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Acute diagnostic oncology clinic: A unique primary care-oncology service
abstracts
Annals of Oncology
Table: 1655P Breast Prostate Colorectal Lung N ¼ 12706 N ¼ 6360 N ¼ 5336 N ¼ 2593 4605 8101
5377 983
3491 1845
1611 982
5.14
13.71
4.29
5.42
8.14
18.14
8.42
8.57
14.29
N/A
20.00
10.00
3.85
6.71
5.00
5.57
N/A
6.42
N/A
6.42
23.57
6.85
28.29
18.00/6.14* *chemo/xrt
Conclusions: Almost half of patients who undergo curative cancer treatment require definitive radiotherapy or multimodality treatment. The median duration of therapy varies widely depending on primary site and modality (6.14 - 28.29 weeks). This has implications for financial support such as United Kingdom’s Statutory Sick Pay (28 weeks) and Canada Employment Insurance (15 weeks), as well as workplace dismissal in the United States where the Family and Medical Leave Act protects employees for 12 weeks absence. Governments should consider amending the laws to reflect current cancer treatment durations. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: C. Ho: Honoraria (self), Research grant / Funding (self): AstraZeneca; Honoraria (self), Research grant / Funding (self), Travel / Accommodation / Expenses: Boehringer Ingelheim; Honoraria (self), Travel / Accommodation / Expenses: Pfizer ; Honoraria (self): BMS; Honoraria (self), Travel / Accommodation / Expenses: Roche; Honoraria (self): Lilly; Research grant / Funding (self): Genzyme; Honoraria (self), Research grant / Funding (self): Eisai; Honoraria (self): Merck; Honoraria (self): Bayer. All other authors have declared no conflicts of interest.
1656P
Acute diagnostic oncology clinic: A unique primary care-oncology service
A. Gill, R. Sharkey, J. Simmons, M. Bower, A. Sita-Lumsden, J. Evans, T. Newsom-Davis Oncology, Chelsea & Westminster Hospital, London, UK Background: Cancers presenting with ‘vague symptoms’ are difficult to diagnose. These non-specific but serious symptoms (weight loss, anorexia, pain, fatigue) have a number of causes including malignancy. The risk for each individual cancer may be low, but the total risk of cancer of any type is higher. Patients diagnosed with cancer as the result of an emergency presentation (EP) to secondary care have poorer survival, usually describe a long history of symptoms, and most have seen their general practitioner (GP) prior to presentation. Earlier diagnosis improves cancer outcomes. But investigating vague symptoms is challenging, requiring both oncology and general medical knowledge, while bespoke rapid-access oncology diagnostic clinics are needed to avoid EP. Methods: The Acute Diagnostic Oncology Clinic was established at Chelsea & Westminster Hospital in 2016. It initially provided rapid access investigations for those too ill to wait for an urgent suspected cancer appointment, as an alternative to the Emergency Department (ED). In February 2018 the clinic expanded to, uniquely, include a GP with specialist interest in oncology and patients with ‘vague symptoms’.
Volume 30 | Supplement 5 | October 2019
1657P
The new mutational model in oncology. What changes in welfare, clinical practice, research, and regulatory procedures?
