Digital symptom monitoring with patient-reported outcomes in community oncology practices: A U.S. national cluster randomized trial.

349527 Background: Symptoms are common during cancer care but often go undetected. Digital systems that elicit patient-reported outcomes (PRO) surveys may detect symptoms early and prompt clinicians to intervene, thereby alleviating suffering and averting complications. Methods: In a cluster-randomized trial, U.S.-based community oncology practices were randomized 1:1 to digital symptom monitoring with PRO surveys, or to usual care control. Patients receiving systemic treatment for metastatic cancer were eligible. At PRO practices, participants were invited to complete a weekly survey via web or automated telephone system for up to one year, including questions about nine common symptoms, performance status, and falls. Severe or worsening symptoms triggered electronic alerts to care team nurses, and reports showing longitudinal symptom data were available to oncologists at visits. Pre-specified secondary outcomes included impact on physical function, symptom control, and health-related quality of life (HRQL). The primary outcome of survival is not yet mature. Results: At 52 practices, 1,191 patients were eligible and enrolled (593 PRO; 598 control). Clinically meaningful benefits were experienced in physical function by 13.8% more patients with PRO versus control (P=0.009); symptom control by 16.1% (P=0.003); and HRQL by 13.4% (P=0.006). Mean changes from baseline were superior with PRO versus control for physical function (mean difference 2.47, 95% CI 0.41-4.53; P=0.02), symptom control (2.56, 0.95-4.17; P=0.002), and HRQL (2.43, 0.90-3.96; P=0.002). Patients completed 20,565/22,486 (91.5%) of expected weekly PRO surveys. Conclusions: Digital symptom monitoring during cancer treatment confers clinical benefits. Clinical trial information: NCT03249090.

Community oncologists’ perceptions and utilization of large-panel genomic tumor testing

Purpose Large-panel genomic tumor testing (GTT) is an emerging technology with great promise but uncertain clinical value. Previous research has documented variability in academic oncologists’ perceptions and use of GTT, but little is known about community oncologists’ perceptions of GTT and how perceptions relate to clinicians' intentions to use GTT. Methods Community oncology physicians (N = 58) participating in a statewide initiative aimed at improving access to large-panel GTT completed surveys assessing their confidence in using GTT, attitudes regarding the value of GTT, perceptions of barriers to GTT implementation, and future intentions to use GTTs. Descriptive and multivariable regression analyses were conducted to characterize these perceptions and to explore the relationships between them. Results There was substantial variability in clinicians’ perceptions of GTT. Clinicians generally had moderate confidence in their ability to use GTT, but lower confidence in patients’ ability to understand test results and access targeted treatment. Clinicians had positive attitudes regarding the value of GTT. Clinicians’ future intentions to use GTT were associated with greater confidence in using GTT and greater perceived barriers to implementing GTT, but not with attitudes about the value of GTT. Conclusions Community oncologists’ perceptions of large-panel genomic tumor testing are variable, and their future intentions to use GTT are associated with both their confidence in and perceived barriers to its use, but not with their attitudes towards GTT. More research is needed to understand other factors that determine how oncologists perceive and use GTT in clinical practice.

Treatment patterns and overall survival in HER2+ metastatic breast cancer at US community oncology practices

Aim: To describe real-world treatment patterns/outcomes among patients with HER2+ metastatic breast cancer (MBC). Materials & methods: Real-world treatments and overall survival (OS) were evaluated among adult women diagnosed with HER2+ MBC, with and without brain metastases (BMs), between June 1, 2012 and May 31, 2018 using electronic medical records from the Definitive Oncology Dataset. Results: Among 372 patients, 69% initiated first-line trastuzumab plus pertuzumab-based therapy; many therapy combinations were utilized in the second- to fourth-line. During follow-up (median 24.8 months), 18% of patients died (22% with and 16% without BMs). Mean OS was shortest among patients with BMs at MBC diagnosis in the third- and fourth-line. Conclusion: OS was poor, and no clear standard of care was observed among patients with HER2+ MBC progressing on trastuzumab-based therapies.

