Outpatient Medical Oncology Research Articles

Increasing RAS mutation result availability in newly diagnosed patients with metastatic colorectal cancer by their first outpatient medical oncology clinic visit at a large safety net hospital.

110 Background: Rat sarcoma virus mutation testing (RASmt) is critical in guiding systemic therapy selection for patients with metastatic colorectal cancer (mCRC) in the first-line setting. Missing results at the initial medical oncology visit can negatively impact patient outcomes by delaying treatment or leading to inappropriate treatment selection. This quality improvement (QI) project aims to increase the percentage of patients with newly diagnosed mCRC with RASmt results available by their first outpatient medical oncology appointment at a large safety net hospital to 20% over an 8-month period. Methods: A multidisciplinary team of key stakeholders including clinicians, a pathologist, and administrators was assembled to determine factors associated with failure to obtain RASmt. A baseline analysis of all patients referred to the gastrointestinal (GI) oncology clinic from June 2022 to April 2023, with manual review of electronic medical records by investigators, showed that only 6% (3/46) of newly diagnosed patients with mCRC had RASmt results available by their first GI oncology appointment. Two Plan-Do-Study-Act (PDSA) cycles were conducted to assess interventions that were implemented based on process mapping and reasons for unavailable test results. To increase the percentage of patients with RASmt results available, starting December 2023, patients initially diagnosed with mCRC as inpatients who were being followed by the oncology consult service had RASmt ordered on the tissue biopsy prior to discharge (PDSA1). Starting April 2024, the medical directorfor outpatient GI oncology clinics ordered RASmt for all patients with mCRC referred to the clinic at the point of referral (PDSA2) . New patient referrals were reviewed through July 3, 2024. Results: At baseline, the most common reason for unavailable RASmt results was the lack of test orders, with 70% (32/46) of new patients with mCRC not having RASmt ordered prior to their first appointment. Once RASmt was ordered, the average time for results was 13 days. After the first intervention, 4% (1/23) of patients with mCRC had RASmt results available at their first appointment. After the second intervention, 42% (5/12) of patients had RASmt results available. Additionally, median time from diagnosis of mCRC to first appointment decreased from 23 days at baseline to 17 days during PDSA1 to 12 days during PDSA2. Conclusions: By ordering RASmt at the point of referral, the percentage of patients who had RASmt available at their first appointment markedly increased from 6% to 42%. This QI initiative additionally demonstrates the importance of multidisciplinary teams to enhance patient care efficiency at a large safety net hospital. Further efforts are ongoing to increase RASmt availability beyond 42% with a focus on reducing the turnaround time of the test.

Prognostic awareness and prognostic information preferences among advanced cancer patients in Kenya.

Cancer is the third leading cause of death in Kenya. Yet, little is known about prognostic awareness and preferences for prognostic information. To assess the prevalence of prognostic awareness and preference for prognostic information among advanced cancer patients in Kenya. Outpatient medical oncology and palliative care clinics and inpatient medical and surgical wards of Moi Teaching and Referral Hospital (MTRH) in Eldoret, Kenya. The authors surveyed 207 adults with advanced solid cancers. The survey comprised validated measures developed for a multi-site study of end-of-life care in advanced cancer patients. Outcome variables included prognostic awareness and preference for prognostic information. More than one-third of participants (36%) were unaware of their prognosis and most (67%) preferred not to receive prognostic information. Increased age (OR = 1.04, 95% CI: 1.02, 1.07) and education level (OR: 1.18, CI: 1.08, 1.30) were associated with a higher likelihood of preference to receive prognostic information, while increased symptom burden (OR= 0.94, CI: 0.90, 0.99) and higher perceived household income levels (lower-middle vs low: OR= 0.19; CI: 0.09, 0.44; and upper middle- or high vs low: OR= 0.22, CI: 0.09, 0.56) were associated with lower odds of preferring prognostic information. Results reveal low levels of prognostic awareness and little interest in receiving prognostic information among advanced cancer patients in Kenya.Contribution:Given the important role of prognostic awareness in providing patient-centred care, efforts to educate patients in Kenya on the value of this information should be a priority, especially among younger patients.

