Oncology Consultation Research Articles

How Long Does Contouring Really Take? Results of the Royal College of Radiologists Contouring Surveys

AimsThe success and safety of modern radiotherapy relies on accurate contouring. Understanding the time taken to complete radiotherapy contours is critical to informing workforce planning and, in the context of a workforce shortfall, advocating for investment in technology and multi-professional skills mix. We aimed to quantify the time taken to delineate target volumes for radical radiotherapy. Materials and methodsThe Royal College of Radiologists circulated two electronic surveys via email to all clinical oncology consultants in the UK. The individual case survey requested anonymous data regarding the next five patients contoured for radical radiotherapy. The second survey collected data on respondents' usual practice in radiotherapy contouring. ResultsThe median time to contour one radiotherapy case was 85 minutes (IQR = 50–131 minutes). Marked variability between and within tumour sites was evident: paediatric cancers took the most time (median = 210 minutes, IQR = 87.5 minutes), followed by head and neck and gynaecological cancers (median = 120 minutes, IQR = 71 and 72.5 minutes respectively). Breast cancer contouring required the least time (median = 43 minutes, IQR = 60 minutes). Radiotherapy technique, inclusion of nodes and 4D CT planning were associated with longer contouring times. A non-medical professional was involved in contouring in 65% of cases, but clinical oncology consultants were involved in target volume delineation in 90% of cases, and OARs in 74%. Peer review took place in 46% of cases with 56% of consultants reporting no time for peer review in their job plan. ConclusionContouring for radical radiotherapy is complex and time-consuming, and despite increasing involvement of non-medical professionals, clinical oncology consultants remain the primary practitioners. Peer review practice is variable and time is often a limiting factor. Many factors influence the time required for contouring, and departments should take these factors and the need for peer-review into account when developing job plans.

Enhanced supportive care in cancer centres: national cross-sectional survey

Objectives‘Early’ specialist palliative care (SPC) has been shown to improve outcomes for patients with advanced cancer, yet patients are often referred late. ‘Enhanced supportive care’ (ESC) aims to facilitate earlier...

Mise en place de consultations pharmaceutiques d’initiation en oncologie digestive dans un centre hospitalo-universitaire : bilan à un an

IntroductionThe announcement of a cancer diagnosis is traumatic for the patient. In France, an announcement system has been in place, providing medical time for announcement and treatment proposal, nursing time for support, without including the pharmacist. In order to improve management of patients treated with intravenous anticancer drugs, we set up introductory pharmaceutical consultations in digestive oncology. The aims were to assess the situation one year after the introduction of these consultations, and to assess their contribution. MethodsWhen a patient was diagnosed with digestive cancer and receiving intravenous treatment, a pharmaceutical initiation consultation was scheduled. Indicators of activity (number of consultations, average duration, average preparation time and various delays) and results (number and type of pharmaceutical interventions, patient satisfaction) were collected in order to assess activity. ResultsForty-seven pharmaceutical initiation consultations were carried out. The average duration of the consultations was 39.3minutes. Consultations were carried out on average 12.1 days after the medical consultation and 9.6 days before the first chemotherapy treatment. Twenty-nine patients responded to the satisfaction questionnaire. All were satisfied, and the majority of patients said they had improved their knowledge of cancer treatment. DiscussionThis activity enables us to review with patients essential aspects of their care, such as implanting an implantable chamber catheter, anti-cancer treatment and managing potential side effects and improve their self-care skills.

Optimizing Outpatient Radiation Oncology Consult Workflow by Using Time-Driven Activity-Based Costing: Efficiency and Financial Impacts.

