Outpatient Cancer Center Research Articles

Бережливые технологии как инструмент организации пациентоцентричного подхода к оказанию медицинской помощи пациентам центра амбулаторной онкологической помощи

It is crucial to implement and use patient-centered approach towards communication between doctors and patients and towards management of treatment and diagnostics. The instruments of lean production can be used in order to find problems of organizational processes and to solve and improve them. Purpose of the study is to evaluate the possibility of using lean production to improve patient-centered approach towards the work of Outpatient Cancer Center. Materials and methods. The scientific articles from databases pubmed, cyberleninka, elibrary were studied. The performance results of Outpatient Cancer Center were analyzed. Results. During research the performance of Outpatient Cancer Center and its change as a result of using lean production instruments was analyzed. The positive results including the improvement of availability of diagnostics and consultations were found out. The medical and patient ratings of organizations have also shown significant improvement. Findings. Thus, the use of lean production not only in outpatient clinic but also in Outpatient Cancer Center is relevant nowadays. The instruments of lean production can improve healthcare processes and make them more patient-centered.

Malnutrition risk screening in adult oncology outpatients: An ASPEN systematic review and clinical recommendations.

Malnutrition screening is not widely practiced in outpatient cancer centers. This review aims to determine the validity of malnutrition screening tools and provide recommendations for clinical use. Studies identified by a systematic review assessed the general validity of screening tools in adult oncology outpatients from five databases through 2022. The American Society for Parenteral and Enteral Nutrition (ASPEN) convened a working group of members from the Academy of Nutrition and Dietetics, Academy of Oncology Nurse and Patient Navigators, American Cancer Society, American Society for Clinical Oncology, American Society for Nutrition, American Society for Radiation Oncology, Association of Cancer Care Centers, and Oncology Nursing Society to answer the following questions: (1) should clinicians screen for malnutrition, (2) which malnutrition screening tools are recommended, and (3) what are the clinical applications for malnutrition risk screening in adult oncology outpatients? Twenty of 738 studies met the criteria and were reviewed. Six screening tools with specific cut-points demonstrated validity and are recommended, including the Mini Nutritional Assessment (≤23.5), Malnutrition Screening Tool (MST; MST ≥ 2 and patient-led MST ≥ 2), Malnutrition Universal Screening Tool (MUST; MUST ≥ 1 and MUST ≥ 2), Nutrition Risk Screening-2002 (NRS-2002; NRS-2002 ≥ 2 and NRS-2002 ≥ 3), NUTRISCORE ≥ 5, and Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF; PG-SGA SF ≥ 7 and PG-SGA SF ≥ 8). Six screening tools are valid for malnutrition risk identification in oncology ambulatory settings and recommended before treatment initiation and regularly thereafter, depending on treatment course. Research is needed to understand to what extent early diagnosis and management of malnutrition improves the clinical care of oncology patients.

Abstract C130: Evaluation of key performance indicators of a community-focused patient navigation program in an outpatient cancer center

Abstract Background: In 2021, Dana-Farber Cancer Institute’s (DFCI) Cancer Care Equity Program (CCEP) implemented a Community-Focused Patient Navigation (CFPN) program to support adult medical oncology patients from historically marginalized groups by proactively identifying and addressing patients’ barriers to cancer treatment. The program has been sequentially implemented in five cancer treatment centers, gastrointestinal, breast, thoracic, and gynecologic oncology and hematologic malignancies with plans to expand further. The purpose of this analysis is to evaluate CFPN against key performance indicators (KPIs) in gastrointestinal oncology, where the program was implemented first. Methods: Patients included in the analysis met CFPN eligibility criteria: adult medical oncology patients from zip codes in the Greater Boston area with significant socio-economic disparities and who agreed to receive support from the patient navigator. Program KPIs included in the analysis were appointment no show rate, New Patient Intake Questionnaire (NPIQ) response rate, and social work encounter rate. A pre- post analysis was used to identify trends in the KPIs of interest among navigated patients from the start of the program in October 2021 through May 2024 compared to similar groups of patients seen one year prior to the launch of the program who would have met CFPN eligibility criteria if the program had existed at that time. The data were taken from the cancer center’s electronic medical record system and visualized in a dashboard. Results: Preliminary findings show a significant decrease in appointment no show rate from 4.07% to 2.29% (p<0.05) and an increase in NPIQ response rate from 20.97% to 34.74% (p<0.05) among all navigated patients after the program was implemented compared to one year prior to the program launch. While not statistically significant, there was an increase from 28.23% to 43.16% in the social work encounter rate for patients engaged with the patient navigator. Conclusion: Preliminary analysis of CFPN demonstrates a positive trend toward meeting KPIs in gastrointestinal oncology and reveals outcomes that will guide further quantitative and qualitative analysis to identify areas of programmatic success and improvement. Next steps include conducting a more in-depth quantitative analysis on additional KPIs, including patient retention rate, stratified by demographics. CCEP also plans to conduct a qualitative analysis to identify patient and care team perceptions of CFPN through focus groups and/or structured interviews. An abstract describing CFPN program design was accepted for online publication at ASCO. This project was undertaken as a Quality Improvement Initiative at DFCI, and as such was not formally supervised by the Institutional Review Board per policy. Citation Format: Sarah Pohl, Emma Green, Katherine Miller, Ludmila Svoboda, Magnolia Contreras, Christopher Lathan. Evaluation of key performance indicators of a community-focused patient navigation program in an outpatient cancer center [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C130.

