cancer undergo invasive and costly invasive procedures at the EoL. There is significant reporting heterogeneity, with variation in patient inclusion criteria and EoL timeframes, demonstrating uncertainty within the literature. Identification of the context where surgical treatment intensity at the EoL is potentially inappropriate is not currently possible.

Specialty Tobacco Treatment Implementation in Oncology: A Qualitative Study

PURPOSE In 2017, the National Cancer Institute (NCI) funded the Cancer Center Cessation Initiative (C3I) to implement and expand tobacco treatment programs in routine oncology care. Many C3I programs developed specialty care programs staffed by tobacco treatment specialists (TTSs) to deliver evidence-based treatment to adult patients who smoke. People involved in specialty tobacco treatment programs can help to identify implementation strategies and adaptations that may enhance tobacco treatment reach and effectiveness in cancer care and help more patients with cancer quit using tobacco. METHODS We conducted semistructured interviews with TTSs from 21 C3I-funded cancer centers and applied content analysis to interview transcripts from 37 TTSs and 17 respondents in other program roles. We used the Consolidated Framework for Implementation Research to code interview data. We identified final themes and implementation strategies and adaptations recommended by respondents on the basis of these codes. RESULTS Respondents shared that implementation of specialty tobacco treatment programs in cancer care settings could be facilitated by training staff to provide patient connection to services, incorporating prescription of no- or low-cost cessation medications, hiring additional staff to deliver tobacco treatment, allocating space to the program, and automating electronic health record workflows. CONCLUSION TTSs and others involved in specialty tobacco treatment in NCI-designated cancer centers identified ways to improve tobacco treatment access, use, and effectiveness by (1) adapting specialty tobacco treatment delivery to meet patient needs; (2) facilitating referrals and pharmacotherapy coordination; and (3) committing staffing, space, and support resources to tobacco treatment programs. Key program participants suggested that these approaches would help more oncology patients connect with evidence-based tobacco treatment and quit smoking.

Shareable artificial intelligence to extract cancer outcomes from electronic health records for precision oncology research

Abstract Databases that link molecular data to clinical outcomes can inform precision cancer research into novel prognostic and predictive biomarkers. However, outside of clinical trials, cancer outcomes are typically recorded only in text form within electronic health records (EHRs). Artificial intelligence (AI) models have been trained to extract outcomes from individual EHRs. However, patient privacy restrictions have historically precluded dissemination of these models beyond the centers at which they were trained. In this study, the vulnerability of text classification models trained directly on protected health information to membership inference attacks is confirmed. A teacher-student distillation approach is applied to develop shareable models for annotating outcomes from imaging reports and medical oncologist notes. ‘Teacher’ models trained on EHR data from Dana-Farber Cancer Institute (DFCI) are used to label imaging reports and discharge summaries from the Medical Information Mart for Intensive Care (MIMIC)-IV dataset. ‘Student’ models are trained to use these MIMIC documents to predict the labels assigned by teacher models and sent to Memorial Sloan Kettering (MSK) for evaluation. The student models exhibit high discrimination across outcomes in both the DFCI and MSK test sets. Leveraging private labeling of public datasets to distill publishable clinical AI models from academic centers could facilitate deployment of machine learning to accelerate precision oncology research.

“Not Having Family, not Having Insurance, not Having Money, Experiencing lots of Pain”: Fears About Cancer Among Older Latino Men

Cancer among older adults is pervasive, placing excessive strain on the individual, caregivers, and wider society. Focusing on cancer among older immigrant Latino men is critical to identifying knowledge gaps, diagnosis and treatment while providing insights to improving cancer care to this growing population. As such, this article presents the multifactorial experience of fears and beliefs about cancer and cancer prevention of 57 older immigrant Latino men based on qualitative responses. From the results emerged three significant sub-themes that provided crucial insight into the thought processes that influence decision-making in regard to cancer for this population. A major concern is the financial impacts of cancer and treatment without insurance. Factors regarding their ability to continuing providing for their families if they were to undergo treatment, and their families’ future financial security once they were gone provide valuable insights to improving cancer care information among older immigrant Latino men.

