Oncology Consultation Research Articles

Rural patients highly satisfied with gynaecological oncology care via telehealth.

Introduction of telehealth for gynaecological oncology consultations aims to improve access to specialised care for rural and remote Queensland women with gynaecological malignancies. This survey examines patient satisfaction with gynaecological oncology consultations via telehealth after introduction of the service in Far North Queensland in 2017. Patients who accessed the gynaecological oncology telehealth service at Cairns Hospital from January 2019 to June 2020 were invited to participate in the study. Demographic details and results of a satisfaction survey were investigated. The questionnaire included 16 statements measured on a five-point Likert scale and three open-ended questions, which were coded into related responses and predominant themes developed. Fifty-three patients completed the study. The mean satisfaction score across all questions was 90.5% (standard deviation 8.7%). The lowest overall patient score was 77.5% and the highest was 100%. Themes emerging from the open questions were emotions experienced by women, communication, relationship building and acceptability of the service. Patients were highly satisfied with the telehealth service. Our findings encourage further development and research into telehealth care models for surgical disciplines such as gynaecological oncology.

Computer-Based Decision Tools for Shared Therapeutic Decision-making in Oncology: Systematic Review.

BackgroundTherapeutic decision-making in oncology is a complex process because physicians must consider many forms of medical data and protocols. Another challenge for physicians is to clearly communicate their decision-making process to patients to ensure informed consent. Computer-based decision tools have the potential to play a valuable role in supporting this process.ObjectiveThis systematic review aims to investigate the extent to which computer-based decision tools have been successfully adopted in oncology consultations to improve patient-physician joint therapeutic decision-making.MethodsThis review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 checklist and guidelines. A literature search was conducted on February 4, 2021, across the Cochrane Database of Systematic Reviews (from 2005 to January 28, 2021), the Cochrane Central Register of Controlled Trials (December 2020), MEDLINE (from 1946 to February 4, 2021), Embase (from 1947 to February 4, 2021), Web of Science (from 1900 to 2021), Scopus (from 1969 to 2021), and PubMed (from 1991 to 2021). We used a snowball approach to identify additional studies by searching the reference lists of the studies included for full-text review. Additional supplementary searches of relevant journals and gray literature websites were conducted. The reviewers screened the articles eligible for review for quality and inclusion before data extraction.ResultsThere are relatively few studies looking at the use of computer-based decision tools in oncology consultations. Of the 4431 unique articles obtained from the searches, only 10 (0.22%) satisfied the selection criteria. From the 10 selected studies, 8 computer-based decision tools were identified. Of the 10 studies, 6 (60%) were conducted in the United States. Communication and information-sharing were improved between physicians and patients. However, physicians did not change their habits to take advantage of computer-assisted decision-making tools or the information they provide. On average, the use of these computer-based decision tools added approximately 5 minutes to the total length of consultations. In addition, some physicians felt that the technology increased patients’ anxiety.ConclusionsOf the 10 selected studies, 6 (60%) demonstrated positive outcomes, 1 (10%) showed negative results, and 3 (30%) were neutral. Adoption of computer-based decision tools during oncology consultations continues to be low. This review shows that information-sharing and communication between physicians and patients can be improved with the assistance of technology. However, the lack of integration with electronic health records is a barrier. This review provides key requirements for enhancing the chance of success of future computer-based decision tools. However, it does not show the effects of health care policies, regulations, or business administration on physicians’ propensity to adopt the technology. Nevertheless, it is important that future research address the influence of these higher-level factors as well.Trial RegistrationPROSPERO International Prospective Register of Systematic Reviews CRD42021226087; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021226087

Optimizing Radiation Oncology Consult Visits Using Patient Flow Analysis (PFA)

