Oncology Service Research Articles

Reducing Operating Room (OR) Cancellations: Results from a Quality Improvement Study from a Tertiary Care Children's Cancer Center

Introduction: Operating Room (OR) is a critical resource that may be used inefficiently in pediatric hematology oncology services and surgical cancellations is a major cause of OR underutilization with major implications on cost-savings, patient satisfaction, quality-of-care and hospital metrics. The purpose of this performance improvement (PI) study was to reduce the surgical cancellation rate by 10% (Pre-PI cancellation rate,22%) at pediatric hematology oncology services at a large tertiary care children's cancer center in Riyadh, Saudi Arabia. Methods: Plan, Do, Study, Act (PDSA) cycle was adapted as project methodology on this performance improvement study. Preoperative checklist was created using REDCap electronic data capture tool hosted at our institution, also served as project database. Daily OR -Huddle was conducted to identify key points of intervention that included customized medical plans involving provision of pre-anesthesia evaluation clinic, sub-specialized inpatient and outpatient consultations, blood product support, while intervention required for improved communication included patient and nursing education. Patients were re-evaluated and preoperative checklist rechecked for provision of 24-hour notice of cancellation to the OR-scheduling team. All elective procedures scheduled between November 2021 and December 2022 were included, cancelled procedures were examined to identify potential reasons. Results: During the PI period, a total of 1063 elective surgical procedures were scheduled, majority 77% (816) were line-related, followed by bone marrow harvest in stem cell transplant donors, 11% (118) ; dental extraction and restoration, 6% (63) ; bone marrow aspiration or biopsy,4% (47) and other (lumbar puncture, Intrathecal chemotherapy etc.) procedures ,2% (19). Majority 58% (621), of the procedures scheduled for malignant diagnoses; followed by stem cell harvests or patients requiring line-insertion for stem cell infusion in 29% (308) and non-malignant diagnoses in 13% (134). Post-intervention, surgical cancellation observed in 54 cases, with majority 93% (50) being line-related cancellation. When compared to the pre-intervention period (12 months prior to PI-project initiation) rate of surgical cancellation dropped from 22% to 5% resulting in 17% improvement. Root cause analysis reports a significant decrease in cancellation related to inappropriate preoperative workup, 40%; followed by co-morbid conditions related to patients disease requiring sub-specialized consultation in 29% ; insufficient routine blood tests in 19% and inappropriate patient education in 8%. The preoperative checklist was approved and adapted as standard of care - clinical pathway to be integrated with the institutional Electronic medical records. Conclusion: In our experience, the observed high rate of elective OR cancellations were associated with ineffective preoperative workflow, team communication, patient coordination and education. Post-intervention measures enabled a visual system to harmonize patients' preoperative progress and the multi-disciplinary, daily OR-Huddle allowed lean-decision minimizing “last minute” cancellations. These interventions are easy to replicate against available resources by other tertiary care centers to improve inefficient OR utilization. Cost-effectiveness analysis resulting from the improvement is warranted.

Implementation of a Standardized Data Collection Tool for Febrile Episodes in Childhood Cancer Patients in Central America and the Caribbean

