ASCO QCS 2018

PHOENIX – An initiative designed to reduce avoidable emergency room visits and hospitalizations cut admissions by 16%, according to a report from a large, independent, community-based oncology practice.

The program saved nearly $3.2 million in Medicare costs over the course of the year, said Molly Mendenhall, RN, of Oncology Hematology Care in Cincinnati.

“By keeping those patients out of the hospital, we were able to improve patient quality of life, and increase patient satisfaction by treating them in their home clinic instead of the hospital,” Ms. Mendenhall said at a symposium on quality care sponsored by the American Society of Clinical Oncology.

The campaign was developed in anticipation of participating in the Oncology Care Model (OCM), a program focused on providing coordinated and high-quality care for Medicare oncology patients at the same or lower cost.

Prior to participating in OCM, Ms. Mendenhall and her colleagues set up an after-hours phone triage system, proactive chemotherapy follow-up calls, and a Saturday-Sunday urgent care clinic designed to help avoid any unnecessary hospitalizations over the weekend.

They also set up a 2-hour structured OCM treatment planning visit to prioritize shared decision making between the patient and the clinical team regarding diagnosis, symptom management, financial assistance, and other aspects of care.

The most influential part of the initiative, according to Ms. Mendenhall, was a patient-directed “Call Us Early – Call Us First” campaign that included symptom management teaching sheets, a 34-page teaching book, and branded buttons, pens, and magnets all designed to emphasize the patient responsibility to use the phone.

“All of those previous steps really wouldn’t make a difference if the patients still weren’t calling us,” Ms. Mendenhall explained.

Over the first year of participation in the OCM program, the oncology practice saw a 16% statistically significant reduction in hospital admissions (P = .005). The number of inpatient admissions per 100 patients dropped from 26.8 at baseline to 22.6 at the most recent follow-up in a report published simultaneously in the Journal of Oncology Practice.

Reduced admissions translated into a drop of $798,000 in inpatient costs per quarter over 1,600 patients, or $3.129 million in savings for the Centers for Medicare & Medicaid Services over the first year of participation in OCM, according to the researchers.

Patient satisfaction scores trended positively over the course of that year based on a review of blinded surveys that asked patients to rate clinical care, communication, access, information exchange, and other aspects of their experience.

Scores on those surveys were 8.03 on a scale of 0-10 (low to high) during the baseline period of January to September 2016, the researchers said. Scores were 8.29 and 8.26 for two follow-up surveys.

Ms. Mendenhall had no disclosures to report. Coauthors on the study provided disclosures related to Janssen Oncology, Pfizer, Amgen, Abbvie, Merck, Pharmacyclics, Bristol-Myers Squibb, Celgene, Genentech/Roche, AZTherapies, and Lilly. Two coauthors reported leadership, stock, or other ownership interests in Oncology Hematology Care/US Oncology.

SOURCE: Mendenhall M et al. Quality Care Symposium, Abstract 30.

PHOENIX – An initiative designed to reduce avoidable emergency room visits and hospitalizations cut admissions by 16%, according to a report from a large, independent, community-based oncology practice.

The program saved nearly $3.2 million in Medicare costs over the course of the year, said Molly Mendenhall, RN, of Oncology Hematology Care in Cincinnati.

“By keeping those patients out of the hospital, we were able to improve patient quality of life, and increase patient satisfaction by treating them in their home clinic instead of the hospital,” Ms. Mendenhall said at a symposium on quality care sponsored by the American Society of Clinical Oncology.

The campaign was developed in anticipation of participating in the Oncology Care Model (OCM), a program focused on providing coordinated and high-quality care for Medicare oncology patients at the same or lower cost.

Prior to participating in OCM, Ms. Mendenhall and her colleagues set up an after-hours phone triage system, proactive chemotherapy follow-up calls, and a Saturday-Sunday urgent care clinic designed to help avoid any unnecessary hospitalizations over the weekend.

They also set up a 2-hour structured OCM treatment planning visit to prioritize shared decision making between the patient and the clinical team regarding diagnosis, symptom management, financial assistance, and other aspects of care.

The most influential part of the initiative, according to Ms. Mendenhall, was a patient-directed “Call Us Early – Call Us First” campaign that included symptom management teaching sheets, a 34-page teaching book, and branded buttons, pens, and magnets all designed to emphasize the patient responsibility to use the phone.

“All of those previous steps really wouldn’t make a difference if the patients still weren’t calling us,” Ms. Mendenhall explained.

Over the first year of participation in the OCM program, the oncology practice saw a 16% statistically significant reduction in hospital admissions (P = .005). The number of inpatient admissions per 100 patients dropped from 26.8 at baseline to 22.6 at the most recent follow-up in a report published simultaneously in the Journal of Oncology Practice.

Reduced admissions translated into a drop of $798,000 in inpatient costs per quarter over 1,600 patients, or $3.129 million in savings for the Centers for Medicare & Medicaid Services over the first year of participation in OCM, according to the researchers.

Patient satisfaction scores trended positively over the course of that year based on a review of blinded surveys that asked patients to rate clinical care, communication, access, information exchange, and other aspects of their experience.

Scores on those surveys were 8.03 on a scale of 0-10 (low to high) during the baseline period of January to September 2016, the researchers said. Scores were 8.29 and 8.26 for two follow-up surveys.

