Phase Of Cancer Care Research Articles

Long-term projections of cancer incidence and mortality in Canada: The OncoSim All Cancers Model

Using the OncoSim All Cancers Model, we estimated the annual cancer incidence, mortality and cancer management costs in Canada from 2020 to 2040. Incidence for each cancer type was estimated from logistic regression analyses of the Canadian Cancer Registry (1992–2017), with province/territory, sex, five-year age groups and year as covariates. Deaths were estimated by sex and tumour site for cancers diagnosed between 2000 and 2017 (deaths to the end of 2017). The total cost of a cancer type was the sum of costs for individuals across four phases of cancer care. The projections presented in this study were generated based on a simulation of 32 million cases. The OncoSim All Cancers Model projects a 40% increase in the overall number of incident cancer cases from 2020 to 2040. The number of the four most commonly diagnosed cancers in Canada (breast, colorectal, lung, and prostate) are projected to increase annually. The overall number of cancer deaths is projected to increase by 44% from 2020 to 2040. More cancer deaths are projected in males than in females. The age-standardized mortality rate is expected to remain relatively stable over time. Overall cancer management costs are projected to increase from $20.6B in 2020 to $31.4B in 2040. Due mainly to an aging population and population growth in Canada, we estimate that cancer incidence, mortality and cancer management costs will increase considerably between 2020 and 2040. These results highlight the importance of planning for increasing investment and capacity in cancer control.

Disparities in cancer concerns in patients with gynecologic cancer on clinical trial compared to standard of care (587)

Disparities in cancer concerns in patients with gynecologic cancer on clinical trial compared to standard of care (587)

Phase-specific costs of care in diffuse large B-cell lymphoma in Ontario, Canada.

e18840 Background: This Canadian study analyzes real-world data to estimate phase-specific costs and health care resource utilization for patients with diffuse large B-cell lymphoma (DLBCL). Methods: A cohort of adult patients diagnosed with DLBCL were identified between 2003-2014 from the Ontario Cancer Registry (OCR) and linked to treatment data from Cancer Care Ontario and other provincial administrative health care databases. Health system costs and resource utilization were determined for four defined phases of care in which index date was defined as the OCR diagnosis date, including: pre-diagnosis (90 days prior to index date), initial treatment (index date to 6 months), follow-up (end of treatment phase to beginning of end-of-life or completion of cohort follow-up) and end-of-life (last 6 months of life for patients who died). Costs (Canadian dollars in 2014) and resource utilization were normalized to 30-days. Results: There were 5,392 individuals (53% males; median age 64 years (IQR 53-74)) diagnosed with DLBCL. The median follow-up was 1,903 days (IQR 1,194-2,882) from index date. At follow-up completion, 4,015 (74.5%) individuals were alive. Total mean 30-day cost was $1,175 (±2,267) in pre-diagnosis, $9,166 (±5,581) during initial treatment, $1,462 (±2,757) during follow-up, and $7,965 (±7,104) during end-of-life. The total 30-day cost for inpatient care was $3,864 (±5,013) during treatment (n = 3,362 hospitalized during treatment) and $5,045 (±5,908) for end-of-life (n = 1,367 hospitalized during end-of-life). For home care, the mean 30-day costs were $528 (±512) during initial treatment (n = 3,508, 65% of cohort) and $725 (±884) during end-of-life (n = 1,211, 23% of cohort). Mean 30-day cost of cancer medication was $80 (±455) in pre-diagnosis, $3,115 (±1,236) during initial treatment, $232 (±712) during follow-up, and $305 (±694) during end-of-life. A subset of 239 individuals had autologous stem cell transplantation (ASCT) for relapsed/refractory DLBCL. For the ASCT subgroup, the mean total 30-day cost was $11,653 (±4632) in pre-ASCT phase, $1,542 (±2961) in post-ASCT phase, and $14,094 (±12,845) in end-of-life phase for those that subsequently died (n = 118). A further subset of 52 individuals had relapsed and proceeded to third-line therapy. The total mean total 30-day cost was $8,288 (±8,943) in the first 6-month follow-up, $2,584 (±4,000) in the post 6-month follow-up, and $14,999 (±9,443) in end-of-life phase for those that died (n = 29). Conclusions: Total mean 30-day cost was highest in initial treatment phase and end-of-life phases following a U-shaped pattern. Inpatient care was the cost driver across all phases. Individuals who required ASCT had significantly increased costs. Home care was less frequently accessed during end-of-life phase compared to initial treatment phase (23% vs. 65%). These findings can help allocate appropriate resources throughout the different phases of cancer care.