N. Normanno1, G. Curigliano2, C. Jommi3, N. Martini4, A. Marchetti5, P. Marchetti6, A. Pedrini4, G. Pruneri7 1 Translational Research, Istituto Nazionale Tumori – I.R.C.C.S - Fondazione Pascale, Naples, Italy, 2Early Drug Development for Innovative Therapies Division, Istituto Europeo di Oncologia, Milan, Italy, 3Practice, Government, Health and Not for Profit Division, SDA Bocconi School of Management, Milan, Italy, 4Fondazione Ricerca&Salute, Fondazione Ricerca&Salute, Rome, Italy, 5Pathology, P.O. Clinicizzato Ss. Annunziata Universita’ Degli Studi, Chieti, Italy, 6Medical Oncology, Azienda Ospedaliera St. Andrea, Rome, Italy, 7Pathology, Istituto Nazionale Tumori, Milan, Italy Background: The diffusion of next-generation sequencing (NGS)-based tests for comprehensive genomic profiling (CGP), the development of new drugs matching specific genetic alterations, and the recent “agnostic approval” processes of anti-cancer agents represent an important innovation that favors the development of Precision Oncology. This “mutational model” supports and integrates the traditional approach to cancer therapy based on histology. Nevertheless, an uncontrolled use of CGP tests and of mutation-driven drugs can compromise their appropriateness, and put the sustainability of the health system at risk. Methods: A group of experts in pathology, molecular biology, medical oncology, organization of health systems and health economics has developed an organizational model for precision oncology based on multidisciplinarity, on the careful selection of patients to be submitted to CGP tests and on access to off-label drugs in the context of a regulatory framework. Results: A network of Molecular Tumor Board (MTB) accredited by the Italian Drug Agency (AIFA) according to transparent criteria with regard to composition, activities, traceability, and processing of data can represent the very new tool for managing the mutational model in clinical practice. The multidisciplinary MTBs meet regularly to select patients to be analyzed with CGP tests in order to ensure the appropriateness of the test. The MTBs also discuss therapeutic options on information deriving from NGS analyses. When no clinical trials matching the genetic alterations are available and an off-label drug is recommended, this therapy will be authorized by the Italian Drug Agency and data on the outcome of the patients will be stored in a national registry. Conclusions: The increasing availability of CGP tests and of possibly active targeted-based agents represents an important opportunity of cancer patients to access to new drugs. The proposed model will allow access of Italian patients to possibly active treatments and at the same time will contribute to ensure the sustainability of this new approach and to increase the knowledge on the activity of target-based agents in specific subgroups of patients. Legal entity responsible for the study: The authors. Funding: Fondazione Ricerca&Salute. Disclosure: All authors have declared no conflicts of interest.
1658P
Selection of a set of quality indicators (QI) for oncological clinical pathway
Fourcade1, M. Ferrua1, M. Chirrane2, M.J. De la Cruz Vega2, E. Minvielle1, M. di Palma3 Research Department, Gustave Roussy, Villejuif, France, 2Oncology, Novartis, RueilMalmaison, France, 3American Hospital of Paris, Neuilly-sur-Seine, France
1
Background: Clinical pathways in oncology have become increasingly complex, involving several different healthcare professionals inside and outside the hospital setting who need particular coordination to provide appropriate care for patients. Very few QI exist to evaluate the oncological clinical pathway in its entirety, particularly regarding the various stages between patient admissions and discharges and the liaisons with non-hospital healthcare professionals (e.g. GPs, pharmacists). Our objective is to select a number of QI describing the oncological clinical pathway with an expert panel.
doi:10.1093/annonc/mdz263 | v679
Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_5/mdz263.027/5576868 by guest on 25 October 2019
No adjuvant treatment Definitive radiation or multimodality treatment Median time from diagnosis to definitive treatment (weeks) Median time between definitive treatment and adjuvant therapy (weeks) Median duration of adjuvant chemotherapy (weeks) Median duration of adjuvant radiation þ/chemotherapy (weeks) Median duration of definitive radiation þ/- chemotherapy (weeks) Median duration from definitive treatment to completion of all treatment (weeks)
Results: 361 referrals were received, 65% were female. Weight loss was the commonest vague symptom (50%). Initially, 96% of patients were seen within 24 hours of referral, falling to 69% after expansion of the clinic remit in 2018. 34% of patients (from 2018, 21%) were diagnosed with cancer. Mean time from referral to diagnosis was 4 days, and to starting cancer treatment it was 20 days. A range of cancers were identified, lung the commonest, and advanced stage disease the most likely. A number of significant nonmalignant conditions were diagnosed. One-third of patients provided feedback. Only 37% were told at referral that cancer was suspected. The service was rated Excellent or Very Good in all cases. 84% valued being seen urgently. Feedback was received from 40 GPs. 100% would use the service again. Alternate referral routes would have been routine cancer referral (60%) or ED (13%). Conclusions: To our knowledge, this is the only GP-oncology led rapid access cancer diagnostic clinic. Combining general medical and oncology expertise is an effective approach for diagnosing patients with vague symptoms and tackling EP cancer. Legal entity responsible for the study: The authors. Funding: CWþ Healthcare Charity. Disclosure: All authors have declared no conflicts of interest.