Breast metastasis from large cell neuroendocrine carcinoma of the lung: a case report

Abstract Background Primary breast carcinoma is far more common than breast metastases. Common breast metastases usually come from lymphoma, leukemia, melanoma, and ovarian cancers. Breast metastases from neuroendocrine carcinomas are considered an exceeding rare entity. It has been reported in the literature that the pathological presentation of this particular metastatic tumor is very challenging as it shares many morphological characteristics with primary breast carcinoma. Case presentation We report a case of a patient with large cell neuroendocrine carcinoma of the lung metastasizes to both breasts. The patient was initially presented with brain metastasis of unknown origin. Further radiological imaging workup showed multiple bilateral breast masses and bilateral lymphadenopathy, which raised concern for secondary lymphoma of the breast. The histopathology of this case was challenging, particularly when triple negative invasive ductal carcinoma diagnosis had been made. Multidisciplinary meetings between medical oncologists, radiologists, and pathologists profoundly helped confirming the diagnosis of metastatic large cell neuroendocrine tumor to the breast. Conclusion Large cell neuroendocrine carcinoma of the lung is a relatively uncommon diagnosis with generally poor prognosis. Large cell neuroendocrine carcinoma that metastasizes to the breast is even scarcer. Correlation between clinical assessment, radiological imaging, and pathological evaluation is the key in making such an unusual and complex diagnosis. Additionally, radiologists should be aware of metastatic presentations of the breast and avoid confusion with mimicking benign entities or primary breast carcinomas.

Optic disc and peripapillary tumors

Abstract This review covers the tumors either originating or seen close to the optic disc in the peripapillary area. Most of the optic disc tumors are diagnosed on clinical examination. In a few atypical cases, ancillary imaging, such as optical coherence tomography, fluorescein angiography, and ultrasonography, may be required to demonstrate characteristic features. The majority of these tumors have systemic associations, and hence, a multidisciplinary approach involving ocular oncologists, neurophysicians, radiation oncologists, and medical oncologists is the need of the hour. The treatment of optic disc tumor is challenging due to its proximity to critical areas such as optic nerve and macula, which could be a limiting step when compared to conventional treatments such as laser photocoagulation and surgical excision.

DISP-07. CURRENT NEURO-ONCOLOGY CAPACITY IN SUB-SAHARAN AFRICAN COUNTRIES: A QUESTIONNAIRE-BASED SURVEY

Abstract Brain tumors constitute significant morbidity and mortality in sub-Saharan Africa (SSA). There is no previous large-scale effort focusing on brain tumor genetics in SSA. This project aims to map out the current neuro-oncology capacity in terms of workforce and available services in SSA. This is an ongoing online survey among a cross section of neuro-oncology practitioners spread across SSA countries to capture information on the distribution, number of available neuro-oncology care practitioners, capacity for neuropathology and molecular diagnosis, management of brain tumors, cancer registration, and tumor biobanking. The survey was disseminated by the Society for Neuro-oncology in SSA (SNOSSA). There were 83 respondents representing 15 countries and 52 health institutions: 46 tertiary, 4 secondary, 1 private and 1 other. Here, we present data on the 52 institutions. The prevalence of specialties was 87% neurosurgery, 75% anatomic pathology, 69% medical oncology, 64% neurology, 60% radiation oncology, and 39% neuropathology. For radiologic evaluation, 81% of institutions were reported to have both CT and MRI, 17% CT only, and one institution neither. For molecular testing, 46% have access to IHC or NGS testing, whereas 52% were reported to have neither. A neuro-oncology tumor board was reported at 58% of institutions. A general cancer registry is available in 64% of institutions, 31% have a brain tumor specific registry and 10% have a brain tumor biorepository. This study shows that SSA has substantial potential in neuro-oncology care practice capacity and facilities. Most significant gaps remain in areas such as neuropathology and molecular testing, which makes widespread implementation of the WHO 2021 diagnosis challenging. Understanding the prevalence of CNS tumor subtypes is also difficult due to low number of brain tumor registries and biobanks in SSA. The present findings reveal strategic opportunities, especially in neuropathology, tumor registries, biobanks, and infrastructure for IHC and NGS in SSA.

