Search

33 Background: The Institute of Medicine and Commission on Cancer recommend systematic delivery of supportive oncology care for cancer patients. The CSOC is focused on quality improvement (QI) of supportive care across Chicago cancer centers (Weldon ASCO ’17). Supportive oncology includes distress, practical, family, physical, nutrition, pain, fatigue and care concerns. To support QI, cross-institution teams developed unique, relevant tools, methods, care delivery processes, patient handouts and online training. Methods: Ten centers (5 academic, 1 VA, 1 public, 2 safety net, 1 community) implemented supportive oncology screening and care delivery quality improvements. Centers collected data for relevant Quality Oncology Practice Initiative (QOPI) metrics. Analyses used simple frequencies and Fishers exact test. Results: Five of six QOPI measures were improved at statistically significant levels from 2014 to 2017, p < .00001. Improvements are more modest in 2016 & 2017 as 4 of the centers started this QI in 2017. Conclusions: The CSOC achieved significant improvements in supportive oncology screening and identifying and addressing patients’ needs and concerns. Additional work is needed to improve these measures to achieve the best quality of cancer care possible for every patient based on their needs and concerns. [Table: see text]

150 Background: The Institute of Medicine (IOM) and Commission on Cancer (CoC) recommend systematic delivery of supportive oncology and survivorship care to all cancer patients. CSOC aims to improve the quality of supportive care across Chicago-area providers. Methods: 35 CSOC participating institutions (cancer centers, support centers, hospice) formed care delivery design teams - Distress, Survivorship and Palliative. Teams collaboratively developed solutions to supportive oncology gaps: patient screening tools, care delivery processes, provider training, and quality metrics to assess supportive oncology quality and the CSOC impact. Six implementation centers (2 safety-net, 3 academic & 1 public) reviewed charts at baseline (2014 diagnoses) and after the initial implementation period (2015 diagnoses), compared by frequencies and Fisher’s exact test. Results: Eight metrics contained patient data at 2 time points; improvements were seen in 7/8 metrics. (See Table). Conclusions: CSOC developed supportive oncology screening, and care processes aligned with IOM and CoC standards. Significant improvements were shown after implementation across diverse settings. Ongoing work will further evaluate the impact of CSOC efforts on patient care. [Table: see text]

61 Background: The Institute of Medicine (IOM) 2013 Report recommends that supportive oncology care start at cancer diagnosis; the Commission on Cancer (CoC) Standard 3.2 requires distress screening and indicated action. Screening tools are not standardized and often address only a portion of patients’ supportive oncology needs. Methods: A collaborative of 100+ clinicians, funded by The Coleman Foundation, developed a patient-centric screening tool adapted from NCCN Distress Problem List, IOM report and CoC standards, with validated sub-tools: PHQ-4 for anxiety and depression and PROMIS short forms for pain, fatigue and physical function. Novel treatment/care and other concerns were included. The screening tool was implemented at 4 cancer centers (2 academic, 1 public & 1 safety-net). End points included correlation of PHQ-4 score with other supportive oncology needs. Descriptive statistics, Fisher’s exact test were used. Results: 2805 patients were screened. Average scores were: PHQ4 – Anxiety and Depression 1.8 (mild > 3), Pain 4.5 (mild > 4), Fatigue 8.8 (mild > 6), Physical Function 20.2 (mild < 20), see table for additional items. Higher scores on the PHQ-4 were significantly associated with each of the following: greater pain, fatigue, , nutritional and specific treatment/care concerns, and lower physical function (p

47 Background: The IOM 2013 Report recommends that supportive oncology care start at cancer diagnosis; the Commission on Cancer (CoC) Standard 3.2 requires distress screening and indicated action. Screening tools are not standardized across institutions and often address only a portion of patients’ supportive oncology needs. Methods: A collaborative of 100+ clinicians, funded by The Coleman Foundation, developed a patient-centric consolidated screening tool based on validated instruments (NCCN Distress, PHQ-4, PROMIS) and IOM and CoC. The screening tool was piloted at 6 practice-improvement cancer centers in the Chicago area (3 academic, 2 safety-net, 1 public). Patients, providers assessing patients’ screening results (assessors), and providers receiving referrals (providers) were surveyed after use of the screening tool. Descriptive statistics were used to assess effectiveness of the tool. Results: Responders included 175 patients, 81 assessors, and 26 referral providers (social workers, chaplains, subspecialists). The majority of patients (160/175, 91%) completed the screening in