Clinical efficiency is a key component of value-based health care. Our objective here was to identify workflow inefficiencies by using time-driven activity-based costing (TDABC) and evaluate the implementation of a new clinical workflow in high-volume outpatient radiation oncology clinics. Our quality improvement study was conducted with the Departments of GI, Genitourinary (GU), and Thoracic Radiation Oncology at a large academic cancer center and four community network sites. TDABC was used to create process maps and optimize workflow for outpatient consults. Patient encounter metrics were captured with a real-time status function in the electronic medical record. Time metrics were compared using Mann-Whitney U tests. Individual patient encounter data for 1,328 consults before the intervention and 1,234 afterward across all sections were included. The median overall cycle time was reduced by 21% in GI (19 minutes), 18% in GU (16 minutes), and 12% at the community sites (9 minutes). The median financial savings per consult were $52 in US dollars (USD) for the GI, $33 USD for GU, $30 USD for thoracic, and $42 USD for the community sites. Patient satisfaction surveys (from 127 of 228 patients) showed that 99% of patients reported that their providers spent adequate time with them and 91% reported being seen by a care provider in a timely manner. TDABC can effectively identify opportunities to improve clinical efficiency. Implementing workflow changes on the basis of our findings led to substantial reductions in overall encounter cycle times across several departments, as well as high patient satisfaction and significant financial savings.

Referred molecular testing as a barrier to optimal treatment decision making in metastatic non-small cell lung cancer: Experience at a tertiary academic institution in Canada.

Molecular testing is critical to guiding treatment approaches in patients with metastatic non-small cell lung cancer (mNSCLC), with testing delays adversely impacting the timeliness of treatment decisions. Here, we aimed to evaluate the time from initial mNSCLC diagnosis to treatment decision (TTD) following implementation of in-house EGFR, ALK, and PD-L1 testing at our institution. We conducted a retrospective chart review of 165 patients (send-out testing, n = 92; in-house testing, n = 73) with newly diagnosed mNSCLC treated at our institution. Data were compared during the send-out (March 2017-May 2019) and in-house (July 2019-March 2021) testing periods. We performed a detailed workflow analysis to provide insight on the pre-analytic, analytic, and post-analytic intervals that constituted the total TTD. TTD was significantly shorter with in-house testing (10 days vs. 18 days, p < 0.0001), driven largely by decreased internal handling and specimen transit times (2 days vs. 3 days, p < 0.0001) and laboratory turnaround times (TAT, 3 days vs. 8 days, p < 0.0001), with 96% of in-house cases meeting the international guideline of a ≤ 10-day intra-laboratory TAT (vs. 74% send-out, p < 0.001). Eighty-eight percent of patients with in-house testing had results available at their first oncology consultation (vs. 52% send-out, p < 0.0001), and all patients with in-house testing had results available at the time of treatment decision (vs. 86% send-out, p = 0.57). Our results demonstrate the advantages of in-house biomarker testing for mNSCLC at a tertiary oncology center. Incorporation of in-house testing may reduce barriers to offering personalized medicine by improving the time to optimal systemic therapy decision.

Evaluating Systemic Burnout in Medical Oncology Through a National Oncology Mentorship Program.

Mentorship has a positive influence on trainee skills and well-being. A 2022 Pilot Mentorship Program in New South Wales involving 40 participants revealed high burnout rates in Medical Oncology trainees. As part of an Australia-wide inaugural National Oncology Mentorship Program in 2023 (NOMP23), a national survey was undertaken to assess the prevalence of burnout, anxiety, depression, professional fulfilment, and drivers of distress in the Australian medical oncology workforce. NOMP23 is a 1-year prospective cohort study that recruited medical oncology trainees and consultants using e-mail correspondence between February and March 2023. Each participant completed a baseline survey which included the Maslach Burnout Index (MBI), Stanford Professional Fulfilment Index, and Patient Health Questionnaire-4 for anxiety and depression. One hundred and twelve participants (56 mentors, 56 mentees) were enrolled in NOMP23, of which 86 (77%) completed the baseline survey. MBI results at baseline demonstrated that 77% of consultants and 82% of trainees experienced burnout in the past 12 months. Professional fulfilment was noted to be <5% in our cohort. Screening rates of anxiety and depression in trainees were 32% and 16%, respectively, compared with 7% and 2% for consultants. When assessing reasons for workplace stress, two thirds stated that heavy patient load contributed to stress, while almost three quarters attributed a heavy administrative load. Lack of supervision was a key stressor for trainees (39%), as was lack of support from the training college (58%). Trainees and consultant medical oncologists demonstrate high rates of burnout and low professional fulfilment. The NOMP23 program has identified a number of key stress factors driving burnout and demonstrated concerning levels of anxiety and depression. Ongoing mentorship and other well-being initiatives are needed to address these issues.