An efficient workflow in the oncology ambulatory care setting can improve patient experience and decrease provider burnout. The purpose of this study was to identify inefficiencies, develop an optimized workflow, and measure the resulting post-implementation impact in a high-volume radiation oncology department.We conducted an IRB-approved study in Gastrointestinal Radiation Oncology (GIRO) at a large academic cancer center. Patient Flow Analysis (PFA) was used to track 556 consults from check-in to check-out. Process maps were created and an improved clinical workflow was designed based on the findings. The specific roles and responsibilities of each clinical team member were defined and clearly communicated. Timepoints were collected using the electronic medical record (EPIC) status board, which was updated by clinical staff. Pre- vs. post-implementation metrics, including total clinic cycle times, waiting times, rooming times, and time spent with each clinical team member were compared.Initial PFA led to recommendations targeting four principal inefficiencies: (1) protracted patient rooming, (2) delays due to inefficient communication, (3) duplicated tasks, and (4) ambiguous clinical roles. There were 485 pre- and 71 post-implementation consults available for analysis. The optimized workflow resulted in reduction in overall median cycle times by 21% (91 vs. 72 min; P < 0.001). Consults > 2 hours in duration occurred in 22% of pre-implementation vs. 0% of post-implementation visits (P < 0.001). Similarly, the proportion of visits requiring < 1 hour was 16% pre- vs. 34% post-implementation (P < 0.001). Patients spent significantly less time in the waiting room (14 vs. 5 min; P < 0.001) despite no significant differences in the proportion of patients arriving early, on-time, or late. Overall, wait times at each step in the visit process were reduced by 55-70% (Table 1).PFA can be used to identify clinical inefficiencies and optimize workflows in radiation oncology. Utilizing this patient-centric model reduced waiting times and total consult duration, which may improve patient satisfaction, decrease staff burnout, and provide a framework for financial savings through innovative staffing models. Efforts are currently underway to expand this process across all sections within our department.

COVID-19 Testing Trends: Pre-Radiation and Throughout Cancer Care

Purpose/Objective(s)Timely care is critical for individuals diagnosed with cancer—despite the ongoing COVID-19 pandemic—as delays adversely affect cancer outcomes. Patients presenting for radiotherapy (RT) at a single institution who underwent COVID-19 screening procedures prior to RT were analyzed regarding treatment delays and disparities.Materials/MethodsOur institution is an urban multidisciplinary cancer center. In April 2020, our Radiation Oncology department implemented universal COVID-19 screening protocols prior to RT initiation (with possible patient opt-out) to ensure patient/staff safety. Patients did not start RT until testing negative. We collected patient demographics and COVID-19 testing information on patients planned for RT from April to October 2020. We studied trends of other lifetime COVID-19 testing that these patients received to evaluate for overall delays. Summary statistics were analyzed within a data collection web application.Results177 consecutive patients with cancer were scheduled to begin RT. 15 (8.5%) declined pre-RT COVID-19 testing and proceeded to RT. Of patients who consented to pre-RT testing, 99 (61.1%) were female; mean age was 60.6 (range 24-94). Most patients were Black (n = 98, 60.5%). 61 (37.7%) and 41 (25.3%) were insured through Medicare and Medicaid, respectively. Common primary cancer sites were breast (n = 52, 32.1%), prostate (n = 27, 16.7%), and lung (n = 23, 14.2%). 58 (35.8%) patients presented with metastatic disease; the most common metastatic sites were bone (n = 26, 44.8%) and brain (n = 12, 20.7%). Most patients received external RT (n = 152, 93.8%), primarily adjuvant (n = 66, 40.7%) and palliative (n = 59, 36.4%) RT. One (0.6%) asymptomatic patient tested "presumptive positive" for COVID-19 pre-RT. The patient was COVID-19 negative on immediate repeat testing and proceeded to RT. Overall, the 162 patients who consented to pre-RT testing received 549 total lifetime COVID-19 tests. Most of these patients received palliative RT (n = 219, 39.9%), followed by adjuvant (n = 199, 36.2%) and definitive RT (n = 101, 18.4%). Mean number of total COVID-19 tests per patient was 3.4 (range 1-14). Only 32 patients (19.8%) were administered a solitary pre-RT COVID-19 screening test. 24 (14.8%) patients had at least one positive COVID-19 test over the study period. In total, 32 (5.8%) positive COVID-19 test results were documented; 11 patients (6.8%) experienced a mean RT delay of 4.0 (range 3-8) weeks until testing negative. Other care delays included surgical/diagnostic procedure delays (n = 4), delayed presentation due to COVID-19 fears (n = 2), and travel restrictions (n = 1).ConclusionThe majority of patients with cancer planned for RT tested negative for COVID-19 and proceeded to RT without delay. However, delays prior to radiation oncology consultation due to diagnostic workup, imaging, or biopsies, as well as testing positive for COVID-19, could intensify underlying disparities affecting our urban patient population.