180 Background: The Institute of Medicine (IOM) 2013 report recommends supportive oncology care from diagnosis through survivorship, to end of life. The Coleman Supportive Oncology Collaborative (CSOC) developed a city-wide plan to improve supportive oncology. Metrics derived from the Commission on Cancer (CoC), ASCO Quality Oncology Practice Initiative (ASCO-QOPI) and National Quality Forum (NQF) were used to assess the CSOC impact. Methods: Medical records of consecutive cancer patients from 6 practice improvement cancer centers in Chicago (3 academic, 2 safety-net, 1 public) were reviewed for 2 periods: 2014 (n = 843) and Q1 of 2015 (n = 313). Descriptive statistics assessed differences in quality metrics. Results: Significant improvement was achieved in 6 of 8 core supportive oncology metrics (see table). Conclusions: Consolidated metrics are feasible to assess supportive oncology quality. Early data indicate improvement and effectiveness of the collaborative approach. [Table: see text]

96 Background: The IOM 2013 report recommends comprehensive supportive oncology care from diagnosis through survivorship to end of life. The Coleman Foundation supported a baseline assessment of supportive oncology care using key COC, ASCO-QOPI and NQF measures. Methods: Data extracted from medical records at 6 Chicago cancer centers in 2014 (n = 843 patients), including stage I-III (n = 391) and stage IV solid tumor or refractory hematologic malignancy (n = 452). Results: Fifty-four percent of patients had discussions on understanding of illness, 24% were informed of prognosis timeframe, and 5% had a documented healthcare power of attorney. Only 6% of stage IV patients received distress screening within 2 weeks of diagnosis and 15% of Stage IV patients had referrals to palliative care. Among patients with Stage I-III cancer, 38% had a supportive oncology screening, and 2% received treatment summaries and a SCPs. Conclusions: There are still large gaps in important supportive care processes based on IOM 2013 recommendations, COC, and ASCO QOPI measures. Future steps include implementing supportive care processes that address gaps across the 6 cancer centers. [Table: see text]

184 Background: Continued smoking among head and neck cancer patients(HNCP) is associated with poor prognosis. These patients (pts) experience highest rates of depressive symptoms of all oncology patients. Smoking and depression are among factors that influence long term quality of life in these pts. Methods: HNCP were evaluated for patterns of smoking and depression at our Hospital. Survey using a standardized questionnaire about smoking patterns and depression using PHQ9 was employed. Pts were stratified as nonsmokers, ex-smokers (quit > 6 mo), recent smokers ( < 6 mo), and current smokers ( < 7 days). EMR was reviewed for sociodemographic variables, stage (stg), diagnosis (Dx) date, treatment(Rx) modality. The cohort was followed till 7/31/2015 to assess disease recurrence and survival. Results: 39 pts were interviewed. Mean age at Dx was 56 +/-7 yrs. 82% were men. 46% were African American, 36% Caucasians(cau) and 8% Hispanics. 74% had stg IV disease at Dx. 76.9% were recent/current smokers at Dx. At 280 days from Dx, 41% continued smoking; decrease in smoking was statistically significant (p value: .000). 52% of smokers with stg III/IV cancer quit smoking while pts with stg I/II continued to smoke. Continued smoking was higher in Cau (p = 0.038). Mild to severe depression was seen in 56% of pts. Higher rates of depression were noted among smokers (62%) with stage III/IV disease; though it was not statistically significant. Complete response to Rx was seen in 82% and recurrence in 20.5%. No difference in outcomes based on smoking patterns was noted. Conclusions: Although smoking rates at Dx were comparable to literature, our pts had higher rates of continued smoking and depression. Dx and stg appear to be important factors in smoking cessation. SSRIs have been prophylactically used to reduce rates of depression in these pts. Studies are needed to determine if they can be used with the same success in minority population. Larger studies are also needed to assess the role of smoking cessation as a strategy to prevent depression among minority population.

6006 Background: Randomized trials and meta-analyses have demonstrated therapeutic superiority for concurrent platinum-based chemoradiation vs. RT alone in unresectable LA-SCCHN. More recently, Bonner et al (NEJM, 2006) reported a survival advantage for (C) plus RT vs RT alone. We report toxicity and response data from an ECOG trial of concurrent chemo-RT and C in LA-SCCHN. Methods: Unresectable, newly diagnosed patients with LA-SCCHN, PS 0–1 and adequate physiologic indices received C 400 mg/m2 d1, then 250 mg/m2 Q wk, in combination with definitive RT (70 Gy/2Gy/d x 7 wks) starting d 15 and DDP 75 mg/m2 days 15, 36 and 57. In the absence of disease progression (PD) or untoward toxicity, pts could continue C weekly for > 6 mos. Results: 69 pts were accrued between 12/21/04 and 7/20/06. 5 were ineligible; 3 never started treatment. Of the remaining 61, median age was 56 (range 42–79); 85% were male, 44% PS 0; 61% had < 5% weight loss. 98% were Stage IV: 43% T4; 75% N2, 15% N3. Most common primary sites in...