Real world effectiveness of regorafenib in heavily pretreated patients with metastatic colorectal cancer.

141 Background: Metastatic colorectal cancer (mCRC) remains a challenge with a significant impact on patient survival and quality of life. Over the past decade, targeted therapies have emerged as promising treatment options for mCRC, including regorafenib. While clinical trials have established efficacy and safety of regorafenib in mCRC, based on the CORRECT and ReDos trials, the real-world utilization and outcomes associated with this therapy have gained increasing importance. This abstract presents a real-world data analysis focused on the use of regorafenib in patients with metastatic colorectal cancer in a community based comprehensive cancer center in Moscow, Russia. The data were collected from 2 outpatient medical oncology departments from 2018-2022 and we evaluated the real world patterns of use, effectiveness and safety. Methods: We evaluated all patients who were issued Regorafenib at a medical pharmacy of our cancer center. We evaluated all Regorafenib issued from 2018-2022 in our center – 348 patients received Regorafenib and 311 of them were patients with metastatic colorectal cancer and identified patterns of use, toxicity and outcomes in this patient population. Results: The median age was 61.2 and 49.5% were female (50.5 – were male%) Primary tumor was right sided in 20.9% of all patients, left sided – 49.1% and rectum in 29.9% De novo metastatic colorectal cancer was in 208 patients and 103 patients were those who progressed after initial treatment. Mutation status was identified in 91% of all patients. 46% had KRAS mutation, 3.8% were BRAF mutated and 4.2% were NRAS mutated. MSI status was known for 71% of the patients and it was negative. We understand the selection bias, because most of MSI-h patients would have gone on to receive immunotherapy rather than a TKI. The patients identified in our practice were more heavily pretreated (93.5% of them received more than 3 lines of prior therapy) and 1/3 of all patients were ECOG 2-3 performance status. Toxicity data were available only in 61% of the patients which reveals data caveats when using real world data outside of a clinical trial. Any grade toxicity was noted in 53% of all patients. Using Kaplan Myer Survival Analysis, the median PFS was 2 months and median OS was 5.3 months in the evaluated population. Conclusions: The real world data analysis shows that while Regorafenib is another treatment option, and our data confirm the results of clinical trial, its utilization and use provides only modest clinical benefit for patients.[Table: see text]

Patient preferred language (Spanish or English) impact on patient reported care metrics and provider recommendations.

555 Background: Sinai Health System in Chicago has a growing medical oncology program serving patients with significant supportive and social needs. Sinai is starting a quality improvement project to address these needs, using the 4R Oncology Model for patient facing care planning and patient self-management. 4R (Right Info/Care/Patient/Time) significantly improves patient self-management and optimizes delivery of supportive and health maintenance care (Trosman JCOOP 2021). This abstract describes a baseline survey of patient experiences related to planning and delivery of guideline directed supportive and health maintenance care, conducted in the patient’s preferred language. Methods: Surveys of patients, in their preferred language of Spanish or English, receiving care at an outpatient medical oncology clinic in an urban area January to March 2023. Participating patients received $25 gift card. Analysis conducted using Fisher’s exact two-tailed test. Results: Survey response rates 72% (36/50). Patients were: 61% female; 58% Hispanic, 39% Black; Education level 78% high school or less; 81% < 30k income; preferred language 53% Spanish, 47% English. Patients who preferred Spanish were more likely to have providers discuss how much they would have to pay for cancer treatment (32% vs. 6%, p=0.09). Patients who preferred English were more likely recommended to get a nutrition consult (65% vs. 32%, P=0.09) and recommended to get help for emotional stress or worry (71% vs. 26%, p=0.02). Language preference had no impact on knowledge of cancer stage or recommendations to get smoking or vaping help. See table for additional results. Conclusions: We found opportunities for improvement and gaps in care planning and recommendations to supportive and health maintenance care. Differences in metrics based on patients preferred language (Spanish or English) need to be addressed. Sinai Health system is implementing 4R Care Sequences and supporting tools for patients with cancer in preferred language of Spanish or English. Results will be shared when available.[Table: see text]

