- Email: [email protected]
Effectively using primary care givers in oncology care through capacity building, task sharing and techno-mentoring
abstracts in the 70-74 age group, 5.8% in the 75-84 age group), and 3.9% under the stop screening strategy (3.9% in the 70-74 age group, 3.9% in the 75-84 age group). Conclusions: Among women who have received at least one screening mammogram, we estimated that, compared with stopping BC screening, continuing screening past the age of 75 years results in no material difference in cancer-specific mortality over the following 8-year period. Our results in the age range of 70-74 match those of existing randomized clinical trials. Legal entity responsible for the study: The authors. Funding: US National Institutes of Health. Disclosure: All authors have declared no conflicts of interest.
Introducing standardized medical procedure and dynamic decision support program in precision oncology for the community of practice
oczi2, D. Mathiasz4, I. Petak1, C. Hegedus2, E. Varkondi1, Z. Farkas1, D. Tihanyi3, R. D E. Lengyel5, G. Pajkos1, R. Schwab1, J. Deri6, I. Valyi-Nagy7 1 Oncompass Medicine Hungary Kft., Budapest, Hungary, 2R&D, Oncompass Medicine Hungary Kft., Budapest, Hungary, 3Interpretation Department, Oncompass Medicine Hungary Kft., Budapest, Hungary, 4Clinical Affairs, Oncompass Medicine Hungary Kft., Budapest, Hungary, 5Bajcsy-Zsilinszky Cancer Center, Budapest, Hungary, 6Counseling, Oncompass Medicine Hungary Kft., Budapest, Hungary, 7National Hematology and Infectology Institute, Centrum Hospital of Southern Pest, Budapest, Hungary Background: While increasing number of diagnostic laboratories perform new generation sequencing on tumor DNA at a rapidly decreasing cost, beyond companion diagnostics, multi-gene panels are still underutilized due to lack of reimbursement and value based technical assessment. Besides financial reasons, prioritizing between diagnostic tests, multiple genetic alterations and multiple on-label or off-label targeted treatment options linked to these alterations can be a major challenge without having a reproducible, standardized and effective information service system in hand that a molecular tumor board could safely rely on. Here, we present an easily clinically adaptable, dynamic treatment decision support program (Protocol), that makes tumor molecular profile-based oncology care feasible and potentially reimbursed by public insurance funds. Methods: Our Protocol was developed based on 4868 cancer cases with 429 different histology, 2367 genes with 36492 variants. Our program utilizes multidisciplinary molecular tumor board (MTB) supported by Realtime Oncology Treatment CalculatorTM (Calculator) with the idea of integrating molecular and clinical data to provide genomics-driven treatment strategy plan. MTB mobilizes multiple sub-specialties for managing patients and tumor samples. The Calculator under constant upgrade is currently operating based on 24000 rules, 4000þ curated evidence, 101 registered and 618 targeted drugs under development. Results: This medical procedure (protocol) was endorsed by the Hungarian National Health Insurance Fund based on QUALY gain calculation and value-based technology assessment. Conclusions: It is crucial to have an established protocol in the community of practice to indicate effective and eliminate ineffective genomics-driven treatments based on molecular profiling. The technology assessment provided evidence that standardized decision support of the molecular tumor board (MTB) to select diagnostic tests and treatments can assure clinical utility and cost effectiveness of multigene testing (NGS). Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: I. Petak: Leadership role, ownership: Oncompass Medicine Hungary Ltd. C. Hegedus: Full / Part-time employment: Oncompass Medicine Hungary Ltd. E. Varkondi: Full / Part-time employment: Oncompass Medicine Hungary Ltd. Z. Farkas: Full / Part-time employment: Oncompass Medicine Hungary Ltd. D. Tihanyi: Full / Part-time employment: Oncompass Medicine Hungary Ltd. R. D oczi: Full / Part-time employment: Oncompass Medicine Hungary Ltd. D. Mathiasz: Full / Part-time employment: Oncompass Medicine Hungary Ltd. G. Pajkos: Full / Parttime employment: Oncompass Medicine Hungary Ltd. R. Schwab: Advisory / Consultancy, ownership: Oncompass Medicine Hungary Ltd. J. Deri: Full / Part-time employment: Oncompass Medicine Hungary Ltd. All other authors have declared no conflicts of interest.
