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PURPOSE Among patients receiving chemotherapy, symptom monitoring with electronic patient-reported outcomes (ePROs) is associated with improved clinical outcomes, satisfaction, and compliance with therapy. Standard approaches for ePRO implementation are not established, warranting evaluation in community cancer practices. We present implementation findings of ePRO symptom monitoring across a large multisite community oncology practice network. METHODS Patients initiating a new systemic therapy at one of the 210 practice sites at Texas Oncology were invited to use the Navigating Cancer ePRO platform, with stepped-wedge implementation from July to December 2020. Participating patients received a weekly prompt by text message or e-mail to self-report common symptoms and well-being. Severe self-reported symptoms triggered a real-time notification to nursing triage to address the symptom. Enrollment and compliance were systematically tracked weekly with evaluation of barriers and facilitators to adoption and sustainability. RESULTS Four thousand three hundred seventy-five patients planning systemic treatment were enrolled and participated. Seventy-three percent (1,841 of 2,522) of enrolled patients completed at least one ePRO assessment. Among these individuals, 64% (16,299 of 25,061) of available weekly ePRO assessments were completed. Over a 10-week period, compliance declined from 72% to 52%. Barriers currently being addressed include lack of a second reminder text or e-mail prompt, inconsistent discussion of reported ePROs by clinicians at visits, and COVID-related changes in workflow. Facilitators included ease of use and patient and staff engagement on the importance of PROs for symptom management. CONCLUSION ePROs can be effectively implemented in community oncology practice. Utilization of ePROs is high but diminishes over time without attention to barriers. Ongoing work to address barriers and optimize compliance are underway.

150 Background: There are currently 500,000 head and neck cancer (HNC) survivors in the United States. Pain is common among survivors and associated with adverse quality of life and outcomes. There is however a lack of data on pain management in the community oncology setting, where a growing number of patients may be receiving long-term care. We described sociodemographic correlates of patient-reported pain among HNC patients receiving care in the community setting. Methods: We used data from Navigating Cancer, a nationwide, community-oncology, patient-reported outcomes database that include electronic patient-reported outcomes (ePROs) from 253 cancer clinics and over 1 million cancer survivors. We identified a retrospective cohort of patients diagnosed with HNC after January 1, 2017, with at least one record of patient-reported pain through nurse triage. We characterized demographic and clinical factors associated with any reported pain, and pain resolution by new pain prescription, based on race (white vs. non-white patients), and other sociodemographic characteristics. Results: Our cohort included 3,762 patients, 62.8% white, 45.3% married, with an average age of 66.0 years. Of these, 652 patients (17%) reported at least one pain event during study period. After adjusting for covariates, there was no statistically significant difference in the odds of any reported pain between white vs. non-white patients (aOR = 0.81; 95% CI 0.57, 1.15). However, we found that white HNC patients were significantly more likely to be provided a new prescription for pain management more than non-white patients, (aOR = 4.58; 95% CI 2.23, 9.38). Other factors associated with prescription of new pain prescription included being single/unpartnered (aOR = 1.34; 95% CI 1.03, 1.75) compared to being married/partnered, having Medicare (aOR = 3.07; 95% CI 1.59, 5.93) or commercial insurance (aOR = 2.88; 95% CI 1.54, 5.38) compared to Medicaid. Additionally, male patients were significantly less likely to receive new prescription compared to females (aOR = 0.48; 95% CI 0.37, 0.61). Conclusions: One-in-six HNC patients in the community oncology setting reported pain, and while there were no racial differences in any pain report, white patients were significantly more likely to receive new pain prescription, as were those with Medicare or commercial insurance. There may be disparity in the management of reported pain among HNC survivors based on race.