Abstract Fever is a common sign of infection and is associated with morbidity and treatment delay in childhood cancer patients. A multinational group of physicians identified the need to develop standardized measures to assess and intervene in the quality of care delivery as measured by adherence to the fever management guidelines published by this group in 2020. Our objective was to create an implement a febrile neutropenia registry that included data for quality assessment. Six sites in Central America and the Caribbean implemented a prototype of a Fever Registry for standardized data collection. Variables collected in the registry included demographic information and quality measures like the performance of selected laboratory tests (neutrophil count and blood culture) and time to antibiotic administration. Sites also collected clinical outcomes, including infection diagnosis, microbiologic diagnosis, critical care support requirements, length of hospital stay, and mortality. The initial implementation cohort included one dedicated pediatric oncology center and five oncology services situated within general pediatric hospitals. From September 9, 2021 to December 5, 2022, the six sites contributed 188 fever episodes from 148 unique patients. The maximum number of fever episodes entered for a single patient was 6 episodes. The distribution of cases entered in the database by site ranged between 5 to 54 cases (average patients enrolled per site=25). 84.9% of iCRFs(Case Report forms) had complete data. The most common incomplete data fields were: Initial antimicrobial administered (9/175=5.1%), nutritional status (6/181=3.3%), and was urinalysis performed at onset of fever (6/181=3.3%). Implementation strategies were developed incorporating responses to a survey based on the Consolidated Framework for Implementation Research. Infectious diseases specialists, who were the site leads, directed the implementation efforts at each site. The coordinating team encouraged sites to incorporate hematologists/oncologists and data managers as part of the team. However, team composition and internal meeting frequency were at the discretion of the site leads. Every site elected to use a paper data collection tool to facilitate centralized data entry, which was conducted by a data manager in all but one site. Staff at local sites received two initial trainings and a retraining by St. Jude staff to identify eligible patients and complete data fields appropriately. Group meetings with all site leads were conducted monthly to review progress and challenges and for quality assurance. The challenges most cited were personnel limitations for data collection and data entry. Surges exacerbated these challenges in caseloads related to respiratory illnesses, including SARS-CoV-2, influenza, and RSV. Conclusion: This group has created and implemented a tool to facilitate standardized data collection for a common clinical problem. Implementation challenges highlight the role of human resources and simplifying data collection to minimize data entry time. Current efforts include developing interim reports so clinicians can use data to improve the quality of care delivery in real-time. The group is also revising data fields to remove data points that are often unavailable or unnecessary to measure care quality. Project implementation in these six sites exposed opportunities to streamline the data collection system and optimize the implementation process.

Mapping of Radiation Oncology and Gynecologic Oncology Services Available to Treat the Growing Burden of Cervical Cancer in Africa

To meet the demand for cervical cancer care in Africa, access to surgical and radiation therapy services needs to be understood. We thus mapped the availability of gynecologic and radiation therapy equipment and staffing for treating cervical cancer. We collected data on gynecologic and radiation oncology staffing, equipment, and infrastructure capacities across Africa. Data was obtained from February to July 2021 through collaboration with international partners using Research Electronic Data Capture. Cancer incidence was taken from the International Agency for Research on Cancer's GLOBOCAN 2020 database. Treatment capacity, including the numbers of radiation oncologists, radiation therapists, physicists, gynecologic oncologists, and hospitals performing gynecologic surgeries, was calculated per 1000 cervical cancer cases. Adequate capacity was defined as 2 radiation oncologists and 2 gynecologic oncologists per 1000 cervical cancer cases. Forty-three of 54 African countries (79.6%) responded, and data were not reported for 11 countries (20.4%). Respondents from 31 countries (57.4%) reported access to specialist gynecologic oncology services, but staffing was adequate in only 11 countries (20.4%). Six countries (11%) reported that generalist obstetrician-gynecologists perform radical hysterectomies. Radiation oncologist access was available in 39 countries (72.2%), but staffing was adequate in only 16 countries (29.6%). Six countries (11%) had adequate staffing for both gynecologic and radiation oncology; 7 countries (13%) had no radiation or gynecologic oncologists. Access to external beam radiation therapy was available in 31 countries (57.4%), and access to brachytherapy was available in 25 countries (46.3%). The number of countries with training programs in gynecologic oncology, radiation oncology, medical physics, and radiation therapy were 14 (26%), 16 (30%), 11 (20%), and 17 (31%), respectively. We identified areas needing comprehensive cervical cancer care infrastructure, human resources, and training programs. There are major gaps in access to radiation oncologists and trained gynecologic oncologists in Africa.

