Routine Cancer Care Research Articles

The use of patient reported outcome measures in oncology clinical practice across Australia and New Zealand.

While there is increasing evidence on the benefits of PROMs in cancer care, the extent of routine collection and use of PROMs in clinical cancer practice across Australia and New Zealand (ANZ) is unknown. This study examined the prevalence and characteristics of PROMs use in routine clinical cancer care in ANZ. An online survey was designed and disseminated via professional societies and organisations using a snowball sampling approach to clinical and health administration professionals managing cancer care in ANZ. A poster advertising the study was also circulated on professional social media networks via LinkedIn and Twitter inviting health professionals from ANZ to participate if they were using or intending to use PROMs in clinical cancer practice. Responders opted into the survey via the survey link. From 132 survey views, 91(response rate, 69%) respondents from 56 clinical practices across ANZ agreed to participate in the survey, and of these 55 (n = 55/91, 60%) respondents reported collecting PROMs within their clinical practice. The majority of the respondents were from the State of New South Wales in Australia (n = 21/55, 38%), hospital (n = 35/55, 64%), and a public setting (n = 46/55, 83%). PROMs were collected in all cancer types (n = 21/36, 58%), in all stages of the disease (n = 31/36, 86%), in an adult population (n = 33/36, 92%), applied in English (n = 33/36, 92%), and used to facilitate communication with other reasons (27/36, 75%). A geospatial map analysis provided insights into the variation in PROMs uptake between the two countries and in certain jurisdictions within Australia. This study also highlights the limited resources for PROMs implementation, and a lack of systematic priority driven approach. PROM use across Australia and New Zealand seems variable and occurring predominantly in larger metropolitan centres with limited standardisation of approach and implementation. A greater focus on equitable adoption of PROMs in diverse cancer care settings is urgently needed.

“Fear of raising the problem without a solution”: a qualitative study of patients’ and healthcare professionals’ views regarding the integration of routine support for physical activity within breast cancer care

ObjectiveThe benefits of physical activity across the cancer continuum for many adult cancers are well established. However, physical activity is yet to be routinely implemented into health services throughout the world. This study aims to explore patients’ and healthcare professionals’ views about integrating conversations and support for physical activity into routine care during treatment for breast cancer.MethodsHealthcare professionals and patients from across the UK living with or beyond breast cancer were invited to take part in semi-structured interviews that were conducted online. Recruitment for the study was advertised on social media, in cancer support groups and newsletters. Data were analysed using inductive thematic analysis.ResultsThree themes captured perceptions of integrating support for physical activity in routine breast cancer care among 12 health care professionals (who deliver breast cancer care) and 15 patients. Themes between healthcare professionals and patients overlapped, and therefore, combined themes are presented. These were: (1) current practice; (2) implementation in care and (3) training needs.ConclusionMany healthcare professionals who offer cancer care are reluctant to raise the topic of physical activity with patients, yet patients have suggested that they would like additional support to be physically active from their medical team. Providing healthcare professionals with education regarding the benefits of physical activity to reduce the risk of recurrence along with evidence based low-cost, remote interventions would allow them to integrate conversations about physical activity within routine cancer care for all patients.

Development, acceptability and usability of culturally appropriate survivor narrative videos for breast cancer treatment in Botswana: a pilot study

ObjectivesNarrative communication has demonstrated effectiveness in promoting positive health behaviours, delivering support and coping with complex decision-making. Formal research evaluating this intervention for cancer treatment in Africa is lacking. We...

A multimodal couple-coping intervention for enhancing sexual adjustment among breast cancer women: Study protocol for a randomised controlled trial.