Ask Questions (ASQ): Implementation of a question prompt list communication intervention in a network of outpatient medical oncology clinics.

e24185 Background: High-quality, patient-centered communication is not experienced equitably across patient populations, likely contributing to healthcare disparities. Question Prompt Lists (QPL) improve patient active participation and other aspects of patient-physician communication in diverse populations and settings. This descriptive, single-arm study assessed the implementation and patient perceptions of a previously-developed, evidence-based QPL, the ASQ brochure, across a network of oncology clinics providing care in a diverse population across Michigan. Methods: The QPL was revised in collaboration with community and physician stakeholders. Implementation was assessed through the reach, adoption, and efficacy domains of the RE-AIM framework. Eligible patients had a cancer diagnosis and were scheduled for a first appointment with an oncologist at any of eight participating clinics. All participants received the ASQ brochure and completed three surveys: one at baseline, one immediately before their appointment, and one following their appointment. Surveys assessed sociodemographic characteristics; communication-related outcomes (knowledge, self-efficacy in interacting with physicians, trust in physicians, distress); and perceptions of the ASQ brochure. Analyses included descriptive statistics and univariable and multivariable linear mixed-effects models. Results: Reach: A total of 81 patients participated with a consent rate of 68.3%. Self-identified racial/ethnic groups were representative of the population served by the clinic network (72.4% white, 21.0% black, 3.7% American Indian/Native Alaskan, and 1.2% Mexican/Hispanic). Adoption: All eight invited clinics participated and recruited patients. Efficacy: All outcomes improved significantly, with no significant differences by clinic site or patient race. Patient perceptions of the ASQ brochure were overwhelmingly positive. Conclusions: The implementation of the ASQ brochure was successful in this oncology clinic network providing care to a diverse patient population. Findings suggest this simple, evidence-based communication intervention should be implemented widely in similar clinical contexts.

Ask questions (ASQ): Implementation of a question prompt list communication intervention in a network of outpatient medical oncology clinics

ObjectiveThis descriptive, single-arm study assessed the implementation and patient perceptions of an evidence-based Question Prompt List (QPL), the ASQ brochure, across a network of oncology clinics in a diverse patient population. MethodThe QPL was revised in collaboration with stakeholders. Implementation was assessed using the RE-AIM framework. Eligible patients were scheduled for a first appointment with an oncologist at any of eight participating clinics. All participants received the ASQ brochure and completed three surveys: one at baseline, one immediately before, and one following their appointment. Surveys assessed sociodemographic characteristics; communication-related outcomes (perceived knowledge, self-efficacy in interacting with physicians, trust in physicians, distress); and perceptions of the ASQ brochure. Analyses included descriptive statistics and linear mixed-effects models. ResultsReach: Participants (n = 81) represented the diverse population served by the clinic network. Efficacy: All outcomes improved significantly, with no significant differences by clinic site or patient race. Adoption: All eight invited clinics participated and recruited patients. Patient perceptions of the ASQ brochure were overwhelmingly positive. ConclusionImplementation of the ASQ brochure was successful in this oncology clinic network providing care to a diverse patient population. Practical ImplicationsThis evidence-based communication intervention can be implemented widely in similar medical contexts and populations.

Prevalence, Severity, and Co-Occurrence of SPPADE Symptoms in 31,866 Patients With Cancer.