Understanding Hematological Adverse Event Management through Health Care Resource Utilization, Costs, and Treatment Patterns of Patients with Extensive-Stage Small Cell Lung Cancer Treated in the Community Oncology Setting

BACKGROUND: Myelosuppressive hematological adverse events (anemia, neutropenia, and thrombocytopenia) are common complications of chemotherapy among cancer patients. Cytotoxic chemotherapy remains the cornerstone of treatment for extensive stage small cell lung cancer (ES-SCLC). This study assessed the health care resource utilization (HCRU), costs, and treatment patterns associated with myelosuppressive hematological adverse events (HAEs) among ES-SCLC patients treated with chemotherapy in the community oncology setting. METHODS: A retrospective observational study was conducted using The US Oncology Network iKnowMed electronic health records data from 1/1/2015 to 12/31/2020. Adult patients with ES-SCLC who initiated chemotherapy (chemotherapy alone or chemotherapy in combination with immunotherapy) between 1/1/2015 and 12/31/2019 were identified and further stratified into two study cohorts: with grade ≥3 HAE vs. without grade ≥3 HAE after chemotherapy initiation. Date of chemotherapy initiation was considered as the index date. Patients were followed longitudinally from index date until 12/31/2020, death or last patient record, whichever came first. HAEs were identified using iKnowMed structured data for laboratory values based on Common Terminology Criteria for Adverse Events v5.0 definitions for anemia, neutropenia, and thrombocytopenia. Health care resource utilization and outpatient costs, and treatment patterns were evaluated for both cohorts. Inpatient costs or costs for transfusions were not included due to data limitation. RESULTS: 778 patients had at least one grade ≥3 HAEs after the chemotherapy initiation (50.3% with grade 3 anemia, 46.0% with grade 3 neutropenia, 28.0% with grade 4 neutropenia, 33.8% with grade 3 thrombocytopenia, 18.1% with grade 4 thrombocytopenia). Among the 778 patients, 454 (58.4%) of patients had grade ≥3 HAEs in 2 or more lineages (21.3% for anemia and neutropenia, 21.0% for neutropenia and thrombocytopenia, 20.6% for anemia and thrombocytopenia, and 12.2% for all 3 lineages). 43.1% of patients were eligible for RBC transfusions and 3.9% eligible for platelet transfusions as indicated by lab value. 12.2% of patients had evidence of major bleeding events. 596 patients were included in the without grade ≥3 HAE cohort. Demographics and baseline ECOG scores were similar for the two cohorts (Table 1). Almost all patients (>99%) received first-line chemotherapy at index (approximately 80% received platinum/etoposide regimen, 15% received platinum/etoposide in combination with immunotherapy) in both cohorts. Patients with grade ≥3 HAE had higher proportion of dose reductions (46.7% vs. 32.2%), treatment holds (12.7% vs. 5.9%), and treatment delays (92.3% vs. 84.3%) after chemotherapy initiation, all p<0.001 when compared to the patients without grade ≥3 HAE. The total outpatient costs within 12 months post-index were higher for patients with grade ≥3 HAE ($37,613 vs. $31,176 p=0.004) (Table 2). Patients with grade ≥3 HAE had an average of 10.7 outpatient visits within 12 months post-index, vs 7.7 outpatient visits for those without grade ≥3 HAE (p<0.0001). Patients with grade ≥3 HAE also had higher G-CSF use (64.1% vs. 57.2%, mean number of administrations 3.5 vs 2.4, mean cost per patient $9864 vs. $8011, all p<0.01), ESA use (18.6% vs. 4.8%, 0.7 vs 0.12 administrations, mean cost per patient $786 vs. $151, all p<0.01), and IV hydration (46.0% vs. 30.3%, 2.3 vs 1.2 administrations, mean cost per patient $148 vs $32, all p<0.01) compared to the patients without grade ≥3 HAE. CONCLUSIONS: The results suggest there is significant burden of myelosuppressive hematological adverse events among ES-SCLC patients in a community oncology setting. A notable proportion of patients had HAEs in 2 or more lineages. Patients with grade ≥3 HAE appear to have more dose reductions, treatment delays, and more health care service utilizations than those without. Therapies to protect bone marrow from multilineage HAEs have potential to reduce such burden. Future research should investigate HCRU and cost burden in the inpatient setting to better understand the full scope of HAE management. Figure 1 Figure 1. Disclosures Goldschmidt: Ontada: Current Employment; Blue Ridge Cancer Care: Current Employment; Amgen: Honoraria, Speakers Bureau; BMS: Honoraria, Speakers Bureau; G1 Therapeutics: Honoraria, Speakers Bureau; TG Therapeutics: Honoraria. Monnette: Ontada: Current Employment, Current holder of individual stocks in a privately-held company; G1 Therapeutics: Consultancy; BMS: Consultancy. Shi: Ontada: Current Employment. Venkatasetty: Ontada: Current Employment. Huang: G1 Therapeutics: Current Employment, Current holder of individual stocks in a privately-held company, Current holder of stock options in a privately-held company. Chioda: G1 Therapeutics: Current Employment, Current holder of individual stocks in a privately-held company, Current holder of stock options in a privately-held company.