1647P
Results: A district cancer care programme has been initiated in six states of India, involving 157 hospitals constituting about 20 % of the nation. The hospital has a nodal cancer unit, with nodal cancer officer and nurse in charge to deliver cancer services, such as counselling at all stages of care, assistance in diagnostics, (which may vary from biopsy to scan to tumor markers), follow up care, palliative care, end of life care and, most importantly, chemotherapy. A patient from the district has a choice of conitnuum of care at local hospital to which he is used. He can visit more frequently with no cost involved. This system change and empowerment has allowed the government to bring care closer to the facility and help patients gain access. A satisfaction survey done amongst patients shows there is a strong willingness to follow in districts.This is saving thousand of families from impoverishment. The creation of a system of cancer care delivery has led to other states following this example. From one state it has gone to six states,(population coverage of around 300 million). Conclusions: Primary care physicians can be effectively empowered to offer specialised cancer care in government-run facilities. This duplicable, sustainable model (Pendharkar model) using existing human resources can be used by many countries fighting with shortages of personnel and access issues. Legal entity responsible for the study: Dinesh Pendharkar. Funding: Has not received any funding. Disclosure: The author has declared no conflicts of interest.
1648P
G. Dart1, D. Swinson2 Oncology, St. James’s University Hospital Leeds, Leeds, UK, 2Medical Oncology, St. James’s University Hospital Leeds, Leeds, UK 1
Background: Capecitabine is an oral pro-drug of 5FU. Dihydropyrimidine dehydrogenase (DPD), an enzyme encoded by the DPYD gene, is the rate-limiting step in 5FU catabolism. Life threatening gut wall injury occurs in a significant minority of patients and can potentially be predicted in patients with specific DPYD gene polymorphisms which result in decreased enzyme activity. Presently DPYD testing is performed in a limited number of centres in the UK. We conducted a retrospective cohort study to assess the frequency and cost of admissions due to capecitabine gut wall injury. Methods: Using our electronic health records data base patients treated with capecitabine who were admitted for 3 days or more and had a stool sample were identified from 2010 to 2017. Individual records were reviewed to identify patients who had been admitted with severe gut wall toxicity. A Patient Level Costing System (PLiCS) was used to calculate the cost of each admission. Adverse outcomes are defined as significant morbidity (Admission > 14 days) or mortality. Results: 2626 patients were identified over the 7 year period; 131 were admitted with a history of G2 diarrhoea. (4.9%) 40 with grade 4 toxicity (1.5%); 13 post C1, 25 post C2, 2 post C3 of treatment. Median length of stay 16 days (3 - 46 days). Medical management included loperamide (73%), codeine (45%), octreotide (17.5%) and TPN (10%) Low albumin levels (<34g/L) or neutropenia (<1*9/L) on admission was a predictor for increased length of stay and adverse outcomes. 14 patients admitted for >14 days (35%). 11 patients died due to significant toxicity (0.4% of initial patient cohort) The costs of admission in this patient group using PLiCS analysis is approximately £37,000/ annum. Conclusions: Patients presenting with significant toxicity and the potential for DPYD deficiency have significantly prolonged inpatient stays, increased morbidity and mortality. Baseline bloods are a weak predictor of outcome in this patient group. DPYD testing is near cost neutral, the introduction of routine testing for DPD deficiency would allow oncologists to identify a meaningful proportion of patients at risk of significant toxicity ahead of treatment, and the ability to modify treatment plans accordingly and improve safety. Legal entity responsible for the study: Leeds Cancer Centre. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
Effectively using primary care givers in oncology care through capacity building, task sharing and techno-mentoring
D. Pendharkar National Cancer Society, New Delhi, India
A single institution review of capecitabine related acute admissions and cost analysis
1649P
Health status of middle-aged and older cancer survivors in China: Results from the China Health and Retirement Longitudinal Study (CHARLS)
J. Li1, L. Zhao1, C. Bai1, H. Pang2, Z. Sun1 Department of Medical Oncology, Peking Union Medical College Hospital, Beijing, China, 2Central Research Laboratory, Peking Union Medical College Hospital, Beijing, China
1
Background: The challenge faced by the cancer patient is access to care and for the health system, thenon-availability of qualified personnel. Besides financial issues, patients face challenges of finding a cancer center. Governments are keen to offer universal health coverage but are in need of sustainable systems. A novel healthcare delivery system was designed and has been operational in several states of India. Methods: General duty medical officers and nurses from government district hospitals were trained in oncology for one month. Various administrative reforms, restructuring and techno-mentoring (constant, 24x7, mentorship using WhatsAppR, Telephonic communication, regular continuing medical education) were used to create a system of health care delivery in oncology. The drug distribution system was changed to include essential oncology drugs.