Palliative care services in paediatric oncology centers across Europe: A cross-sectional survey

BackgroundPalliative care (PC) is an integral part of cancer treatment. However, data on service availability is limited in childhood cancers. AimTo describe the availability of PC services in paediatric oncology centres across Europe, and to identify barriers and facilitators for implementing and providing paediatric palliative care (PPC). MethodsPaediatric oncology centres across Europe were invited to complete an online questionnaire. ResultsA total of 158 paediatric oncology centres from 27 European countries participated. More than half of the centres (n = 102, 64.6 %) reported offering specialised PPC (defined as 24/7 coverage services with a specialised physician and a multidisciplinary team). Most centres included a multidisciplinary care team (n = 123, 80.9 %) and PC at home (n = 105, 69.1 %). In 38.7 % centres, service capacity was reported to be lower than demand. In most centres, PC consultation was initiated for a refractory neoplasm (n = 126, 81.2 %). Few centres (n = 11, 7.1 %) offered PC consultation at the time of a new cancer diagnosis. Eighty-two centres (52.6 %) reported having bereavement services. Negative parental perception (n = 99, 64.7 %) and late referrals (n = 91, 59.5 %) were major barriers to implementation perceived by health care providers. ConclusionOur results suggest that specialised PPC is available in more than half of paediatric oncology settings across Europe. Although half have had PPC available for > 10 years, many cannot fulfil the demand for service. Barriers to implementation (i.e., parental education, staff training) should be addressed, with resources and services further expanded to cover the demand for PPC, including bereavement care.

Cervical cancer in Mozambique: Clinical characteristics, treatment and survival of incident cases admitted to the Oncology Service of Maputo Central Hospital in 2016-2018.

In Mozambique, cervical cancer is the most frequent cancer in women. However, studies about cervical cancer treatment and prognosis are scarce. We describe the clinical characteristics, treatment and survival of patients with cervical cancer admitted to Maputo Central Hospital (MCH) in 2016 to 2018. Sociodemographic, clinical and cancer-related data were retrieved from clinical records of patients admitted to the Oncology Service of the MCH with an incident cervical cancer in 2016 to 2018 (n = 407). The Pathology Service database was used to obtain information regarding pathological diagnosis. Survival data was obtained through the MCH Cancer Registry and clinical records. Odds ratios for the association between patients' characteristics and the diagnosis of advanced stage cancer were computed using logistic regression. Survival analyses were performed using the Kaplan-Meier estimator. A total of 91.2% of the patients were diagnosed with advanced disease (stage IIB-IV) and squamous cell carcinoma was the predominant histological subtype. Most of the patients underwent chemotherapy (93.1%) but <7% were submitted to surgery, radiotherapy or brachytherapy. Those living with HIV had 3.4-fold higher odds of advanced disease. Overall survival was 72.7% (95% confidence interval [CI]: 67.9-77.0) at 1-year and 51.0% (95%CI: 45.3-56.3) at 2-years. Those with early stage (IA-IIA) and asymptomatic at diagnosis had a significantly higher 2-year overall survival. In Mozambique, cervical cancer is diagnosed mostly in advanced stages, resulting in poor prognosis. This highlights the importance of HPV vaccination and screening, to decrease the burden of cervical cancer in this context.

Social representations attributed to prostate cancer by men undergoing follow-up at an in-hospital Oncology service

Objective: to understand the social representations of prostate cancer by men undergoing follow-up at an in-hospital oncology service. Methods: a qualitative study, developed using the Collective Subject Discourse method, with 30 men over the age of 18 undergoing treatment for prostate cancer. The data were collected through semi-structured interviews and analyzed using the Theory of Social Representations. Results: the most shared central ideas in the studied community were as follows: A curable disease; Worry, fear, annoyance and sadness; Loss/Impairment of sex; Nothing, something normal/common; A minor ailment that doesn't shake/shook me, it was faced head on, without fear; Something/Disease that is bad, difficult, serious, intense, dangerous, that ends life and kills. Conclusion: the social representations found in this study denoted intense and difficult experiences in dealing with the disease and treatment, but also showed coping, with potential for overcoming/resilience. Contributions to practice: understanding these representations enables the implementation of integrated and interprofessional education, assistance and management actions.