Impact of the COVID-19 Pandemic on Radiation Oncology Consult Volumes Within a Multi-Site Academic Practice

Purpose/Objective(s)Cancer care has been significantly impacted by the COVID 19 pandemic; however, a comprehensive understanding of the downstream effects of the pandemic on radiation oncology practice in the United States has not been well quantified. We sought to quantify the differences in radiation consult volumes across varying disease sites and practice locations within our National Cancer Institute (NCI) designated Comprehensive Cancer Center, at time points preceding and during the COVID 19 pandemic. The purpose of this study is to identify potential gaps in care for specific disease sites that could addressed in the future.Materials/MethodsWe collected new patient referral data from three clinical radiation oncology sites for the 2019 calendar year and the 2020 calendar year. Overall new patient referrals for 2019 and 2020 were analyzed and compared as well as consult volume for each disease site.ResultsIn 2019, there was a total 4,284 overall consults and in 2020 there was a total of 3,442 consults. This is a 20% reduction in consults over a 12-month period. The month of April had the most significant decrease in consults with a total of 357 consults in April 2019 compared to a total of 179 consults in April 2020 (50% reduction). The month of February had the least reduction with 329 total consults in 2019 compared to a total of 313 consults in 2020 (5% reduction). There was a decrease in consult volumes for all tumor sites with the exception of following tumor sites which saw an increase in consult volumes: colon (55.6%), kidney &renal pelvis (15.8), larynx (32.7%), oral cavity (7%), Non-Hodgkin's Lymphoma (9.9%), other head & neck (13.9%), and thyroid cancer (36.4%). Breast and prostate cancer had the greatest absolute change in consult volume loss (32.6%, 29.3% respectively). Oral tongue cancer was the sole tumor site that had no change in consult volume across the study period.ConclusionThe ramifications of COVID-19 will be seen in the practices of clinicians, cancer centers, and the experiences of patients and their families for years to come. We found a 20% overall reduction in new patient referrals for 2020. The most significant absolute change in volume loss was seen in breast and prostate cancer. Head and neck cancer referrals were the most minimally impacted, with some increases in referrals during the study period which could possibly be related to limited surgical resources necessitating non-operative treatment. Further studies are needed to more comprehensively understand the impact of the COVID 19 pandemic on radiation oncology practice.

Hypofractionated Dose-Escalation for Elderly Patients With a Newly Diagnosed Glioblastoma Improves Survival

The standard of care for elderly glioblastoma patients (GBM) is 40 Gy in 15 fractions with temozolomide (TMZ). However, this regimen has a lower biologic equivalent dose (BED) compared to the Stupp regimen of 60 Gy in 30 fractions. We hypothesize that dose escalated hypofractionated radiation of 52.5 Gy in 15 fractions (BED equivalent to Stupp) will have superior survival compared to 40 Gy in 15 fractions.Elderly patients (> 60 yo) who received hypofractionated radiation with TMZ were included in this analysis. Overall survival (OS) and progression free survival (PFS) were defined as the time elapsed between surgery/biopsy and death from any cause or progression. Baseline characteristics were compared with pairwise tests. Univariate and multivariate analyses were performed.66 newly-diagnosed patients were eligible for this analysis. 39 patients were treated with 40 Gy in 15 fractions, and 27 patients were treated with 52.5 Gy in 15 fractions. The median follow up for this cohort was 8.8 months. Patients were well balanced with no significant differences in age, sex, MGMT, extent of resection, or KPS. The median OS was 7.9 months in the 40 Gy arm and 13.1 months in the 52.5 Gy arm (P = 0.035). For unmethylated patients, the median OS was 6.7 months in the 40 Gy arm and 11.3 months in the 52.5 Gy arm (P = 0.012). Increasing planning treatment volume (P = 0.007) was associated with decreased OS. On multivariate analysis, MGMT methylation (HR 0.45 [0.23-0.87] P = 0.018) and dose escalation (HR 0.45 [0.21-0.96] 0.04) remained independent prognostic factors for OS. In a multivariate model for PFS, only dose-escalation was significant (HR 0.49 [0.25-0.98] P = 0.045). No significant differences in toxicity were observed between treatment groups.Dose-escalation to 52.5 Gy in 15 fractions was associated with superior OS and PFS compared to standard of care 40 Gy in 15 fractions. This treatment regimen gives the elderly population an alternative to Stupp that is not de-escalating therapy. These hypothesis generating data support dose-escalated hypofractionation in future prospective trials.H.K. Perlow: None. M. Yang: None. B. Klamer: None. R. Raval: None. D.M. Blakaj: None. A.L. Arnett: None. S. Beyer: None. J.C. Grecula: None. M. Ammirati: None. J.B. Elder: None. R.R. Lonser: None. D. Hardesty: None. S.S. Ong: None. P. Giglio: None. C. Pillainayagam: None. J. Goranovich: None. A. Chakravarti: None. V. Gondi: Partner; Radiation Oncology Consultants, Ltd. Honoraria; UpToDate, RaySearch. Partnership; Radiation Oncology Consultants, Ltd. Co-Principal Investigator; NRG Oncology. P.D. Brown: None. J.D. Palmer: Research Grant; Varian Medical Systems, The Kroger Company. Consultant; Huron Consulting. Speaker's Bureau; Varian Medical Systems, Depuy Synthes. Advisory Board; Novocure. Member of panel; NCCN.