Ms. Mendenhall had no disclosures to report. Coauthors on the study provided disclosures related to Janssen Oncology, Pfizer, Amgen, Abbvie, Merck, Pharmacyclics, Bristol-Myers Squibb, Celgene, Genentech/Roche, AZTherapies, and Lilly. Two coauthors reported leadership, stock, or other ownership interests in Oncology Hematology Care/US Oncology.

SOURCE: Mendenhall M et al. Quality Care Symposium, Abstract 30.

PHOENIX – An initiative designed to reduce avoidable emergency room visits and hospitalizations cut admissions by 16%, according to a report from a large, independent, community-based oncology practice.

The program saved nearly $3.2 million in Medicare costs over the course of the year, said Molly Mendenhall, RN, of Oncology Hematology Care in Cincinnati.

“By keeping those patients out of the hospital, we were able to improve patient quality of life, and increase patient satisfaction by treating them in their home clinic instead of the hospital,” Ms. Mendenhall said at a symposium on quality care sponsored by the American Society of Clinical Oncology.

The campaign was developed in anticipation of participating in the Oncology Care Model (OCM), a program focused on providing coordinated and high-quality care for Medicare oncology patients at the same or lower cost.

Prior to participating in OCM, Ms. Mendenhall and her colleagues set up an after-hours phone triage system, proactive chemotherapy follow-up calls, and a Saturday-Sunday urgent care clinic designed to help avoid any unnecessary hospitalizations over the weekend.

They also set up a 2-hour structured OCM treatment planning visit to prioritize shared decision making between the patient and the clinical team regarding diagnosis, symptom management, financial assistance, and other aspects of care.

The most influential part of the initiative, according to Ms. Mendenhall, was a patient-directed “Call Us Early – Call Us First” campaign that included symptom management teaching sheets, a 34-page teaching book, and branded buttons, pens, and magnets all designed to emphasize the patient responsibility to use the phone.

“All of those previous steps really wouldn’t make a difference if the patients still weren’t calling us,” Ms. Mendenhall explained.

Over the first year of participation in the OCM program, the oncology practice saw a 16% statistically significant reduction in hospital admissions (P = .005). The number of inpatient admissions per 100 patients dropped from 26.8 at baseline to 22.6 at the most recent follow-up in a report published simultaneously in the Journal of Oncology Practice.

Reduced admissions translated into a drop of $798,000 in inpatient costs per quarter over 1,600 patients, or $3.129 million in savings for the Centers for Medicare & Medicaid Services over the first year of participation in OCM, according to the researchers.

Patient satisfaction scores trended positively over the course of that year based on a review of blinded surveys that asked patients to rate clinical care, communication, access, information exchange, and other aspects of their experience.

Scores on those surveys were 8.03 on a scale of 0-10 (low to high) during the baseline period of January to September 2016, the researchers said. Scores were 8.29 and 8.26 for two follow-up surveys.

Ms. Mendenhall had no disclosures to report. Coauthors on the study provided disclosures related to Janssen Oncology, Pfizer, Amgen, Abbvie, Merck, Pharmacyclics, Bristol-Myers Squibb, Celgene, Genentech/Roche, AZTherapies, and Lilly. Two coauthors reported leadership, stock, or other ownership interests in Oncology Hematology Care/US Oncology.

SOURCE: Mendenhall M et al. Quality Care Symposium, Abstract 30.

PHOENIX – Opioid use in urologic oncology patients dropped by 46% after one high-volume surgical center introduced changes to order sets and adopted new patient communication strategies, a researcher has reported.

The changes, which promoted opioid-sparing pain regimens, led to a substantial drop in postoperative opioid use with no compromise in pain control, according to Kerri Stevenson, a nurse practitioner with Stanford Health Care.

“Patients can be successfully managed with minimal opioid medication,” Ms. Stevenson said at a symposium on quality care sponsored by the American Society of Clinical Oncology.

However, “it takes a multidisciplinary team for effective change to occur – this cannot be done in silos,” she told attendees at the meeting.

Seeking to reduce their reliance on opioids to manage postoperative pain, Ms. Stevenson and her colleagues set out to reduce opioid use by 50%, from a baseline morphine equivalent daily dose (MEDD) of 95.1 in June to September 2017 to a target of 47.5 by March 2018.

The actual MEDD at the end of the quality improvement project was 51.5, a 46% reduction that was just shy of that goal, she reported.

Factors fueling opioid use included patient expectations that they would be used and the belief that adjunct medications were not as effective as opioids, Dr. Stevenson found in a team survey.

“We decided to target those,” she said. “Our key drivers were really focused on appropriate prescriptions, increasing patient and provider awareness, standardizing our pathways, and setting expectations.”

To tackle the problem, they revised EMR order sets to default to selection of adjunct medications, educated providers, and introduced new patient communication strategies.

Instead of asking “Would you like me to bring you some oxycodone?” providers would instead start by asking about the patient’s current pain control medications and whether they were working well. When prescribed, opioids should be started at lower doses and escalated only if needed.

“Once we started our interventions, we noticed an immediate effect,” Ms. Stevenson.

The decreases were consistent across a range of surgery types. For example, the MEDD dropped to 55.1 with robotic prostatectomy, a procedure with a 1-day admission and very small incisions, and to 50.6 for open radical cystectomy, which involves a large incision and a stay of approximately 4 days, she said.

To address concerns that they might just be undertreating patients, investigators looked retrospectively at pain scores. They saw no differences pre- and post intervention in pain or anxiety scores within the first 24-48 hours post procedure, Ms. Stevenson reported.

Ms. Stevenson had no disclosures related to the presentation. Coauthor Jay Bakul Shah, MD of Stanford Health Care reported a consulting or advisory role with Pacira Pharmaceuticals.