A Unique Spectrum of Care Tool Provides a Self-Regulated Learning Opportunity and Facilitates Client Communication.

Providing only the most state-of-the-art, intensive, and expensive level of treatment available does not meet the needs of every pet owner and pet. To overcome this barrier, veterinarians are working to provide spectrum of care (SOC) options to pet owners. This teaching tip describes the creation of a Spectrum of Care Options Presentation and Explanation (SCOPE), a tool which can serve a variety of educational purposes and improve delivery of care across the spectrum of care. The SCOPE considers andragogy, evidence-based medicine and pet owner preferences related to communication as well as the cost of care. Using a SCOPE during oncology consultations led by an intern on an oncology service rotation demonstrated the utility of the SCOPE to identify evidence-based SOC options for pets with cancer, serve as a self-regulated learning experience for the participating intern and elicit pet owner, and pet contextual issues impacting the care plan. The SCOPE can used to promote the implementation of SOC in veterinary medicine. The SCOPE has flexibility and may be adapted for use in disciplines other than oncology and with a variety of learners such as veterinary students or in early career mentoring programs.

The impact of multidisciplinary care for locally advanced rectal cancer referrals: A systems perspective.

85 Background: Locally advanced rectal cancer patients require multidisciplinary care for treatment planning. We sought to determine whether the order of surgical and radiation oncology consultation in relation to medical oncology consultation affects the time from cancer diagnosis to treatment initiation and the requirement for additional pre-treatment visits with medical oncology. Methods: We conducted a retrospective chart review of adult patients referred to The Ottawa Hospital with locally advanced rectal adenocarcinoma, seen in consultation by a surgical, radiation, and medical oncologist between January 2018 and December 2022. Results: Of 195 patients, the median time from diagnosis to treatment was 55 days (IQR: 45-68). Both surgical and radiation oncology consultation preceded medical oncology consultation in a minority of patients (72; 37%), and 48 (25%) patients required multidisciplinary cancer conference (MCC) discussion. However, the time from cancer diagnosis to treatment initiation was not significantly different between patients who were and were not seen by the surgeon and radiation oncologist prior to the medical oncologist (56 vs. 55 days respectively), nor if MCC discussions were or were not required (55 vs. 55 days). However, almost half of all patients (93; 48%) required an additional pre-treatment visit with their medical oncologist, and patients who saw both surgical and radiation oncology prior were significantly less likely to require additional pre-treatment visits with medical oncology (25% vs. 61%; p&lt;0.0001). Conclusions: The time from cancer diagnosis to treatment initiation was not significantly impacted by the order of specialist consultations with the multidisciplinary team, nor if patients required MCC discussion or additional pre-treatment visits with medical oncology. However additional pre-treatment visits with medical oncology were significantly more likely to occur when patients were seen by medical oncology prior to surgical and/or radiation oncology, representing a logistical and financial inefficiency in the system, and a potential area for process improvement. [Table: see text]

Addressing sexual health in oncology: perspectives and challenges for better care at a national level.

The emotional impacts of oncological treatments can negatively affect sexual health and intimate relationships. Advances in cancer management have extended patient survival, underscoring the importance of addressing sexual health post-diagnosis. To explore physicians' practices regarding the approach to sexual health during oncological consultations; identifying barriers to addressing sexuality and assessing the need for sexual health training. An observational, cross-sectional study that assessed the management of sexual health by physicians involved in oncological treatment, using an anonymous questionnaire distributed via SurveyMonkey. Of 133 physicians surveyed, 31.6% never or rarely address sexual health. Only 10.5% feel frequently prepared on this topic, while 24.8% almost never have the appropriate tools to address it. 97.7% of oncologists and 92.9% of otolaryngologists (ENTs) recognize the need for sexual health training. Sexual health was more frequently discussed among patients diagnosed with prostate, cervical and breast cancer, and less so among those with ENT, bladder and colorectal tumours. The approach was more frequent among patients treated with curative intent (77.4%) than those with palliative intent (5%). The main barriers identified were lack of training (46%), lack of time (39.8%) and patient discomfort (34.6%). The majority of professionals dealing with oncological patients do not address their sexual health, with the lack of training, lack of time and patient discomfort being the main barriers identified. However, 92% indicate a need for sexual health training, which could contribute to early intervention, strategy establishment and timely referral to specialists in the field.