Exploring the experiences of staff conducting psychology consultations via telehealth in an oncology hospital

Purpose During the COVID-19 pandemic, telehealth delivery of psychological care services expanded to meet the needs of people with cancer. This study examined psychologists’ attitudes toward using telehealth during the pandemic peak in a tertiary oncology hospital. Methods Semi-structured interviews were conducted with ten psychologists who used telehealth to deliver psychological services. Thematic analysis was conducted to identify themes in the interview data. Results Themes identified: (1) increased uptake and attendance of psychology sessions was due to greater accessibility of services; (2) clinicians reported ease of communication and building of rapport when using telehealth; and (3) clinicians perceived differences in the psychotherapeutic process when sessions were delivered via telehealth compared to in-person. Conclusions Clinicians expressed high satisfaction with delivering telehealth psychological support for oncology patients. Implications for Psychosocial Providers: Oncology services that are considering developing or expanding a telehealth psychology service can facilitate this by ensuring a reliable technological platform and providing training and/or support to staff and patients. Clinicians should also use their clinical judgment to decide if a patient is appropriate for telehealth-delivered psychological care or if a mix of modalities is more ideal.

Comparisons of telemedicine and in-person visits: Utilization, oncology services and satisfaction among patients with breast cancer.

517 Background: Since the COVID-19 pandemic, telemedicine utilization has expanded in oncology settings and helps facilitate access to oncology services for breast cancer patients (pts). However, it remains unclear what types of oncology services are received via telemedicine and whether receipts of these services differ between telemedicine and in-person visits. Methods: We conducted a cross-sectional study surveying breast cancer pts in the Chicago Multiethnic Epidemiologic Breast Cancer Cohort from July-September 2022. Telemedicine (i.e., audio call [AC], video conference [VC], and both) and in-person visits were measured as having had a telemedicine and in-person visit with a provider in the past 12 months. Types of oncology services included treatment consultation, management of side effects/symptoms, review of lab, screening or pathology results, cancer genetic counseling, and clinical trial follow-up. We assessed common side effects/symptoms discussed during telemedicine or in-person visits. Satisfaction was assessed using a 5-point Likert scale. McNemar’s test was used to evaluate paired data on types of oncology services between telemedicine and in-person visits. Results: Of 1,160 pts (mean age 61.8 years, SD 12.0), 72.8% were White, followed by 19.7% Black, 4.5% Asian, and 3.0% Hispanic; 70.8% were privately insured and 23.0% on Medicaid/Medicare; 81.0% had stage I-III disease. Overall, 36.0% used telemedicine (of these, 65.0% VC, 22.7% AC, and 12.2% both) and 92.4% had in-person visits. Telemedicine users reported 93.9% and 95.5% of somewhat-to-extreme satisfaction with AC and VC, respectively, and 61.8% were likely or very likely to continue using telemedicine. In pts having both telemedicine and in-person visits, we observed differences between these visits in management of side effects/symptoms (15 vs. 54, p&lt;.001), review of lab, screening or pathology results (26 vs. 90, p&lt;.001), or trial follow-up (4 vs. 12, p=.046). However, there were no differences in treatment consultation (45 vs. 55, p=.317) or cancer genetic counseling (11 vs. 19, p=.144). Furthermore, BC pts who had in-person visits reported higher percentages of discussion of fatigue (50.3% vs. 41.1%), hot flashes (45.6% vs. 33.9%), lymphedema (26.0% vs. 19.6%), chemotherapy-induced neuropathy (24.9% vs. 19.5%), or nausea/vomiting (16.0% vs. 8.9%) than those used telemedicine; whereas a higher proportion of pts having discussed depressive symptoms via telemedicine than in-person visits (37.5% vs. 29.6%). Conclusions: In this multiethnic cohort of breast cancer pts, telemedicine use was prevalent and achieved high-level satisfaction. Our findings also suggest that both telemedicine and in-person visits are equally likely to include treatment consultation and genetic counseling, and telemedicine may be in greater need among breast cancer pts with mental health challenges.

Telemedicine use prevalence and disparities among sexual minority adults with cancers in the US: National Health Interview Survey, 2021.