Integration of patient navigation into clinical operations of an outpatient cancer center.

e23091 Background: Recognizing the critical importance of expanding access to high-quality, integrated cancer care, Dana-Farber Cancer Institute’s (DFCI) Cancer Care Equity Program developed a multi-year plan to integrate a centralized, systems-based patient navigation (PN) program focused on supporting adult medical oncology patients from historically marginalized groups. The goal was to proactively address patients’ socio-economic, emotional, and structural barriers to attending medical appointments and adhering to cancer treatment plans through care coordination, physical accompaniment, and resource provision. Methods: Inclusion of the new program in DFCI’s operating goals supported prioritization of the work across the cancer center. A multidisciplinary workgroup developed standard operating procedures grounded in evidence-based approaches while leveraging existing clinical operations. The Freeman Navigation Model informed PN scope of work with a focus on historically marginalized communities. DFCI’s Community Health Needs Assessment guided the decision to prioritize patients from zip codes with significant disparities related to social determinants of health. Utilization of electronic health records for PN documentation ensured effective communication with care teams and enabled accurate and consistent data collection and reporting. Alignment of the program’s measurement strategy with national PN metrics and development of a data dashboard allowed for ongoing monitoring and evaluation. Results: The program was implemented sequentially in five cancer treatment centers: gastrointestinal, breast, thoracic, and gynecologic oncology as well as hematologic malignancies. 517 patients were contacted and 1,736 barriers to cancer care were addressed at time of analysis. Preliminary findings from the first cancer treatment center suggest a decreased no show rate in the second year of the program. Conclusions: The multidisciplinary approach to integrating an evidence-based PN program into clinical operations supported general adoption among care teams and timely replication across cancer types. The infrastructure developed for the program could potentially support implementation of Centers for Medicare and Medicaid Services reimbursement for PN services. Next steps include confirming preliminary findings in a larger sample, conducting a cost-benefit analysis, and expanding the program across the clinical enterprise. [Table: see text]

The Impact of a Narrative Medicine Life Story Pilot Program on Press Ganey™ Scores in an Outpatient Cancer Center

ABSTRACT Oncology patients face challenges beyond those directly affecting their cancer management. Guided personal narrative programs have been shown to help patients with chronic conditions and life-framing events. Few such narrative programs have been reported for cancer patients or analyzed for their impact on patient experience. We established our Life Story Narrative Program, modeled on the United States Veterans Affairs’ “My Life, My Story” for outpatient oncology patients in our hospital’s cancer center. Press Ganey™ patient experience scores from program participants were compared retrospectively with scores from patients who were not participants. Over an eight-month period, we invited 30 cancer center outpatients to participate. Twenty-seven individuals accepted, and 18 had their stories edited, approved, and scanned into their electronic health record. Cohort matching yielded a control arm consisting of 255 responses from 48 surveys, while the intervention arm consisted of 68 responses from 12 surveys. 78.4% of responses from the control arm were rated 5 compared with 100% in the intervention arm. The mean Press Ganey™ score response in the control arm was 4.71 compared with 5.00 from the intervention arm. Wilcoxon U value was 10,540 with p < .001. An outpatient narrative medicine program for cancer patients to tell their life stories can easily be organized. Patients were willing to participate, enrollment was brisk, and the use of resources was limited. Although our sample size was small, participation in our Life Story Narrative Pilot Program resulted in a statistically significant improvement in Press Ganey™ scores.