This Month in Adult Urology

This Month in Adult Urology

Methodological choices in experimental research on medical communication using vignettes: The impact of gender congruence and vignette modality

ObjectiveExperimental vignette designs are used to systematically test the effects of medical communication. We tested the impact of two methodological choices –gender congruence and vignette modality– on analogue patient reported outcomes. MethodsIn an online experiment using a vignette portraying an oncological bad news consultation, we manipulated (1) gender congruence between the analogue and the vignette patient, and (2) vignette modality, i.e., text, audio, or video. Cancer-naïve students acting as analogue patients (N = 209, 22 ± 3 years old, 75% F) were assigned one randomly-selected vignette variant and completed questionnaires. Using 3 × 2 (repeated-measures) ANOVAs, we tested main and interaction effects of gender congruence and modality on self-reported engagement, recall, trust, satisfaction and anxiety. ResultsWe found no main effects of gender congruence or modality on any of the outcomes, nor any interaction effects between modality and congruence. ConclusionOur results indicate that researchers may needlessly create gender-congruent vignettes at considerable cost and effort. Also, the currently assumed superiority of videos over other modalities for experimental vignette-based research may be inaccurate. Practice implicationsAlthough further testing in an offline format and among different populations is warranted, decisions regarding gender congruence and modality for future vignette-based studies should be based primarily on their specific aims.

Survivors' preferences for the organization and delivery of supportive care after treatment: An integrative review.

Quality supportive care during cancer survivorship contributes to positive physical and psychosocial health. However, the potential positive impacts are influenced by survivors' perceptions of and ability to access the supportive care services that they deem important to their well-being. The purpose of this integrative review was to examine cancer survivors' preferences for the organization and delivery of supportive care services in the post-treatment period. We conducted a systematic search for relevant quantitative, qualitative and mixed methods studies. Included studies were analyzed using directed content analysis, focused on models of care and type of provider, site of care, specialized services, structural supports through transitions, and sources of information. Sixty-nine studies were included. Overall, survivors' preferences are not static and fluctuate over time based on their perceived health needs, concerns and points of transition in care. While specialist supportive care led by consultant oncologists is often identified as the preferred model of care, survivors' also express preferences for integrated and shared models of care, involving oncology nurses, primary care and multidisciplinary professionals to optimise coordination and impact of supportive care. Flexibility in care delivery, leveraging technology and expertise, was preferred to ensure convenient and timely access to supportive care. Cancer survivors express preferences for the organization and delivery of supportive care in the post-treatment phase that fluctuate based on their perceived health needs. The development of novel survivorship health services must consider survivors' preferences and allow flexibility in care delivery to facilitate engagement, uptake, and effectiveness.

“The waiting is the worst”: Development of a next day access (NDA) program for patients with cancer.

205 Background: Delays in access to treatment can cause anxiety and distress in patients with cancer. Time to treatment is increasing nationally, with retrospective analyses showing worse outcomes in patients with longer times to treatment initiation. It is critical to implement interventions that enhance navigation, improve access to cancer care, and eliminate operational and cultural barriers to prompt establishment of care and subsequent treatment initiation. We piloted a program for oncologic consultation within 1 business day in two subspecialty clinics and two network sites within our NCI designated comprehensive cancer center. Methods: Each pilot team created an implementation plan, with algorithms defining patients “eligible” for NDA. Generally, patients with a diagnosis or findings suggestive of cancer were eligible; full records were not required prior to the NDA visit. Interventions included adjusting physician templates and use of specific scripting to set expectations for patients prior to NDA visit. An institutional dashboard was created to display metrics--including new patient volume, % NDA visits, and reasons for non-utilization. Plan-Do-Study-Act cycles were completed every 2 weeks to assess data input/validity and address challenges. Patients seen via NDA completed a brief anonymous survey regarding their experience. Results: In 7 months, a total of 3107 new patients were seen across the 4 pilot sites, 900 (29.8%) of whom met “next day appropriate” criteria, and 370 (12%) of whom were seen via NDA. Uptake of NDA appointments was higher in patients with breast cancer. NDA patient satisfaction was extremely high, with 96% indicating that expectations were met or exceeded. Over half (56%) responded that a timely appointment was important when choosing a cancer center. The most common reasons patients were not seen via NDA included: specific provider requested (41%), specific date requested (23%), unavailable next day appointment (6%). Cultural barriers, particularly from treating physicians, included feeling that NDA appointments were inefficient with incomplete data, less time for clinical review, and increased burden due to last minute new patients; operational challenges included insufficient staffing and ensuring complete/accurate data collection. During 12/2019 – 2/2020, median time to first visit ranged from 17 to 36 days; median time to first visit decreased in 3 of the 4 pilot sites to 6-20 days 1 year later. Conclusions: Overall, 12% of patients were seen via NDA Success of this pilot required extensive effort to address change management and perceived barriers. Deployment in other disease teams and community sites is underway.[Table: see text]

First-Line Palliative Chemotherapy for Esophageal and Gastric Cancer: Practice Patterns and Outcomes in the General Population.