To investigate the effects of a multimodal couple-based sexual health intervention for premenopausal women treated for breast cancer and their partners to provide personalised psychosexual care, and to understand participants' experience of, and adherence to, the intervention. This is an assessor-blinded, randomised controlled trial. Premenopausal women treated for breast cancer (N = 160) and their partners will be recruited. Dyads will be randomised into an intervention (n = 80) or attention control (n = 80) group. The intervention group will receive the multimodal couple-based sexual health intervention over eight weeks. The intervention comprises five face-to-face and virtual individual couple counselling sessions combined with online reading, a chat-based discussion forum, and telephone calls. The intervention is based on level I-II evidence and a robust theoretical framework. The attention control group will receive usual care plus telephone calls comprising general greetings and reminders to complete follow-up surveys. Sexual adjustment, relationship quality and quality of life will be measured at baseline, after completion of the intervention, three months and six months post-intervention. The project will adhere to the CONSORT-EHEALTH checklist. Qualitative interviews will explore the participants' experience of, and adherence to, the intervention. This study will provide the first pragmatic evidence of the effectiveness of a multimodal couple-coping intervention to support premenopausal women and their partners to improve sexuality, relationship quality and quality of life after treatment for breast cancer. Sexual health is a neglected area in clinical practice, for patients and partners. The ever-growing population of women treated for breast cancer at younger age has created a more pressing need for the development of tailored sexual health interventions. If effective, this intervention could be incorporated into routine cancer care to provide better support and care for this patient population to enhance sexual health, intimacy and overall well-being. ISRCTN35481498; prospectively registered on 08/05/2023.

Electronic patient-reported outcome measures (ePROs) as tools for assessing health-related quality of life (HRQoL) in women with gynecologic and breast cancers: a systematic review

Objectives To provide a comprehensive review of the use of electronic patient-reported outcomes measures (ePROs) as digital health tools to assess health-related quality of life (HRQoL) in women with breast, ovarian, cervical, and endometrial cancers. Methods A systematic review was conducted to identify studies that used ePROs to evaluate HRQoL in women diagnosed with breast and gynecological cancers. The review followed the 2020 update of the PRISMA guidelines and a pre-registered protocol in PROSPERO (CRD42024516737). Inclusion criteria encompassed studies focusing on ePROs for HRQoL assessment in the specified cancers, without language restrictions, and published between January 2000 and December 2023. Studies were retrieved from PubMed, Web of Science, and Scopus. Two reviewers independently screened titles, abstracts, and full texts to identify eligible studies. Results The search yielded 4978 articles. After removing duplicates, 900 articles were assessed for eligibility by screening the titles and abstracts. After screening the full text of 168 articles, a total of 16 studies were included in this systematic review. These studies were mainly conducted in Europe and the Americas and included different study designs such as randomized controlled trials (four articles), prospective studies (seven articles), and feasibility and validation studies (five articles). The majority of the studies focused on breast cancer (87.5%), with fewer studies addressing ovarian and cervical cancers. A variety of ePRO tools were used, including the FACT and EORTC QLQ. Findings show that ePROs enhance therapeutic management, treatment adherence, and HRQoL through improved symptom monitoring and communication between patients and providers. Conclusion The integration of ePROs in oncology care facilitates a patient-centered approach, enhances communication between patients and healthcare providers, and supports personalized treatment strategies. These findings underscore the importance of incorporating ePROs into routine cancer care to improve overall patient outcomes and HRQoL.

Lymphedema Surveillance and Prevention.

Lymphedema is a chronic condition, which can impact a person's quality of life and function. Identifying lymphedema at an early stage is key to preventing a person from developing chronic lymphedema. Physiatry can play an important role in education, identification of risk factors, performing prospective lymphedema surveillance programs, and prevention/treatment of lymphedema. Incorporating lymphedema surveillance programs into routine cancer care provides physiatry with the opportunity to assess additional rehabilitation and functional needs of a cancer patient.

Implementing a nurse-led screening clinic for symptom distress with community-based referral for cancer survivors: A feasibility study.