To examine the prevalence, severity, and co-occurrence of SPPADE symptoms as well as their association with cancer type and patient characteristics. The SPPADE symptoms (sleep disturbance, pain, physical function impairment, anxiety, depression, and low energy /fatigue) are prevalent, co-occurring, and undertreated in oncology and other clinical populations. Baseline SPPADE symptom data were analyzed from the E2C2 study, a stepped wedge pragmatic, population-level, cluster randomized clinical trial designed to evaluate a guideline-informed symptom management model targeting the six SPPADE symptoms. Symptom prevalence and severity were measured with a 0-10 numeric rating (NRS) scale for each of the six symptoms. Prevalence of severe (NRS ≥ 7) and potential clinically relevant (NRS ≥ 5) symptoms as well as co-occurrence of clinical symptoms were determined. Distribution-based methods were used to estimate the minimally important difference (MID). Associations of cancer type and patient characteristics with a SPPADE composite score were analyzed. A total of 31,886 patients were assessed for SPPADE symptoms prior to, during, or soon after an outpatient medical oncology encounter. The proportion of patients with a potential clinically relevant symptom ranged from 17.5% for depression to 33.4% for fatigue. Co-occurrence of symptoms was high, with the proportion of patients with three or more additional clinically relevant symptoms ranging from 45.2% for fatigue to 68.6% for depression. The summed SPPADE composite score demonstrated good internal reliability (Cronbach's alpha of 0.86), with preliminary MID estimates of 4.1-4.3. Symptom burden differed across several types of cancer but was generally similar across most sociodemographic characteristics. The high prevalence and co-occurrence of SPPADE symptoms in patients with all types of cancer warrants clinical approaches that optimize detection and management.

Sexuality and marital satisfaction in patients followed for breast cancer in a regional hospital

IntroductionBreast cancer is the leading cancer in women in developed and developing countries. Treatment strategies can affect sexuality in the short or long term.ObjectivesThe aim of our study was to assess sexuality and martial satisfaction in patients followed for breast cancer.MethodsCross-sectional descriptive study including patients followed for breast cancer at the outpatient medical oncology consultation of Hadj Ali Soua regional hospital from January to March 2021. We passed the Female Sexual Function Index (FSFI) and the martial adjustment test (MAT).ResultsFifteen patients were included with a mean age of 49.87 ± 8.48 years and a mean age at diagnosis of 46.73 ± 7.55 years. At the TNM classification, 66.6% of the patients had a T1 or T2 at the time of diagnosis and 80% had an N0. All patients received a surgical intervention, which was conservative in 53.3% of cases. No patient underwent breast reconstruction. Chemotherapy and hormone therapy were prescribed in 86.7% of patients. Radiotherapy and targeted therapy were prescribed in 12 and 2 case, respectively. Amenorrhea, hot flushes and vaginal dryness were noted in 98.7%, 26.7% and 7.6% of patients, respectively. Sexual disorders were found in 53.3% of cases, which settled in a chronic mode in 75% of cases and progressed in a continuous mode in half of cases. The assessment of physical and erotic life was revealed to be neat in 73.3% of the patients. The mean score of the FSFI questionnaire was 17.25 [2.6-31.9]. Eleven patients (73.3%) had sexual dysfunction. A low marital satisfaction was found in 34% of cases.ConclusionsThe medical consultation to identify sexuality disorders in correlation with the martial dissatisfaction in women followed for new breast cancer is crucial allowing a better management of this pathology.Disclosure of InterestNone Declared