The influence of "bad news" and "neutral/good news" on patients' perception of physician empathy during oncology consultations.

Being met with empathy increases information sharing, treatment coherence, and helps patients to recover faster. However, we do not know how the content of the conversation about disease progression, new treatments, or other issues concerning serious illness affects patients' perceptions of the physician's empathy, and thus, the quality of the conversation. This study aimed to test the hypothesis that patients will rate their physician lower following a "bad news" consultation using the consultation and relational empathy (CARE) measure. A total of 186 outpatients from the Department of Oncology were recruited for this study. After meeting with a patient, the physician filled out a form, placing the patient in either the "bad news" group, or the "neutral/good news" group along with information about the patient and the consultation. The patient was given the CARE measure after the visit. The patients who had received bad news rated their physicians a significantly lower score on the CARE measure, even though the effect size was small, than those who had neutral/good news. On average, bad news consultations were 11 min longer. Physicians need to be aware of the patients' need to be known and understood, in addition to having skills to attend to emotional cues and concerns, since the current study's finding could be a sign either of the content being projected onto the physician or that the physician is focused on the message rather than on the patient.

Is it ethical today not to prescribe physical exercise in the gynaecology oncology consultation?

If you have been diagnosed with cancer you can and should exercise. If you treat cancer patients you can and should prescribe exercise.

Integrated Oncology Nursing Service (IONS)

In recent years, the clinical context for cancer has changed and it is now characterized by extended survival rates and complex cancer trajectories and symptomatology.The changes in landscape of cancer care have included a shift towards the home setting or the outpatient setting with an increase in the amount of care being delivered at home or transferred to the patient/family themselves.&#x0D; According to the literature, societies are confronted with an increasing burden of health care as a result of an ageing population, the growing number of chronic diseases and coronavirus have forced governments and health care to seek new models in order to organize health care cost-effectively, without losing the current quality of care.Multi-professional and multi-agency interventions are now needed compared to when single specialities used to suffice.We need holistic care delivered in partnership to individuals, by flexible person-centred approaches.&#x0D; The Acute Oncology and Community Services have come together to collaborate to provide supportive care to vulnerable cancer patients in the community. The objective of this Integrated Oncology Nursing Service (IONS) role is to refer cancer patients to Community Intervention Team (CIT), post a specialised oncology telephone triage by the Acute Oncology Clinical Nurse Specialist (AO CNSp), to further assess/treat patients in the community. The CIT will provide services such as clinical vitals, phlebotomy, medication administration and psychological support to patients in their home. The AO CNSp. will then link in with the patient at home the next day and continue to consult with the oncology/haematology team to discuss the best way to manage the patient at home. We aim to bring together these separate organisations and place an emphasis on the shared values of timely, efficient and person-centered care. &#x0D; The benefit of this innovation is hoped to&#x0D; •Reduce unscheduled presentations and result in admission avoidance for patients accessing the Tallaght Hospital Oncology Services.&#x0D; •Improve the quality of patients treatment&#x0D; •Bring specialist knowledge to patients&#x0D; •Provides support to patients in their own home&#x0D; •Provide outreach to unwell patients at home&#x0D; &#x0D; The network governance model including nursing and clinical governance is shared by the Director of Public Health Nursing, the Director of Nursing of Tallaght University Hospital and the Oncology and Haemtology Consultants in Tallaght University Hospital. &#x0D; We will roll out education and training with competencies before commencing the pilot.&#x0D; There will be a dual approach to the evaluation of this initiative focusing on organisational impact and patient outcomes and experiences. A service evaluation has been completed already. A qualitative approach will be utilised to determine the patient’s experience and ethical considerations will be incorporated into the rolling out of the service.&#x0D; In conclusion, modern cancer care is mainly delivered on an outpatient basis, meaning that there are many people in the community at risk of side effects of treatment or manifestations of progressive disease that can present as emergencies. This is where the Integrated Oncology Nursing Service is most valuable, providing outreach to acutely unwell patients at home and bringing specialist knowledge to their management.&#x0D;

"Palliare" surrounded with care.