This prospective, single-arm, pragmatic implementation study evaluated the feasibility of a nurse-led symptom-screening program embedded in routine oncology post-treatment outpatient clinics by assessing (1) the acceptance rate for symptom distress screening (SDS), (2) the prevalence of SDS cases, (3) the acceptance rate for community-based psychosocial support services, and (4) the effect of referred psychosocial support services on reducing symptom distress. Using the modified Edmonton Symptom Assessment System (ESAS-r), we screened patients who recently completed cancer treatment. Patients screening positive for moderate-to-severe symptom distress were referred to a nurse-led community-based symptom-management program involving stepped-care symptom/psychosocial management interventions using a pre-defined triage system. Reassessments were conducted at 3-months and 9-months thereafter. The primary outcomes included SDS acceptance rate, SDS case prevalence, intervention acceptance rate, and ESAS-r score change over time. Overall, 2988/3742(80%) eligible patients consented to SDS, with 970(32%) reporting ≥1 ESAS-r symptom as moderate-to-severe (caseness). All cases received psychoeducational material, 673/970(69%) accepted psychosocial support service referrals. Among 328 patients completing both reassessments, ESAS-r scores improved significantly over time (p<0.0001); 101(30.8%) of patients remained ESAS cases throughout the study, 112(34.1%) recovered at 3-month post-baseline, an additional 72(22%) recovered at 9-month post-baseline, while 43(12.2%) had resumed ESAS caseness at 9-month post-baseline. Nurse-led SDS programs with well-structured referral pathways to community-based services and continued monitoring are feasible and acceptable in cancer patients and may help in reducing symptom distress. We intend next to develop optimal strategies for SDS implementation and referral within routine cancer care services.

Assessing oncology patient interest in using telehealth for routine cancer care and clinical trials.

525 Background: Since the onset of COVID-19, oncology practices across the U.S. have integrated telemedicine (TM) and remote patient monitoring (RPM) into cancer care. However, the future role of telehealth in oncology remains unknown. We conducted a survey among a diverse group of oncology patients to assess their access to technology and interest in using TM/RPM as part of routine cancer care and clinical trials. Methods: Between March 27 and June 21, 2023, we administered in person surveys to oncology patients receiving cancer treatment at an academic cancer center in New York City. We collected respondent demographic and clinical data, as well as information about their access to technology and interest in using TM/RPM as part of cancer care. Results: There were 50 respondents with a mean age of 60 (SD 16). 62% identified as female, 22% were Hispanic of any race, 16% were non-Hispanic Black, and 48% were non-Hispanic White. 52% had a yearly income below $70,000 and 40% had less education than a bachelor’s degree. 34% had Medicare, 24% had Medicaid only, and 42% had commercial insurance. Regarding travel, 28% of respondents lived over an hour from the cancer center, and 39% paid &gt;$20 for travel each visit. The majority owned an electronic communication device (93%) and had internet access at home (98%). 80% had internet fast enough for video visits and 86% identified as comfortable using the internet. Prior to the survey, 66% of respondents had participated in a video visit and 59% had participated in a telephone visit with their oncologist. Of these patients, more than 95% were somewhat or very satisfied with their remote visit. If provided with internet, more than half of respondents were willing to participate in video visits (57%) and telephone visits (61%) as part of regular care. Convenience and eliminating travel were the most commonly cited reasons for preferring remote care. Regarding trial participation, 52% had previously enrolled in a cancer clinical trial and 67% reported openness to trial participation. If the risks and benefits of a trial were explained over the phone or in a video visit as opposed to in person, 73% of respondents reported they would be equally or more likely to enroll. If the risks and benefits had already been explained in person, 77% would be willing to sign consent electronically. A large majority (91%) would be equally or more likely to enroll in a clinical trial that reduced travel time by providing the option of remote visits. Similarly, 78% would be willing to use wearable technology and 80% would be willing to use a health app as part of a clinical trial. Conclusions: In this diverse and underprivileged group, patients have access to technology and are willing to use it for both routine cancer care and clinical trial enrollment and participation. In the future, oncology practices should incorporate remote technology into cancer care, including trials, to reduce travel time and enhance convenience.