v676 | Public Policy
Background: The number of Chinese cancer survivors is increasing due to the trend of an aging population and improved cancer survival. It is urgently required to estimate the health status of cancer survivors and provide scientific evidence for future health care reform. This study aimed to evaluate the general health status of cancer survivors older than 45 years in China. Methods: We identified cancer survivors (n ¼ 354) and participants without cancer (n ¼ 16,664) in the China Health and Retirement Longitudinal Study (CHARLS).
Volume 30 | Supplement 5 | October 2019
Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_5/mdz263.018/5576798 by guest on 25 October 2019
1645P
Annals of Oncology
Introducing standardized medical procedure and dynamic decision support program in precision oncology for the community of practice
oczi2, D. Mathiasz4, I. Petak1, C. Hegedus2, E. Varkondi1, Z. Farkas1, D. Tihanyi3, R. D E. Lengyel5, G. Pajkos1, R. Schwab1, J. Deri6, I. Valyi-Nagy7 1 Oncompass Medicine Hungary Kft., Budapest, Hungary, 2R&D, Oncompass Medicine Hungary Kft., Budapest, Hungary, 3Interpretation Department, Oncompass Medicine Hungary Kft., Budapest, Hungary, 4Clinical Affairs, Oncompass Medicine Hungary Kft., Budapest, Hungary, 5Bajcsy-Zsilinszky Cancer Center, Budapest, Hungary, 6Counseling, Oncompass Medicine Hungary Kft., Budapest, Hungary, 7National Hematology and Infectology Institute, Centrum Hospital of Southern Pest, Budapest, Hungary Background: While increasing number of diagnostic laboratories perform new generation sequencing on tumor DNA at a rapidly decreasing cost, beyond companion diagnostics, multi-gene panels are still underutilized due to lack of reimbursement and value based technical assessment. Besides financial reasons, prioritizing between diagnostic tests, multiple genetic alterations and multiple on-label or off-label targeted treatment options linked to these alterations can be a major challenge without having a reproducible, standardized and effective information service system in hand that a molecular tumor board could safely rely on. Here, we present an easily clinically adaptable, dynamic treatment decision support program (Protocol), that makes tumor molecular profile-based oncology care feasible and potentially reimbursed by public insurance funds. Methods: Our Protocol was developed based on 4868 cancer cases with 429 different histology, 2367 genes with 36492 variants. Our program utilizes multidisciplinary molecular tumor board (MTB) supported by Realtime Oncology Treatment CalculatorTM (Calculator) with the idea of integrating molecular and clinical data to provide genomics-driven treatment strategy plan. MTB mobilizes multiple sub-specialties for managing patients and tumor samples. The Calculator under constant upgrade is currently operating based on 24000 rules, 4000þ curated evidence, 101 registered and 618 targeted drugs under development. Results: This medical procedure (protocol) was endorsed by the Hungarian National Health Insurance Fund based on QUALY gain calculation and value-based technology assessment. Conclusions: It is crucial to have an established protocol in the community of practice to indicate effective and eliminate ineffective genomics-driven treatments based on molecular profiling. The technology assessment provided evidence that standardized decision support of the molecular tumor board (MTB) to select diagnostic tests and treatments can assure clinical utility and cost effectiveness of multigene testing (NGS). Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: I. Petak: Leadership role, ownership: Oncompass Medicine Hungary Ltd. C. Hegedus: Full / Part-time employment: Oncompass Medicine Hungary Ltd. E. Varkondi: Full / Part-time employment: Oncompass Medicine Hungary Ltd. Z. Farkas: Full / Part-time employment: Oncompass Medicine Hungary Ltd. D. Tihanyi: Full / Part-time employment: Oncompass Medicine Hungary Ltd. R. D oczi: Full / Part-time employment: Oncompass Medicine Hungary Ltd. D. Mathiasz: Full / Part-time employment: Oncompass Medicine Hungary Ltd. G. Pajkos: Full / Parttime employment: Oncompass Medicine Hungary Ltd. R. Schwab: Advisory / Consultancy, ownership: Oncompass Medicine Hungary Ltd. J. Deri: Full / Part-time employment: Oncompass Medicine Hungary Ltd. All other authors have declared no conflicts of interest.