514 Background: Telemedicine can help facilitate access to health care and oncology services for adults with cancers (AWCs); however, little is known about its utilization among lesbian, gay, bisexual, or other (LGB+) populations in the US. This study aimed to estimate the national prevalence of telemedicine use and examine disparities in telemedicine use among AWCs by sexual orientation. Methods: We obtained a population-based sample of US adults aged ≥18 years from the 2021 National Health Interview Survey. In this analysis, our sample was further limited to adults who 1) ever had a cancer diagnosis, 2) reported sex assigned at birth, and 3) self-identified as either heterosexual/straight or LGB+. Telemedicine use was defined as having had a virtual (i.e., phone and video) medical visit with a provider in the past 12 months and was dichotomized as “yes/no.” Weighted percentages and 95% confidence intervals (CI) were compared using Rao-Scott chi-squared tests. Multivariable logistic regression was used to calculate adjusted odds ratios (aOR) and 95% CIs. All analyses accounted for complex sample design and survey weights. Results: The unweighted sample was 3,517 which represented a weighted sample of 23,747,209 US AWCs; of whom, the mean age was 65.4 years; 55.5% were female, and 3.1% self-identified as LGB+. Overall, 50.8% (95% CI: 48.8%–52.4%) had a virtual medical visit with a provider in the past 12 months. LGB+ AWCs reported a significantly higher percentage of telemedicine use than heterosexual AWCs (64.8% [95% CI: 53.3%–76.2%] vs. 50.4% [95% CI: 48.4%–52.4%], p=0.019). After controlling for key sociodemographic covariates, LGB+ AWCs had higher odds of telemedicine use than heterosexual AWCs (aOR=1.75, 95% CI: 1.09–2.80). In the same adjusted regression model, we also observed that AWCs with an Associate’s (aOR=1.50, 95% CI: 1.23–1.84), Bachelor’s (aOR=1.72, 95% CI: 1.38–2.13), or graduate (aOR=1.79, 95% CI: 1.40–2.27) degree had a greater likelihood of telemedicine use than those with high school or less education. Uninsured AWCs were less likely than those privately insured to have used telemedicine (aOR=0.20, 95% CI: 0.09–0.40). AWCs residing in rural areas had a lower likelihood of telemedicine use than those residing in large metropolitan areas (aOR=0.62, 95% CI: 0.50–0.76). Conclusions: In this nationally representative sample of AWCs, the prevalence of telemedicine use was higher in LGB+ groups, suggesting a greater need for virtual care in these sexual minority populations. Our findings also suggest that to increase the utilization of telemedicine, oncology services and telehealth programs may need to improve equitable access among AWCs with a lower level of education, living in rural areas, or without insurance coverage.

Increasing cancer genetic referrals via best practice alerts (BPA).

565 Background: Germline genetic testing (GT) is recommended for all patients (pts) with pancreatic cancer (PC). However, genetic referral (GR) rates for PC are low even at academic centers; there is a paucity of literature at safety-net hospitals (SNH) which often treat higher percentages of cancers at advanced stages. Providers focused on the challenging treatment of PC and may not prioritize GT referrals. Technology can be adapted to aid in this process. Best practice alerts (BPA) built in Electronic Medical Records (EMR) can prompt providers to place GR order. We initiated BPA at John Peter Smith (JPS) hospital, a SNH in Texas, and evaluated if the BPA improved referral patterns. Methods: A retrospective review was conducted using JPS tumor registry data. We studied pts diagnosed with pancreatic adenocarcinoma (AC) or neuroendocrine tumors (NET) from 1/1/2018 to 4/30/2023 at JPS. BPA go-live date was 10/19/2022. Data Analytics team queried EMR regarding GR, if pts completed their genetics encounter (GE), and GT. Statistical analysis using a two-tailed T test was performed. Results: 162 PC pts were identified: 155 (96%) AC and 7 (4%) NET, and the median age was 59 years. A majority of patients were diagnosed in house (114/162, 70%), while the rest were referred to JPS after diagnosis elsewhere. A total of 57 pts were excluded due to being placed on hospice, death within 3 months of diagnosis, or refusing oncology services at JPS. 105 pts were included for analyses: 96 were diagnosed with PC before the BPA go-live date (pre-BPA) and 9 after the BPA go-live date (post-BPA). 36 (38%) pts were referred pre-BPA. 23 pre-BPA pts completed GE, median of 15 days from referral. 7 out of 9 (78%) pts received GR post-BPA. Post-BPA pts were all referred due to BPA triggers being fired. 2 post-BPA pts completed GE with a median time of 27.5 days from GR. Since launching the BPA, a statistically significant increase in GR has been observed (p=0.0187). 2 pre-BPA pts who completed GT were found to have a pathogenic variant. Conclusions: BPA has shown a significant improvement in GR for PC. Our study population is limited by rarity of PC, and the BPA alert is set to only fire for pts receiving oncology care at JPS. We noted a large number of pre-BPA pts that have yet to be referred and remain at risk. Updates to the BPA build are needed to capture previously diagnosed pts who are receiving JPS oncology services. For future studies, we will analyze pts with other cancer diagnoses to continue to improve upon the GR process.[Table: see text]