Clinical trials have shown that palliative chemotherapy (PC) improves survival in patients with incurable esophageal and gastric cancer; however, outcomes achieved in routine practice are unknown. We describe treatment patterns and outcomes among patients treated in the general population of Ontario, Canada. The Ontario Cancer Registry was used to identify patients with esophageal or gastric cancer from 2007 to 2016, and data were linked to other health administrative databases. Patients who received curative-intent surgery or radiotherapy were excluded. Factors associated with the receipt of PC were determined using logistic regression. First-line PC regimens were categorized, and trends over time were reported. Survival was determined using the Kaplan-Meier method. The cohort included 9,848 patients; 22% (2,207 of 9,848) received PC. Patients receiving PC were younger (mean age, 63 v 74 years; P < .0001) and more likely male (71% v 65%; P < .0001). Thirty-seven percent of non-PC patients saw a medical oncologist in consultation. Over the study period, utilization of PC increased (from 11% in 2007 to 19% in 2016; P < .0001), whereas the proportion of patients receiving triplet regimens decreased (65% in 2007 to 56% in 2016; P = .04). In the PC group, the median overall and cancer-specific survival from treatment initiation was 7.2 months. One fifth of patients with incurable esophageal and gastric cancer in the general population receive PC. Median survival of patients treated in routine practice is inferior to that in clinical trials. Only one third of patients not treated with PC had consultation with a medical oncologist. Further work is necessary to understand low utilization of PC and medical oncology consultation in this patient population.

Interprofessional Education Curriculum for Medical Assistants in Radiation Oncology: A Single Institution Pilot Program

PurposeMedical assistants (MAs) occupy an increasingly prevalent role in the clinical setting. Subspecialized fields such as oncology require specific clinical knowledge; however, MAs have few requirements for continued education. Here we assess the role and effect of a pilot MA Radiation Oncology education curriculum. Methods and MaterialsA needs assessment survey was conducted and reviewed to develop a comprehensive introductory oncology curriculum. A resident physician-led program was implemented in an academic cancer care center consisting of monthly, 1-hour lectures. Pre- and postlecture surveys were administered to assess learning. Quarterly surveys were conducted over the 20-month curriculum timeframe. ResultsThe needs assessment revealed that there were no pre-existing MA continuing education didactics, but all (100%) MAs surveyed were “very interested” in such a curriculum. Sessions were found to be clear, comprehensive, relevant, and associated with a significant increase in a sense of empowerment (P = .035). Topics in Head and Neck and Breast Cancer showed large improvements in understanding (change in median Likert score of 3-4 points each) whereas topics in Introduction to Oncology and New Patient Consultation showed the smallest change (change 0.5-1). For 20 months, there was a sustained improvement in clinical understanding within and outside the scope of the MA role and an improvement in perceived empathy for patients (from median Likert score 3.5-5). ConclusionsDedicated education programs for MAs show the potential to improve clinical understanding and participation in patient care. Further studies may demonstrate how such programs translate to staff productivity or patient clinical outcomes. Interprofessional education may facilitate collaboration and enhanced clinical workflow.

Barriers to cancer care for people with significant mental health difficulties: What healthcare staff say?

Despite similar rates in cancer morbidity, patients with comorbid significant mental health difficulties (SMHD) experience higher mortality rates. This population has largely been neglected in cancer care research. Little is known about how to improve cancer outcomes for patients with SMHD. The aim of this research is to explore the views of healthcare professionals concerning the provision of cancer care to individuals with SMHD in an Irish context. Semi-structured interviews were conducted with healthcare professionals (n=28) providing care to people with SMHD and cancer. This included oncology and psychiatry consultants (n=10); clinical nurse specialists (n=8); clinical psychologists (n=6); and medical social workers (n=4). Data were analysed using thematic analysis. Four overarching themes were generated from the data highlighting the challenges associated with healthcare provision for this cohort. The themes were: Fragmentation of Care, Healthcare Providers' Understanding of SMHD, Complex Nature of Presentation, and Specialised Care Needs. The findings contribute to advancing our understanding of cancer care provision for patients with SMHD. They identify important barriers and facilitators to cancer care provision for this population from the perspective of healthcare professionals in Ireland. These findings will help to shape future research and contribute to improving the quality-of-care for people with SMHD and cancer.