Factors associated with sexual disorders in women followed for breast cancer

IntroductionBreast cancer is the most frequently encountered malignant tumor among women in Tunisia and in the world. The quality of sexual life of patients with breast cancer is impaired by multifactorial mechanisms.ObjectivesThe aim of our study was to determine the factors associated with sexual disorders in patients followed for breast cancer.MethodsCross-sectional analytic study including patients followed for breast cancer at the outpatient medical oncology consultation of Hadj Ali Soua regional hospital from January to March 2021. We collected sociodemographic and clinical data with an assessment of sexuality (FSFI), marital satisfaction (MAT), psychological profile (HAD) and quality of life (SF36).ResultsFifteen patients were included with a mean age of 49.87 ± 8.48 years and a mean age at diagnosis of 46.73 ± 7.55 years. At the TNM classification, 66.6% of the patients had a T1 or T2 at the time of diagnosis and 80% had an N0. All patients received a surgical intervention, which was conservative in 53.3% of cases. No patient underwent breast reconstruction. Chemotherapy and hormone therapy were prescribed in 86.7% of patients. The mean score of the FSFI questionnaire in our study was 17.25. Eleven patients (73.3%) had an FSFI score below 26.55. We found negative correlations between age and FSFI score (r=-0.622; p=0.013). We noted statistically significant negative correlations between FSFI and HAD-D (r=-0.606; p=0.017) and FSFI and HAD-a (r=-0.707; p=0.01) as well as significant correlations between FSFI and the following items: RE (r=0.84p=0.000), SF (r=0.684 p=0.005), GH (r=0.671 p=0.006) and MCS (r=0.788 p=0.000).ConclusionsFocusing on a small sample of patients followed for breast cancer, our study provides an assessment of the sexual function in its various areas and shows how sexuality is deeply intertwined with other sections of medical management.Disclosure of InterestNone Declared

Anxiety and depression among breast cancer patients

IntroductionNeoplastic disease affects all aspects of life. People with cancer may experience a variety of emotions and reactions to their new reality that may be mild or intense, transitory or permanent.ObjectivesThe aim of our study was to assess the psychological distress of patients with breast cancer.MethodsCross-sectional descriptive study including patients followed for breast cancer at the outpatient medical oncology consultation of Hadj Ali Soua regional hospital from January to March 2021. We used the “Hospital Anxiety and Depression Scale (HAD-S)” for the assessment of anxiety and depression.ResultsFifteen patients were included with a mean age of 49.87 ± 8.48 years and a mean age at diagnosis of 46.73 ± 7.55 years. At the TNM classification, 66.6% of the patients had a T1 or T2 at the time of diagnosis and 80% had an N0. All patients received a surgical intervention which was conservative in 53.3% of cases. No patient underwent breast reconstruction. Chemotherapy and hormone therapy were prescribed in 86.7% of patients. The mean anxiety and depression scores according to the HAD-S were 9.53 and 4.93, respectively. The majority of our patients had no depressive symptoms (80%) against only 2 patients (13.33%) with depressive symptoms. On the other hand, most of our patients were anxious: 6 patients (40%) showed probably clinically relevant levels of anxiety (score of 11 or higher) and 5 patients showed possibly clinically relevant levels of anxiety (scores of 8 or higher) (33,33%).ConclusionsOur study revealed a high prevalence of psychological distress. The presence of clinical psychologists in the medical oncology department and the training of nursing staff in psycho-oncology are essential for the overall care of patients with cancer.Disclosure of InterestNone Declared

Are You an Oncology Nurse or an Infusion Nurse?

Outpatient medical oncology has been my nursing focus for the past 34 years. I spent the first 17 years exclusively at the chairside in the outpatient cancer treatment center, practicing primary oncology nursing, honing my expertise in administering infusion therapies to individuals with blood and cancer disorders, and specializing in the complex nursing care associated with this patient population.

Limited waiting areas in outpatient clinics: an intervention to incorporate the effect of bridging times in blueprint schedules

BackgroundDistancing measures enforced by the COVID-19 pandemic impose a restriction on the number of patients simultaneously present in hospital waiting areas.ObjectiveEvaluate waiting area occupancy of an intervention that designs clinic...

Performance of clinician prediction of survival in oncology outpatients with advanced cancer.