SOURCE: Stevenson K et al. Quality Care Symposium, Abstract 269.

PHOENIX – Opioid use in urologic oncology patients dropped by 46% after one high-volume surgical center introduced changes to order sets and adopted new patient communication strategies, a researcher has reported.

The changes, which promoted opioid-sparing pain regimens, led to a substantial drop in postoperative opioid use with no compromise in pain control, according to Kerri Stevenson, a nurse practitioner with Stanford Health Care.

“Patients can be successfully managed with minimal opioid medication,” Ms. Stevenson said at a symposium on quality care sponsored by the American Society of Clinical Oncology.

However, “it takes a multidisciplinary team for effective change to occur – this cannot be done in silos,” she told attendees at the meeting.

Seeking to reduce their reliance on opioids to manage postoperative pain, Ms. Stevenson and her colleagues set out to reduce opioid use by 50%, from a baseline morphine equivalent daily dose (MEDD) of 95.1 in June to September 2017 to a target of 47.5 by March 2018.

The actual MEDD at the end of the quality improvement project was 51.5, a 46% reduction that was just shy of that goal, she reported.

Factors fueling opioid use included patient expectations that they would be used and the belief that adjunct medications were not as effective as opioids, Dr. Stevenson found in a team survey.

“We decided to target those,” she said. “Our key drivers were really focused on appropriate prescriptions, increasing patient and provider awareness, standardizing our pathways, and setting expectations.”

To tackle the problem, they revised EMR order sets to default to selection of adjunct medications, educated providers, and introduced new patient communication strategies.

Instead of asking “Would you like me to bring you some oxycodone?” providers would instead start by asking about the patient’s current pain control medications and whether they were working well. When prescribed, opioids should be started at lower doses and escalated only if needed.

“Once we started our interventions, we noticed an immediate effect,” Ms. Stevenson.

The decreases were consistent across a range of surgery types. For example, the MEDD dropped to 55.1 with robotic prostatectomy, a procedure with a 1-day admission and very small incisions, and to 50.6 for open radical cystectomy, which involves a large incision and a stay of approximately 4 days, she said.

To address concerns that they might just be undertreating patients, investigators looked retrospectively at pain scores. They saw no differences pre- and post intervention in pain or anxiety scores within the first 24-48 hours post procedure, Ms. Stevenson reported.

Ms. Stevenson had no disclosures related to the presentation. Coauthor Jay Bakul Shah, MD of Stanford Health Care reported a consulting or advisory role with Pacira Pharmaceuticals.

SOURCE: Stevenson K et al. Quality Care Symposium, Abstract 269.

PHOENIX – Opioid use in urologic oncology patients dropped by 46% after one high-volume surgical center introduced changes to order sets and adopted new patient communication strategies, a researcher has reported.

The changes, which promoted opioid-sparing pain regimens, led to a substantial drop in postoperative opioid use with no compromise in pain control, according to Kerri Stevenson, a nurse practitioner with Stanford Health Care.

“Patients can be successfully managed with minimal opioid medication,” Ms. Stevenson said at a symposium on quality care sponsored by the American Society of Clinical Oncology.

However, “it takes a multidisciplinary team for effective change to occur – this cannot be done in silos,” she told attendees at the meeting.

Seeking to reduce their reliance on opioids to manage postoperative pain, Ms. Stevenson and her colleagues set out to reduce opioid use by 50%, from a baseline morphine equivalent daily dose (MEDD) of 95.1 in June to September 2017 to a target of 47.5 by March 2018.

The actual MEDD at the end of the quality improvement project was 51.5, a 46% reduction that was just shy of that goal, she reported.

Factors fueling opioid use included patient expectations that they would be used and the belief that adjunct medications were not as effective as opioids, Dr. Stevenson found in a team survey.

“We decided to target those,” she said. “Our key drivers were really focused on appropriate prescriptions, increasing patient and provider awareness, standardizing our pathways, and setting expectations.”

To tackle the problem, they revised EMR order sets to default to selection of adjunct medications, educated providers, and introduced new patient communication strategies.

Instead of asking “Would you like me to bring you some oxycodone?” providers would instead start by asking about the patient’s current pain control medications and whether they were working well. When prescribed, opioids should be started at lower doses and escalated only if needed.

“Once we started our interventions, we noticed an immediate effect,” Ms. Stevenson.

The decreases were consistent across a range of surgery types. For example, the MEDD dropped to 55.1 with robotic prostatectomy, a procedure with a 1-day admission and very small incisions, and to 50.6 for open radical cystectomy, which involves a large incision and a stay of approximately 4 days, she said.

To address concerns that they might just be undertreating patients, investigators looked retrospectively at pain scores. They saw no differences pre- and post intervention in pain or anxiety scores within the first 24-48 hours post procedure, Ms. Stevenson reported.

Ms. Stevenson had no disclosures related to the presentation. Coauthor Jay Bakul Shah, MD of Stanford Health Care reported a consulting or advisory role with Pacira Pharmaceuticals.

SOURCE: Stevenson K et al. Quality Care Symposium, Abstract 269.

PHOENIX – Metastatic breast cancer care may be a bigger financial burden for uninsured patients, but it’s actually causing more financial distress for the insured, results of a recent survey suggest.

The uninsured more often reported material burdens, such as lack of savings or refusing treatment because of cost, according to survey results reported at a symposium on quality care sponsored by the American Society of Clinical Oncology.