189 Background: Digital monitoring strategies that include electronic patient reported outcomes (ePRO) measures to monitor symptoms among cancer patients have been shown to be effective in improving patient outcomes in a large academic setting and across several smaller multi-center trials. However, demonstration of clinical utility in the real-world setting must incorporate patient and provider perspectives of ePRO programs to ensure successful implementation. We sought to understand perceptions among patients and clinicians in ePRO digital symptom monitoring program. Methods: Texas Two-Step is an ongoing hybrid implementation-effectiveness study of Navigating Cancer’s ePRO digital monitoring program at Texas Oncology. Patients initiating new systemic therapy for their cancer diagnosis were introduced to the program by their oncologist and enrolled in the program by nursing staff for weekly reporting of symptoms based on a modified version of NCI’s PRO-CTCAE instrument. Feedback surveys were administered to both patients and clinic staff after 6 months of implementation of the program to evaluate the overall experience with the program. Results: 1040 (23.5%) patients and 215 (12.4%) clinicians completed the feedback survey. Of the patient responders, 90% found the program very or somewhat easy for reporting symptoms, 85% moderately-extremely beneficial for having symptoms addressed, and 84% moderately-extremely interested in utilizing the program for future treatments. Of the clinician responders, 73% indicated that that they had a good understanding of the benefit of the program; 70.6% felt confident in their ability to interpret patients’ ePRO responses; 80.3% felt confident in their ability to discuss the program with patients; 71.2% confident in their ability to counsel patients based on ePRO responses; and 55.3% felt the program enhanced communication with patients. Additionally, 59% of clinicians felt the program was beneficial for patients. Conclusions: Patients have a more favorable perception of the benefit of the ePRO program than clinicians. Methods to reduce staff burden and reinforcement of program benefits during training and implementation are imperative to improve clinical utility and will be studied further as the program is optimized. As implementation occurred during the COVID-19 pandemic, this may impact perceptions regarding the tool.

1578 Background: Value-based care models such as the Oncology Care Model incentivize practices to reduce hospitalizations and emergency department (ED) visits. Texas Oncology found that most ED visits occurred during regular business hours. Prolonged patient call back times were consistently rated poorly on satisfaction surveys and often led to ED visits for symptoms that could be managed in our offices. We partnered with Navigating Cancer (NC) to implement an electronic patient management technology solution. Methods: For each of our 200 locations, call volume was estimated based on clinic volume. We then reallocated or hired dedicated triage nurses and operators. Incoming calls were entered into the NC dashboard by operators as incidents which were routed based on symptom priority following system generated prompts. Incident volumes and resolution times were tracked. We instituted PDSA cycles at all locations with a goal of less than 90-minute resolution of symptom-related incidents Utilizing the electronic dashboard allowed us to continue this initiative during the COVID-19 public health emergency as our staff could work remotely. Nurses were able to document if a potential ED visit was avoided. These data points allowed our practice to establish comprehensive and strategic actions plans for quality improvement. Results: We finalized implementation of the system in February of 2020. Total incidents for 2020 were over 1 million, averaging over 5000 per location. Resolution time for all incidents started at 3.2 hours pre-implementation and improved to 2.2 hours in December of 2020. Resolution times for symptom-related incidents started at 2.3 hours pre-implementation and ended at 1.5 hours in December of 2020 with over 60% resolved under one hour. 8% of symptom-related incidents resulted in definite or probable ED avoidances by nursing assessment. Shortness of breath, vomiting, chills, and weakness were the top symptom types addressed for ED avoidances. Conclusions: An electronic patient management solution with PDSA cycles of quality improvement can markedly reduce call back times, especially for symptom related calls. We believe managing symptoms in a timely fashion will lower ED visits and hospitalizations as well as improve patient satisfaction. We will report on these outcomes once available.[Table: see text]

12103 Background: Among patients receiving chemotherapy, symptomatic adverse event monitoring with electronic patient-reported outcomes (ePRO) is associated with improved clinical outcomes, satisfaction, and compliance with therapy. Standard approaches for ePRO implementation are not established warranting evaluation in community cancer practices. Objective: Evaluate implementation of ePRO symptom monitoring across a large multi-site community oncology practice network. Methods: Patients initiating a new systemic therapy at one of 210 practice sites in the Texas Oncology Practice were invited to use in the Navigating Cancer ePRO platform, with rolling implementation from July-December 2020. Participating patients received a weekly prompt by text message or email (patient choice) to self-report common symptoms and well-being via web or smartphone. Severe self-reported symptoms triggered a real-time notification alert to nursing triage to address the symptom. Enrollment and compliance were systematically tracked weekly with evaluation of barriers and facilitators to adoption and sustainability. Results: 4375 patients planning systemic treatment enrolled and participated, with baseline characteristics are shown in Table 1. 73% (1841/2522) of enrolled patients with follow up completed at least one ePRO assessment, and among these individuals, 65% (8762/25061) of all available weekly ePRO assessments were completed. Over a 10-week period, compliance with weekly symptom reporting declined from 72% to 52%. Patients on oral therapy had higher compliance rates overall. Barriers currently being addressed include lack of a second reminder text/email prompt, inconsistent discussion of reported ePROs by clinicians at visits, and COVID-related changes in workflow. Facilitators included patient and staff engagement on the importance of PROs for symptom management. Conclusions: ePROs can be effectively implemented in community oncology practice. Utilization of ePROs is high, but diminishes over time without attention to barriers. Ongoing work to address barriers and optimize compliance are underway.[Table: see text]