Exercise for cancer cachexia in adults.

Exercise for cancer cachexia in adults.

Mouth Cancer: the Maxillofacial Surgeon's perspective

This article summarizes current practice according to UK guidelines for the management of oral cancer from the perspective of the oral and maxillofacial surgeon. The article discusses the patient pathway, starting with recognition of sinister features by the general dental practitioner in primary care and referral to specialist oral and maxillofacial surgery services, followed by the multidisciplinary approach to tumour staging, cancer treatment planning and delivery, and finally key issues in the ‘post-treatment’ phase of cancer care. Additional focus is provided for some of the surgical treatments and anatomical and physiological changes, of which the general dental practitioner should have some understanding.CPD/Clinical Relevance: General dental practitioners play a key role in the detection and early management of oral cancer, referring approximately 40% of all cases to secondary care. It is therefore important to understand key milestones and technical elements of the patient's journey.

From Cancer Treatment to Cancer Survivorship: A Case Report Demonstrating the Dynamic Roles of Intrathecal Drug Delivery System in Various Phases of Cancer Care

Background: Until the continued improvements in cancer diagnosis and treatment, many cancers were once considered terminal illnesses. Opioid-based therapy is frequently utilized from the armamentarium for cancer pain treatment since the immediate goals of acute cancer pain management are focused on alleviating pain severity and improving quality of life during this limited time – despite the risks of chronic opioid therapy. However, now, with an expanding cancer survivor population, we lack guidance and tools to assist health care providers and patients in pivoting the focus of cancer pain management from acute relief toward improving function, rehabilitation, and limiting the long-term adverse effects of pain and opioid therapy. Case Report: Here, we present a case exemplifying the ability of intrathecal drug delivery systems to serve a multitude of roles during the various phases of cancer care: from treating acute cancer-related pain, acting as a tool to wean systemic opioid therapy, to being clinically dormant in situ but ready to serve again in the event of cancer recurrence. Conclusion: Intrthecal drug delivery systems are effective tools in managing acute cancer pain and can also be adapted to help manage chronic pain in cancer survivors. Key words: Cancer pain, intrathecal drug delivery system, intrathecal pump, opioid weaning

Adherence to post-surgery follow-up assessment and its association with sociodemographic and disease characteristics in patients with breast cancer in China.

e19232 Background: The incidence of breast cancer has increased more than 30% in the past decades in China. Epidemiological studies based on international and Chinese data have showed that breast cancer is the most common in female malignant tumors. Breast cancer patients with early breast cancer have better survival, lower recurrence and metastasis rate due to early diagnosis and improved treatment. As an important element in the comprehensive management of breast cancer patients, follow-up can eliminate treatment-related complications, detect recurrence and metastasis as early as possible, and improve mental health and quality of life. It is increasingly recognized as a distinct phase of cancer care. However, follow-up adherence after breast surgery has not been studied in China. The aim of this study is to investigate the loss of follow-up after breast cancer surgery and its association with patients', tumor and treatment characteristics. Methods: A total of 711 patients underwent surgical treatment in Shanxi Bethune Hospital from March 2012 to May 2018 were included in this study. Baseline socio-demographic, tumor, and treatment characteristics were obtained from the hospital electronic medical records. The post-surgery follow-up was reviewed and assessed from the patients’ follow-up examination record. Factors associated with the first three-year follow-up was evaluated using logistic regression analysis. Results: The annual follow-up rate after surgery decreased gradually from 67.1% at the 1st year, 60.2% at the 3rd year to 51.9% at the 4th year, and 43.5% at the 5th year. Loss of follow-up during the first three years after surgery was significantly associated with older age >65 years(OR=2.34, 95% CI:1.14-4.82), lower medical insurance coverage(OR=4.26, 95%CI:1.77-10.25), axillary lymph node dissection(OR=2.52, 95%CI:1.39-4.55), no chemotherapy(OR=3.55, 95% CI:1.87-6.75) and no radiotherapy(OR=3.85, 95%CI:2.11-7.03). Conclusions: This study indicated that the annual follow-up rate after curative surgery for breast cancer survivors decreased significantly within five years, and that the risk of poor adherence to follow-up examinations was significantly increased in patients aged over 65 years with lower medical insurance coverage, having extensive axillary lymph node dissection, and lack of systematic treatments. These results suggest potential for improving adherence to follow-up in higher-risk subgroups and help clinicians to develop tailored patient management.