By contrast, the insured reported more worry, distress, and frustration related to financial problems, reported Stephanie B. Wheeler, PhD, MPH, of the Gillings School of Global Public Health, University of North Carolina at Chapel Hill.

That divide suggests increased health insurance coverage is not enough to tackle the problem of cancer-related financial harm, said Dr. Wheeler.

“Health insurance expansion is important,” she said, “but it’s going to be ultimately inadequate in solving the problem of financial distress in our cancer patients. We really need to be thinking about other types of interventions that can do a better job of meeting patients where they are.”

Regardless of insurance status, this survey showed an “unprecedented” high level of cancer-related financial harm in metastatic breast cancer patients as compared with previous studies of early-stage cancer patients, Dr. Wheeler said.

The online survey was completed by 1,054 individuals who were members of the Metastatic Breast Cancer Network, a patient advocacy group. Approximately 30% of participants were uninsured, Dr. Wheeler reported.

Overall, 56% of respondents reported not having enough savings to cover costs of care, while 54% stopped or refused treatment because of cost, and 49% said they had been contacted by collection agencies, survey results show.

These material burdens were “perhaps not surprisingly” significantly more often reported by the uninsured respondents, Dr. Wheeler said. What may be surprising, she added, is that psychosocial burdens were more frequently reported by the insured respondents.

The most frequently reported psychosocial burden was worry about cancer-related financial problems, reported by 68% of respondents overall, but nearly 80% of insured and around 45% of uninsured respondents (P less than .001), Dr. Wheeler said.

The least often reported psychosocial issue was worry about the effects of financial stress on the family, at 31% of all respondents. Even so, there was a significant difference in response by insurance status, with the percentage approaching 40% for the insured, but less than 20% for the uninsured (P less than .001).

This high level of worry and distress may indicate that insured cancer patients may be expecting their insurance to cover more that it does, but ultimately, it is inadequate to meet their needs, Dr. Wheeler said.

“It’s also possible that because insured participants are more often affluent – they more often have retirement and other savings to draw down – that they actually have more to lose,” she added, “and when it comes to the legacy that they leave behind for their family, that creates additional stress – not just for them as an individual, but for their entire household.”

Previous research shows that the adverse financial impacts of cancer, also referred to as financial toxicity, affect about 30% of cancer patients, Dr. Wheeler said in her presentation.

Dr. Wheeler had no relationships to disclose. Funding for the project was provided from the National Comprehensive Cancer Network and Pfizer Independent Grants for Learning & Change.

SOURCE: Wheeler SB et al. Quality Care Symposium, Abstract 32.

PHOENIX – Metastatic breast cancer care may be a bigger financial burden for uninsured patients, but it’s actually causing more financial distress for the insured, results of a recent survey suggest.

The uninsured more often reported material burdens, such as lack of savings or refusing treatment because of cost, according to survey results reported at a symposium on quality care sponsored by the American Society of Clinical Oncology.

By contrast, the insured reported more worry, distress, and frustration related to financial problems, reported Stephanie B. Wheeler, PhD, MPH, of the Gillings School of Global Public Health, University of North Carolina at Chapel Hill.

That divide suggests increased health insurance coverage is not enough to tackle the problem of cancer-related financial harm, said Dr. Wheeler.

“Health insurance expansion is important,” she said, “but it’s going to be ultimately inadequate in solving the problem of financial distress in our cancer patients. We really need to be thinking about other types of interventions that can do a better job of meeting patients where they are.”

Regardless of insurance status, this survey showed an “unprecedented” high level of cancer-related financial harm in metastatic breast cancer patients as compared with previous studies of early-stage cancer patients, Dr. Wheeler said.

The online survey was completed by 1,054 individuals who were members of the Metastatic Breast Cancer Network, a patient advocacy group. Approximately 30% of participants were uninsured, Dr. Wheeler reported.

Overall, 56% of respondents reported not having enough savings to cover costs of care, while 54% stopped or refused treatment because of cost, and 49% said they had been contacted by collection agencies, survey results show.

These material burdens were “perhaps not surprisingly” significantly more often reported by the uninsured respondents, Dr. Wheeler said. What may be surprising, she added, is that psychosocial burdens were more frequently reported by the insured respondents.

The most frequently reported psychosocial burden was worry about cancer-related financial problems, reported by 68% of respondents overall, but nearly 80% of insured and around 45% of uninsured respondents (P less than .001), Dr. Wheeler said.

The least often reported psychosocial issue was worry about the effects of financial stress on the family, at 31% of all respondents. Even so, there was a significant difference in response by insurance status, with the percentage approaching 40% for the insured, but less than 20% for the uninsured (P less than .001).

This high level of worry and distress may indicate that insured cancer patients may be expecting their insurance to cover more that it does, but ultimately, it is inadequate to meet their needs, Dr. Wheeler said.

“It’s also possible that because insured participants are more often affluent – they more often have retirement and other savings to draw down – that they actually have more to lose,” she added, “and when it comes to the legacy that they leave behind for their family, that creates additional stress – not just for them as an individual, but for their entire household.”

Previous research shows that the adverse financial impacts of cancer, also referred to as financial toxicity, affect about 30% of cancer patients, Dr. Wheeler said in her presentation.

Dr. Wheeler had no relationships to disclose. Funding for the project was provided from the National Comprehensive Cancer Network and Pfizer Independent Grants for Learning & Change.

SOURCE: Wheeler SB et al. Quality Care Symposium, Abstract 32.

