Tertiary Comprehensive Cancer Center Research Articles

Safety and Efficacy of Surgical Implantation of Intrathecal Drug Delivery Pumps in Patients With Cancer With Refractory Pain.

Pain management in patients with cancer is a critical issue in oncology palliative care as clinicians aim to enhance quality of life and mitigate suffering. Most patients with cancer experience cancer-related pain, and 30%-40% of patients experience intractable pain despite maximal medical therapy. Intrathecal pain pumps (ITPs) have emerged as an option for achieving pain control in patients with cancer. Owing to the potential benefits of ITPs, we sought to study the long-term outcomes of this form of pain management at a cancer center. We retrospectively reviewed medical records of all adult patients with cancer who underwent ITP placement at a tertiary comprehensive cancer center between 2013 and 2021. Baseline characteristics, preoperative and postoperative pain control, and postoperative complication rate data were collected. A total of 193 patients were included. We found that the average Numerical Rating Scale (NRS) score decreased significantly by 4.08 points (SD = 2.13, P < .01), from an average NRS of 7.38 (SD = 1.64) to an average NRS of 3.27 (SD = 1.66). Of 185 patients with preoperative and follow-up NRS pain scores, all but 9 experienced a decrease in NRS (95.1%). The median overall survival from time of pump placement was 3.62 months (95% CI: 2.73-4.54). A total of 42 adverse events in 33 patients were reported during the study period. The 1-year cumulative incidence of any complication was 15.6% (95% CI: 10.9%-21.1%) and for severe complication was 5.7% (95% CI: 3.0%-9.7%). Eleven patients required reoperation during the study period, with a 1-year cumulative incidence of 4.2% (95% CI: 2.0%-7.7%). Our study demonstrates that ITP implantation for the treatment of cancer-related pain is a safe and effective method of pain palliation with a low complication rate. Future prospective studies are required to determine the optimal timing of ITP implantation.

Patient perspective on virtual prechemotherapy visits in gynecologic oncology

ObjectiveTo assess gynecologic oncology patients’ experiences with virtual prechemotherapy evaluation and determine preference for incorporating virtual visits into a chemotherapy schedule. MethodsFrom June-August 2023, a survey was distributed to patients with gynecologic malignancies who had both an in-person and virtual prechemotherapy visit at a tertiary comprehensive cancer center. Patient satisfaction and preference for incorporating virtual visits was elicited. Patients who preferred ≥ 50 % of prechemotherapy visits to be virtual were classified as “virtual-leaning” and those who preferred < 50 % virtual as “in-person-leaning.” ResultsOf 110 eligible patients, 93 agreed to participate and 73 completed the survey, yielding an overall 66.4% response rate and 78.5% (73/93) survey completion rate. Overall satisfaction with in-person and virtual visits were rated positively at similar rates (in-person 87.7%, virtual 87.2%). Sixty-four (88.4%) patients preferred some proportion of their visits to be virtual, 5 (7.0%) preferred no virtual care, and 4 (5.0%) had no preference. In a 6-cycle schedule of chemotherapy, the median number of preferred virtual visits was 3 (IQR 1.8–4.2). Forty-six (63.0%) patients were “virtual-leaning” and 23 (32.0%) were “in-person-leaning.” When comparing groups, there was no difference in age, race, category of residence, commute, experience with technical difficulty, primary disease site, disease stage, number of prior chemotherapy cycles, or number of prior virtual visits. ConclusionsMost patients are highly satisfied with virtual visits and prefer virtual care to be included when undergoing chemotherapy. A hybrid model should be offered to gynecological cancer patients undergoing chemotherapy, with patient preference dictating the cadence of virtual visits.

Abstract 2237: Determinants of time to cancer treatment initiation at a comprehensive cancer center