Prevalence and scope of advanced practice provider oncology care among Medicare beneficiaries with breast cancer.

Advanced practice providers (APPs) have increasingly become members of the oncology care team. Little is known about the scope of care that APPs are performing nationally. We determined the prevalence and extent of APP practice and examined associations between APP care and scope of practice regulations, phase of cancer care, and patient characteristics. We performed an observational study among women identified from Medicare claims as having had incident breast cancer in 2008 with claims through 2012. Outpatient APP care included at least one APP independently billing for cancer visits/services. APP scope of practice was classified as independent, reduced, or restricted. A logistic regression model with patient-level random effects was estimated to determine the probability of receiving APP care at any point during active treatment or surveillance. Among 42,550 women, 6583 (15%) received APP care, of whom 83% had APP care during the surveillance phase and 41% during the treatment phase. Among women who received APP care during a given year of surveillance, the overall proportion of APP-billed clinic visits increased with each additional year of surveillance (36% in Year 1 to 61% in Year 4). Logistic regression model results indicate that women were more likely to receive APP care if they were younger, black, healthier, had higher income status, or lived in a rural county or state with independent APP scope of practice. This study provides important clinical and policy-relevant findings regarding national practice patterns of APP oncology care. Among Medicare beneficiaries with incident breast cancer, 15% received outpatient oncology care that included APPs who were billing; most of this care was during the surveillance phase. Future studies are needed to define the degree of APP oncology practice and training that maximizes patient access and satisfaction while optimizing the efficiency and quality of cancer care.

The effect of medical home enrollment on cardiometabolic medication adherence among Medicaid-insured cancer patients.

279 Background: Medical homes, developed to increase care coordination among vulnerable patient populations, have been successful in improving outcomes of patients with multiple chronic comorbidities, but have not been evaluated among cancer survivors. We determined the impact of medical home enrollment on adherence to anti-diabetics, anti-lipidemics, and anti-hypertensives among Medicaid patients diagnosed with non-metastatic breast, colorectal, or lung cancer. Methods: Using linked cancer registry and claims data from North Carolina, we included Medicaid-insured adults diagnosed from 2004-2012 with breast, colorectal, or lung cancer who had at least one cardiometabolic condition (i.e., hyperlipidemia, hypertension, and diabetes mellitus). For each cardiometabolic condition, we measured medication adherence using ambulatory proportion of days covered (PDC). We examined the impact of medical home enrollment on PDC across the phases of cancer care (i.e., pre-cancer diagnosis, treatment, and survivorship phases) using a differences-in-differences model. All models adjusted for age, sex, race/ethnicity, dual enrollment, cancer type, comorbidity index, and number of cardiometabolic conditions. Results: We included, respectively, 765, 1079, and 1634 cancer patients with diabetes, hyperlipidemia, and hypertension. Overall, adherence to anti-lipidemics was lower than adherence to anti-diabetics and anti-hypertensives. In the pre-diagnosis phase, mean PDC across all cardiometabolic conditions was slightly lower for cancer patients enrolled in a medical home than those not enrolled in a medical home. However, medication adherence improved 3-5% in the treatment phase and 7% in the survivorship phase for cancer patients in a medical home compared to cancer patients not in a medical home during the pre-diagnosis phase. Conclusions: These results provide evidence that enrollment in a medical home can improve medication adherence, even among vulnerable cancer patients with complex health needs. The medical home model is an effective healthcare system intervention through which to provide better care coordination and improve patient outcomes.

How adverse events and permanent medication stoppages affect changes in patients'beliefs about oral antineoplastic agents.