Developing tumor-specific PRO-CTCAE item sets: analysis of a cross-sectional survey in three German outpatient cancer centers

BackgroundTo include the patient perspective in the assessment of adverse events in oncology, a patient-reported outcomes (PRO) version of the Common Terminology Criteria for Adverse Events (CTCAE) was developed by the US National Cancer Institute, the so called PRO-CTCAE. The objective of this study was the development of disease-specific PRO-CTCAE item sets for patients with breast cancer (BC), multiple myeloma (MM), and prostate cancer (PC).MethodsThe cross-sectional survey was conducted at three German outpatient cancer centers. Prevalence and importance of the 78 PRO-CTCAE symptoms were assessed using a patient questionnaire. To select the most relevant PRO-CTCAE items for each tumor entity, symptoms were ranked based on patient answers.Results101 patients with BC, 107 with MM, and 66 with PC participated. The final item sets contained 21 symptoms (BC) or 19 symptoms (MM and PC), respectively. Eight symptoms (fatigue, muscle pain, insomnia, joint pain, general pain, dizziness, shortness of breath, and swelling) were represented in all three item sets. Fatigue was the symptom with the highest ranking across item sets followed by insomnia. Symptoms with the highest rankings represented in only one item set were symptoms affecting the urogenital system in the PC item set, blurred vision in the BC item set, and decreased appetite in the MM item set.ConclusionsIndividual PRO-CTCAE item sets for a German patient population were developed for the three tumor entities on the basis of patients’ differences in symptom profiles and perceptions. The quality and psychometric criteria of the newly compiled item sets should be evaluated in validation studies.

Measures to Increase Job Satisfaction of Oncologists at Outpatient Cancer Centers

Introduction: Job satisfaction of oncologists at outpatient cancer centers is an important factor that determines not only personal well-being of a doctor, but also the effectiveness of provision, quality and availability of primary specialized oncological care. Objectives: To assess the risk of emotional burnout and to determine the level of job satisfaction of oncologists working in outpatient departments in order to propose actions to reduce the risk of job burnout and to elaborate measures promoting job satisfaction. Materials and methods: In June–August 2022, as part of quantitative sociological surveys, 71 oncologists of Outpatient Cancer Centers located in Moscow and the Moscow and Ivanovo Regions were interviewed to assess their job satisfaction using V.A. Rozanova’s questionnaire. In addition, we conducted a qualitative sociological study consisting of six in-depth interviews with healthcare experts, including heads of federal and regional cancer clinics. Results: We established that 21.1 % of the respondents were not satisfied with their job. Male specialists and surgeons demonstrated significantly lower job satisfaction than their colleagues. The main reasons for such dissatisfaction were the amount and fairness of wages, long working hours, disunity of actions between employees when performing collective tasks, and the leadership style of the chief. As measures to optimize the performance, the respondents emphasized better equipment of departments, impartial record of achievements of each employee for fair incentive pays, clear distribution of duties and responsibilities within implementation of collective project tasks, creation of opportunities for paid extra work, and organization of regular meals at the expense of the employer. Conclusions: The main ways to increase job satisfaction of oncologists at outpatient cancer centers can be optimization of the incentive system that takes into account individual performance indicators, effective organization of the workflow in departments and their sufficient equipment, elaboration of personal development plans, organization of additional formal internal communication channels, an increase in the level of knowledge, skills and abilities of chief medical officers in the field of human resource management, and expansion of employee benefits based on their preferences.

Perceptions of prognosis and end-of-life care outcomes in patients with advanced lung and gastrointestinal cancer

Background: Many patients with advanced cancer have misperceptions of their prognosis, which may impact end-of-life decision-making. Data regarding associations between prognostic perceptions over time and end-of-life care outcomes are lacking. Aim: To describe patients’ perceptions of their prognosis with advanced cancer and examine associations between these perceptions and end-of-life care outcomes. Design: Secondary analysis of longitudinal data from a randomized controlled trial of a palliative care intervention for patients with newly diagnosed incurable cancer. Setting/Participants: Conducted at an outpatient cancer center in the northeastern United States and patients were within 8 weeks of a diagnosis with incurable lung or non-colorectal gastrointestinal cancer. Results: We enrolled 350 patients in the parent trial, of which 80.5% (281/350) died during the study period. Overall, 59.4% (164/276) of patients reported they were terminally ill, and 66.1% (154/233) reported that their cancer was likely curable at the assessment closest to death. Patient acknowledgment of terminal illness was only associated with lower risk of hospitalizations in the last 30 days of life (OR = 0.52, p = 0.025). Patients who reported their cancer as likely curable were less likely to utilize hospice (OR = 0.25, p = 0.002) or die at home (OR = 0.56, p = 0.043), and they were more likely to be hospitalized in the last 30 days of life (OR = 2.28, p = 0.011). Conclusions: Patients’ perceptions of their prognosis are associated with important end-of-life care outcomes. Interventions are needed to enhance patients’ perceptions of their prognosis and optimize their end-of-life care.