Abstract Background: Delays in treatment initiation adversely impact cancer mortality and survival. To inform potential enhancements and targets for our existing oncology patient navigation program, we examined characteristics associated with timely treatment initiation among patients at a tertiary comprehensive cancer center that serves four diverse counties in Southern California. Methods: We performed a retrospective analysis of patients newly diagnosed with non-hematological cancers between January 2020 and June 2023. Using electronic medical record data, we used a multivariable Cox proportional model to examine the association between patient demographic and clinical characteristics and time to treatment initiation (time between first encounter and start of definitive treatment) within a clinical benchmark of 3 months. A hazard ratio (HR)&amp;gt;1 indicates shorter (faster) time to treatment initiation while a HR&amp;lt;1 indicates a longer (slower) time. Results: Our sample included 9,148 patients, who were predominantly &amp;lt;65 years (57%), female (61%), married or with a partner (64%), and retired or unemployed (56%); 50% were non-White. In multivariable analyses, patient’s age, primary language, employment status, cancer diagnosis type, and first treatment type were significant determinants of time to treatment initiation. Faster treatment initiation was observed among patients ages &amp;gt;=75 vs &amp;lt;65 years (HR=1.36, 95% CI 1.23 - 1.52). Among the primary languages spoken in our sample (Spanish, Chinese, Korean, Vietnamese, among others), patients who spoke Armenian vs English also had shorter time to treatment (HR=1.64, 95% CI 1.32 - 2.04). By contrast, longer time to treatment initiation was associated with patients who were retired or disabled vs employed full-time (HR=0.85, 95% CI 0.78 - 0.94, and HR=0.70, 95% CI 0.59 - 0.83, respectively) and underwent radiation or oral chemotherapy vs chemo-infusion (HR=0.65, 95% CI 0.57 - 0.74, and HR=0.82, 95% CI 0.76 - 0.89, respectively). With the exception of melanoma, all diagnoses had a longer time to treatment compared with neuro-oncology. In our multivariable model, sex, marital status, race and ethnicity, and receipt of at least one navigation encounter were not significant determinants. Conclusions: In our study, which overlapped the early stages of the COVID-19 pandemic, findings highlight opportunities to enhance navigation delivery, especially for certain subpopulations, diagnoses, and treatment types with complex scheduling and coordination needs. Future research will explore navigation intensity and other process and clinical outcomes modifiable through navigation. Citation Format: Narissa J. Nonzee, Marianne Razavi, William Dale, Lauren Cai, Annette Mercurio, Lorena Gaytan, Deborah Lefkowitz, Chrissy Kim, Terry Hernandez, Steven Morales, Danilo Duque, Ana I. Tergas. Determinants of time to cancer treatment initiation at a comprehensive cancer center [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2237.

Upfront transoral robotic surgery (TORS) versus intensity-modulated radiation therapy (IMRT) in HPV-positive oropharyngeal cancer: real-world data from a tertiary comprehensive cancer centre.

SUMMARYObjectiveThis study aims to provide real-world data on oncologic and functional outcomes of the most modern surgical and non-surgical treatments of locally advanced HPV-positive oropharyngeal cancer.MethodsWe reviewed data on patients treated for stage III and IV HPV-positive oropharyngeal squamous cell carcinoma with either endoscopic surgery (Transoral Robotic Surgery, TORS; Transoral Laser Microsurgery, TLM – group A) or intensity-modulated radiotherapy (IMRT – group B). The minimum follow-up required was 6 months. Survival outcomes and toxicities of treatments were evaluated.Results30 patients in group A and 66 in group B were eligible for the analysis. 28% of patients in group A underwent a unimodal treatment, while 42% needed trimodal treatment. 90% of patients in group B underwent concurrent chemoradiation. We found no statistically significant difference in survival outcomes (group A: overall survival 97%, progression-free survival 83%; group B: OS 98%, PFS 86%) or toxicities between groups.ConclusionsBoth transoral surgery and IMRT provide excellent outcomes in HPV-positive oropharyngeal cancer. Because of the good prognosis, treatments need to be refined to reduce toxicities while preserving oncologic soundness.

Feasibility of systematic screening for unmet social determinants of health (SDoH) needs and associated resource utilization in ambulatory oncology.