Quality improvement project to improve smoking cessation among an oncology cohort at a large US multistate cancer center.

435 Background: Assessing tobacco use and providing cessation support is recommended by the American Society for Clinical Oncology (ASCO). As part of the National Cancer Institute Cancer Center Cessation Initiative, we established an electronic health record based "opt-out" approach to refer patients to tobacco treatment specialists. However, the role of oncologists in contributing to the “opt-out” approach to patients has not been explored. We tested the hypothesis that a multi-component educational program for oncologists would increase the proportion of patients who completed tobacco treatment appointments. Methods: As a quality improvement initiative, oncology providers at the Rochester Mayo Clinic Cancer Center were educated using a multimodal academic detailing approach with group and individual educational sessions. Its effectiveness was tested using a modified step-wedge implementation design. The primary outcomes were patient behaviors that could plausibly be changed by conversations with their provider: the rate at which cancer patients identified as current tobacco users scheduled an appointment in the Nicotine Dependence Center, and the rate at which patients scheduled for a NDC appointment completed their appointment. Comparisons were made before, during, and after the education period (from July through Dec 2019) and with a separate group of providers who did not complete education (results examined over a similar time period). Results: Education intervention did not improve outcomes among providers who received education; indeed, the rate of appointment scheduling decreased, although this may reflect other concurrent changes in the tobacco treatment referral process (Table 1). Outcomes were similar between oncology providers who did and did not receive multicomponent education intervention. Conclusions: Smoking cessation efforts can be successfully integrated into routine cancer care. The implementation of the “opt-out” referral system resulted in approximately 1 in 5 patients being seen for tobacco use, but a multicomponent education intervention designed to equip oncologists to encourage patients to complete appointments was not effective. Novel approaches are needed to increase the uptake of tobacco treatment among patients.[Table: see text]

“A double-edged sword”: Influence of the 21st Century Cures Act on the childhood cancer care experience.

360 Background: The 21st Century Cures Act allows patients to immediately access their electronic health record (EHR) via an online portal. For pediatric patients with cancer and their families, this federal mandate has profound implications. We sought to explore perspectives of key stakeholders on how the Cures Act influences the childhood cancer care experience, receipt of results, and communication with the oncology team. Methods: In a multi-center qualitative study at three National Cancer Institute-designated comprehensive cancer centers, we conducted semi-structured interviews with adolescent and young adult patients with cancer (n=26), parents of children with cancer (n=32), and interdisciplinary clinicians in pediatric oncology (n=23). Interviews were audio-recorded, transcribed verbatim, coded, and thematically analyzed. Results: Across 81 participants, 73% self-identified as women, 69% as White race, and 17% as Hispanic/Latinx ethnicity. Most patients and parents perceived the EHR portal to be a convenient, centralized record-keeping tool that enables them to prepare for appointments, track treatment progress, and assume greater agency in their cancer care. Many patients and parents preferred the immediacy of the portal to bypass wait times and facilitate real-time decision-making. Access to notes and results on the portal was widely perceived to enhance communication and appeared to engender greater trust in the oncology team. Simultaneously, patients and parents acknowledged that instant access to results laden with medical jargon can heighten confusion, worry, and anger, particularly upon receipt of concerning results (i.e., pathology or radiology results revealing a new diagnosis of cancer or relapse) before meeting with a clinician. Clinicians generally favored the EHR portal and reported adapting their practices to provide greater anticipatory guidance, occasionally altering language in clinical notes to avoid upsetting patients or families. However, several clinicians expressed concern about situations in which high-stakes results are instantly available to patients and the responsible clinician has not yet had an opportunity to interpret and discuss. Clinicians spoke of shifting expectations regarding prompt communication of results. Many clinicians would prefer a system in which a time delay is built into the release of particularly sensitive results. Overall, clinicians reported that the EHR portal may increase administrative burden and interfere with clinical workflow. Conclusions: While key stakeholders recognize that the Cures Act offers important patient-centered innovations, many participants identified challenges that impede on optimal implementation. This study underscores the need to establish best practices for integrating use of the EHR portal into routine childhood cancer care.