Allocating Blood Products During a Time of Remarkable Shortage

Abstract The COVID-19 Pandemic adversely impacted the nation’s blood supply such that blood suppliers could not fill standing orders. To address the dwindling blood supply, the American Red Cross (ARC) implemented daily thresholds, which distributed red blood cells (RBCs) based on clients’ historical blood orders and the ARC’s inventory. The threshold system left the blood bank to devise a process to judiciously allocate the reduced RBC supply across our institution. Herein, we describe an internal RBC utilization audit, the data from which we used to devise an algorithm to predict our ability to meet transfusion requirements for operating room (OR) procedures. An OR adjudication committee used our report to prioritize elective surgical cases taking places the following day. Thirty-one non-consecutive days of blood inventory release slips were reviewed across three months of recent transfusions. Weekdays were disproportionally investigated to predict the blood utilization for days with scheduled OR procedures. For all RBCs released, the blood type requested and the final disposition (transfused vs returned to blood bank) of the units were recorded. Average use was calculated as well as interquartile range (IQR) to account for transfusion variability. Utilization data was then used to develop a worksheet-based tool to predict ability to meet RBC requirements. Overall, the hospital transfused an average of 80 RBC units each weekday (IQR: 64-92 units). Approximately 40% of all requested RBC units were released to the OR. In turn, the OR transfused only 39% of the RBCs released to them, which represented 20% of transfusions hospital-wide. The OR requested an average of 41 RBC units each weekday (IQR: 25-57 units). The OR transfused an average of 16 units of RBCs each weekday (IQR: 9-21 units). The outpatient cancer center infusion clinic used less than 15% of total RBCs. The biggest user of RBCs were inpatients, who were transfused 65% of RBCs during the week and 82% of transfusions during the weekend. These percentages and the average-to-third-quartile range were used to devise a blood allocation algorithm to inform the OR if the blood bank could support anticipated use. The data was also used to devise a blood allocation worksheet for the on-call transfusion medicine physicians to predict our ability to provide adequate blood for emergent, non-elective procedures that require transfusion support such as liver transplants and aortic repairs. The audit of RBC disposition informed blood inventory management practices during a time of remarkable shortage. Within the confines of the threshold system, the transfusion medicine service allocated the expected number of units based on historical request and transfusion data to predict whether inventory levels could support scheduled and nonscheduled OR procedures.

Improving performance status documentation using an electronic medical record tool.

309 Background: Performance status (PS) is used regularly in oncology care to select appropriate cancer treatment, track changes in level of functioning, and determine clinical trial eligibility. In addition, the American Society of Clinical Oncology (ASCO)/Oncology Nursing Society (ONS) Chemotherapy Administration Safety Standards requires that on each clinical encounter, staff performs and documents a patient assessment that includes 8 elements; one of which is PS. Currently, little instruction is provided on how to utilize and record a more standardized criteria, such as PS with either ECOG or Karnofsky scores, in the electronic medical record (EMR) which results in suboptimal documentation. We assessed documentation of PS before and after implementation of a tool within the EMR at our outpatient cancer center. Methods: Using the Plan-Do-Study-Act (PDSA) technique, a quality improvement project was developed to determine if our center was consistent with the ASCO/ONS guidelines. An EMR tool was developed that enabled clinicians to standardize PS documentation within an encounter via population of a flowsheet to improve compliance. Clinicians were educated on guidelines and utilization of the PS tool and data was collected pre- and post- implementation. A survey was developed and administered to assess PS tool use and to learn of any barriers to implementation. Based on survey results, we created a reminder tip sheet for clinicians to utilize the PS tool; a subsequent chart review was completed. Results: In a random pre-study 50 chart review, 0% of encounters in our lung and breast clinic had PS documented. At the time of pre-tool implementation, due to the lack of a retrievable flowsheet, we did not obtain a reliable PS documentation percentage. After education and tool implementation, 2481 random encounters were evaluated of which 315 encounters (12.6%) documented PS and used the PS tool. A total of 7 (35%) clinicians completed the survey: 4 physicians and 3 advanced practice registered nurses. Of those who responded, 57% used the PS tool, 71% used a note template with ECOG PS embedded, and 85.7% were willing to alter their note template to incorporate ECOG PS. Barriers identified included: limited time, workflow constraints and redundant documentation. After tip sheet implementation, 66% of encounters documented PS; however, only 6 out of those 33 encounters (18%) documented PS using the PS EMR tool. Conclusions: Documentation support tools help facilitate care and enable measurement of guideline concordance, but once implemented it can be challenging to maintain adherence. Although this study improved overall PS documentation (0 to 66%), we were only able to demonstrate a 6% increase in the use of our PS documentation tool. While PS tool implementation was feasible, adoption of the additional tool was not universal. We aim to gather additional clinician input to improve PS documentation completion and guideline adherence.