Annals of Oncology
Table: 1655P Breast Prostate Colorectal Lung N ¼ 12706 N ¼ 6360 N ¼ 5336 N ¼ 2593 4605 8101
5377 983
3491 1845
1611 982
5.14
13.71
4.29
5.42
8.14
18.14
8.42
8.57
14.29
N/A
20.00
10.00
3.85
6.71
5.00
5.57
N/A
6.42
N/A
6.42
23.57
6.85
28.29
18.00/6.14* *chemo/xrt
Conclusions: Almost half of patients who undergo curative cancer treatment require definitive radiotherapy or multimodality treatment. The median duration of therapy varies widely depending on primary site and modality (6.14 - 28.29 weeks). This has implications for financial support such as United Kingdom’s Statutory Sick Pay (28 weeks) and Canada Employment Insurance (15 weeks), as well as workplace dismissal in the United States where the Family and Medical Leave Act protects employees for 12 weeks absence. Governments should consider amending the laws to reflect current cancer treatment durations. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: C. Ho: Honoraria (self), Research grant / Funding (self): AstraZeneca; Honoraria (self), Research grant / Funding (self), Travel / Accommodation / Expenses: Boehringer Ingelheim; Honoraria (self), Travel / Accommodation / Expenses: Pfizer ; Honoraria (self): BMS; Honoraria (self), Travel / Accommodation / Expenses: Roche; Honoraria (self): Lilly; Research grant / Funding (self): Genzyme; Honoraria (self), Research grant / Funding (self): Eisai; Honoraria (self): Merck; Honoraria (self): Bayer. All other authors have declared no conflicts of interest.
1656P
Acute diagnostic oncology clinic: A unique primary care-oncology service
A. Gill, R. Sharkey, J. Simmons, M. Bower, A. Sita-Lumsden, J. Evans, T. Newsom-Davis Oncology, Chelsea & Westminster Hospital, London, UK Background: Cancers presenting with ‘vague symptoms’ are difficult to diagnose. These non-specific but serious symptoms (weight loss, anorexia, pain, fatigue) have a number of causes including malignancy. The risk for each individual cancer may be low, but the total risk of cancer of any type is higher. Patients diagnosed with cancer as the result of an emergency presentation (EP) to secondary care have poorer survival, usually describe a long history of symptoms, and most have seen their general practitioner (GP) prior to presentation. Earlier diagnosis improves cancer outcomes. But investigating vague symptoms is challenging, requiring both oncology and general medical knowledge, while bespoke rapid-access oncology diagnostic clinics are needed to avoid EP. Methods: The Acute Diagnostic Oncology Clinic was established at Chelsea & Westminster Hospital in 2016. It initially provided rapid access investigations for those too ill to wait for an urgent suspected cancer appointment, as an alternative to the Emergency Department (ED). In February 2018 the clinic expanded to, uniquely, include a GP with specialist interest in oncology and patients with ‘vague symptoms’.
Volume 30 | Supplement 5 | October 2019
1657P
The new mutational model in oncology. What changes in welfare, clinical practice, research, and regulatory procedures?