Patients with advanced cancer often experience adverse events related to oral antineoplastic agents (OAAs) and permanent OAA medication stoppages, yet it is unknown how these factors impact medication beliefs. Such beliefs about OAA therapy may lend insight into decisions about continued cancer treatment near the end of life. To explore relationships that adverse events and permanent OAA stoppages have on medication beliefs during the first 12weeks following new OAA initiation. A secondary data analysis from a National Cancer Institute-funded randomized controlled trial testing an intervention to promote symptom management and OAA adherence. Patients ≥ 21years of age initiating a new course of OAA medication were recruited from six United States Comprehensive Cancer Centers. This analysis was based on a subset of patients with advanced disease (N = 60). Beliefs about Medicine Questionnaire, Common Terminology Criteria for Adverse Events, and medical records of permanent OAA stoppages. Significant decline in beliefs regarding the necessity of OAA medications existed between patients experiencing three or more adverse events and those experiencing a permanent OAA stoppage. Beliefs about the necessity of OAA medication change when physicians stop OAA medication or the patient experiences three or more adverse events. Concern regarding OAA medication did not change in response to medication stoppage or adverse events for this sample. Perhaps, patients with advanced cancers may be more accepting of adverse events that occur along the treatment trajectory and are not concerned about OAA medication once it is stopped. Findings suggest the importance of physicians' discussions of adverse events and decisions to permanently stop OAA medication as a means of transitioning to a new phase of cancer care that may include palliative or hospice considerations, given that beliefs about medication necessity are changing during these threats to cancer treatment.

OP69 Initiatives To Improve The Timeliness Of Cancer Diagnosis

IntroductionConventional wisdom suggests that accelerating the speed of cancer diagnosis should improve health outcomes. However, cancer diagnosis requires complex coordination and effective communication between care providers working across many areas of the healthcare system. Since 2000, several nations and jurisdictions have aimed to improve timeliness of cancer diagnosis by integrating and coordinating cancer diagnostic services for patients. The objective of this study was to describe the impact of these existing initiatives.MethodsWe conducted an environmental scan consisting of a literature review (published academic and grey literature) and key informant consultations (online surveys and telephone interviews with experts who have knowledge of existing initiatives). We searched for initiatives in the United Kingdom, the Nordic countries, Canada, Australia, and New Zealand. For each initiative, we extracted data on their development and implementation, structure and functioning, intended outcomes and effectiveness, costs and cost savings, and enablers and barriers.ResultsEighty-nine relevant documents and 20 key informants contributed to this study. We identified 21 relevant initiatives, including seven national initiatives targeting multiple types of cancer. The literature review found that most initiatives accelerated the diagnostic phase of cancer care by several days or weeks. These wait time reductions were often associated with improved patient experience, but not less advanced cancer stage or increased long-term survival. Insights from key informants improved our understanding of the costs, enablers, and barriers associated with program implementation and maintenance.ConclusionsThese results can be used as a first step to inform the development, evaluation, and improvement of international cancer diagnostic pathways. Stakeholders wishing to accelerate cancer diagnosis should consider the feasibility of achieving their intended program outcomes based on the existing research evidence, desired type of initiative, and jurisdiction's unique contextual factors.

Sexual Health as Part of Gynecologic Cancer Care: What Do Patients Want?

Sexual health is important to quality of life; however, the sexual health of gynecologic cancer patients is infrequently and inadequately addressed. We sought to understand patient experiences and preferences for sexual health care to help inform strategies for improvement. An anonymous, cross-sectional survey of outpatient gynecologic cancer patients at a large academic medical center was performed as part of a larger study examining patient and caregiver needs. The survey explored patient-provider discussions about sexuality across 3 domains (experiences, preferences, barriers) and 4 phases of cancer care (diagnosis, treatment, treatment completion, follow-up). Age, relationship status, sexual activity, and cancer type were recorded. Mean age was 63 years. Most patients had ovarian cancer (38%) or endometrial cancer (32%). Thirty-seven percent received treatment within the last month, 55% were in a relationship, and 35% were sexuality active. Thirty-four percent reported sexuality as somewhat or very important, whereas 27% felt that it was somewhat or very important to discuss. Importance of sexuality was associated with age, relationship status, and sexual activity but not cancer type. Fifty-seven percent reported never discussing sexuality. Age was associated with sexuality discussions, whereas relationship status, sexual activity, and cancer type were not. The most common barrier to discussion was patient discomfort. Follow-up was identified as the best time for discussion. Sexuality was most often discussed with a physician or advanced practice provider and usually brought up by the provider. Demographic predictors of importance of sexuality to the patient are age, relationship status, and sexual activity. Providers primarily use age as a proxy for importance of sexuality; however, relationship status and sexual activity may represent additional ways to screen for patients interested in discussing sexual health. Patient discomfort with discussing sexuality is the primary barrier to sexual health discussions, and awareness of this is key to developing effective approaches to providing sexual health care.