Optimizing the implementation of systematic financial screening.

277 Background: Implementation of routine financial screening is a critical step toward mitigating financial toxicity. Screening facilitates identification and intervention delivery. We evaluate the feasibility and acceptability of systematic financial screening in a large, urban, outpatient cancer center. Methods: We developed and implemented a stakeholder-informed process to systematically screen all patients with cancer for financial hardship and financial worry using two items from the Comprehensive Score for Financial Toxicity. Screening was completed by patients in English or Spanish on paper forms or through the patient electronic portal; all responses were entered into the electronic health record (EHR). Repeated measures were prompted through the EHR monthly. We evaluated the feasibility of the implementation by completion rates, mode of completion and follow-up completion rates; and identified key factors to optimize implementation strategies and improve sustainability through key stakeholder feedback from patients, clinicians and staff. Results: From 3/2021 – 3/2022, 3,500 patients were seen in the outpatient breast oncology clinic and thus, eligible for screening. Of these, 39% (1,349) responded, either by paper or portal, 12% (N = 437) preferred not to answer when checking in via the patient portal, and the remaining 49% (N = 1,714) did not have data in their EHR, meaning screening was not offered or they did not complete the paper forms. Of the 1,349 respondents, most (79%, N = 1,063) responded via portal. Repeated screening measures were completed by 42% (N = 563) more than once. By language preference, response rates were 46% (English), 28% (Spanish), and 29% (Other languages). Completion rates on paper were not sustained after the initial implementation and dropped significantly after 6/2021; this correlated with staffing shortages. After expanding capacity for patients to check-in using kiosks in clinic in 7/2021, completion rates increased 78% in the following 3 months. Significant financial hardship was endorsed by 51% (N = 694), and financial worry by 36% (N = 484). From stakeholder feedback, including patient interviews, components were identified to improve screening completion rates: partnering with staff to facilitate distribution of paper forms for patients who do not use the portal; optimizing patient engagement with the portal; partnering with the electronic health record vendor to ensure non-English access is optimized; and transparent communication to patients regarding the purpose of the screening and resources available. Conclusions: We demonstrate that implementation of systematic financial screening requires an inclusive approach to achieve acceptable and equitable response rates. Electronic data capture contributes to successful financial screening implementation, but inclusive procedures that address language and technology preferences are needed to optimize screening.

Improving patient satisfaction and care delivery for female veteran patients with cancer receiving outpatient infusion therapies.

279 Background: Our objective was to explore if differences in patient satisfaction based on gender exist in a Veterans Health Administration (VHA) outpatient chemotherapy infusion unit. Methods: Veterans who received outpatient infusion treatments from 2018 to 2020 were contacted by phone and agreed to partake in an anonymous 25 question online survey. Response differences were analyzed using Fisher’s exact and Welch's t-tests. Results: 69 veterans were contacted. 70% (21/30) of women and 51% (20/39) of male veterans completed the survey. Most women were &lt; 65 years (62%), and 52% treated for breast cancer. 90% of men were &gt; 65 years old, majority treated for prostate cancer (20%) or a hematological cancer (20%). Using our survey, patient satisfaction was 8.71/10 points (± 0.60) in women vs. 9.55 (± 2.24) in men (p = 0.113). 86% of women endorsed hx of sexual abuse or harassment vs 10% of men (p &lt; 0.001). More women vs men felt uncomfortable around other patients and unable to voice uncomfortable experiences to a provider in the infusion unit (p &lt; 0.05). Not statistically significant but potential clinical importance was more women felt uncomfortable around the offending gender (29% vs 0%), more women felt greater emotional support and importance with access to a tx room with the same gender (29% vs 0%), and more women preferred access to a gender specific restroom (30% vs 20%). Conclusions: Gender appears related to how veterans with cancer perceive their ambulatory cancer care. This may be due to the combination of high sexual abuse and/or harassment hx amongst women who are a minority of the total infusion unit population, the majority of whom receive tx for a primarily gender specific breast malignancy. Analysis was limited by the small sample size of women, many with advanced malignancy. Ongoing initiatives based on these survey results are underway and may be applicable to other outpatient cancer center facilities where patient demographic and infusion unit design may be similar.[Table: see text]