PHOENIX – Metastatic breast cancer care may be a bigger financial burden for uninsured patients, but it’s actually causing more financial distress for the insured, results of a recent survey suggest.

The uninsured more often reported material burdens, such as lack of savings or refusing treatment because of cost, according to survey results reported at a symposium on quality care sponsored by the American Society of Clinical Oncology.

By contrast, the insured reported more worry, distress, and frustration related to financial problems, reported Stephanie B. Wheeler, PhD, MPH, of the Gillings School of Global Public Health, University of North Carolina at Chapel Hill.

That divide suggests increased health insurance coverage is not enough to tackle the problem of cancer-related financial harm, said Dr. Wheeler.

“Health insurance expansion is important,” she said, “but it’s going to be ultimately inadequate in solving the problem of financial distress in our cancer patients. We really need to be thinking about other types of interventions that can do a better job of meeting patients where they are.”

Regardless of insurance status, this survey showed an “unprecedented” high level of cancer-related financial harm in metastatic breast cancer patients as compared with previous studies of early-stage cancer patients, Dr. Wheeler said.

The online survey was completed by 1,054 individuals who were members of the Metastatic Breast Cancer Network, a patient advocacy group. Approximately 30% of participants were uninsured, Dr. Wheeler reported.

Overall, 56% of respondents reported not having enough savings to cover costs of care, while 54% stopped or refused treatment because of cost, and 49% said they had been contacted by collection agencies, survey results show.

These material burdens were “perhaps not surprisingly” significantly more often reported by the uninsured respondents, Dr. Wheeler said. What may be surprising, she added, is that psychosocial burdens were more frequently reported by the insured respondents.

The most frequently reported psychosocial burden was worry about cancer-related financial problems, reported by 68% of respondents overall, but nearly 80% of insured and around 45% of uninsured respondents (P less than .001), Dr. Wheeler said.

The least often reported psychosocial issue was worry about the effects of financial stress on the family, at 31% of all respondents. Even so, there was a significant difference in response by insurance status, with the percentage approaching 40% for the insured, but less than 20% for the uninsured (P less than .001).

This high level of worry and distress may indicate that insured cancer patients may be expecting their insurance to cover more that it does, but ultimately, it is inadequate to meet their needs, Dr. Wheeler said.

“It’s also possible that because insured participants are more often affluent – they more often have retirement and other savings to draw down – that they actually have more to lose,” she added, “and when it comes to the legacy that they leave behind for their family, that creates additional stress – not just for them as an individual, but for their entire household.”

Previous research shows that the adverse financial impacts of cancer, also referred to as financial toxicity, affect about 30% of cancer patients, Dr. Wheeler said in her presentation.

Dr. Wheeler had no relationships to disclose. Funding for the project was provided from the National Comprehensive Cancer Network and Pfizer Independent Grants for Learning & Change.

SOURCE: Wheeler SB et al. Quality Care Symposium, Abstract 32.

PHOENIX – By starting supportive measures early in the care of cancer patients undergoing curative treatment, a cancer center cut costs, emergency department visits, and admissions, a researcher said at symposium on quality care sponsored by the American Society of Clinical Oncology.

The supportive care pathway resulted in double-digit decreases in admissions and an opportunity cost savings of $1,500 per patient, reported Christopher D. Koprowski, MD, MBA, of Helen F. Graham Cancer Center & Research Institute, Christiana Care Health System, Newark, Del.

Although satisfaction hasn’t been measured yet, anecdotal reports suggest the patient experience has improved because of the multidisciplinary program, which included mandatory supportive care screening and enhancements to computer systems, said Dr. Koprowski, who is director of quality and safety at the cancer center.

“From all outward signs, the patients are extraordinarily grateful in this program,” Dr. Koprowski said in an interview. “I just had one who said that being seen at the same time by all these people just makes things so much easier.”

The Supportive Care of Oncology Patients (SCOOP) clinical pathway, introduced in November 2016, includes palliative and supportive care service screening that occurs during the multidisciplinary visit. The pathway incorporates a checklist integrated into a nurse navigator information system to support care standardization, according to Dr. Koprowski.

Also added were “flags” in the inpatient information system that trigger alerts to navigators, oncologists, and the supportive care service whenever a patient in the SCOOP pathway is admitted, discharged, or seen in the emergency room, he said.

Enrollment in SCOOP was limited to lung, esophageal, head and neck, and colorectal cancer patients receiving concurrent radiation and chemotherapy. Out of approximately 200 eligible patients in the first year, about half entered the clinical pathway, according to Dr. Koprowski.

For that first year, 32% of SCOOP patients had ED visits, compared with 54% of combined modality patients who did not enter the pathway, Dr. Koprowski reported.

Similarly, admissions were 25% for the SCOOP patients and 34% of non-SCOOP patients, and readmissions were seen in 20% versus 32% of those groups, respectively.

These findings are much like what has been seen when early supportive care is introduced in patients with more advanced disease, according to Dr. Koprowski.

He said the SCOOP program was partly inspired by a study in the New England Journal of Medicine showing that patients with advanced non–small cell lung cancer who received early palliative care had longer survival despite less-aggressive care, including reduced use of chemotherapy, at the end of life.

“Early-stage patients aren’t that much different if they are being treated very aggressively with combined modality chemotherapy and radiation,” he said. “The treatment is very, very tough on people.”

Dr. Koprowski and his coinvestigators had no relationships to disclose relevant to the research presented at the ASCO symposium.