Recommendations about the Programming of Medical Activities in Medical Oncology of the Chilean Society of Medical Oncology

The objective of this publication is to expose the current situation and to establish recommendations for the scheduling of the medical activities in medical oncology considering the different types of care delivery and the necessary time for these to improve patient care while protecting the physician wellbeing. A review of the national and international literature was carried out regarding the scheduling of medical oncology care, and a web seminar was held with national medical specialists in oncology. We were able to show that there are no standard schedules, and there is a great dispersion in the number of patients treated in the different centers at the national level. The Chilean Society for Medical Oncology considers essential to standardize medical programming in the different oncology services, in order to assure the best care for cancer patients and to protect the medical personnel from work overload.

The Value of the Advanced Practitioner in Hematology and Oncology: Establishing Benchmarks

Advanced practitioners (APs) in hematology and oncology (heme/onc) practice and provide oversight across myriad settings, including outpatient, inpatient, specialty centers, infusion centers, and other care settings. Understanding the complexity of care within the specific role APs play in providing day-to-day services across the oncology service line and throughout the continuum of care is critical to developing productivity metrics that adequately reflect the value and scope of the heme/onc AP role. Productivity metrics specific to APs are lacking. Physician models, commonly applied to APs, do not adequately reflect the changing landscape of oncology services, and more importantly do not capture nonbillable services APs provide that are essential to run a practice safely, effectively, and efficiently. Here we describe results of the APSHO Productivity, Burnout, and Work-Life Balance Survey deployed to APSHO members in October 2022 with insight into the day-to-day workload of heme/onc APs, levels of burnout, and perceptions of work-life balance in their current role. Results of the survey confirm the significant amount of time APs spend performing tasks that are not billable but are crucial for access to care and treatment, patient safety, practice efficiency, and downstream revenue. Imperative to an agile and stable heme/onc workforce is an AP leadership structure. Advanced practitioner leaders are at the cornerstone of AP retention, yet metrics for measuring AP leader productivity are also lacking. Now, more than ever, it is essential to accurately describe and assign value to the broad scope of services APs and AP leaders bring to heme/onc practices.

Provision of acute oncology services in the UK: data from the Society for Acute Medicine Benchmarking Audit 2022 (SAMBA22)

Acute oncology services (AOS) manage acute cancer-related presentations alongside acute medical teams. This study assessed AOS provision against national peer review measures and the burden of acute cancer-related admissions. The 2022 Society for Acute Medicine Benchmarking Audit surveyed UK hospitals, collecting hospital-level and patient-level data for all medical admissions over a 24-h period. Logistic regression models were constructed to identify differences in patient outcomes for cancer-related admissions. Most hospitals (n=120 or 91.6%) reported having an AOS. There was heterogeneity in AOS provision, with many failing to meet peer-review measures. Of the 7,116 patients, 542 (7.6%) were cancer-related admissions. Cancer-related admissions had greater clinical acuity (p<0.05), length of stay (p<0.001) and 14-day mortality (adjusted odds ratio (OR)=3.54, 95% confidence interval (CI): 2.41–5.22, p<0.001) compared with other medical admissions. Increasing availability of AOS with integration of ambulatory pathways are vital next steps to improving care for acute cancer-related admissions.

Ferric derisomaltose and Outcomes in the Recovery of Gynecologic oncology: ERAS (Enhanced Recovery After Surgery) (FORGE) – a protocol for a pilot randomised double-blinded parallel-group placebo-controlled study of the feasibility and efficacy of intravenous ferric derisomaltose to correct preoperative iron-deficiency anaemia in patients undergoing gynaecological oncology surgery

IntroductionIron-deficiency anaemia is common in gynaecological oncology patients. Blood transfusions are immunosuppressive and carry immediate and long-term risks. Oral iron replacement remains the standard of care but requires prolonged treatment...