BackgroundWe aimed to investigate the performance of clinician prediction of survival (CPS) and the association between CPS and the prognostic confidence of clinicians in ambulatory medical oncology outpatients.MethodsEight medical oncologists estimated the expected survival of their patients in a prospective cohort study. They were asked to provide a temporal type of CPS in weeks, together with their level of confidence for each prediction (0–100%). We analyzed the accuracy of CPS, the association between CPS and the prognostic confidence, and the characteristics of patients showing inaccurate CPS.ResultsA total of 200 advanced cancer patients were enrolled and the median overall survival was 7.6 months. CPS was accurate in 67 (33.5%) patients, underestimated in 87 (43.5%), and overestimated in 46 (23.0%). The overall accuracy of CPS for 12-week, 24-week, 36-week, and 48-week survival was 83.0%, 72.0%, 75.5%, and 74.0%, respectively. The specificity was highest for 12-week survival (90.2%) and the sensitivity was highest for 48-week survival (96.1%). The sensitivity of 12-week CPS was 51.4% and the area under the receiver operating characteristic (AUROC) curve was 0.79 (95% confidence interval [CI] 0.71–0.87). The prognostic confidence of clinicians was not significantly associated with the accuracy of prediction (P = 0.359). Patients with overestimated survival had significantly poorer global health status and physical/role/emotional functioning in the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). Additionally, they showed significantly higher levels of fatigue, nausea/vomiting, pain, dyspnea, and loss of appetite.ConclusionThe overall accuracy of CPS in predicting 12-week to 48-week survival was high in medical oncology outpatients. However the sensitivity of 12-week CPS was low and prognostic confidence was not associated with the accuracy of CPS. Patients with overestimated CPS showed poorer quality of life and higher symptom burden.

Disparities in telemedicine during COVID-19.

BackgroundOncology rapidly shifted to telemedicine in response to the COVID‐19 pandemic. Telemedicine can increase access to healthcare, but recent research has shown disparities exist with telemedicine use during the pandemic. This study evaluated health disparities associated with telemedicine uptake during the COVID‐19 pandemic among cancer patients in a tertiary care academic medical center.MethodsThis retrospective cohort study evaluated telemedicine use among adult cancer patients who received outpatient medical oncology care within a tertiary care academic healthcare system between January and September 2020. We used multivariable mixed‐effects logistic regression models to determine how telemedicine use varied by patient race/ethnicity, primary language, insurance status, and income level. We assessed geospatial links between zip‐code level COVID‐19 infection rates and telemedicine use.ResultsAmong 29,421 patient encounters over the study period, 8,541 (29%) were delivered via telemedicine. Several groups of patients were less likely to use telemedicine, including Hispanic (adjusted odds ratio [aOR] 0.86, p = 0.03), Asian (aOR 0.79, p = 0.002), Spanish‐speaking (aOR 0.71, p = 0.0006), low‐income (aOR 0.67, p < 0.0001), and those with Medicaid (aOR 0.66, p < 0.0001). Lower rates of telemedicine use were found in zip codes with higher rates of COVID‐19 infection. Each 10% increase in COVID‐19 infection rates was associated with an 8.3% decrease in telemedicine use (p = 0.002).ConclusionsThis study demonstrates racial/ethnic, language, and income‐level disparities with telemedicine use, which ultimately led patients with the highest risk of COVID‐19 infection to use telemedicine the least. Additional research to better understand actionable barriers will help improve telemedicine access among our underserved populations.