Telemedicine Use Among Caregivers of Cancer Patients: Systematic Review.

BackgroundThe number of published studies and systematic reviews examining different telehealth interventions targeting patients and their effects on patients’ well-being and quality of life have grown in recent decades. However, the use of telemedicine tools aimed at the family members and caregivers of adult cancer patients is less defined.ObjectiveWe aimed to conduct a systematic review to provide a more complete picture regarding telemedicine tools for informal caregivers (usually family members or close friends) implemented in all phases of cancer care. More specifically, the review aimed to better describe the study samples’ characteristics, to analyze measured outcomes and the specific questionnaires used to assess them, and to describe in depth the implemented interventions and their formats. Finally, we examined the role of telehealth, and usability and feasibility trends in supporting patients’ caregivers.MethodsWe systematically searched the literature in the following databases: Web of Science, Cochrane Library, PubMed, Scopus, CINAHL, MEDLINE, EMBASE, Google Scholar, and PsycINFO. Inclusion criteria were being written in English, published in peer-reviewed journals, describing a telehealth-implemented intervention, and focusing on caregivers of adult cancer patients at any stage of the disease. We selected studies published up to November 2017. We critically appraised included articles using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and graded the quality of evidence by outcome using the Centre for Evidence-Based Medicine framework.ResultsWe included 24 studies in the final selection. In 21 of the 24 studies, the patient-caregiver dyad was analyzed, and the study population dealt with different types of cancer at different stages. Included studies considered the caregiver’s condition from both an individual and a relational point of view. Along with psychosocial variables, some studies monitored engagement and user satisfaction regarding Web-based platforms or telehealth interventions. All studies reported significant improvements in some of the investigated areas, but they often showed small effect sizes. Two types of telehealth intervention formats were used: Web-based platforms and telephone calls. Some of the included studies referred to the same project, but on study samples with different cancer diagnoses or with new versions of previously developed interventions.ConclusionsReported outcomes seem to suggest that we are in an exploratory phase. More detailed and targeted research hypotheses are still needed. Clarifying caregivers’ needs related to telehealth tools and better defining outcome measures may yield more significant results.

Costs of Cancer Care Across the Disease Continuum.

The aim of this study was to estimate Medicare payments for cancer care during the initial, continuing, and end-of-life phases of care for 10 malignancies and to examine variation in expenditures according to patient characteristics and cancer severity. We used linked Surveillance, Epidemiology and End Results-Medicare data to identify patients aged 66-99 years who were diagnosed with one of the following 10 cancers: prostate, bladder, esophageal, pancreatic, lung, liver, kidney, colorectal, breast, or ovarian, from 2007 through 2012. We attributed payments for each patient to a phase of care (i.e., initial, continuing, or end of life), based on time from diagnosis until death or end of study interval. We summed payments for all claims attributable to the primary cancer diagnosis and analyzed the overall and phase-based costs and then by differing demographics, cancer stage, geographic region, and year of diagnosis. We identified 428,300 patients diagnosed with one of the 10 malignancies. Annual payments were generally highest during the initial phase. Mean expenditures across cancers were $14,381 during the initial phase, $2,471 for continuing, and $13,458 at end of life. Payments decreased with increasing age. Black patients had higher payments for four of five cancers with statistically significant differences. Stage III cancers posed the greatest annual cost burden for four cancer types. Overall payments were stable across geographic region and year. Considerable differences exist in expenditures across phases of cancer care. By understanding the drivers of such payment variations across patient and tumor characteristics, we can inform efforts to decrease payments and increase quality, thereby reducing the burden of cancer care. Considerable differences exist in expenditures across phases of cancer care. There are further differences by varying patient characteristics. Understanding the drivers of such payment variations across patient and tumor characteristics can inform efforts to decrease costs and increase quality, thereby reducing the burden of cancer care.

System-Level Health-Care Integration and the Costs of Cancer Care Across the Disease Continuum.