“It is not the fault of the health care team - it is the way the system works”: a mixed-methods quality improvement study of patients with advanced cancer and family members reveals challenges navigating a fragmented healthcare system and the administrative and financial burdens of care

Abstract Background Healthcare fragmentation and lack of care coordination are longstanding problems in cancer care. This study’s goal was to provide in-depth understanding of how the organization and fragmentation of healthcare impacts the experiences of patients with advanced cancer and their families, especially near the end-of-life. Methods This mixed-methods quality improvement study took place at a large multi-specialty healthcare organization in Northern California. Electronic health record data was used to identify patients with advanced cancer and their characteristics. Data were collected 10/2019-05/2022 through periodic patient surveys and in-depth interviews with sampled family members, including open-ended questions about overall healthcare experiences. Data were analyzed using inductive thematic analysis. Results Overall, 281/482 (58.3%) patients with advanced cancer completed surveys. Surveyed patients’ mean age was 68 (SD: 12.8) years, 53% were male, 73% White, 14.2% Asian, 1.4% Black, 3.9% Other; 8.9% Hispanic, and 19.2% were deceased within 12 months. Twenty-four family members completed in-depth interviews: 17/24 (70.8%) were spouses, 62.5% were female and 50% were interviewed after the patient’s death. Respondents were generally positive about health care team interactions, but consistently brought up the negative impacts of the organization of healthcare, “It is not the fault of the health care team - it is the way the system works.” Three major challenges were identified. (1) Systemic healthcare care fragmentation, including difficulties navigating care across providers and institutions, “It seems like everything is like an isolated incident… there’s no overall, big picture viewpoint.” (2) Administrative burdens, “In the end I gave up [scheduling care] because I was tired of calling.” (3) Financial burdens, “This oncologist wanted to put him on a drug…but it was $4000 a month.” Respondents described these challenges leading to worse quality of care, health, and quality of life, and loss of trust in the national healthcare system. Conclusions These findings illustrate how care fragmentation and administrative and financial burdens lead to worse quality care and distrust of healthcare. Better coordination of patient-centered care, and a fundamental restructuring of a highly fragmented national healthcare system are required to meet the needs of patients with complex conditions like advanced cancer and their families.

Barriers to Cancer Care in the LGBTQ+ Community

ABSTRACTIndividuals that identify as lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA) make up a medically underserved population, that experience disparities in cancer care. Specific cancer incidence and mortality in this population is understudied, as national cancer registries and cancer surveys have limited data about sexual orientation or gender identity. The LGBTQIA community face disparate cancer outcomes in prevention, screening, diagnosis, and treatment due to barriers that limit access to cancer care. To better understand these concerns, we will take a deep dive into the three primary barriers that prevent access to cancer care: personal, provider and systems barriers.

BIOM-19. METHYLATION PROFILING OF PLASMA CELL-FREE DNA IN PEDIATRIC BRAIN TUMOR PATIENTS

Abstract BACKGROUND Circulating tumor DNA (ctDNA) assays are being evaluated to inform clinical decisions in cancer care in adult patients, but the study in pediatric brain tumor patients is rare partly due to very low levels of ctDNA in blood. Currently, treatment decisions require invasive diagnostic surgical biopsies that carry risks and morbidity. The aim of this study is to utilize methylomes from plasma ctDNA for non-invasive diagnosis in pediatric brain tumor patients. METHODS Using cell-free methylated DNA immunoprecipitation and high-throughput sequencing (cfMeDIP-seq), which with low input DNA requirement, we measured methylation profiles of plasma samples from 77 pediatric brain tumor patients and 16 patients with non-neoplastic diseases like epilepsy. Binomial GLMnet classifiers of tumor or tumor subtype were built, in 2000 iterations of 60% training sets. Performance was evaluated in 40% test sets. RESULTS. These 77 pediatric brain tumor patients were a mixture of the most common pediatric brain tumors, include circumscribed astrocytic gliomas (N=23), glioneuronal tumors (N=16), embryonal tumor (N=9), ependymal tumor (N=7), pediatric type diffuse high grade glioma (N= 5), glioma NOS (N=4), mesenchymal tumor (N=4) and other pediatric brain tumors (N=9). The methylation profile differentiated brain tumors from non-neoplastic diseases with 82.9% accuracy (precision = 92.6%, sensitivity = 86.2%, specificity = 66.7 %). For subtype analysis, the methylation profile detected circumscribed astrocytic glioma from non-neoplastic diseases with 85.7% accuracy (precision = 87.5%, sensitivity = 87.5 %, specificity = 83.3 %), and glioneuronal tumors from non- neoplastic diseases with 83.3% accuracy (all precision, sensitivity, and specificity = 83.3 %). CONCLUSIONS The results suggest that methylation profiling of plasma cell-free DNA has the potential to discriminate between pediatric brain tumor patients and patients with non- neoplastic diseases. Larger population cohorts to train even more accurate classifiers will be needed.