SIOG2023-5-P-394 - Bone Health Assessments in Geriatric Oncology: The Senior Adult Oncology Service & Endocrinology

SIOG2023-5-P-394 - Bone Health Assessments in Geriatric Oncology: The Senior Adult Oncology Service & Endocrinology

Virtual inpatient continuity visit to reduce readmissions, establish goals of care and engage palliative care: A feasibility pilot.

421 Background: Patients with solid tumors readmitted within 30 days (d) have a median overall survival of less than 90d. Decisions regarding goals of care (GOC), engagement with Palliative Care (PC) and further therapy are often deferred to the outpatient team leading to future readmissions. Methods: A pilot virtual continuity visit (VCV) program was developed using a video platform to arrange meetings with outpatient oncologists, inpatient teams, patients, families and PC providers during a hospital readmission within 30d. The intervention occurred on a single solid tumor oncology service at an academic medical center. Patients were included if discharged from the same hospital within 30d and not readmitted from hospice or SNF. Exclusion criteria included admission for scheduled therapy, curative-intent treatment, or acute side effects of new therapy. Orders were placed at the discretion of the inpatient team. Visits were scheduled only on weekdays. A structured discussion tool was used for prognostic awareness, GOC and availability of PC services. Results: From April 1, 2022 through March 31, 2023, 96 unique patients were eligible for VCVs. This represented 6% admissions to this floor. 15 VCV were completed, 23 were scheduled but not completed, 58 were not scheduled. Reason scheduled visits not completed included: in-person family meeting (7 ), physician unavailable (9), transfer off floor (1), conversation deferred to outpatient visit (4), not clinically necessary (2). Reason visits not scheduled: unable to schedule prior to D/C (37), deferred to outpatient (2) hospice D/C (3), not appropriate (5), in person visit (1). Of the 15 patients who completed VCV, 0% were readmitted within 30d, 100% had documented GOC discussion and 100% had PC engaged in the VCV. Of the 7 patients who had in person visits, 3 of 7 were readmitted, 1 of 7 in person visits had a documented GOC discussion. No PC engagement was present for the in-person meetings. 51/58 patients without scheduled VCV were readmitted, 22 within 30d. Conclusions: VCV are feasible via a video platform with the patient, primary oncologist, inpatient team and PC. The structured discussion provided clear documentation of prognostic awareness, GOC and engagement with PC. No patient who completed a VCV was readmitted.

Integrated supportive oncology program and outcomes for cancer patients at the end of life.

240 Background: Patients with advanced cancer are often exposed to acute medical care that does not improve quality of life or restore health. Further, the cost of care during the terminal phase defined as the last 30 days of life is substantially higher with the vast majority related to acute care services. We established an integrated outpatient supportive oncology service to improve quality of life for patients with advanced cancer. The embedded program provides same day access, longitudinal symptom management, and advanced care planning services. Here, we looked at our institutional outcomes of those patients managed by the integrated supportive oncology program. Methods: A retrospective cohort analysis was performed on patients with metastatic cancer treated at Intermountain Medical Center who died between January 1, 2022 and December 31, 2022. The study population included patients who were seen in the integrated supportive oncology clinic. Hospitalizations, length of stay, and deaths in the hospital during the last 30 days of life were recorded. We used Medicare and commercial insurance claims data to calculate the cost of these end-of-life hospitalizations. Results: Of 164 patients with cancer who died in 2022, 111 (67%) received longitudinal care from the supportive oncology clinic. Hospitalization rate in the last 30 days of life was lower in the study population compared to the control cohort (26% vs 50%) as were in-hospital deaths (7% vs 19%). The median cost of an end-of-life hospitalization was $20,648. Conclusions: An integrated supportive oncology service decreases the rates of end of life hospitalizations and in-hospital deaths for patients with advanced cancer. This is associated with a cost savings.

Introducing a multidisciplinary approach to medication optimization for geriatric oncology inpatients.