Cross-sectional Census Survey of Patients With Cancer who Received a Pharmacist Consultation in a Pharmacist Led Anti-cancer Clinic

Pharmacists have a critical consulting role in patients undergoing oral antineoplastic drug therapy to ensure harm minimisation. Studies exploring the benefits of pharmacists in this role are limited. This study evaluated patient perceptions, experiences and overall satisfaction with clinical pharmacist consultations in patients treated with oral antineoplastic drugs. Data on 160 patients initiated on oral antineoplastic drugs between January 2019 and February 2021 were collected retrospectively from an outpatient Comprehensive Cancer Centre of a quaternary hospital in Western Australia (demographics, cancer type, oral antineoplastic drugs prescribed). In addition, patients were mailed a hard copy questionnaire in March 2021 to assess their satisfaction with pharmacist consultations in the pharmacist clinic, using a 5-point Likert scale. The statements included perceptions of the patient’s understanding, medication adherence, experiences and overall satisfaction with the clinical pharmacist consultation. There were 76 (47.5%) completed questionnaires returned (52.6% female; average age was 63.2 ± 13.9 years). The majority of patients were satisfied with the service offered by the clinical pharmacist (73/76; 96.1%), perceived that clinical pharmacists provided an important service in outpatient cancer care (71/76; 93.4%) and improved their understanding of the use of oral antineoplastic drugs and side-effect management (48/74; 64.9%). Patients’ perceived understanding of their medication regimen and additional health services available improved after pharmacist counselling. The patients also reported overall satisfaction with the service provided by the clinical pharmacist and found it beneficial to their care. The study supports the expanding role of the clinical pharmacist in an outpatient cancer centre.

Registered Dietitian Nutritionist Interventions for Weight Maintenance in Oncology Patients Remain Effective During the COVID-19 Pandemic

ObjectivesThe objective was to investigate if differences in weight outcomes existed for oncology patients seeing Registered Dietitian Nutritionists (RDNs) between pre-pandemic versus COVID-19 pandemic-era care. MethodsA retrospective chart review analyzed patients who received nutrition interventions with RDNs over 12 weeks at a midwestern outpatient cancer center. Data were collected from patient care encounters in 2019 (Cohort 1, pre-pandemic) and 2021 (Cohort 2, pandemic). Weight maintenance was defined as within 7.5% of baseline weight, based off malnutrition criteria of weight loss over 3 months. Weight, malnutrition, and nutrition support were analyzed to identify comparability of cohorts. Independent samples t-tests and Chi Square tests were used, with statistical significance set at p < 0.05. ResultsThe final analysis included 50 participants in Cohort 1 and 46 in Cohort 2. In total, the majority of patients were White (85%), with a mean age of 62 years. No statistically significant differences were found between Cohort 1 and Cohort 2. While weight loss prior to seeing an RDN was high in both groups, it was not significantly different between groups (Cohort 1: –9.92% vs Cohort 2: –10.69%, p = 0.560). In both cohorts, 70% of patients either maintained or gained weight during the 12 weeks (p = 0.983). Additionally, Cohorts 1 and 2 maintained similar weight amounts over 12 weeks (–3.62 kg ± 5.52 kg, versus –3.12 kg ± 6.65 kg; p = 0.688). Similar proportions of patients were malnourished (p = 0.295) and used nutrition support (p = 0.285). ConclusionsOutpatient RDN interventions effectively supported oncology patients’ weight and nutritional status during both pre-pandemic care and pandemic-era care. Despite considerable weight loss prior to seeing an RDN, further weight loss was attenuated in both groups. High-level nutrition care persisted during the COVID-19 pandemic, while facing many healthcare challenges. Funding SourcesNo funding sources.