WIR im interaktionalen Gebrauch: Zur Verwendung des Pronomens der 1. Person Plural in der institutionellen Kommunikation – am Beispiel onkologischer Aufklärungsgespräche

AbstractThis empirically oriented article focuses on uses of the pronoun “wir” (‘we’) in medical interaction – more precisely, in oncological consultations. After a brief presentation of major research on the 1st person plural pronoun in German, I will – based on methods of Interactional Linguistics – analyze interactional uses of this deictic pronoun in institutional doctor-patient conversations. This article aims at contributing to research of how grammar is used in response to local interactional needs within social interaction (Auer/Pfänder 2011). As the data show, participants in these institutional settings make use of various types of “wir” – beyond the prototypical forms of usage (a) “self and person addressed”; (b) “self and person or persons spoken of” and (c) “self, person or persons addressed, and person or persons spoken of” (Boas 1911: 39). These “alternative”, non-prototypical uses of “wir”, which partly override the “residual semanticity” (Silverstein 1976: 47), are found to be related to the way in which they are embedded within the particular “social field” (Hanks 2005: 18). Thus, the indexical anchoring of “wir” proves to be rather flexible and responsive to interactional contingencies.

FIELDRT: an open-source platform for the assessment of target volume delineation in radiation therapy

Objectives:Target volume delineation (TVD) has been identified as a weakness in the accuracy of radiotherapy, both within and outside of clinical trials due to the intra/interobserver variations affecting the TVD quality. Sources of variations such as poor compliance or protocol violation may have adverse effect on treatment outcomes. In this paper, we present and describe the FIELDRT software developed for the ARENA project to improve the quality of TVD through qualitative and quantitative feedbacks and individual and personalized summary of trainee”s performance.Methods:For each site-specific clinical case included in the FIELDRT software, reference volumes, minimum and maximum “acceptable” volumes and organ at risk were derived by outlines of consultants and senior trainees. The software components currently developed include: (a) user-friendly importing interface (b) analysis toolbox to compute quantitative and qualitative (c) visualiser and (d) structured report generator for personalised feedback. The FIELDRT software was validated by comparing the performance of 63 trainees and by measuring performance over time. In addition, a trainee evaluation day was held in 2019 to collect feedback on FIELDRT.Results:Results show the trainees’ improvement when reoutlining a case after reviewing the feedback generated from the FIELDRT software. Comments and feedback received after evaluation day were positive and confirmed that FIELDRT can be a useful application for training purposes.Conclusion:We presented a new open-source software to support education in TVD and ongoing continuous professional development for clinical oncology trainees and consultants. ARENA in combination with FIELDRT implements site-specific modules with reference target and organs at risk volumes and automatically evaluates individual performance using several quantitative and qualitative feedbacks. Pilot results suggests this software could be used as an education tool to reduce variation in TVD so to guarantee high quality in radiotherapy.Advances in knowledge:FIELDRT is a new easy and free to use software aiming at supporting education in TVD and ongoing continuous professional development. The software provides quantitative/qualitative feedback and an exportable report with an individual and personalised summary of trainee’s performance.