6535 Background: Addressing unmet SDoH needs may reduce interruptions to cancer care caused by ED visits and hospitalizations (EDH). We aimed to determine feasibility of systematic screening for unmet patient-reported SDoH needs within a large tertiary academic comprehensive cancer center and association of unmet needs with EDH. Methods: We conducted a cross-sectional analysis of SDoH needs among new oncology patient (pts) consults from 5/15-9/21 at Dana-Farber Cancer Institute (DCFI). Pts completed an intake questionnaire including demographics, disease, and SDoH needs of financial distress, health literacy/numeracy, social isolation on a dichotomous or 5-point Likert scale. We ran bivariate and multivariable models on the association between demographics, SDoH and EDH within 30 days of consult using robust generalized estimating equations controlling for clustering by consult provider. Results: 125,997 unique new consults were seen from 5/15 – 9/21 of which 20,913 completed the intake questionnaire and were alive at 30 days after consult. Respondents were age 40-64 (50%), female (60%), non-Hispanic (84%), White (90%) and English speaking (97%), and 7% had an EDH within 30 days of consult. The most reported SDoH need was limited health numeracy (26%). In bivariate analysis, factors associated with ED visits were: non-English language, lung or GU/GYN cancer, living &gt; 25 mi from DFCI and limited health literacy and numeracy (all p &lt; 0.05). Demographics associated with hospitalizations included: White race and English as a primary language (EPL) (both p &lt; 0.05). Multivariable analysis showed female gender (OR 1.53, p &lt; 0.01), lung (OR 3.22*) and GU/GYN (OR 2.21*) (p &lt; 0.05 for both) cancer, and living &gt; 25 mi from DFCI (OR 2.50, p &lt; 0.0001) were associated with increased likelihood of ED visit while EPL (OR 1.80, p &lt; 0.05) and GU/GYN (OR 1.65, p &lt; 0.01*) cancer were associated with increased likelihood of hospitalization. Conclusions: It is feasible to systematically screen for unmet SDoH which are associated with increased frequency of ED visits. Differences in characteristics associated with ED vs. hospitalization could indicate possible bias or suggest SDoH needs as a reason for avoidance of costly medical care. Further study will expand SDoH screening and measure impact of resource matching to reduce disruptions to cancer care. [Table: see text]

Less is more: Postoperative pain management using restrictive opioid protocols in all surgical services in a comprehensive cancer center.

103 Background: Opioids are routinely given for postoperative pain management with limited evidence on the amount needed to be dispensed. Prescribed opioids increase the risk of chronic use, abuse, and diversion, which contribute to the opioid epidemic. We sought to demonstrate that postsurgical acute pain can be effectively managed across different surgical specialties with a markedly reduced number of opioids. Methods: A prospective case-control study of restrictive opioid prescription protocol (ROPP) was implemented in all surgical services from February 2019 through July 2019 at a tertiary comprehensive cancer center for all patients undergoing a surgery for which opioids would be routinely prescribed at discharge (n = 2,015). Data from surgeries performed by the same services from August 2018 through January 2019 were used for comparison (n = 2,051). At discharge, patients did not routinely receive opioids unless they had a maximally invasive procedure or if they required multiple doses of opioids during hospitalization (maximum 3-day supply). Compliance with the protocol was tracked by pharmacists daily. Patient demographics and surgical details were collected. State-run opioid prescription database was used to determine the number of opioids prescribed to all surgical patients within a 120-day surgical window. Validated patient satisfaction surveys were used at postoperative visits to assess patient experience. Results: After implementation of the ROPP, 45% less opioids were prescribed after surgery for all participating patients (323,674 morphine milligram equivalents (MME) vs 179,458 MME, p &lt; 0.001). The majority of services complied with the ROPP in more than 95% of cases. There was no difference in postsurgical pain intensity between cohorts. Patients in the ROPP cohort had less refill requests compared to the control group (20.9% vs 17.9%, p value = 0.016). Surveys were completed by 338 patients in the control group (16.5%) and 360 in the ROPP group (17.9%). There was no significant difference in patient reported satisfaction with postoperative pain control or on the impact of pain on daily activities between the cohorts. Conclusions: Implementation of a ROPP by multiple surgical services at a tertiary cancer center was feasible and resulted in substantial decrease in the number of opioids prescribed while not compromising patient experience. Patients did not require more prescription refills despite being provided no opioids or a limited supply. This study provides evidence to support reducing the number of opioids routinely prescribed after surgery.[Table: see text]

Cutaneous toxicities occurring during palbociclib (CDK4/6 inhibitor) and endocrine therapy in patients with advanced breast cancer: a single-centre experience.