Current situation and capacity of cancer diagnosis and treatment in county hospitals in China: a multicenter cross-sectional survey

Abstract Purpose County-level hospitals in China constitute a vital component of the healthcare system, delivering essential medical services, emergency care, and specialized treatments, particularly in oncology. This study aimed to comprehensively evaluate the current status of cancer diagnosis and treatment in county hospitals and assess their overall capacity. Methods A nationwide cross-sectional survey by the China Anti-cancer Association (CACA) from February to May 2023 assessed cancer diagnosis and treatment in mainland China's county hospitals. Using a multi-center approach, a fifty-five-question questionnaire was administered to oncology professionals and management staffs, focusing on hospital facilities, oncology specialists, cancer cases, treatment capabilities, and healthcare collaboration. Questionnaire reliability and validity were established in a 2022 national survey. Participants, aged 18 or older, were recruited through purposive sampling, receiving self-administered questionnaires for confidentiality. SAS 9.4 software facilitated statistical analysis. Results The study encompassed 76 county-level medical institutions, with 82.9% of them featuring established oncology departments providing comprehensive cancer care, including early screening, diagnosis, treatment, and long-term follow-up. Notably, a total of 56.6% of the institutions surveyed implemented programs for cancer screening and early diagnosis. A significant proportion of advanced cancer patients received treatment and follow-up at the county level. Persistent disparities in medical insurance policies at the county level were identified as a continuing challenge. Furthermore, 82.9% of hospitals had cultivated collaborative relationships with higher-level institutions to enhance patient care quality and treatment capacity. The study revealed a 56.6% shortage of remote collaboration platforms in these hospitals. The need for a patient-centered approach in county hospitals was underscored. Conclusion While county-level hospitals face challenges, such as a shortage of specialized oncologists and advanced resources, they exhibit progress in standardizing cancer care to enhance diagnosis and treatment in rural areas.

DISP-13. TELEHEALTH UTILIZATION IN NEURO-ONCOLOGY: EXPERIENCE AFTER THE COVID-19 PANDEMIC

Abstract BACKGROUND Central nervous system (CNS) tumors are frequently characterized by physical disabilities, and treatment is often associated with side effects, as well as financial toxicity and loss of income owing to disease-related neurological deficits. Treatment at centers with specialized neuro-oncology care is associated with an overall survival benefit. However, access to such centers can be limited for many patients. Telehealth services represent an option for improving access to specialized care. During the COVID-19 pandemic public health emergency (PHE), regulatory and reimbursement changes provided patients improved access to neuro-oncology by telehealth. METHODS We retrospectively analyzed our institutional utilization of telehealth visits in the neuro-oncology vs solid tumor oncology practice after the COVID-19 pandemic. RESULTS Between July 2020 and April 2021, telehealth represented 24.1% of all neuro-oncology visits compared to 13.3% for all solid tumor groups. Between May 2021 and April 2023, telehealth visits remained frequent in neuro-oncology compared to solid tumor groups (34.6% vs 15.2%). Utilization rates declined across the practice in the year following expiration of the COVID-19 PHE in May 2023, though remained high for neuro-oncology at 34.1% vs 15.2% for solid tumor groups. Overall, telehealth visit utilization for neuro-oncology has remained more than double that of the oncology practice as a whole. CONCLUSIONS The striking difference between telehealth visit utilization in neuro-oncology compared with general medical oncology indicates that patients with CNS tumors, and those that provide care for these patients, have come to depend on this mode of care delivery. Even after expiration of the COVID-19 PHE, telehealth use remains high in neuro-oncology at our institution. Prospective evaluation to determine the safety of and clinical outcomes associated with telehealth visits for individuals with CNS tumors are critically needed. Such data may promote regulatory and reimbursement reform enabling broader adoption, service sustainability, and improved access to specialized care.