Introduction The purpose of our study was to identify the key risk factors for the development of posterior reversible encephalopathy syndrome (PRES) after administration of the combination chemotherapy regimen, DA-EPOCH (dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin). Materials and Methods We performed a retrospective medical record review of patients receiving DA-EPOCH with or without rituximab (DA-EPOCH ± R) at our institution from July 2012 to September 2014. The patients were screened for evidence of severe neurotoxicity through identification of requests for neurology consultations or neuroimaging studies. Patients with evidence of central nervous system (CNS) neurotoxicity were reviewed in detail to identify documented cases of PRES. The key risk factors assessed included rituximab administration sequence, and the presence of CNS insults, fluid status or electrolyte abnormalities, organ dysfunction, and hypertension. Results A total of 44 patients received DA-EPOCH ± R at our institution from July 2012 to September 2014. Of these 44 patients, 3 (7%) were diagnosed with PRES. The patients who developed PRES were more likely to have a pre-existing CNS insult, fluid status or electrolytes abnormalities, and hypertension. Conclusion To the best of our knowledge, the present study is the first description of PRES associated with DA-EPOCH. The key risk factors for the development of PRES identified in our study included hypertension, fluid imbalance, electrolyte abnormalities, baseline organ dysfunction, a high tumor burden, and the presence of pre-existing CNS insults during chemotherapy, such as CNS infection. Patients with these risk factors appear to have a greater risk of developing PRES and should be monitored closely during treatment.

Progressive multifocal leukoencephalopathy is a neurological disease caused by the human polyoma virus JC virus and can present in patients with known immunodeficiencies. However, when associated with idiopathic CD4+ lymphocytopenia, management of patients can be quite challenging as these are two rare diseases with limited effective treatment options. In conjunction with the case report of a patient diagnosed with both conditions presented within this issue, a discussion of available treatment strategies is detailed.

e20048 Background: Ipi (anti-CTLA4 antibody) is associated with improved survival and durable responses in a subset of melanoma pts. However, the optimal dose and schedule remain unclear and an unmet need to identify predictors of clinical benefit exists. This retrospective study of pts at the University of Washington aims at gaining further insight into these questions. Methods: Efficacy and safety outcomes and baseline characteristics of 126 pts receiving single agent Ipi from 2006-2012 were subjected to univariate analysis. Efficacy endpoints included OS, PFS, ORR and Duration of Clinical Benefit (DCB) defined as the time from Ipi initiation until documented progression or change in therapy (to capture outcomes on non-trial pts). Immune-related adverse events (IRAEs), absolute lymphocyte count (ALC), concordance of disease response by metastatic site, and use of radiation therapy (RT) were also analyzed. Results: The median age was 57.7 yrs. The 3 mg/kg (N=84; 67%) and 10 mg/kg (N=42; 33%) cohorts matched well for standard prognostic criteria. The efficacy endpoints, including OS, PFS, DCB, and ORR (see table) were not significantly different for the 3 mg/kg and 10 mg/kg cohorts. However, grade III/IV IRAEs were more frequent in the 10 mg/kg group (33% vs 17%, p=0.04). There was a significant correlation between efficacy outcomes and development of IRAEs (see table). Baseline ALC or changes in ALC at 7 weeks post-therapy and concurrent RT administration did not significantly correlate with improved outcomes. Responses were concordant between CNS and non-CNS sites. Conclusions: Our data supports the currently approved dose of 3mg/kg. The development of IRAEs was significantly associated with clinical benefit and further confirmation of this association is warranted. Results of other exploratory analyses will be presented at the meeting. [Table: see text]