Treatment with Palbociclib, a cyclin-dependent kinase 4/6 inhibitor, has demonstrated significantly improved progression-free survival in patients with hormone receptor-positive, HER2-negative, advanced breast cancer, when used in combination with letrozole or fulvestrant endocrine therapies. However, limited information exists on its cutaneous adverse effects (AE). Hence, we conducted a retrospective cohort study to investigate the prevalence and management of cutaneous AE during palbociclib and endocrine therapy. We included 324 adult patients with advanced breast cancer who received palbociclib between March 2016 and August 2020 within a tertiary comprehensive cancer centre. Patient demographics, details of previous and concurrent treatments, as well as treatment-related cutaneous AE were recorded from electronic records. The incidence of treatment-related cutaneous AE was 14.2% (46 from a total of 324 patients). The most frequent cutaneous reactions included maculopapular rash (41%), asteatosis (37%), pruritus and urticaria (20%), and bullous dermatitis reactions (9%). We identified two patients with treatment-induced subacute cutaneous lupus erythematosus, one case of bullous pemphigoid, and a single erythema multiforme. Patients received an average of 9 cycles of treatment, completing an average of 6 cycles before developing cutaneous AE, which persisted for a median of 43days. Only 15% (n = 7) of affected patients required temporary suspension, and 4% (n = 2) required discontinuation. The majority were managed with potent topical steroids, with oral corticosteroids being required in 3 patients, and one patient required hydroxychloroquine. Our study describes both the spectrum of cutaneous AE of palbociclib and endocrine therapy, and approaches to management. Prompt management may limit the negative impact on patients, facilitating beneficial continuation of palbociclib and endocrine therapy.

Patient-reported outcome measures and supportive care need assessment in patients attending an Australian comprehensive care centre: a multi-method study.

Patient-reported outcome measures (PROMs) are useful clinical tools to recognise symptoms, patient needs and their severity. Whilst PROMs are routinely utilised in integrative oncology (IO) and supportive care (SC) services to improve patient care, they are not as common in general oncology. We explored our patients' symptom burden, the approach taken by clinicians to identify and manage patient needs, and barriers and facilitators to using PROMs in an Australian tertiary comprehensive cancer centre to inform wider implementation of PROMs. From 2017 to 2018, PROM data collected for patients accessing IO and SC was retrospectively analysed. Semi-structured interviews with oncology doctors and nurses explored their approach to patient needs assessment and their use of PROMs. A total of 404 patients completed the Edmonton Symptom Assessment Scale (ESAS). The most frequently identified symptoms were sleep disturbance, fatigue and lack of wellbeing. Symptom clusters included drowsiness, fatigue and shortness of breath; anxiety and depression; sleep and pain; appetite and nausea. In total, 9 nurse consultants, 5 surgeons, 7 medical and 5 radiation oncologists were interviewed. Most participants took an intuitive approach to identifying and managing patient needs and did not routinely use PROMs. Perceived risks, barriers and facilitators to using PROMS are presented. High and complex symptom burden was found in our IO and SC patient population, reinforcing the need for screening. Whilst wider clinical use of PROMs within the hospital may improve clinical outcomes, the barriers and facilitators identified by Health Care Professionals (HCPs) need to be addressed before implementing PROMs more broadly.

The impact of changes in service delivery in patients with colorectal cancer during the first peak of the COVID-19 pandemic.

28 Background: Increased levels of anxiety and distress in both patients and physicians have been reported in response to the significant impact COVID-19 has on cancer service delivery globally. We aimed to investigate how these changes have been perceived by patients diagnosed with colorectal cancer and identify determinants of increased anxiety. Methods: Survey (32-item) of consecutive patients diagnosed with colorectal cancer attending a large tertiary comprehensive cancer centre in the United Kingdom (18 May to 1 July 2020). Self-reported GAD-7 (both paper/electronic forms) was used as a screening tool for anxiety. Statistical analyses of associations:Chi-square, Fisher’s exact, and uni- and multi-variable analyses were performed using SPSS v19 and R. Results: A total of 143 patients (response rate 67%), 82% male, and median age of 61-70 years were included. Majority of patients had telephone consultation (78%), including 40% who had scan results discussed over the phone; with favourable feedback received with both respectively. Twenty-three patients (18%) were considered to have anxiety, with 7 (6%) scoring for moderate or severe anxiety. Three items asked patients if they had concerns about getting COVID-19, were worried that COVID-19 would have effect on mental health, and affect their experience of cancer care. Patients answering positively to any of these items were most likely to have anxiety; multivariate analysis – OR 2.361 (95% CI 1.187-4.694, p=0.014), 3.219 (95% CI 1.401-7.395, p=0.006) and 3.206 (95% CI 1.036-9.920, p=0.043), respectively. Majority of the patients did not feel that they needed support during the pandemic period and hence the available well-being services were not used. Patients felt that friends and family had been very supportive but less so the primary care services (p&lt;0.05). However, they felt they were supported by the clinical team. Conclusions: At our centre, during the first-peak of COVID-19 pandemic in the UK, patients with colorectal cancer did not display increased rates of significant anxiety. The findings of this survey suggests that some service changes implemented, including increased telephone follow-up, may have already improved the overall experience of cancer care. Importantly, patients were much more concerned about their cancer treatment than COVID-19, emphasising the need to continue to provide comprehensive cancer care even if we get a “2nd wave” of COVID-19.