Scalp Cooling for Prevention of Chemotherapy-Induced Alopecia for Women and Men with Various Cancer Entities: A Two-Year Survey of an Outpatient Cancer Center in Germany

Introduction: The aim of this survey was to assess the efficacy and the feasibility of scalp cooling (SC) in an outpatient hematological and oncological center in a real-world setting. Methods: We prospectively monitored cancer patients from August 2017 to October 2019 receiving oncological treatments with SC, using the sensor-controlled system “DigniCap.” Effectiveness was defined by a self-estimated hair loss < Grad 2 (<50%) according to the Common terminology Criteria for adverse events V4.0 or not requiring a wig. Withdrawal from SC on patient’s demand was considered as failure. Tolerability and safety were also evaluated. Results: Ninety-four patients with chemotherapy for their primary (52%) or metastatic (48%) disease had a total of 634 SC sessions. SC was well accepted with increasing experience of the nurses (withdrawal for any reason 29/94). Among the female population (N = 85) 54% received a (neo-)adjuvant chemotherapy. Forty-eight percentages received a taxane-based therapy, 35% anthracycline-based, 17% platin compounds, and others. The overall success rate in the female sample was 72%. In the male group (N = 9), the majority had a metastatic disease (6/9) and received a taxane-based therapy (5/9). The rate of withdrawal by discomfort and pain was high, and the success rate was 44%. Conclusion: Our study confirms the satisfaction of patients with SC to prevent chemotherapy-induced alopecia. SC increases acceptance of the recommendation and administration of chemotherapy and decreases the degree of distress of patients and their treating physicians. Reimbursement remains a major issue in the out patient setting.

Pain Control: Normalization of the BPCQ Questionnaire on a Group of Patients Diagnosed with Malignant Cancer.

The purpose of this article is to examine the applicability of the Beliefs about Pain Control Questionnaire (BPCQ) among cancer patients and develop norms that allow differentiation of patients with diagnosed cancer in terms of beliefs about pain control. Normalization aims to establish the value of test results in the study population. The study involved 1187 patients diagnosed with cancer in outpatient care Maria Sklodowska-Curie Cancer Center and Institute of Oncology, in Warsaw. The applied tool was the Beliefs about Pain Control Questionnaire developed by S. Skevington. The results are most strongly differentiated in each dimension of pain control by education, income, and professional status. Sten norms were developed to determine the level of beliefs about pain control in low, average, and high categories. The BPCQ assessment applies to cancer patients, and the assessment of the location of pain control in patients will allow for the identification of patients whose standard therapy should be supplemented with psychotherapeutic support.

Master chemotherapy planning and clinicians rostering in a hospital outpatient cancer centre

Master chemotherapy planning and clinicians rostering in a hospital outpatient cancer centre

Incorporating systematic financial screening into the electronic health record.

184 Background: Routine screening for financial hardship may identify patients at risk of financial crisis (bankruptcy or inability to afford food or medication). Identifying financial hardship risk is a critical step toward mitigating financial toxicity, associated with earlier mortality and poorer quality of life. We are studying the implementation of systematic financial hardship screening using the electronic health record (EHR) in a large, urban, outpatient cancer center. Methods: Guided by the Consolidated Framework for Implementation Research, we met with key stakeholders, including providers, medical assistants (MA’s), administrative staff, and patient advocates to develop a process to systematically screen all cancer patients for financial hardship risk using 2 items (Q1 and Q3) from the Comprehensive Score for Financial Toxicity (COST). We initiated the process in the breast oncology clinic and partnered with EPIC to integrate the items in the EHR and patient portal. In March 2021, we implemented systematic screening, with automatic prompts to reassess monthly. Results: The workflow includes two mechanisms for patients to complete the 2 items: through the online patient portal during appointment check-in; or through a paper form in English or Spanish, distributed to patients during check-in. An EHR flag was created to notify staff if the patient is due to complete the questions during check-in. During vital signs assessment, the MA collects the form and enters the responses into the EHR. Two important factors were identified to improve the implementation: 1) Patient support to facilitate EHR portal use to reduce clinic workflow congestion; and 2) printed resources for patients who express financial concern. Ongoing discussions reveal that certain clinic days are busier, during which staff find it difficult to review EHR flag, provide and collect paper forms. To date, of 1,358 patients seen in the breast oncology clinic, 526 (39%) have responded to the question, “I know that I have enough money in savings, retirement, or assets to cover the costs of my treatment,” and of those, 278 (53%) responded “not at all” or “a little bit.” Of the 532 patients (39%) who responded to the question, “I worry about the financial problems I will have in the future as a result of my illness or treatment,” 215 (40%) responded “quite a bit” or “very much.” Conclusions: Preliminary analysis highlights the complexities of initiating systematic financial screening in oncology clinics. However, interim results suggest financial hardship is prevalent. Next steps include: expanding to pediatric and gynecologic oncology; building a dashboard to inform financial referrals; comparison of the 2-item screener to the COST survey in a subset of patients; qualitative interviews and focus groups with patients and staff to improve current procedures and optimize the use of dashboards and alerts to focus interventions and referrals on patients most in need.