DEVELOPMENT OF EDUCATION MATERIAL FOR HEALTH LITERACY AND EDUCATION NEEDS OF PATIENTS WHO RECEIVE CHEMOTHERAPY IN TURKEY

Aim: The aim of the study was to determine the health literacy levels of patients receiving chemotherapy in Turkey, to develop written educational material considering the health literacy level and to evaluate the appropriateness. Methods: 360 patients who received chemotherapy at the Istanbul University Cerrahpaşa Medical Faculty Medical Oncology Outpatient Clinic. Descriptive and methodological research method was used. The data were collected using the DISCERN, Patient Data Form, Turkish Health Literacy Scale-32, Evaluation of the Conformity of Written Materials Form. "Chemotherapy Patient Education Guide" has developed. The data were evaluated by using descriptive analysis, parametric, non-parametric and advanced analysis in IBM SPSS Statistics 21 program. Results: 72.2% of the patients receiving chemotherapy have a poor health literacy level and 6.1% are excellent. The developed “Chemotherapy Patient Education Guide” was found to be high in reliability and information quality by experts and patients. Conclusions: With cooperation of health care professionals work on the development and growth of written training materials in different disciplines and health policy regulators, it can be advised planning and organizing training activities, development of written training materials and evaluation of the readability level, reliability and information quality of the developed written training materials in accordance with results obtained from the research. Nurses should plan educational activities that will increase the health literacy levels of patients receiving chemotherapy, and develop written education materials taking into account their health literacy levels.

Cancer-Associated Venous Thromboembolic Disease, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology.

NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Cancer-Associated Venous Thromboembolic Disease focus on the prevention, diagnosis, and treatment of patients with cancer who have developed or who are at risk for developing venous thromboembolism (VTE). VTE is a significant concern among cancer patients, who are at heightened risks for developing as well as dying from the disease. The management of patients with cancer with VTE often requires multidisciplinary efforts at treating institutions. The NCCN panel comprises specialists from various fields: cardiology, hematology/hematologic oncology, internal medicine, interventional radiology, medical oncology, pharmacology/pharmacy, and surgery/surgical oncology. This article focuses on VTE prophylaxis for medical and surgical oncology inpatients and outpatients, and discusses risk factors for VTE development, risk assessment tools, as well as management methods, including pharmacological and mechanical prophylactics. Contraindications to therapeutic interventions and special dosing, when required, are also discussed.

Implementation of a medical oncology fellow-initiated financial toxicity screening program in outpatient medical oncology clinics

Introduction The National Cancer Institute defines financial toxicity as “problems a patient has related to costs of cancer care.” Financial toxicity is a critical problem in cancer treatment and one that remains conventionally outside of clinical discussion and treatment decision-making. Methods This is a feasibility pilot study of the implementation of a medical oncology fellow-led financial toxicity screening intervention program at the Helen Diller Family Comprehensive Cancer Center (HDFCCC) at the University of California San Francisco. Fellows were asked to conduct and document financial toxicity screening of patients seen in medical oncology outpatient clinics from August 2017 to March 2018 in the electronic medical record. Results At baseline, no fellows documented financial toxicity screening. Screening rates peaked at 49%, however at the end of the intervention the screening rate decreased to 11% among participants. Conclusions The results of the pilot feasibility study revealed that a fellow-led financial toxicity screening program in medical oncology clinics rendered low adherence to patient screening. Future research will need to develop mechanisms for identifying patients who may experience high levels of financial distress in medical oncology practice.

A Prognostic Model to Facilitate Palliative Care Referral in Oncology Outpatients.

PurposeWe aimed to develop a prognostic model to assist palliative care referral at least 3 months before death in advanced cancer patients treated at an outpatient medical oncology clinic.Materials and MethodsIn this prospective cohort study, a total of 200 patients were enrolled at a tertiary cancer center in South Korea. The major eligibility criterion was an expected survival of less than a year as estimated by their oncologists. We analyzed the influences of known prognostic factors along with chemotherapy status, mid-arm circumference, and triceps skinfold thickness on survival time.ResultsThe mean age of the patients was 64.5 years, 36% were female, and the median survival time was 7.6 months. In the multivariate analysis, we found six significant factors related to poor survival: a poor Eastern Cooperative Oncology Group (ECOG) performance status (≥ 2), not undergoing chemotherapy, anorexia, a low lymphocyte level (< 12%), a high lactate dehydrogenase (LDH) level (≥ 300 IU/L), and a low mid-arm circumference (< 23 cm). We developed a prognostic model (score, 0–8.0) to predict 3-month survival based on the multivariate analysis. Patients who scored ≥ 4.0 points had a short survival of less than 3 months (p < 0.001). The discriminating ability of the prognostic model using the area under the receiver operating characteristic curve was 0.88.ConclusionThe prognostic model using ECOG performance status, chemotherapy status, anorexia, lymphocytes, LDH, and mid-arm circumference can predict 3-month survival in medical oncology outpatients. It can alert oncologists to refer patients to palliative care specialists before it is too late.