Laryngeal dysplasia: Oncological outcomes in a large cohort of patients treated in a tertiary comprehensive cancer centre

PurposeLaryngeal dysplasia represents a series of precancerous lesions, observed as laryngeal leukoplakia. General agreement has been lacking for their management and treatment ranging from simple biopsy to complete excision with cold blade/laser. In this work, we aim at providing the oncological outcomes of patients affected by laryngeal dysplasia, treated with a single modality, and at identifying clinical parameters predictive of malignant transformation. Materials and methodsWe performed a retrospective analysis of patients treated with transoral laser microsurgery between January 2005 and December 2015 in a tertiary comprehensive cancer centre. Data were collected about smoke and alcohol habits, site of the laryngeal lesion, surgical outcomes and progression to invasive squamous cell carcinoma. ResultsThe grade of dysplasia, margins' status and smoke habit were not associated with a significantly worse DFS and a higher risk of invasive SCC. We identified three parameters (supraglottic involvement, multifocality and history of more than one recurrence of dysplasia) that have a significant prognostic value. ConclusionsOn the base of these clinical parameters, a more intensive follow-up might be warranted for high-risk patients.

Safety and financial analysis of outpatient dose-adjusted EPOCH for B-cell lymphoma at a tertiary comprehensive cancer center.

Dose-adjusted (DA-) EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin) is a front-line treatment option for aggressive B-cell lymphomas. Due to regimen complexity, inpatient administration of DA-EPOCH has been historically required. Moffitt Cancer Center (MCC) developed an Inpatient/Outpatient (IPOP) program to facilitate administration of complicated regimens in the outpatient setting. We hypothesized that outpatient administration of DA-EPOCH at a comprehensive cancer center is both safe and cost-effective. We conducted a single-center, retrospective chart review including B-cell lymphoma patients who were 18 years or older and who had received DA-EPOCH at MCC from April 26, 2017 through August 10, 2019. The primary endpoint was hospital admissions during outpatient chemotherapy administration. Additional safety endpoints included hospitalizations between cycles, infectious complications, extravasations, drug spills, pump-malfunctions, and drug-related adverse events. Financial analysis included drug cost, resource utilization, and impact of hospital bed backfill. 56 patients received 219 cycles of DA-EPOCH with 193 cycles administered outpatient. Zero patients required hospitalization during outpatient administration of DA-EPOCH, resulting in 965 saved hospital days. 23 patients (41%) were hospitalized between cycles, most commonly due to neutropenic fever (52%). No extravasations were documented throughout the study period. There were few incidences of drug spills or pump malfunctions. Based on current regimen utilization, the annual transition of 84 cycles of DA-EPOCH to the outpatient setting has a positive impact on margin of $1,444,548. Routine outpatient administration of DA-EPOCH is both safe and feasible with a positive annual impact on margin of $1,444,548 at a comprehensive cancer center.

Clinician perspectives of complementary and integrative medicine (CIM) at an academic cancer center.