N. Normanno1, G. Curigliano2, C. Jommi3, N. Martini4, A. Marchetti5, P. Marchetti6, A. Pedrini4, G. Pruneri7 1 Translational Research, Istituto Nazionale Tumori – I.R.C.C.S - Fondazione Pascale, Naples, Italy, 2Early Drug Development for Innovative Therapies Division, Istituto Europeo di Oncologia, Milan, Italy, 3Practice, Government, Health and Not for Profit Division, SDA Bocconi School of Management, Milan, Italy, 4Fondazione Ricerca&Salute, Fondazione Ricerca&Salute, Rome, Italy, 5Pathology, P.O. Clinicizzato Ss. Annunziata Universita’ Degli Studi, Chieti, Italy, 6Medical Oncology, Azienda Ospedaliera St. Andrea, Rome, Italy, 7Pathology, Istituto Nazionale Tumori, Milan, Italy Background: The diffusion of next-generation sequencing (NGS)-based tests for comprehensive genomic profiling (CGP), the development of new drugs matching specific genetic alterations, and the recent “agnostic approval” processes of anti-cancer agents represent an important innovation that favors the development of Precision Oncology. This “mutational model” supports and integrates the traditional approach to cancer therapy based on histology. Nevertheless, an uncontrolled use of CGP tests and of mutation-driven drugs can compromise their appropriateness, and put the sustainability of the health system at risk. Methods: A group of experts in pathology, molecular biology, medical oncology, organization of health systems and health economics has developed an organizational model for precision oncology based on multidisciplinarity, on the careful selection of patients to be submitted to CGP tests and on access to off-label drugs in the context of a regulatory framework. Results: A network of Molecular Tumor Board (MTB) accredited by the Italian Drug Agency (AIFA) according to transparent criteria with regard to composition, activities, traceability, and processing of data can represent the very new tool for managing the mutational model in clinical practice. The multidisciplinary MTBs meet regularly to select patients to be analyzed with CGP tests in order to ensure the appropriateness of the test. The MTBs also discuss therapeutic options on information deriving from NGS analyses. When no clinical trials matching the genetic alterations are available and an off-label drug is recommended, this therapy will be authorized by the Italian Drug Agency and data on the outcome of the patients will be stored in a national registry. Conclusions: The increasing availability of CGP tests and of possibly active targeted-based agents represents an important opportunity of cancer patients to access to new drugs. The proposed model will allow access of Italian patients to possibly active treatments and at the same time will contribute to ensure the sustainability of this new approach and to increase the knowledge on the activity of target-based agents in specific subgroups of patients. Legal entity responsible for the study: The authors. Funding: Fondazione Ricerca&Salute. Disclosure: All authors have declared no conflicts of interest.
1658P
Selection of a set of quality indicators (QI) for oncological clinical pathway
Fourcade1, M. Ferrua1, M. Chirrane2, M.J. De la Cruz Vega2, E. Minvielle1, M. di Palma3 Research Department, Gustave Roussy, Villejuif, France, 2Oncology, Novartis, RueilMalmaison, France, 3American Hospital of Paris, Neuilly-sur-Seine, France
1
Background: Clinical pathways in oncology have become increasingly complex, involving several different healthcare professionals inside and outside the hospital setting who need particular coordination to provide appropriate care for patients. Very few QI exist to evaluate the oncological clinical pathway in its entirety, particularly regarding the various stages between patient admissions and discharges and the liaisons with non-hospital healthcare professionals (e.g. GPs, pharmacists). Our objective is to select a number of QI describing the oncological clinical pathway with an expert panel.
doi:10.1093/annonc/mdz263 | v679
Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_5/mdz263.027/5576868 by guest on 25 October 2019
No adjuvant treatment Definitive radiation or multimodality treatment Median time from diagnosis to definitive treatment (weeks) Median time between definitive treatment and adjuvant therapy (weeks) Median duration of adjuvant chemotherapy (weeks) Median duration of adjuvant radiation þ/chemotherapy (weeks) Median duration of definitive radiation þ/- chemotherapy (weeks) Median duration from definitive treatment to completion of all treatment (weeks)
Results: 361 referrals were received, 65% were female. Weight loss was the commonest vague symptom (50%). Initially, 96% of patients were seen within 24 hours of referral, falling to 69% after expansion of the clinic remit in 2018. 34% of patients (from 2018, 21%) were diagnosed with cancer. Mean time from referral to diagnosis was 4 days, and to starting cancer treatment it was 20 days. A range of cancers were identified, lung the commonest, and advanced stage disease the most likely. A number of significant nonmalignant conditions were diagnosed. One-third of patients provided feedback. Only 37% were told at referral that cancer was suspected. The service was rated Excellent or Very Good in all cases. 84% valued being seen urgently. Feedback was received from 40 GPs. 100% would use the service again. Alternate referral routes would have been routine cancer referral (60%) or ED (13%). Conclusions: To our knowledge, this is the only GP-oncology led rapid access cancer diagnostic clinic. Combining general medical and oncology expertise is an effective approach for diagnosing patients with vague symptoms and tackling EP cancer. Legal entity responsible for the study: The authors. Funding: CWþ Healthcare Charity. Disclosure: All authors have declared no conflicts of interest.