Implementation of precision medicine in (routine) cancer care in Belgium in a fair and equitable way

Abstract Background Personalized medicine has been found to be highly promising in the prevention or early detection of cancers. Despite the advantages, the scope and potential of personalized health care are under-appreciated and underrealized in health systems. Taking into account the advantages that personalized medicine can bring to cancer prevention and treatment, and acknowledging at the same time the trends happening outside of the field of oncology, Sciensano Cancer Centre conducted research on the use of personalized medicine in the Belgian healthcare system. Methods By applying foresight methodology, we first conducted desk research and sent a survey to experts; this was then followed by two stakeholder meetings where we discussed the importance and uncertainties of the factors that have an influence on the implementation of precision medicine in (routine) cancer care in Belgium in a fair and equitable way and developed future scenarios accordingly. Results The main influential factors are concerned with economic issues, such as the allocated budget in the healthcare system. Similarly, technological factors around precision medicine should not be neglected: especially issues concerning digitalization will be decisive to determine the future of precision medicine in Belgium. Conclusions With the increasing prevalence and incidence of cancer in Belgium, several factors should be considered to implement precision medicine for cancer prevention and treatment in a fair and equitable way. Strategic foresight on precision medicine can support decision-makers in these tasks and help them develop future-oriented policies.

Universal Germline-Genetic Testing for Breast Cancer: Implementation in a Rural Practice and Impact on Shared Decision-Making

BackgroundWhereas the National Comprehensive Cancer Network (NCCN) criteria restrict germline-genetic testing (GGT) to a subset of breast cancer (BC) patients, the American Society of Breast Surgeons recommends universal GGT. Although the yield of pathogenic germline variants (PGV) in unselected BC patients has been studied, the practicality and utility of incorporating universal GGT into routine cancer care in community and rural settings is understudied. This study reports real-world implementation of universal GGT for patients with breast cancer and genetics-informed, treatment decision-making in a rural, community practice with limited resources.MethodsFrom 2019 to 2022, all patients with breast cancer at a small, rural hospital were offered GGT, using a genetics-extender model. Statistical analyses included Fisher’s exact test, t-tests, and calculation of odds ratios. Significance was set at p < 0.05.ResultsOf 210 patients with breast cancer who were offered GGT, 192 (91.4%) underwent testing with 104 (54.2%) in-criteria (IC) and 88 (45.8%) out-of-criteria (OOC) with NCCN guidelines. Pathogenic germline variants were identified in 25 patients (13.0%), with PGV frequencies of 15 of 104 (14.4%) in IC and ten of 88 (11.4%) in OOC patients (p = 0.495). GGT informed treatment for 129 of 185 (69.7%) patients.ConclusionsUniversal GGT was successfully implemented in a rural, community practice with > 90% uptake. Treatment was enhanced or de-escalated in those with and without clinically actionable PGVs, respectively. Universal GGT for patients with breast cancer is feasible within rural populations, enabling optimization of clinical care to patients’ genetic profile, and may reduce unnecessary healthcare, resource utilization.

Feasibility of implementing patient-reported outcome measures into routine breast cancer care delivery using a novel collection and reporting platform.