e24047 Background: Surveys suggest up to 87% of patients with cancer use complementary and integrative (CIM) therapies such as herbal medicine, acupuncture, massage and mind-body practices. These therapies may assist with symptoms of pain, nausea and anxiety. However, several studies have demonstrated that many clinicians do not inquire about CIM use, which may be due to lack of education and/or limited evidence-based data. We sought to explore the perspectives of clinicians at an academic comprehensive cancer center on the use of CIM therapies. Methods: Physicians and advanced practice providers (APPs) who practice medical oncology, hematology, radiation oncology, surgical oncology and neuro-oncology in a Midwest tertiary comprehensive cancer center were asked to participate in a 9-question online survey which inquired about their personal knowledge and recommendation for 21 different CIM therapies (not all are offered at the cancer center). Responses were summarized using descriptive statistics. Results: The response rate for this survey was 24.5% (n = 49). Responders were from the following specialties: hematology (n = 17; 35%); solid tumor (n = 18; 37%); both hematology and solid tumor (n = 8; 16%), surgical oncology (n = 3; 6%); gynecologic oncology (n = 2; 4%) and radiation oncology (n = 1; 2%). Sixty-seven percent were attending physicians and hematology/oncology fellows (n = 33), and 33% were APPs (n = 16). Median age range was 30-39 years (range 20-59). The most recommended CIM therapy for cancer treatment-related effects was massage (80%), followed by deep breathing (55%). The least recommended CIM therapies were traditional Chinese medicine (TCM) and Ayurvedic medicine (2%), followed by vitamins/minerals and homeopathy (both 6%). Participants requested more education on CBD/CBD oil (59%) and herbs/botanicals (49%). Up to 14% of respondents already had education on five integrative therapies. Conclusions: Hematology/oncology clinicians do not routinely recommend most CIM therapies, except for massage therapy. Efforts should be made to educate clinicians regarding CIM therapies used by patients with cancer as well resources that appraise the efficacy, safety, and potential drug interactions of these therapies. Education could encourage informed decision-making and improved patient-clinician communication and satisfaction.

Tipping point: When patients stop eating and drinking in the last phase of their life.

Eating and drinking are essential also in social life. Nutrition and hydration (N&H) at end of life are often a source of discussion and distress. Stopping eating and drinking is a defining element of the dying phase, however, this time point is not well defined. The aim of this retrospective analysis was to investigate whether such a time point can be detected, whether there are specific characteristics associated. The time point when patients stopped oral intake was analyzed in relation to time until death on a specialist palliative care ward (sPCW) of a tertiary comprehensive cancer center. This "tipping point" (TP) was defined as the time point when total food intake fell below 25% of normal solid intake (TP-S) and "tipping point fluid" (TP-F) when fluid intake fell below 500ml/day (oral/intravenous/subcutaneous). Demographic and medical data, the N&H-module in the electronic patient management system and the daily multiprofessional treatment notes at TP (±3 days) were analyzed in all patients cared on the sPCW between 1/15 and 9/17. In these 32 months, of 1194 treated patients 683 (57%) died on the ward. A TP-S was identified in 291 patients prior to dying on the ward (43%) with a median time of six days from to TP-S death. In 75% of these patients, TP-S occurred within two weeks prior to death (range: 0-5 weeks). A TP-F was detected in 202 patients (30%) with a median TP-F-time of two days prior to death. In 75% of these patients, the TP-F was within three days prior to death (range: 0-14 days). The cancer entities in patients in whom TPs could be detected were heterogeneous. No specific disease-related or sociodemographic characteristics for patients with TPs could be determined. In the daily treatment notes, oral and swallowing problems, taste alterations and discussions about stopping artificial nutrition were mentioned. In less than half of dying patients a definitive TP could be detected. In these patients, TP-S occurred within two weeks and TP-F within few days before death. No specific characteristics of patients with TPs could be observed. This indicates the individual nature of the trajectory at end of life.

Short Hospice Length of Service in a Comprehensive Cancer Center.

Background: The benefits of hospice for patients with advanced cancer are well established. Short hospice length of service (LOS) is a marker of poor quality care and patient and family dissatisfaction. Interventions based on behavioral science might reduce suboptimal hospice use. Objective: To assess effects of peer comparisons on rates of short hospice LOS for cancer patients at a tertiary comprehensive cancer center. Design: Pre-post design utilizing a peer-comparison feedback intervention comparing individual oncologist hospice data. Setting: Urban, academic, comprehensive cancer center in Maryland. Measurements: Hospice enrollment rate. Median hospice LOS and percentage short hospice LOS (defined as ≤7 days). Results: Sixty oncologists received the intervention. Before the intervention, 394 patients enrolled in hospice for a period of 21 months (18.76 enrollments per month). Median hospice LOS was 14.5 days. After the intervention, 418 patients enrolled in hospice for 14 months (29.85 enrollments per month). Median hospice LOS was nine days. The percentage of patients experiencing a short hospice LOS increased from 33.3% to 43.5%. Conclusions: The methods are not sufficient to conclude that the intervention does not improve hospice use. A substantial number of patients with cancer who used hospice had LOS ≤7 days, a marker of poor quality. Using peer comparison in combination with additional behavioral interventions should be considered to improve end-of-life care.