Policy reforms in the Affordable Care Act encourage health care integration to improve quality and lower costs. We examined the association between system-level integration and longitudinal costs of cancer care. We used linked SEER-Medicare data to identify patients age 66 to 99 years diagnosed with prostate, bladder, esophageal, pancreatic, lung, liver, kidney, colorectal, breast, or ovarian cancer from 2007 to 2012. We attributed each patient to one or more phases of care (ie, initial, continuing, and end of life) according to time from diagnosis until death or end of study interval. For each phase, we aggregated all claims with the primary cancer diagnosis and identified patients treated in an integrated delivery network (IDN), as defined by the Becker Hospital Review list of the top 100 most integrated health delivery systems. We then determined if care provided in an IDN was associated with decreased payments across cancers and for each individual cancer by phase and across phases. We identified 428,300 patients diagnosed with one of 10 common cancers. Overall, there were no differences in phase-based payments between IDNs and non-IDNs. Average adjusted annual payments by phase for IDN versus non-IDNs were as follows: initial, $14,194 versus $14,421, respectively ( P = .672); continuing, $2,051 versus $2,099 ( P = .566); and end of life, $16,257 versus $16,232 ( P = .948). However, in select cancers, we observed lower payments in IDNs. For bladder cancer, payments at the end of life were lower for IDNs ($11,041 v $12,331; P = .008). Of the four cancers with the lowest 5-year survival rates (ie, pancreatic, lung, esophageal, and liver), average expenditures during the initial and continuing-care phases were lower for patients with liver cancer treated in IDNs. For patients with one of 10 common malignancies, treatment in an IDN generally is not associated with lower costs during any phase of cancer care.

Costs of cancer care in children and adolescents in Ontario, Canada.

Cancer in children and adolescents presents unique issues regarding treatment and survivorship, but few studies have measured economic burden. We estimated health care costs by phase of cancer care, from the public payer perspective, in population-based cohorts. Children newly diagnosed at ages 0 days-14.9 years and adolescents newly diagnosed at 15-19.9 years, from January 1, 1995 to June 30, 2010, were identified from Ontario cancer registries, and each matched to three noncancer controls. Data were linked with administrative records describing resource use for cancer and other health care. Total and net (patients minus controls) resource-specific costs ($CAD2012) were estimated using generalized estimating equations for four phases of care: prediagnosis (60 days), initial (360 days), continuing (variable), final (360 days). Mean ages at diagnosis were 6 years for children (N = 4,606) and 17 years for adolescents (N = 2,443). Mean net prediagnosis phase 60-day costs were $6,177 for children and $1,018 for adolescents. Costs for initial, continuing, and final phases were $138,161, $15,756, and $316,303 per 360 days for children, and $62,919, $7,071, and $242,008 for adolescents. The highest initial phase costs were for leukemia patients ($156,225 per 360 days for children and $171,275 for adolescents). The final phase was the most costly ($316,303 per 360 days for children and $242,008 for adolescents). Costs for children with cancer are much higher than for adolescents and much higher than those reported in adults. Comprehensive population-based long-term estimates of cancer costs are useful for health services planning and cost-effectiveness analysis.

Abstract P4-19-04: Psychosocial distress monitoring in a multidisciplinary, inner city breast center

Abstract Objective: Beginning in 2015, all Commission on Cancer–accredited cancer programs must have developed and implemented a process to screen for psychosocial distress and provide appropriate psychosocial care. At our institution that serves uninsured and underrepresented minority populations, we integrated a distress tool on a continuum, rather than as a onetime event. We reviewed the initial screening tools from our breast center to determine how psychosocial distress differs throughout treatment in order to identify pivotal times during course of treatment and to prioritize intervention strategy. Methods: NCCN distress thermometer was administered to each patient with review of stressors to complete at 4 different intervals after diagnosis with breast cancer. Newly diagnosed breast cancer patients were asked to complete distress screening at various phases of their cancer care: shortly after diagnosis at surgery office visit, after surgery at first chemotherapy cycle, third medical oncology office visit, and last chemotherapy cycle. The tools were administered by patient navigators and referred to social work with a distress score of 5/10 or higher. Tools were then scanned into the medical record and collected by the social worker. We reviewed the collected distress tools and compared the data based on the where the patient was in course of treatment. Identifying stressors were grouped into 4 categories: practical, family, emotional, and physical. Results: in April 2015, the implementation and preparation of distress screening was begun. Between August 2015 and April 2016, 94 distress tools were completed by patients in our breast center. 42.5 % patients had a distress score of 5 or above at their initial screen at surgical consultation, 31.8 % at their first cycle of chemotherapy, 53.3% at third medical oncology office visit and 50 % at completion of chemotherapy, triggering a social work intervention. The most common stressors were emotional, worry and fear, (44%) at initial assessment and physical, fatigue and tingling in hands and feet, (100%) at last chemotherapy cycle, with family stressors 33.3 ?%, and practical matters 28%. The least common stressor was treatment decision or need for treatment change. Mean stress levels were 8/10 for surgical patients and 6/10 for patients seeing medical oncology. Although 4 screens were performed, the spectrum of stressors did not change significantly over continuum of care other than all patients reporting fatigue with a score of 5 or higher at completion of chemotherapy. All patients had psychosocial barriers to care that caused stress regardless of phase of cancer care. Conclusion: Patients are at their peak stress levels at the time of diagnosis in consultation with the surgeon. As they move along their treatment plan, stress levels decrease, but the stressors seem to remain the same, except for physical stress being highest at end of chemotherapy. We recommend timing of the administration of the distress tools be based on capturing peak stress (at time of diagnosis) and then again at completion of chemotherapy to monitor for stress reduction. Addressing psychosocial barriers seems to be paramount in lowering distress scores in our underrepresented, minority breast cancer population. Citation Format: Castaldi M, Elrafei T, Soliman C. Psychosocial distress monitoring in a multidisciplinary, inner city breast center [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-19-04.