Referral patterns for gynecologic oncology consultation

Objectives: To identify delays in access to gynecologic oncology (GO) consultation through a detailed characterization of patients’ interactions with the healthcare system prior to GO evaluation. Methods: Medical records of 50 consecutive patients were reviewed from each of 6 academic cancer centers beginning in January, 2018. Clinical and demographic characteristics were abstracted with dates of: first evaluation, testing ordered, testing resulted, diagnosis, referral, and treatment. Degree, specialty, and clinic ZIP code were collected from providers referring to GO, as well as up to two providers previously evaluating the patient for the same complaint (Figure). Primary outcomes were 1) total time in healthcare for a complaint prior to GO referral; 2) first evaluation by referrer #1 to GO referral; and 3) GO referral to treatment start. Intervals >1 year were preliminarily excluded, pending case review. Chi-square and Kruskal-Wallis tests were used for groupwise comparisons of categorical and continuous variables, respectively. Results: 300 cases were analyzed. Mean age was 57.8 years (SD 14.7); patients were predominantly White (77.5%), or Black (17.2%); 89.1% were non-Hispanic. Primary disease sites were uterine corpus (45.8%), ovary (31%), cervix (12.9%) and vulva (5.5%). Final pathology was malignant in 61.9% of cases, borderline/hyperplastic/dysplastic in 13.5%, and benign/unknown in 24.5%.5 patients (1.6%) were evaluated by 3 providers before GO referral; 74 (24%) by 2 providers, and 227 (74%) by 1 provider. GO referral was commonly initiated by OB/GYN (71%), family medicine (9%) and internal medicine (6%). Mean time from first healthcare encounter to GO evaluation was 50.6 days (SD=65); time from first evaluation by referrer #1 to GO referral was 26.8 days (SD=46.8). The longest average interval identified was between first evaluation and diagnostic testing by referrer #1; mean=21.8 days, (SD=48.4). Mean time from GO referral to treatment initiation was 20.7 days (SD=27.5) Mean distance from residence to GO was 41.0 miles (SD=53.7), and was >50mi in 27.8% of all cases. Patients evaluated by 3 providers spent substantially more time in the healthcare system than those evaluated by 1 or 2 providers prior to GO referral (mean 91.0 vs 49.6 and 50.8 days, respectively; p 50 miles compared to patients residing Download : Download high-res image (40KB) Download : Download full-size image Conclusions: We identified two areas amenable to intervention to improve access to GO consultation. First, patients residing >50 miles from the nearest GO experienced delays in treatment. Interventions, including telemedicine, should be developed to address this geographic disparity in care. Second, there was substantial variation in time between patients’ initial evaluation and diagnostic testing by the referring provider. Educational and systems interventions are needed to ensure that signs and symptoms of gynecologic cancers are evaluated appropriately.

Preoperative wait times in high-grade endometrial cancer: do surgical delays impact patient survival?

<h3>Objectives:</h3> Practice guidelines advocating for the regionalization of endometrial cancer surgery to gynecologic oncologists practicing in designated gynecologic oncology centres were released by Cancer Care Ontario in June 2013. We sought to determine the impact this policy had on contemporary surgical wait times. Moreover, a discussion about the impact of delays in treatment has never been more timely than in the context of the current COVID19 pandemic, which has burdened health care systems around the world. Our primary objective was to establish whether longer wait time to surgery is a predictor of survival in patients with high grade endometrial cancer. <h3>Methods:</h3> This was a retrospective cohort study, which included patients diagnosed with non-endometrioid high-grade endometrial cancer (serous, carcinosarcoma, clear cell, and undifferentiated) between 2003 and 2017. A total of 2 regionalization periods were defined, before and after January 2014 to allow 6 months for knowledge translation after guideline publication. Patients were identified in population-based administrative provincial data sources. Multivariable Cox proportional hazards regression with a spline function was used to model the relationship between wait time and overall survival, as measured from time of surgery. <h3>Results:</h3> We identified 3518 patients with high grade endometrial cancer. Median wait time between diagnosis and surgery for the entire cohort did not significantly change with regionalization of care (50 vs 52 days, p=0.14). Patients who had surgery with a gynecologic oncologist had a median surgical wait time from diagnosis to hysterectomy of 55 days compared to 59 days pre-regionalization (p=0.0002), and from first gynecologic oncology consultation to hysterectomy of 29 days compared to 32 days pre-regionalization (p=0.0006). Survival was worst for patients who had surgery within 14 days of diagnosis (HR death 2.7, 95% CI 1.61-4.51 for 1-7 days and HR death 1.96, 95% CI 1.5-2.57 for 8-14 days), indicating disease severity. Decreased survival occurred with surgical wait times of more than 45 days from the patient's first gynecologic-oncology appointment (HR death 1.19, 95% CI 1.04-1.36 for 46-60 days and HR death 1.42, 95% CI 1.11-1.82). <h3>Conclusions:</h3> Regionalization of surgery for high grade endometrial cancer has not had a negative impact on surgical wait times. Impact on survival is seen with patients who have surgery more than 45 days after surgical consultation.

Development of a generalizable natural language processing pipeline to extract physician-reported pain from clinical reports: Generated using publicly-available datasets and tested on institutional clinical reports for cancer patients with bone metastases