How Do Breast Cancer Patients Present Following COVID-19 Early Peak in a Breast Cancer Center in Turkey?

Coronavirus disease 2019 (COVID-19) has placed an unprecedented burden on healthcare systems and restricted resources for non-COVID patients worldwide. Treatment approaches and follow-up plans have been modified to prevent the risk of infection for patients and healthcare workers. Patients prefer to delay or cancel their treatments during the peak period of infection. We retrospectively reviewed the characteristics of patients with breast cancer who were consulted at our outpatient clinic right after early COVID-19 peak in May and June 2020 and compared them with the same period in 2017 to 2019. The number of patients who consulted at our outpatient medical oncology clinic declined in May and June 2020. This decline was regardless of stage and was larger in May than in June 2020. In general, the distribution of tumor subtypes [luminal, human epidermal growth factor receptor 2 (HER-2) positive, and triple negative] was not different from 2017 to 2020. Less than half of the patients received adjuvant chemotherapy following early COVID-19 peak in May and June 2020. Few patients received chemotherapy for metastatic disease, whereas many metastatic patients received endocrine therapy. None of the consulted new patients had a non-invasive disease. More patients received endocrine therapy than chemotherapy. The presentation patterns of patients with breast cancer after early COVID-19 peak differed from those during the same period in the last 3 years. The pandemic affected the number of new patients consulted and the way medical oncologists treat their patients.

Improving the Delivery of High-Quality Cancer Care in Medically Underserved Communities: A Formative Evaluation Method.

In 2015, the American Society of Clinical Oncology launched a new program: Improving Quality of Care in Underserved Communities with the overarching aim of serving patients with cancer who have traditionally had difficulty accessing the care they need. Cancer care requires intense coordination of complex services to provide safe, effective, timely, and equitable care. If chemotherapy and/or radiation is needed, patients must navigate a complex system of care many times, a formidable challenge for many disadvantaged patients. Many practices believe that these patients face such significant issues that it is almost impossible to provide high-quality care. A grant from the Stavros Niarchos Foundation allowed us to select 4 oncology practices serving high proportions of racial minorities and persons of low socioeconomic status to participate in the new American Society of Clinical Oncology program. The program had 2 objectives: (1) to improve the capacity and capability of the participating practices to provide evidence-based, high-quality care; and (2) to identify and disseminate lessons learned for improving quality of care among oncology practices serving underserved patients. The program leveraged existing programs including the Quality Oncology Practice Initiative, which is a national performance measurement and improvement program that collects data about processes of care provided in the outpatient medical oncology setting, and the American Society of Clinical Oncology Quality Training Program, which provides training in how to apply the tools and methods of quality improvement in routine care settings. Training was provided in face-to-face and virtual meetings and participants were provided mentors throughout the program. At the conclusion, a formative evaluation method was used to assess whether the goals had been achieved. Objectives, activities, and desired outcomes were identified for each of the goals and thus became the framework for the evaluation. The program met the stated goals and objectives. The evaluation revealed many successes, some surprises, and a list of improvements that were incorporated in the next iteration of this program. Based on data from the evaluation, the Niarchos Foundation provided funds for an additional 10 practices to participate in a similar program in 2020. This article outlines the evaluation of a new program demonstrating that medical oncology practices can make improvements in the care of their underserved populations if provided with the proper tools, methods, and coaching. The use of formative evaluation methodology also identified opportunities for improvement and ultimately resulted in additional funding for more practices to participate in the program.