SOURCE: Koprowski CD et al. 2018 ASCO Quality Care Symposium, Abstract 142.

PHOENIX – By starting supportive measures early in the care of cancer patients undergoing curative treatment, a cancer center cut costs, emergency department visits, and admissions, a researcher said at symposium on quality care sponsored by the American Society of Clinical Oncology.

The supportive care pathway resulted in double-digit decreases in admissions and an opportunity cost savings of $1,500 per patient, reported Christopher D. Koprowski, MD, MBA, of Helen F. Graham Cancer Center & Research Institute, Christiana Care Health System, Newark, Del.

Although satisfaction hasn’t been measured yet, anecdotal reports suggest the patient experience has improved because of the multidisciplinary program, which included mandatory supportive care screening and enhancements to computer systems, said Dr. Koprowski, who is director of quality and safety at the cancer center.

“From all outward signs, the patients are extraordinarily grateful in this program,” Dr. Koprowski said in an interview. “I just had one who said that being seen at the same time by all these people just makes things so much easier.”

The Supportive Care of Oncology Patients (SCOOP) clinical pathway, introduced in November 2016, includes palliative and supportive care service screening that occurs during the multidisciplinary visit. The pathway incorporates a checklist integrated into a nurse navigator information system to support care standardization, according to Dr. Koprowski.

Also added were “flags” in the inpatient information system that trigger alerts to navigators, oncologists, and the supportive care service whenever a patient in the SCOOP pathway is admitted, discharged, or seen in the emergency room, he said.

Enrollment in SCOOP was limited to lung, esophageal, head and neck, and colorectal cancer patients receiving concurrent radiation and chemotherapy. Out of approximately 200 eligible patients in the first year, about half entered the clinical pathway, according to Dr. Koprowski.

For that first year, 32% of SCOOP patients had ED visits, compared with 54% of combined modality patients who did not enter the pathway, Dr. Koprowski reported.

Similarly, admissions were 25% for the SCOOP patients and 34% of non-SCOOP patients, and readmissions were seen in 20% versus 32% of those groups, respectively.

These findings are much like what has been seen when early supportive care is introduced in patients with more advanced disease, according to Dr. Koprowski.

He said the SCOOP program was partly inspired by a study in the New England Journal of Medicine showing that patients with advanced non–small cell lung cancer who received early palliative care had longer survival despite less-aggressive care, including reduced use of chemotherapy, at the end of life.

“Early-stage patients aren’t that much different if they are being treated very aggressively with combined modality chemotherapy and radiation,” he said. “The treatment is very, very tough on people.”

Dr. Koprowski and his coinvestigators had no relationships to disclose relevant to the research presented at the ASCO symposium.

SOURCE: Koprowski CD et al. 2018 ASCO Quality Care Symposium, Abstract 142.

PHOENIX – By starting supportive measures early in the care of cancer patients undergoing curative treatment, a cancer center cut costs, emergency department visits, and admissions, a researcher said at symposium on quality care sponsored by the American Society of Clinical Oncology.

The supportive care pathway resulted in double-digit decreases in admissions and an opportunity cost savings of $1,500 per patient, reported Christopher D. Koprowski, MD, MBA, of Helen F. Graham Cancer Center & Research Institute, Christiana Care Health System, Newark, Del.

Although satisfaction hasn’t been measured yet, anecdotal reports suggest the patient experience has improved because of the multidisciplinary program, which included mandatory supportive care screening and enhancements to computer systems, said Dr. Koprowski, who is director of quality and safety at the cancer center.

“From all outward signs, the patients are extraordinarily grateful in this program,” Dr. Koprowski said in an interview. “I just had one who said that being seen at the same time by all these people just makes things so much easier.”

The Supportive Care of Oncology Patients (SCOOP) clinical pathway, introduced in November 2016, includes palliative and supportive care service screening that occurs during the multidisciplinary visit. The pathway incorporates a checklist integrated into a nurse navigator information system to support care standardization, according to Dr. Koprowski.

Also added were “flags” in the inpatient information system that trigger alerts to navigators, oncologists, and the supportive care service whenever a patient in the SCOOP pathway is admitted, discharged, or seen in the emergency room, he said.

Enrollment in SCOOP was limited to lung, esophageal, head and neck, and colorectal cancer patients receiving concurrent radiation and chemotherapy. Out of approximately 200 eligible patients in the first year, about half entered the clinical pathway, according to Dr. Koprowski.

For that first year, 32% of SCOOP patients had ED visits, compared with 54% of combined modality patients who did not enter the pathway, Dr. Koprowski reported.

Similarly, admissions were 25% for the SCOOP patients and 34% of non-SCOOP patients, and readmissions were seen in 20% versus 32% of those groups, respectively.

These findings are much like what has been seen when early supportive care is introduced in patients with more advanced disease, according to Dr. Koprowski.

He said the SCOOP program was partly inspired by a study in the New England Journal of Medicine showing that patients with advanced non–small cell lung cancer who received early palliative care had longer survival despite less-aggressive care, including reduced use of chemotherapy, at the end of life.

“Early-stage patients aren’t that much different if they are being treated very aggressively with combined modality chemotherapy and radiation,” he said. “The treatment is very, very tough on people.”

Dr. Koprowski and his coinvestigators had no relationships to disclose relevant to the research presented at the ASCO symposium.

SOURCE: Koprowski CD et al. 2018 ASCO Quality Care Symposium, Abstract 142.

PHOENIX – Despite clear guidance on lack of benefit and potential harms, many patients with early-stage breast cancers at low metastasis risk have undergone imaging tests for staging, recent retrospective studies have shown.