Objective:The majority of cancer patients suffer from severe pain at the advanced stage of their illness. In most cases, cancer pain is underestimated by clinical staff and is not properly managed until it reaches a critical stage. Therefore, detecting and addressing cancer pain early can potentially improve the quality of life of cancer patients.The objective of this research project was to develop a generalizable Natural Language Processing (NLP) pipeline to find and classify physician-reported pain in the radiation oncology consultation notes of cancer patients with bone metastases. Materials and Methods:The texts of 1249 publicly-available hospital discharge notes in the i2b2 database were used as a training and validation set. The MetaMap and NegEx algorithms were implemented for medical terms extraction. Sets of NLP rules were developed to score pain terms in each note. By averaging pain scores, each note was assigned to one of the three verbally-declared pain (VDP) labels, including no pain, pain, and no mention of pain. Without further training, the generalizability of our pipeline in scoring individual pain terms was tested independently using 30 hospital discharge notes from the MIMIC-III database and 30 consultation notes of cancer patients with bone metastasis from our institution’s radiation oncology electronic health record. Finally, 150 notes from our institution were used to assess the pipeline’s performance at assigning VDP. Results:Our NLP pipeline successfully detected and quantified pain in the i2b2 summary notes with 93% overall precision and 92% overall recall. Testing on the MIMIC-III database achieved precision and recall of 91% and 86% respectively. The pipeline successfully detected pain with 89% precision and 82% recall on our institutional radiation oncology corpus. Finally, our pipeline assigned a VDP to each note in our institutional corpus with 84% and 82% precision and recall, respectively. Conclusion:Our NLP pipeline enables the detection and classification of physician-reported pain in our radiation oncology corpus. This portable and ready-to-use pipeline can be used to automatically extract and classify physician-reported pain from clinical notes where the pain is not otherwise documented through structured data entry.

Abstract 25: End User Support for Telemedicine Oncology Care in Sub Saharan Africa

Abstract Purpose: Health Information Technology has hugely improved patient healthcare with fast and simple information access and communication. Telemedicine uses telecommunications technology as a tool to deliver health care to populations with limited access to care. International Cancer Institute (ICI) number one goal is to provide end-to-end solutions for optimization of care on patients' journey in sub-Saharan Africa. Supporting the end-user clearly shows there is a lot going on “under the skin” in healthcare Information technology (IT) to bring information access to life and patients closer to the oncology experts. Methods: In 2020, ICI IT team provided end-user support in bi-weekly multidisciplinary oncology –tumour boards with specialists from Africa and the world. It also provided support in Provider-to-provider tele-consults for patients in 10 partner counties in Kenya. The IT team also provided online support to healthcare providers to access online oncology preceptorships/training and webinars in different aspects of the cancer control continuum. Result: The IT team was able to support over 80 Multidisciplinary tumor boards, ensuring a team-based care approach to delivering care. Provider-to-provider tele-oncology ensured a platform to support interprofessional care and mentorship to non-specialists in remote sites. It has also provided one on one county patient consultations and hence ensured delivery of cancer services in 10 county government clinics &amp; 8 private health facilities. Over 300 patient consults have been completed. Online platforms have ensured healthcare provider training despite COVID 19 restrictions; ICI has successfully trained over 1000 health care providers using eLearning and online platforms. Conclusion IT support has successfully provided assistance to physicians, healthcare providers, and patients with technical &amp; non-technical support demonstrating the potential of delivering specialized oncology consultations and improved access to information in primary care settings with limited resources. Citation Format: Lamech Sigu, Emmah Achieng, Chite Asirwa, Gloria Kitur. End User Support for Telemedicine Oncology Care in Sub Saharan Africa [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 25.

Impact of the Covid-19 Pandemic on Oncology Consultations and Practical Management Recommendations

Background: The COVID-19 pandemic had an impact on the organization and access to cancer care, requiring the implementation of unusual management measures. Our study aims to assess the impact of the SARS-CoV-2 (COVID-19) pandemic on cancer outpatients within the oncology and haematology university hospital in Marrakech, in order to establish the best cancer care management strategies. Materials and Methods: Cancer patients, who consulted during the month of April Since the start of national lockdown in Morocco following the COVID 19 pandemic, were invited to respond a questionnaire aimed at assessing the impact of this pandemic on their consultations. The characteristics of the consultants, their infectious status, the ease of access to the hospital, the type of consultation, with or without symptoms, the difficulties encountered, as well as the progress after deconfinement are the main items included in the questionnaire. Results: 73 consultations were carried out in the oncological emergency room during the determined period with 76.71% of the responses, against 247 in April 2019. 57.14% consulted following the presence of symptoms to which the access was easy for 59.37% of 'between them and 46.87% could not go to the emergency room because of lockdown. 42.85% had a follow-up appointment, while 20.83% of these appointments were changed, and 29.16% of these patients have already missed it due to lack of transport and means. An increase in the number of consultants, advanced stages and positive COVID cases was marked after deconfinement. Conclusion: During the COVID-19 pandemic, most consultations at the Marrakech oncology hospital were affected by the state of sanitary lockdown, hence the need for a mutual effort to deal with the fallout from this crisis.