Introduction: Despite scientific evidence about the benefits of Advance Care Planning (ACP) for patients with non-curative treatment, ACP is rarely discussed in practice. Why is it difficult for health professionals to mention ACP? How can patients and their family caregivers take control of their own care process and be actively engaged?&#x0D; The aim of this project is to empower patients and their family caregivers to discuss their wishes and care goals in a palliative phase, and to provide health professionals with communication techniques and skills to use in a palliative conversation. A common language is introduced so that all parties can communicate more comfortably with each other.&#x0D; Target groups: We focus on oncology patients with non-curative therapy, their relatives and their professional care providers.&#x0D; To identify these palliative patients, physicians will have to indicate via MOC (multidisciplinary oncologic consultation) registration if the therapy of an oncology patient is curative or non-curative. If the patient can’t be cured, early palliative care needs to be integrated into daily oncology practice by offering an interactive meeting in group. The group of care providers is a multidisciplinary team with oncologists, oncology nurses, palliative care specialists, bedside nurses, social workers, psychologists, etc.&#x0D; Methodology: We started with a kick-off session in which the members of the project (oncologists, oncology nurse, palliative care specialist and palliative care nurse) explained the purpose of the project to healthcare professionals. We explained a number of concepts and suggested the specific language we want to maintain.&#x0D; After this first session, we organized interactive workshops for patients and their relatives to provide them with tools to establish and communicate about their end of life wishes and care goals. In this workshop, we explained the concept of ‘palliative care’ and the importance of an active involvement of the patient and his/ her relatives during this palliative phase. By performing a role play, we elaborated on the questions that are important to ask the physician, and how patients and relatives can ask these questions.&#x0D; In parallel we organized workshops for different teams of health professionals to provide them with more advanced communication skills and to learn them how to sense when patients are ready for a palliative care conversation. In these interactive workshops we also interspersed communication theory with role plays.&#x0D; Results: Surveys based on the validated PAM-13 questionnaire will be provided to all participants (patients and healthcare professionals). Because the project is still in full development at the moment, we don’t have results yet. We hope to present our results during the ICIC23 in May 2023 and to enthuse and inspire other healthcare professionals about the importance of patient empowerment during a palliative phase.

“Normally I Always Ask Briefly…”: How Patients and Healthcare Professionals in Oncology Construct Sexuality as a Delicate Topic

Oncology healthcare professionals (HCPs) and cancer patients often have difficulties in navigating conversations about sexual changes and concerns due to cancer and its treatments. The present study draws on Discursive Psychology to analyze how the topic of sexuality is raised and managed in Dutch oncological consultations. Our corpus consists of 28 audio recordings. We analyzed the discursive practices used by cancer patients and oncology HCPs and to what effect. Patients, on the one hand, employ vagueness, pronouns, and ellipses, while HCPs attribute talk to others and use generalizations and speech perturbations. Through these practices they collectively keep the topic of sexuality at a distance, thereby constructing it as a delicate topic. Moreover, we explicate the norms related to sexual behavior that cancer patients and oncology HCPs orient to in their talk. Finally, we address ways in which oncology HCPs can open the door on discussing sexual changes with their patients.

Validity and reliability of the Japanese version of the Patient Satisfaction Questionnaire (PSQ-J) for evaluating oncologist consultations

To develop the Japanese version of the Patient Satisfaction Questionnaire (PSQ-J) and examine its validity and reliability. A cross-sectional, web-based survey was conducted among cancer patients in Japan. The PSQ-J was developed following the forward-backward translation method, using a numerical rating scale. Data on patient characteristics and psychometric scales, like the PSQ-J, willingness to recommend an oncologist to others, trust in the healthcare system, uncertainty, and the Physician Compassion Questionnaire were collected. Validity was examined using exploratory and confirmatory factor analyses and by calculating the correlations between the total PSQ-J score and the criterion variables. Reliability was confirmed by Cronbach's alpha and test-retest score correlations at a two-week interval. The first and second surveys were conducted on 309 and 107 patients, respectively. One-dimensionality and model fit were verified using factor analyses. The PSQ-J was significantly associated with other comparable scales. Cronbach's alpha was 0.962; the correlation between the PSQ-J test-retest scores was 0.835 (p < .001). The current study indicates that the PSQ-J can be valid and reliable for assessing satisfaction with oncologist consultation. The PSQ-J enables the effective assessment of patient satisfaction with oncologist consultations, leading to better practice reflecting the patient's viewpoint.