BPI20-015: Safety and Financial Analysis of Outpatient Dose-Adjusted EPOCH for B-cell Lymphoma at a Tertiary Comprehensive Cancer Center

BPI20-015: Safety and Financial Analysis of Outpatient Dose-Adjusted EPOCH for B-cell Lymphoma at a Tertiary Comprehensive Cancer Center

Experience of Palliative Care Services at Tertiary Comprehensive Cancer Center during COVID-19 Lockdown Phase: An Analytical Original Study.

Background:Recent pandemic Coronavirus disease 2019 has brought the whole world to a standstill. In India too, phases of the lockdown of the country were declared. This hampered the availability of essential health-care services to needy patients. With full emphasis on the pandemic, patients suffering from other diseases and palliative oncology patients requiring essential palliative care services were affected due to the shutting down of regular health-care services.Aim:In this study, we emphasize that in the middle of a pandemic, we need to continue serving the needs of palliative care patients, and simultaneously, necessary steps should be taken for the prevention of the spread of virus by following guidelines, training, support, and monitoring.Materials and Methods:In this study, we analyzed electronic medical record of 1161 patients who received palliative care from our institute in the first two lockdown periods, regarding their demographics, extent of travel, type of malignancy, and opioid utilization.Results:Of 1161 patients, male outnumbered female and the patient suffering from head-and-neck malignancy were in the maximum number (48.7%). Our essential opioids utilization rate was 34.2%, and patients who traveled from different states were 21.6%.Conclusion:During this pandemic, we cannot overlook the need for essential palliative care services. We can continue regular services with proper precautions as advised and by training the staff. Collaboration with different palliative centers across the country should be done to minimize patient movement.

Returning to life activities after hematopoietic cell transplantation in older adults

ObjectivesThe prevalence of hematopoietic cell transplant (HCT) among older adults with hematological malignancies has more than doubled over the last decade and continues to grow. HCT is an intense process that can impact functional status and health-related quality of life. The objective of this paper is to describe the experience of returning to life activities after HCT in patients 60 years of age and older and the resources required to adapt and cope to limitations in physical, psychological, and cognitive function. Materials and MethodsTwenty English speaking adults 60 years and older with hematological malignancy 3 to 12 months post-HCT completed semi-structured interviews. Open-ended questions and probes were guided by the Transactional Model of Stress and Coping to explore adaptive functioning, coping resources, and coping strategies. An integrated grounded theory approach was used to code the textual data to identify themes. The study took place at a tertiary comprehensive cancer center in the Midwest United States. ResultsEight allogeneic and twelve autologous HCT recipients participated in the interviews. Nineteen participants were within 6–12 months and 1 participant was at 3 months post-HCT. Our findings identify the significant role of engaging in life activities and social support in the recovery of physical, psychological and cognitive function. ConclusionOlder HCT recipients are an understudied population. They are at high risk for functional decline. Our findings may provide community oncologists and primary care physicians with a context for providing care to older HCT survivors during their recovery.

Efficacy of medical cannabis for cancer-related pain in the elderly: A single-center retrospective analysis.

13 Background: Use of medical cannabis (MC) for cancer-related symptoms is growing, yet many prior studies used formulations not available in the United States (US). Clinical data on formulation, dosing and efficacy for formulations available in the US is limited. Furthermore, though interest is growing in the use of MC for elderly patients, data on safety and efficacy in this population is limited. We aimed to assess the clinical characteristics of elderly people using MC, formulations prescribed, and efficacy for cancer-related pain, insomnia and anxiety. Methods: We conducted a retrospective chart review of patients age 65 and older prescribed MC in the year 2018 in an outpatient palliative care clinic at a tertiary comprehensive cancer center. Pain intensity and anxiety were measured by numerical rating (0-10), and insomnia was assessed by self-reported hours of sleep per night, with data collected at consecutive clinic visits before and after MC use. Results: Eighty-three patients aged 65 and over were included in our analysis. Half of patients were age 65-70, while 12% were age 76 or older. Slightly more than half were male (58%), while the majority were Caucasian (92%). For patients with pain, two thirds were already prescribed opioids; 28% were using gabapentin/pregabalin, 22% duloxetine, and 7% nortriptyline/amitriptyline. Two-thirds (65%) reported never using cannabis previously. The most common MC product used was oil (35%), followed by vape (13%), pill (6%) and powder (3%). The most common initial concentrations were equal THC/CBD (41%) and high THC (43%); 8% of patients used high CBD, and 8% used a combination. The median delta pain score did not change with use of MC (delta pain = 0.0, p = 0.72), nor did anxiety (delta anxiety = -0.2, p = 1.00) nor insomnia (delta hours sleep = -0.1, p = 1.000). Conclusions: In this study of elderly patients prescribed MC, the majority of whom were cannabis naïve and already prescribed opioids, most were initially prescribed high THC or 1:1 THC/CBD, with oil and vape the most common formulations used. Use of MC was not associated with changes in pain, anxiety nor insomnia scores.