Nearly one-third of early-stage breast cancer patients received the unnecessary and potentially harmful interventions in one of the two studies presented at a symposium on quality care sponsored by the American Society of Clinical Oncology (ASCO).

Low-risk patients in that study were more likely to undergo imaging if they were younger or had triple-negative disease, among other factors, said researcher Brett Barlow, of the University of Alabama at Birmingham.

Physicians should be further educated about the low-risk nature of early-stage breast cancer, even in subgroups that are perceived to be higher risk, Mr. Barlow said in an interview.

“I think we can reassure physicians that these patients will do well and that these guidelines are based on good data,” he said “There could potentially be an element of distrust in these guidelines in these higher-risk patients, and that may be what’s driving some of these extra tests.”

According to Mr. Barlow, imaging low-risk patients is inconsistent with guidance from Choosing Wisely, an initiative designed to promote discussions between clinicians and patients about medical tests or procedures that are unnecessary.

As part of that initiative, ASCO recommended that PET, CT, and radionuclide bone scans should not be performed for staging of early-stage breast cancer at low risk for metastasis.

There is a lack of evidence that demonstrates a benefit for those imaging modalities in patients with newly identified ductal carcinoma in situ (DCIS) or clinical stage I or II disease, the society said at the time.

Unnecessary imaging can result in unnecessary invasive procedures, overtreatment, radiation exposure, and misdiagnosis, the society said in the guidance, which was published in 2012.

Despite the guidance, 262 out of 872 patients with stage 0-II breast cancer (30%) seen during 2013-2015 underwent imaging, according to results of the single-center retrospective cohort study Mr. Barlow and his coauthors described in a poster presentation.

The median age of the patients who underwent unnecessary imaging was 55 years versus 60 years for patients who did not, according to the researchers.

Risk of inappropriate imaging was increased in younger patients, those with triple-negative disease versus those with any hormone receptor–positive disease, those with higher-stage breast cancer, and those without Medicare insurance, investigators found.

Although it’s unclear whether there were any formal, institution-level efforts to promote the ASCO recommendations during the 2013-2015 period, it was “definitely a topic of debate at the time,” Mr. Barlow said.

“Something we hope to evaluate further is whether we have improved,” he said. “It’s important to set a baseline and see how we did in this area. We look forward to reevaluating that in a few years to see.”

In a separate study, investigators reviewed records from Mount Sinai Health System in New York and found that unnecessary scans were performed in 19% of patients diagnosed with stage I-II breast cancer during 2014-2015.

No cases of metastatic disease were found in 733 patients included in the study, and 43% had false-positive findings, according to Ana I. Velazquez Manana, MD, MS, of Mount Sinai Beth Israel Foundation, New York, and her coinvestigators.

Imaging increased costs by $4,480 per patient, according to the investigators, who found in multivariate analysis that the unnecessary scans were associated with young age, presence of T2 tumor, positive lymph nodes, and triple-negative disease.

“Further educational efforts are needed to avoid unnecessary scans in patients with early-stage breast cancer,” the researchers wrote in an abstract describing the results.

Mr. Barlow reported no disclosures, while one coauthor reported disclosures related to Carevive Systems, Genentech/Roche, Medscape, Pack Health, and Pfizer. Dr. Velazquez Manana and her coauthors had no relationships to disclose, and their study was funded by the Medical Student Rotation for Underrepresented Populations.

SOURCE: Barlow B et al. Quality Care Symposium, Abstract 51. Velazquez Manana AI et al. Quality Care Symposium, Abstract 52.

PHOENIX – Despite clear guidance on lack of benefit and potential harms, many patients with early-stage breast cancers at low metastasis risk have undergone imaging tests for staging, recent retrospective studies have shown.

Nearly one-third of early-stage breast cancer patients received the unnecessary and potentially harmful interventions in one of the two studies presented at a symposium on quality care sponsored by the American Society of Clinical Oncology (ASCO).

Low-risk patients in that study were more likely to undergo imaging if they were younger or had triple-negative disease, among other factors, said researcher Brett Barlow, of the University of Alabama at Birmingham.

Physicians should be further educated about the low-risk nature of early-stage breast cancer, even in subgroups that are perceived to be higher risk, Mr. Barlow said in an interview.

“I think we can reassure physicians that these patients will do well and that these guidelines are based on good data,” he said “There could potentially be an element of distrust in these guidelines in these higher-risk patients, and that may be what’s driving some of these extra tests.”

According to Mr. Barlow, imaging low-risk patients is inconsistent with guidance from Choosing Wisely, an initiative designed to promote discussions between clinicians and patients about medical tests or procedures that are unnecessary.

As part of that initiative, ASCO recommended that PET, CT, and radionuclide bone scans should not be performed for staging of early-stage breast cancer at low risk for metastasis.

There is a lack of evidence that demonstrates a benefit for those imaging modalities in patients with newly identified ductal carcinoma in situ (DCIS) or clinical stage I or II disease, the society said at the time.

Unnecessary imaging can result in unnecessary invasive procedures, overtreatment, radiation exposure, and misdiagnosis, the society said in the guidance, which was published in 2012.

Despite the guidance, 262 out of 872 patients with stage 0-II breast cancer (30%) seen during 2013-2015 underwent imaging, according to results of the single-center retrospective cohort study Mr. Barlow and his coauthors described in a poster presentation.

The median age of the patients who underwent unnecessary imaging was 55 years versus 60 years for patients who did not, according to the researchers.