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

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

The Biologic Diversity of Colorectal Carcinoma (CRC) is Present in the Early Stage: Quantitative Analysis of Malignant Polyps

Abstract Introduction/Objective Risk factors in malignant polyps to predict recurrence in T1 colorectal carcinoma (CRC) include depth of invasion, margin status, lymphovascular invasion, tumor differentiation and budding. However, the effect of other factors, such as tumor volume and tumor cellularity, are not well studied. We quantitatively, using image analysis, determined the strength and interdependence of the depth of invasion, margin status, tumor volume and tumor cell density on the probability of having residual adenocarcinoma on resection and long term patient outcomes. Methods/Case Report Endoscopic mucosal resection (EMR) specimens of polyps with T1 CRC were identified by retrospective search of the pathology database over a 14-year period (01/01/2008 to 05/05/2022). Depth of invasion, distance of tumor to margin, tumor volume (defined by the invasive area comprising the tumor cells and associated others cells) and cellularity (number of adenocarcinoma cells/area) were measured using Aperio eSlide Manager Leica Biosystems Imaging, Inc. The depth of invasion was measured from the muscularis mucosa. Available outcome data was collected from subsequent segmental resection and oncology consultations and imaging from the patient charts. Results (if a Case Study enter NA) 22 patients of malignant polyps with EMR were identified; 11 patients underwent subsequent resection with residual tumor in 4 and lymph node metastasis in 1. Follow-up period was from 3 to 12 yrs, with recurrence in none. The median tumor cellularity was 2712 cells/mm2 with SD 1421 cells/mm2 and was similar in residual versus non residual tumors with no correlation with LVI. Distance of tumor (um) from deep margin was measured in 20 cases and by Receiver Operator Characteristic analysis and calculation of the area under the curve (AUC) was a good test of residual tumor (AUC = 0.88) while depth of invasion was not a good test (AUC =0.5). Tumor volume and adenocarcinoma cells/area were not correlated; however, interestingly, tumor volume and depth of invasion were linearly correlated (p&amp;lt;0.001). Conclusion The distance of tumor to the margin is a better predictor for residual cancer than depth of invasion. The linear correlation of tumor volume and depth of invasion implies the same shape of invasion which is interestingly independent of tumor cellularity. This finding further strengthens the hypothesis that cancer associated cells in the tumor microenvironment are important in driving the biological behavior of malignant polyps.

Predictors of prolonged treatment time intervals in oral cavity cancer

ObjectivesDelays in treatment time intervals have been associated with overall survival in oral cavity squamous cell carcinoma (OCSCC). The aim of this study was to identify bottlenecks leading to prolonged treatment intervals. Material and methodsA retrospective analysis was conducted using a cohort of OCSCC patients who underwent surgery and adjuvant radiation therapy. The endpoints of interest were prolonged treatment intervals. Multivariable logistic regression was used to adjust for patient and tumour characteristics. ResultsMedian diagnosis-to-treatment interval (DTI) and surgery to initiation of postoperative radiation therapy interval (S-PORT) were 39 days (IQR 30–54) and 64 days (IQR 54–66), respectively. Prolonged DTI was associated with older age, worse Charlson Comorbidity index scores and worse T stages. Patients with prolonged DTI had longer times to preoperative imaging reports (25 vs 9 days; P < 0.01). Time to preoperative pathology did not differ. Prolonged S-PORT was associated with longer times to pathology report (28 vs 18 days; P < 0.01), to maxillofacial consult (38 vs 15 days; P < 0.01) and to maxillofacial approval of radiation (50 vs 28 days; P < 0.01). In patients requiring medical oncology consults, those with prolonged S-PORT had longer waiting times until consultation (58 vs 38 days; P = 0.02). Multivariate analysis showed independent predictors of prolonged DTI: time to preoperative imaging; and prolonged S-PORT: time to pathology report, time to maxillofacial consult, and time to medical oncology consult. ConclusionsStrategies targeting these organizational bottlenecks may be effective for shortening treatment time intervals, hence representing potential opportunities for improving oncological outcomes in OCSCC patients.