imPROVE is a new Health Information Technology platform that enables systematic patient-reported outcome measure (PROM) collection through a mobile phone application. The purpose of this study is to describe our initial experience and approach to implementing imPROVE among breast cancer patients treated in breast and plastic surgery clinics. We describe our initial implementation in 4 phases between June 2021 and February 2022: preimplementation, followed by 3 consecutive implementation periods (P1, P2, P3). The Standards for Reporting Implementation Studies statement guided this study. Iterative Plan-Do-Study-Act (PDSA) cycles supported implementation, and success was evaluated using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. Qualitative interviews conducted during the preimplementation phase elicited 4 perceived implementation barriers. Further feedback collected during each phase of implementation resulted in the development of brochures, posters in clinic spaces, and scripts for clinic staff to streamline discussions with patients, and the resolution of technical issues concerning patient login capabilities, such as compatibility with cell phone software and barriers to downloading imPROVE. Feedback also generated ideas for facilitating provider interpretation of PROM results. By the end of P3, 2961 patients were eligible, 1375 (46.4%) downloaded imPROVE, and 1070 (36.1% of those eligible, 78% of those who downloaded) completed at least 1 PROM. Implementation efforts across 2 surgical departments at 2 academic teaching hospitals enabled collaboration across clinical specialties and longitudinal PROM reporting for patients receiving breast cancer care; the implementation effort also highlighted patient difficulties with mobile app-based PROM collection, particularly around initial engagement.

Harnessing Electronic Patient-Reported Outcomes (ePRO) in Routine Care to Promote Clinical Trial Enrollment: A Randomized Study

Only approximately 5% of adult cancer patients participate in clinical trials. While collection of patient-reported outcomes (PRO) is now routine in clinical trials, their role in actively improving care is evolving, particularly in radiation oncology. At our single multi-site institution, weekly electronic patient reported outcomes (ePRO) questionnaires regarding acute toxicity are routinely sent to all patients undergoing breast radiation We hypothesized that using ePROs to prompt recruitment to a clinical trial assessing a supportive intervention would increase enrollment. An automated weekly query of ePRO survey responses was generated to identify patients with moderate or greater fatigue, the primary eligibility criterion for an ongoing randomized clinical trial testing an integrative medicine intervention. 23 radiation oncologists treating breast cancer were randomized to have their patients potentially eligible by ePRO receive a direct portal message about the trial, or to usual care (physician-based referral). Physician randomization was stratified by patient caseload and assigned in a 1:1 ratio. Secondarily, every other patient in the portal message group was assigned to receive the message either from their radiation oncologist or integrative medicine. Statistical analysis included two-sample, two-sided proportion tests. From September 5, 2022, to December 19, 2022, among 776 patients completing ePROs during radiation treatment, 252 patients (32%) screened positive for fatigue. Of those who screened positive, 135 were randomized to the ePRO-prompted portal message group and 117 to the usual care group (physician-based referral). Among patients in the portal message group, 52 responded (39%) and 27 enrolled (20%), compared to 1 patient referred (0.8%) and 0 enrolled with physician-based referral alone (p < 0.001). In the portal message group, there were 21 responses (30%) and 12 enrollments (17%) among those messaged by their radiation oncologist, compared to 31 responses (48%) and 15 enrollments (23%) among those messaged by integrative medicine. When evaluating the source of the portal message, there was a significant difference in response rate favoring integrative medicine (p = 0.03), but no difference in enrollments (p = 0.39). Utilization of ePROs to prompt recruitment to a trial testing a symptom intervention resulted in increased enrollment compared to standard physician-based referral, suggesting a promising new role for ePROs. Importantly, messaging from the supportive care service directly did not result in a difference in enrollments and may help reduce oncology physician-level barriers to studies testing supportive interventions. Future directions should investigate this method to reduce disparities in patients enrolling on clinical trials and facilitate access to symptom support services in routine cancer care.

Introducing a standardized assessment of patients’ interest in and usage of CAM in routine cancer care: chances and risks from patients’ and physicians’ point of view