Risk of inappropriate imaging was increased in younger patients, those with triple-negative disease versus those with any hormone receptor–positive disease, those with higher-stage breast cancer, and those without Medicare insurance, investigators found.

Although it’s unclear whether there were any formal, institution-level efforts to promote the ASCO recommendations during the 2013-2015 period, it was “definitely a topic of debate at the time,” Mr. Barlow said.

“Something we hope to evaluate further is whether we have improved,” he said. “It’s important to set a baseline and see how we did in this area. We look forward to reevaluating that in a few years to see.”

In a separate study, investigators reviewed records from Mount Sinai Health System in New York and found that unnecessary scans were performed in 19% of patients diagnosed with stage I-II breast cancer during 2014-2015.

No cases of metastatic disease were found in 733 patients included in the study, and 43% had false-positive findings, according to Ana I. Velazquez Manana, MD, MS, of Mount Sinai Beth Israel Foundation, New York, and her coinvestigators.

Imaging increased costs by $4,480 per patient, according to the investigators, who found in multivariate analysis that the unnecessary scans were associated with young age, presence of T2 tumor, positive lymph nodes, and triple-negative disease.

“Further educational efforts are needed to avoid unnecessary scans in patients with early-stage breast cancer,” the researchers wrote in an abstract describing the results.

Mr. Barlow reported no disclosures, while one coauthor reported disclosures related to Carevive Systems, Genentech/Roche, Medscape, Pack Health, and Pfizer. Dr. Velazquez Manana and her coauthors had no relationships to disclose, and their study was funded by the Medical Student Rotation for Underrepresented Populations.

SOURCE: Barlow B et al. Quality Care Symposium, Abstract 51. Velazquez Manana AI et al. Quality Care Symposium, Abstract 52.

PHOENIX – Despite clear guidance on lack of benefit and potential harms, many patients with early-stage breast cancers at low metastasis risk have undergone imaging tests for staging, recent retrospective studies have shown.

Nearly one-third of early-stage breast cancer patients received the unnecessary and potentially harmful interventions in one of the two studies presented at a symposium on quality care sponsored by the American Society of Clinical Oncology (ASCO).

Low-risk patients in that study were more likely to undergo imaging if they were younger or had triple-negative disease, among other factors, said researcher Brett Barlow, of the University of Alabama at Birmingham.

Physicians should be further educated about the low-risk nature of early-stage breast cancer, even in subgroups that are perceived to be higher risk, Mr. Barlow said in an interview.

“I think we can reassure physicians that these patients will do well and that these guidelines are based on good data,” he said “There could potentially be an element of distrust in these guidelines in these higher-risk patients, and that may be what’s driving some of these extra tests.”

According to Mr. Barlow, imaging low-risk patients is inconsistent with guidance from Choosing Wisely, an initiative designed to promote discussions between clinicians and patients about medical tests or procedures that are unnecessary.

As part of that initiative, ASCO recommended that PET, CT, and radionuclide bone scans should not be performed for staging of early-stage breast cancer at low risk for metastasis.

There is a lack of evidence that demonstrates a benefit for those imaging modalities in patients with newly identified ductal carcinoma in situ (DCIS) or clinical stage I or II disease, the society said at the time.

Unnecessary imaging can result in unnecessary invasive procedures, overtreatment, radiation exposure, and misdiagnosis, the society said in the guidance, which was published in 2012.

Despite the guidance, 262 out of 872 patients with stage 0-II breast cancer (30%) seen during 2013-2015 underwent imaging, according to results of the single-center retrospective cohort study Mr. Barlow and his coauthors described in a poster presentation.

The median age of the patients who underwent unnecessary imaging was 55 years versus 60 years for patients who did not, according to the researchers.

Risk of inappropriate imaging was increased in younger patients, those with triple-negative disease versus those with any hormone receptor–positive disease, those with higher-stage breast cancer, and those without Medicare insurance, investigators found.

Although it’s unclear whether there were any formal, institution-level efforts to promote the ASCO recommendations during the 2013-2015 period, it was “definitely a topic of debate at the time,” Mr. Barlow said.

“Something we hope to evaluate further is whether we have improved,” he said. “It’s important to set a baseline and see how we did in this area. We look forward to reevaluating that in a few years to see.”

In a separate study, investigators reviewed records from Mount Sinai Health System in New York and found that unnecessary scans were performed in 19% of patients diagnosed with stage I-II breast cancer during 2014-2015.

No cases of metastatic disease were found in 733 patients included in the study, and 43% had false-positive findings, according to Ana I. Velazquez Manana, MD, MS, of Mount Sinai Beth Israel Foundation, New York, and her coinvestigators.

Imaging increased costs by $4,480 per patient, according to the investigators, who found in multivariate analysis that the unnecessary scans were associated with young age, presence of T2 tumor, positive lymph nodes, and triple-negative disease.

“Further educational efforts are needed to avoid unnecessary scans in patients with early-stage breast cancer,” the researchers wrote in an abstract describing the results.

Mr. Barlow reported no disclosures, while one coauthor reported disclosures related to Carevive Systems, Genentech/Roche, Medscape, Pack Health, and Pfizer. Dr. Velazquez Manana and her coauthors had no relationships to disclose, and their study was funded by the Medical Student Rotation for Underrepresented Populations.

SOURCE: Barlow B et al. Quality Care Symposium, Abstract 51. Velazquez Manana AI et al. Quality Care Symposium, Abstract 52.