Computational intelligence techniques for achieving sustainable development goals in female cancer care

Computational intelligence techniques for achieving sustainable development goals in female cancer care

Simplifying acquisition of essential diagnostics: A comprehensive costing tool for anatomic pathology

Abstract Objectives Histopathology is the core diagnostic tool for cancer in pathology laboratories around the world, but there are disparities in access to diagnostics globally. As recognition of the need for cancer care and treatment grows, especially in the wake of World Health Organization programs for cervical, breast, and pediatric cancers, policymakers and health care funders are seeking tools and processes that allow for the largest number of patients to receive a diagnosis at the lowest cost. Methods As histopathology represents the most cost-effective diagnostic method by sheer number of tumor types and volume, understanding the detailed logistics and costs for histology as well as the impactful benefits of economies of scale (ie, larger volumes are less expensive per patient) and scope (ie, the multiple stains available after basic histology sectioning) is paramount to planning an effective publicly funded or government laboratory. Understanding the economic structure of a country’s population along with the financial model of a histology laboratory also leads to a market understanding of private laboratories, which can provide services at a profit as well as pro bono services more cost-effectively than purely public laboratories. Results We have developed a comprehensive, scalable costing tool of a functioning histology laboratory that accounts for all feasible costs and variations in models of service. The tool allows for a standardized approach to selecting goods needed to provide histology services and serves as a guide for implementation of pathology services. Conclusions Using the tool, laboratories can achieve self-sustainment and long-term financial health while incorporating a proportion of impoverished patients who cannot afford out-of-pocket expenses.

Acute myeloid leukemia in the next-generation sequencing era

Summary Background Next-generation sequencing (NGS) has recently entered routine acute myeloid leukemia (AML) diagnostics. It is paramount for AML risk stratification and identification of molecular therapeutic targets. Most NGS feasibility and results data are derived from controlled clinical intervention trials (CCIT). We aimed to validate these data in a real-world setting. Patients, materials and methods This study retrospectively analyzed 447 AML patients treated at an Austrian tertiary cancer care center. A total of 284 out of the 447 cases were treated between 2013–2023 when NGS was locally available for the clinical routine. Results The NGS was successfully performed from bone marrow biopsies and aspirates, with processing times decreasing from 22 days in 2013/2014 to 10 days in 2022. Molecular therapeutic target(s) were identified by NGS in 107/284 (38%) cases and enabled risk stratification in 10 cases where conventional karyotyping failed. Concerning molecular landscape, TET2 (27%), FLT3 (25%), DNMT3A (23%), and NPM1 (23%) were most frequently mutated. Comparing older and younger patients (cut-off 70 years) showed enrichment in older people for mutations affecting DNA methylation (72% vs. 45%; P < 0.001) and the spliceosome (28% vs. 11%; P = 0.006) and more cellular signaling mutations in younger patients (61% vs. 46%; P = 0.022). Treatment outcomes corroborated a significant survival benefit in the recent NGS era and patients treated with novel/molecularly targeted drugs. Ultimately, biospecimens of these patients are stored within a leukemia biobank, generating a valuable tool for translational science. Conclusion Our study validates data from CCIT and supports their relevance for treatment decisions in a real-world setting. Moreover, they demonstrate the feasibility and benefits of NGS within a routine clinical setting.

QOL-09. “I’VE DEFINITELY CHANGED WHO I AM”: A THEMATIC ANALYSIS OF CHALLENGES FACED BY PATIENTS WITH IDH-MUTANT GLIOMAS

Abstract BACKGROUND Despite their more favorable prognosis, patients with isocitrate dehydrogenase (IDH)-mutant gliomas experience significant psychological distress across their disease trajectory. The specific drivers of distress in this population are poorly understood, and interventions to support these patients are lacking. We sought to better characterize drivers of distress and ways to enhance support for patients with IDH-mutant gliomas as they confront potentially prolonged but ultimately unpredictable survival with an incurable, progressive brain tumor. METHODS Eligible individuals were English-speaking adults ages 65 and younger diagnosed with an IDH-mutant glioma at a single academic medical center. We conducted semi-structured interviews (N=20) to better understand the distress patients experience as they progress along their illness trajectories. We audio-recorded and transcribed interviews and analyzed interview content using reflexive thematic analysis. RESULTS Distress among participating patients (female = 7/20; age <40 years = 10/20) was linked to their struggles to maintain a coherent sense of identity while adapting to 1) neurocognitive changes and 2) altered life plans amidst prognostic uncertainty. Patients described feeling self-conscious and distrustful of their cognitive capacities, frequently comparing their current performance to their premorbid functioning (e.g. by checking their symptoms and indexing perceived deficits against scan results). Patients felt overwhelmed by the need to make decisions and set priorities (e.g., regarding family planning, retirement) due to the uncertain timing of their tumor’s progression and its unclear impact on their future functioning. Patients identified the transition from treatment to surveillance as a time of heightened worry, as they shifted their focus from the logistics of cancer care to the task of planning – financially, occupationally, socially – for an uncertain future. CONCLUSION These findings highlight the need for tailored supportive care to help patients with IDH-mutant gliomas cope with the distress caused by significant changes to identity and ongoing uncertainties regarding their future.