BackgroundCancer patients often use complementary and alternative medicine (CAM), however, standardized assessment in clinical routine is missing. The aim of this study was to evaluate a screening questionnaire on CAM usage that was published in the S3 Guideline Complementary Medicine in the Treatment of Oncological Patients.MethodsWe developed a survey questionnaire to assess the practicability of the guideline questionnaire and communication on CAM between health care providers (HCPs) and patients. We collected 258 guideline questionnaires and 116 survey questionnaires from ten clinics and held twelve semi-structured interviews with HCPs.Results85% used at least one of the listed CAM methods, 54 participants (N = 77) never disclosed usage to a physician. The most frequently used CAM methods were physical activity (76.4%) and vitamin D (46.4%). 25.2% used at least one method, that was labeled risky by the guideline. 53.4% did not know of CAM’s risk of interactions and side effects. Introducing the guideline questionnaire in routine cancer care increased the rate of patients talking to an HCP regarding CAM significantly from 35.5 to 87.3%. The HCPs stated positive effects as an initiation of conversation, increased safety within CAM usage and patients feeling thankful and taken seriously. However, due to the limited amount of time available for discussions on CAM, generalized distribution to all patients was not feasible.ConclusionInstitutions should focus on implementing standard procedures and resources that help HCPs discuss CAM on a regular basis. HCPs should meet the patient’s demands for CAM counseling and make sure they are equipped professionally.

Integrating evidence-based communication principles into routinecancer care.

The global incidence of cancer and available cancer-directed therapy options is increasing rapidly, presenting patients and clinicians with more complex treatment decisions than ever before. Despite the dissemination of evidence-based communication training tools and programs, clinicians cite barriers to employing effective communication in cancer care (e.g., discomfort of sharing serious news, concern about resource constraints to meet stated needs). We present two composite cases with significant communication challenges to guide clinicians through an application of evidence-based approaches to achieve quality communication. Composite cases, communication skills blueprint, and visual conceptualization. High-stakes circumstances in each case are described, including end-of-life planning, advanced pediatric illness, strong emotions, and health inequities. Three overarching communication approaches are discussed: (1) content selection and delivery; (2) rapport development; and (3) empathic connection. The key takeaways following each case provide succinct summaries of challenges encountered and approaches used. A communication blueprint from the Memorial Sloan Kettering Cancer Center Communication Skills Training Program and Research Laboratory has been adapted and is comprised of strategies, skills, process tasks, andsample talking points. A visually concise tool - the Communication Blueprint Traffic Circle - illustrates these concepts and demonstrates the iterative, holistic, and agile considerations inherent to effective communication. Evidence-based communication is foundational to person-centeredness, associated with improved clinician and patient/caregiver outcomes, and can be integrated throughout routineoncology care. When used by clinicians, evidence-based communication can improve patient and caregiver experiences and assist in ensuring goal-concordant cancer care delivery.

Optimizing equitable social needs screening with digital and in-person modalities in routine gynecologic cancer care (170)

Optimizing equitable social needs screening with digital and in-person modalities in routine gynecologic cancer care (170)

Staff- and service-level factors associated with organisational readiness to implement a clinical pathway for the identification, assessment, and management of anxiety and depression in adults with cancer

BackgroundOrganisational readiness is recognised as a key factor impacting the successful translation of research findings into practice. Within psycho-oncology, measuring organisational readiness and understanding factors impacting organisational readiness is crucial as it is often challenging to implement evidence-based findings into routine cancer care. In this quantitative study, we examined the level of organisational readiness of cancer services preparing to implement a clinical pathway for the screening, assessment, and management of anxiety and depression in adult cancer patients (the ADAPT CP) within a cluster randomised controlled trial and sought to identify staff- and service-level factors associated with organisational readiness.MethodsMultidisciplinary staff across 12 Australian cancer services were identified. Their perceptions of their services’ readiness to implement the ADAPT CP in the cancer stream or treatment modality selected within their service was assessed prior to implementation using the Organizational Readiness for Implementing Change scale. Data collection included staff demographic and professional characteristics, and their perception of the ADAPT CP using a set of 13 study-specific survey items. Service characteristics were captured using a site profile audit form and workflows during site engagement.ResultsFourteen staff- and service-level factors were identified as potentially impacting organisational readiness. To identify factors that best explained organisational readiness, separate univariate analyses were conducted for each factor, followed by a backward elimination regression. Compared to services that implemented the ADAPT CP in one treatment modality, those opting for four treatment modalities had significantly higher organisational readiness scores. Staff in administrative/technical support/non-clinical roles had significantly higher organisational readiness scores compared to psychosocial staff. Higher organisational readiness scores were also significantly related to more positive perceptions of the ADAPT CP.ConclusionsReadiness to implement an anxiety and depression clinical pathway within 12 oncology services was high. This may be attributed to the extensive engagement with services prior to implementation. The factors associated with organisational readiness highlight the importance of ensuring adequate resourcing and supporting staff to implement change, effectively communicating the value of the change, and taking a whole-of-service approach to implementing the change. Future longitudinal studies may identify factors associated with ongoing readiness and engagement prior to implementation.Trial registrationThe ADAPT RCT was registered prospectively with the ANZCTR on 22/03/2017. Trial ID ACTRN12617000411347. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372486&isReview=true.