Geriatric Assessment, Not ASA Physical Status, Is Associated With 6-Month Postoperative Survival in Patients With Cancer Aged ≥75 Years.

The American Society of Anesthesiologists physical status (ASA PS) classification system is the most common method of assessing preoperative functional status. Comprehensive geriatric assessment (CGA) has been proposed as a supplementary tool for preoperative assessment of older adults. The goal of this study was to assess the correlation between ASA classification and CGA deficits among oncogeriatric patients and to determine the association of each with 6-month survival. Oncogeriatric patients (aged ≥75 years) who underwent preoperative CGA in an outpatient geriatric clinic at a single tertiary comprehensive cancer center were identified. All patients underwent surgery, with a hospital length of stay (LOS) ≥1 day and at least 6 months of follow-up. ASA classifications were obtained from preoperative anesthesiology notes. Preoperative CGA scores ranged from 0 to 13. Six-month survival was assessed using the Social Security Death Index. In total, 81 of the 980 patients (8.3%) included in the study cohort died within 6 months of surgery. Most patients were classified as ASA PS III (85.4%). The mean number of CGA deficits for patients with PS II was 4.03, PS III was 5.15, and PS IV was 6.95 (P<.001). ASA classification was significantly associated with age, preoperative albumin level, hospital LOS, and 30-day intensive care unit (ICU) admissions. On multivariable analysis, 6-month mortality was associated with number of CGA deficits (odds ratio [OR], 1.14 per each unit increase in CGA score; P=.01), 30-day ICU admissions (OR, 2.77; P=.003), hospital LOS (OR, 1.03; P=.02), and preoperative albumin level (OR, 0.36; P=.004). ASA classification was not associated with 6-month mortality. Number of CGA deficits was strongly associated with 6-month mortality; ASA classification was not. Preoperative CGA elicits critical information that can be used to enhance the prediction of postoperative outcomes among older patients with cancer.

Chemical coping and efficacy of buprenorphine for cancer pain.

200 Background: The management of cancer-related pain is challenging in the age of the opioid epidemic. Patients who struggle with substance misuse or chemical coping use these substances to dull emotional and or existential suffering. Buprenorphine is often used for cancer pain due to less reported euphoria when compared to other opioids. Methods: We conducted a retrospective review of patients in an outpatient palliative care clinic at a tertiary comprehensive cancer center who were prescribed buprenorphine for cancer pain. Total oral morphine equivalent (OME), as well as use of adjuvant non-opioid neuropathic pain medication, were assessed prior to transition to buprenorphine. Chemical coping behavior was defined as patients taking opioids for emotional pain in excess of the maximum prescribed amount. Pain scores were reported before and after buprenorphine administration using a Likert pain scale (0-10). Patients were also assessed for the presence of withdrawal symptoms after transition to buprenorphine. Results: Patients were predominantly female (75%), slightly more than half had a psychiatric diagnosis (56%), a majority were on non-opioid neuropathic pain medication (93%), and the majority were identified as chemical copers (75%). For all patients, the mean pain score prior to buprenorphine (pain pre) was 8.3 and the mean pain score on follow up post buprenorphine (pain post) was 6.1, with a reduction in mean pain score (pain change) of -2.0 (p = 0.059). Patients without chemical coping behaviors reported a significantly greater reduction in pain scores compared to patients with chemical coping (pain change -5.0 vs -1.3, p = 0.02). Illicit drug use and psychiatric co-morbidity were not associated with differences in reported pain scores. Only a small number of patients reported withdrawal symptoms (6%) during buprenorphine transition. Conclusions: Rotation to buprenorphine led to a trend of reduction in pain score, though not statistically significant. Patients without chemical coping experienced greater reductions in pain score than those with chemical coping behavior. Illicit drug use and psychiatric co-morbidity were not associated with differences in reported pain.