Clinical treatment pathways utilization in an outpatient academic cancer center.

323 Background: Clinical treatment pathway (CTP) tools have been incorporated into oncology practices to help standardize treatment, reduce care variation in cancer patients, and move towards value-based care. CTP tools incorporate the latest guidelines and are developed through multidisciplinary committees. Treatment decisions are prioritized by efficacy, toxicity, and cost to improve quality and value. This is especially important in cancer care which is associated with high drug costs. However, use and implementation of CTP tools has been met with mixed reviews and published data from academic medical centers are limited. Methods: Outpatient treatment decisions for patients across different cancer types, including colorectal, gastroesophageal, and breast cancers from July 2018 to March 2020 at an urban NCI-designated cancer center were evaluated. Every treatment decision was evaluated in relation to physician utilization of CTP tools. Treatment decisions were categorized as choosing a CTP recommended option ( pathways dependent), not choosing a CTP recommended option ( pathways independent), or not using the CTP tool at all ( non-pathways). Descriptive statistics and significance testing were used to explore CTP utilization over time, physician years in practice, cancer type, and cancer stage. Multinomial and binary logistic regression models were used to evaluate associated factors with CTP utilization. Results: During the study period, 1,007 treatment decisions were identified. Of these, 76% were pathways dependent, 13% were pathways independent, and 11% were non-pathways. CTP utilization was statistically significant in association with cancer type, cancer stage, physician years in practice, and year of encounter. In multinomial logistic regression models, physicians with more years in practice were more likely to be pathways independent and non-pathways than pathways dependent. Physicians treating colorectal or gastroesophageal cancer were more likely to be pathways independent [OR 3.27; 95% CI: 1.98-5.42 and OR 2.25; 95% CI: 1.12-4.49, respectively] or non-pathways [OR 2.98; 95% CI: 1.65-5.37 and OR 3.21; 95% CI: 1.58-6.54, respectively] than pathways dependent compared to physicians treating breast cancer. Treatment decisions for patients with either stage 2 and stage 4 cancers were more likely to be pathways independent than stage 1 cancers [OR 4.13; 95% CI: 1.44-11.84 and OR 4.37; 95% CI: 1.27-15.04, respectively]. Conclusions: This study found that a large proportion of treatment decisions for patients across different cancer types were made utilizing CTP tools, but utilization varies according to cancer type, stage, and physician years in practice. Further research is needed to better understand the physician decision making process and implementation of CTP tools to drive improvement in design, education, and training.

"When I Heard the Word Palliative": Obscuring and Clarifying Factors Affecting the Stigma Around Palliative Care Referral in Oncology.

Palliative care (PC) can help patients with cancer manage symptoms and achieve a greater quality of life. However, there are many barriers to patients with cancer receiving referrals to PC, including the stigmatizing association of PC with end of life. This study explores factors that obscure or clarify the stigma around PC referrals and its associations with end of life in cancer care. A qualitative descriptive design using grounded theory components was designed to investigate barriers to PC referrals for patients receiving treatment at an outpatient cancer center. Interviews with patients, caregivers, and oncology professionals were audio-recorded, transcribed, and independently coded by three investigators to ensure rigor. Participants were asked about their perceptions of PC and PC referral experiences. Interviews with 44 participants revealed both obscuring and clarifying factors surrounding the association of PC as end of life. Prognostic uncertainty, confusion about PC's role, and social network influence all perpetuated an inaccurate and stigmatizing association of PC with end of life. Contrarily, familiarity with PC, prognostic confidence, and clear referral communication helped delineate PC as distinct from end of life. To reduce the stigmatizing association of PC with end of life, referring clinicians should clearly communicate prognosis, PC's role, and the reason for referral within the context of each patient and his or her unique cancer trajectory. The oncology team plays a vital role in framing the messaging surrounding referrals to PC.