Deep learning-based characterization of the drug tolerant persister cell state in lung cancer.

141 Background: Lung cancer is the leading cause of cancer-related lethality globally. Targeted therapies improve the clinical outcome of cancer treatment; however, a subpopulation of cancer cells survive during initial therapy and evolve into drug tolerant persister cells (DTPs) that maintain a residual disease reservoir. Residual disease preludes acquired resistance and tumor progression; therefore, identifying and eliminating DTPs could benefit future treatment paradigms. We have shown that Hippo pathway effector YAP1 (Yes Associated Protein-1) is activated in oncogene-driven lung cancers when cancer cells are exposed to various targeted therapies, such as EGFR, ALK, and RAS inhibitors. YAP1 transcriptional activation during targeted therapy is characterized by its increased nuclear localization and interaction with transcription factors. This activation promotes the expression of genes involved in cell survival, cellular plasticity, and metabolic reprogramming at the residual disease state. We hypothesized that detection of intrinsic or acquired persister cells may aid the development of optimized treatment regimens. In this study, we are building image-based deep learning models to identify YAP1 activation-mediated DTPs from histologically stained slides. Methods: H&amp;E or YAP-stained immunohistochemistry (IHC) images from clinical lung cancer and patient-derived tumor xenograft samples were collected throughout targeted therapy and were annotated with semi-automation using high performance computing clusters. A deep learning model (U-Net algorithm) was used for image segmentation, training, validation, and testing. Results: 1638 images were annotated and over 80,000 patches from these images for YAP positive cells (or regions of interest) comprised the training dataset with semi-supervised automation. Subsequently, we built a customized deep-learning model to detect YAP-mediated DTP cell states from whole histopathological image slides. The deep learning-based model achieved excellent accuracy of 0.8238 and 0.9091 in training, and 0.8040 and 0.8949 in validation datasets for two different annotations, respectively. For a test dataset, the model obtained 0.81 and 0.902 accuracy for the two annotations, respectively. Conclusions: We have constructed a deep learning convolutional neural network model to infer the presence of the YAP1 activation-mediated drug tolerant persister cell state prior to or during targeted treatment of lung cancer. Implementing our AI-based model into routine lung cancer care in the future could identify patient subpopulations with YAP1 activated tumors who would most benefit from receiving YAP1-targeted small molecule inhibitors.

Patients Undergoing Systemic Anti-Cancer Therapy Who Require Surgical Intervention: What Surgeons Need to Know.

As part of routine cancer care, patients may undergo elective surgery with the aim of long-term cure. Some of these patients will receive systemic anti-cancer therapy (SACT) in the neoadjuvant and adjuvant settings. The majority of patients, usually with locally advanced or metastatic disease, will receive SACT with palliative intent. These treatment options are expanding beyond traditional chemotherapy to include targeted therapies, immunotherapy, hormone therapy, radionuclide therapy and gene therapy. During treatment, some patients will require surgical intervention on an urgent or emergency basis. This narrative review examined the evidence base for SACT-associated surgical risk and the precautions that a surgical team should consider in patients undergoing SACT.