A patient-centered, symptom-focused qualified clinical data registry (QCDR) as a framework to guide quality improvement.

253 Background: Clinically meaningful quality measures have been identified as a catalyst for healthcare improvement and better patient outcomes. Amidst rapidly changing quality reporting and re-imbursement schema, eligible providers struggle to choose a portfolio of measures across multiple registries that will demonstrate the value of their practice to consumers and payers. It is critical that a roadmap to quality improvement be evident to registry users. Utilizing the Model for Improvement developed by the Associates in Process Improvement and adapted to health care by the Institute for Healthcare Improvement, a framework to guide performance improvement was developed and incorporated into an oncology specific QCDR for PQRS reporting. Methods: Fourteen patient-centered quality measures with a focus on cancer related symptom assessment and intervention were piloted and tested in 40 practices and incorporated into the Oncology Nursing Society (ONS)/CE City QCDR. Six measures focus on the active treatment phase of cancer care and eight on breast cancer survivorship. The registry platform was designed with capabilities for tracking of data over time, goal setting, benchmarking, and providing suggested performance improvement (PI) activities. A technical expert panel (TEP) was convened to develop a model to guide PI activities to address QCDR identified practice gaps. Results: A quality improvement framework was developed to help QCDR subscribers answer the question “How Do I Improve” and was incorporated into the ONS/CE City QCDR platform. This framework provides the subscriber with the education and training necessary to improve care through use of quality improvement tools and implementation strategies aimed at practice change. Conclusions: It is essential that measures be incorporated into an infrastructure that provides opportunities for the assessment and improvement of care quality provided by practices. The QCDR can act as a means to drive performance improvement along with supporting quality measurement for PQRS and Meaningful Use reporting. The “How Do I Improve” Framework developed as part of the ONS/CE City QCDR platform provides a model to accomplish this goal.

Assesment of distress among breast cancer survivors.

e12610 Background: Several studies have documented distress in breast cancer patients during the diagnosis and treatment phases of cancer care, however, data are more scarce regarding the prevalenc...

German general practitioners' views on their involvement and role in cancer care: a qualitative study

The multidisciplinary and sequential nature of cancer care makes continuity of care for patients difficult. Cancer patients have often known their general practitioners (GPs) for years and are often in constant contact with them. Objective(s). We examined German GPs' views on their involvement in the care of cancer patients. We conducted semi-structured interviews with 30 German GPs. Purposeful sampling was applied to secure maximum heterogeneity. Interviews were recorded, transcribed and then analyzed using qualitative content analysis according to Mayring. GPs perceive a clear involvement in the latter phase of cancer care but a mainly sporadic role (as and when required) in earlier phases. They think that greater care contributions from GPs are generally beneficial to cancer patients, as their ability to take the patient's history, surroundings and co-morbidities into account enables them to provide more patient-centred care. GPs want to stay involved and to know how their cancer patients are progressing, and they complain about slow or non-existent information sharing between providers, as well as insufficient care coordination. They pro-actively try to overcome these obstacles through direct contact with patients and physicians, and by building networks of trusted care providers. Given their long-lasting and close relationships with cancer patients, GPs are in a position to accompany them throughout the whole process of cancer care. However, such general involvement is as yet uncommon. Shared care models may have the potential to take into account the complementary character of primary and specialist care.