Reducing 30% of waiting time in the administration of antineoplastic oral drugs in patients with urological cancer.

325 Background: In order to reduce waiting time in the administration of oral antineoplastics we participated in ASCO/ECO QTP. We propose the creation of an oncology nursing office, trained to evaluate and administer oral antineoplastic medication. Methods: The waiting times of patients diagnosed with urological cancer and receiving treatment with oral antineoplastic drugs are collected, between their arrival at the hospital and the drug’s dispensation. Waiting times are calculated using a prospective qualitative analysis and we represent the data using SPC graphs such as R-Charts, process maps, Pareto and cause-effect diagram, objectifying, the longest waiting time between the oncology consultation appointment and the entrance to consultation. An oncology nursing consultation, with protocols based on checklists (where the most frequent adverse effects are collected, blood pressure is measured and the corresponding analytical parameters are assessed) is created to facilitate the job and train nursing for the administration of drugs. Subsequently, the waiting times are analyzed again, after the implementation of the nursing consultation and a month after it. Results: Along a period of 6 months (time from when we started the ASCO/ECO QTP course, until we implemented the medical oncology consultation), we have reduced the median time between the patient's appointment to the drug dispensation, from 35 minutes to 5 minutes, approximately a reduction higher than the 80%. One month after the implementation of the nursing consultation, waiting times are analyzed again, and the improvement is maintained. Conclusions: The creation of a specific nursing consultation has made possible to reduce waiting times in the administration of oral antineoplastic drugs, reducing the waiting list and managing to quote 3 more patients each day in medical oncology consultation.

Implementation and assessment of an advanced practice nurse-led early palliative care initiative for patients with advanced pancreatic cancer.

262 Background: Early palliative care (EPC) referral reduces health care costs and improves quality of life and survival in some advanced cancers. Barriers to EPC exist. In April 2022, our provincial cancer centre (CCMB) implemented a clinical nurse specialist (CNS)-led intervention for patients with advanced pancreatic cancer (PANC), circumventing known barriers. New PANC referrals received at the provincial centralized referral office are triaged by an oncologist and concurrently referred to the CNS. CNS consultation focuses on physical and psychological symptoms, medication review, patient and family coping, and goals of care. Education is provided on PANC diagnosis, prognosis, symptoms, potential treatment options, navigating the cancer system, and community palliative care/hospice supports, with close collaboration with the patient’s primary care provider. This study reports on the impact of the CNS role and patient perceptions of this role on patient-centered care. Methods: We compared patients with PANC in the pre-implementation period (Jan 1, 2021, to December 31, 2021) to the post-implementation period (April 1, 2022, to March 31, 2023). Patients were identified using the Manitoba Cancer Registry and the CNS clinical database. Descriptive statistics were used to report quality measures. Results of patient reported perception of patient-centered care during the post-implementation period will also be reported. Results: In the pre-implementation period, 83 patients were referred to CCMB with PANC. In the post implementation period, 135 patients were referred. 125 (93%) accepted a consultation with the CNS, with a median time to meeting of 5 days (range, 0-18). After CNS consultation, 35% declined biopsy, oncology appointment or both. In the pre-implementation period, 29 (55%) patients were referred to palliative care/hospice within 8 weeks of diagnosis, compared to 66 (77%) in the post-implementation period. The mean time to palliative care referral was 18.2 weeks pre-implementation vs 8.0 weeks post-implementation (p=0.0007). Data on number of diagnostic biopsies, medical oncology consultations, and receipt of chemotherapy are in the attached table. Conclusions: This novel approach of CNS assessment and education soon after diagnosis of PANC, at the time of referral to CCMB, is acceptable to patients. It results in increased early referral to community-based palliative care/hospice. Exploring patient goals early may also spare patients from treatments that are time-consuming and associated with adverse effects, allowing those with a life limiting illness to focus on quality of life.[Table: see text]