455 Background: Drug-related complications have been associated with adverse outcomes in older adults with cancer. This pilot interventional study aimed to assess the feasibility of introducing an inpatient multidisciplinary (MDT) comprehensive medication assessment focussing on the specific needs of older adults with cancer, in addition to standard hospital medication review and reconciliation. Methods: Patients≥70 years with a solid tumour diagnosis, admitted under the medical oncology service, were discussed at a weekly MDT meeting involving geriatric oncology physicians, nurses and pharmacists. Relevant data including age, cancer type and stage, Rockwood clinical frailty scale, comorbidities, medications on admission and initiated during hospitalisation, systemic anti-cancer therapy (SACT), falls history, cognitive screening, and laboratory parameters were prospectively collected. An MDT medication review was conducted including SACT toxicity assessment, drug-drug interactions (DDI), potentially inappropriate medication (PIM) assessment using STOPP/START criteria, and anticholinergic burden (ACB) scoring. A summary of medication review findings and recommendations was provided to the primary inpatient team to support medication optimisation. Results: Sixty patients were included over a 4 month period, with a median age of 76.5 years (range 65-88). Most patients had lung cancer (36.7%), 80% had stage IV disease. Twenty-five patients (42%) were moderately or severely frail. Most patients (61.7%) were on systemic anti-cancer therapy (SACT). Seven patients (11.7%) had a fall in the previous 3 months and 15 patients (25%) experienced acute confusion during the hospitalisation. ADEs were identified in 26 patients (43%), PIMs in 33 (55%), excessive ACB in 43 (72%) and DDIs in 53 (88%). MDT medication optimisation recommendations were made in 59 patients (98%) in addition to standard of care review. Based on review findings, medication interventions included recommendations to deprescribe, start drug, amend drug dose, route or frequency, perform additional laboratory monitoring, and SACT-specific recommendations (Table 1). Conclusions: Implementing an interprofessional geriatric oncology MDT approach to medication review in hospitalised older adults with cancer can result in additional medication recommendations alongside standard of care.[Table: see text]

SIOG2023-5-P-329 - The Pharmacist Role Within the Senior Adult Oncology Service at the Christie NHS Foundation Trust

SIOG2023-5-P-329 - The Pharmacist Role Within the Senior Adult Oncology Service at the Christie NHS Foundation Trust

OTHER-07 NEUROSURGICAL ONCOLOGY CAPACITY IN KENYA: RESULTS FROM A NATIONWIDE SURVEY OF CONSULTANTS AND RESIDENTS.

Abstract Neurosurgical oncology services (NOS) in Kenya have grown in tandem with resident training programs yet little is known objectively on current capacity and challenges. A 37-item electronic survey was distributed to neurosurgical consultants and residents practicing in Kenya. Among 49 respondents [27 consultants (69% national response rate), 22 residents; median age of 36 – 40; 51% practice &amp;lt; 5 years], 100% and 88% had access to CT scan and MRI brain respectively. 57% performed more than 40 cranial tumor surgeries annually and 48/49 (98%) perform oncology cases on a “regular basis”. Radiotherapy, chemotherapy, and pathology are performed within the respondents’ institutions in 63%, 65% and 61% of surveys, while the rest are sent out. 45 (96%) utilize an operating microscope, and 8 (17%) have an ultrasonic aspirator. Palliative care services are available for 45 (92%). 41 (84%) “agree” or “strongly agree” that delays in referrals between specialties are a major challenge to practice. 38 (78%) “agree” or “strongly agree” that treatment abandonment is also a major challenge. 49% participate in a tumor registry however major barriers to conducting research included lack of funding and protected research time. Having a mentor is perceived as the greatest facilitator for conducting research. No respondents enrolled any patient in a clinical oncology trial during the past year yet nearly every neurosurgeon performs oncology cases and 60% of Kenyan neurosurgeons carry a major tumor case load, in contrast to countries where elective spine surgery predominates neurosurgical practice. Clinical trial enrolment remains uncharted in Kenyan neurosurgery and more than 2/3 of Kenyan counties lack NOS. This survey highlights progress in availability of neurosurgical oncology services while identifying that containing treatment cost, reducing referral delays, and embedding clinical research in clinical practice through mentorship can be NOS growth catalysts.