DISP-09. IMPROVING ADHERENCE TO CANCER CARE IN UNDERSERVED PATIENTS WITH CENTRAL NERVOUS SYSTEM TUMORS

Abstract Patients with central nervous system tumors have disease-specific symptoms such as aphasias, motor symptoms, neuropsychiatric symptoms, or seizures that make treatment adherence difficult. This is further exacerbated by the social determinants of health – patients from historically marginalized groups or those with lower socioeconomic status have additional barriers to treatment. The Integrated Cancer Care Access Network (ICCAN) is a multi-institutional patient navigation program assisting patients who express socioeconomic needs during cancer treatment. In this pilot program, we assessed the impact of ICCAN on treatment adherence and quality of life of CNS cancer patients from marginalized backgrounds. 42 participants with primary brain tumors or brain metastases were recruited from inpatient and outpatient services at Memorial Sloan Kettering Cancer Center to enroll in ICCAN-CNS. Patients were eligible if they were 18 years or older, receiving active treatment or under active surveillance, and screened positive for an essential need. Through standardized patient interviews and questionnaires, we evaluated their needs such as food access, housing, and financial needs. The clinical research coordinator interviewed the patients via phone, taking approximately 60 minutes. The interviews comprised an Essential Needs Assessment, Health Related Social Needs Assessment, NCCN Distress Thermometer, and an ICCAN-CNS questionnaire focused on neurology-specific symptoms. Caregivers helped complete the questions for patients with cognitive impairments. Patients were then matched with resources based on their initial needs assessment. The interviewer conducted 2, 4, and 6-month follow-ups to see if new needs emerged for which resources were provided. Response to the program was overwhelmingly positive with many patients expressing gratitude for the resources provided to them. This pilot demonstrates the feasibility of CNS tumor patients participating in the ICCAN intervention and the need for additional patient navigation programs and interventions that focus on the social determinants of health.

QLTI-16. QUALITY IMPROVEMENT PROJECT (QIPR) FOR IMPLEMENTATION OF PSYCHOSOCIAL ASSESSMENTS FOR ONCOLOGY CLINICAL CARE

Abstract BACKGROUND Patient-reported outcomes (PROs) have been used to assess individuals’ quality of life (QoL) throughout cancer treatment. Individuals with cancer often experience physical, psychological, and social challenges. It is crucial to evaluate their QoL to provide supportive care services to improve survival and treatment outcomes in real-world cancer clinical settings. Patients’ ability to engage with completing PROs is critical to ensuring PRO implementation efficacy. This QIPR (UF: 2216) examined these completion rates in coordinated medical-behavioral cancer care. METHODS Questionnaires delivered to neuro-oncology and psycho-oncology patients through the electronic health record (EHR) prior to scheduled office visits were: PROMIS – Anxiety, Depression, Pain Interference, Ability to Participate in Social Roles, and Cognitive and Physical Function. Data collection occurred from July 2023-January 2024. Descriptive statistics were calculated to assess battery completion rates. Information from the first 3 encounters following initiation of the battery into clinical practice were analyzed. RESULTS Of 906 scheduled encounters, 491 (54.2%) were attended by 280 unique patients. The battery was completed at least once by 106 (37.9%) patients. 72.6% (N=77) of these patients completed the battery at the first scheduled visit at which it was assigned. Of patients with 2 scheduled visits (N=25, 23.6%); 24.0% (N=6) completed the battery at both visits. Of patients that had 3 scheduled visits (N=12, 11.3%); 16.7% (N=2) completed it at all 3 visits. CONCLUSION Only approximately 38% of patients completed the battery at least once across 3 consecutive visits. The highest battery completion rate was at the first visit at which it was assigned. Completion rates were lower across additional visits. Future work will seek to understand barriers and facilitators of these completion rates to optimize implementation of PROs in coordinated medical-behavioral oncology care.