1647P
Results: A district cancer care programme has been initiated in six states of India, involving 157 hospitals constituting about 20 % of the nation. The hospital has a nodal cancer unit, with nodal cancer officer and nurse in charge to deliver cancer services, such as counselling at all stages of care, assistance in diagnostics, (which may vary from biopsy to scan to tumor markers), follow up care, palliative care, end of life care and, most importantly, chemotherapy. A patient from the district has a choice of conitnuum of care at local hospital to which he is used. He can visit more frequently with no cost involved. This system change and empowerment has allowed the government to bring care closer to the facility and help patients gain access. A satisfaction survey done amongst patients shows there is a strong willingness to follow in districts.This is saving thousand of families from impoverishment. The creation of a system of cancer care delivery has led to other states following this example. From one state it has gone to six states,(population coverage of around 300 million). Conclusions: Primary care physicians can be effectively empowered to offer specialised cancer care in government-run facilities. This duplicable, sustainable model (Pendharkar model) using existing human resources can be used by many countries fighting with shortages of personnel and access issues. Legal entity responsible for the study: Dinesh Pendharkar. Funding: Has not received any funding. Disclosure: The author has declared no conflicts of interest.
1648P
G. Dart1, D. Swinson2 Oncology, St. James’s University Hospital Leeds, Leeds, UK, 2Medical Oncology, St. James’s University Hospital Leeds, Leeds, UK 1
Background: Capecitabine is an oral pro-drug of 5FU. Dihydropyrimidine dehydrogenase (DPD), an enzyme encoded by the DPYD gene, is the rate-limiting step in 5FU catabolism. Life threatening gut wall injury occurs in a significant minority of patients and can potentially be predicted in patients with specific DPYD gene polymorphisms which result in decreased enzyme activity. Presently DPYD testing is performed in a limited number of centres in the UK. We conducted a retrospective cohort study to assess the frequency and cost of admissions due to capecitabine gut wall injury. Methods: Using our electronic health records data base patients treated with capecitabine who were admitted for 3 days or more and had a stool sample were identified from 2010 to 2017. Individual records were reviewed to identify patients who had been admitted with severe gut wall toxicity. A Patient Level Costing System (PLiCS) was used to calculate the cost of each admission. Adverse outcomes are defined as significant morbidity (Admission > 14 days) or mortality. Results: 2626 patients were identified over the 7 year period; 131 were admitted with a history of G2 diarrhoea. (4.9%) 40 with grade 4 toxicity (1.5%); 13 post C1, 25 post C2, 2 post C3 of treatment. Median length of stay 16 days (3 - 46 days). Medical management included loperamide (73%), codeine (45%), octreotide (17.5%) and TPN (10%) Low albumin levels (<34g/L) or neutropenia (<1*9/L) on admission was a predictor for increased length of stay and adverse outcomes. 14 patients admitted for >14 days (35%). 11 patients died due to significant toxicity (0.4% of initial patient cohort) The costs of admission in this patient group using PLiCS analysis is approximately £37,000/ annum. Conclusions: Patients presenting with significant toxicity and the potential for DPYD deficiency have significantly prolonged inpatient stays, increased morbidity and mortality. Baseline bloods are a weak predictor of outcome in this patient group. DPYD testing is near cost neutral, the introduction of routine testing for DPD deficiency would allow oncologists to identify a meaningful proportion of patients at risk of significant toxicity ahead of treatment, and the ability to modify treatment plans accordingly and improve safety. Legal entity responsible for the study: Leeds Cancer Centre. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
Effectively using primary care givers in oncology care through capacity building, task sharing and techno-mentoring
D. Pendharkar National Cancer Society, New Delhi, India
A single institution review of capecitabine related acute admissions and cost analysis
1649P
Health status of middle-aged and older cancer survivors in China: Results from the China Health and Retirement Longitudinal Study (CHARLS)
J. Li1, L. Zhao1, C. Bai1, H. Pang2, Z. Sun1 Department of Medical Oncology, Peking Union Medical College Hospital, Beijing, China, 2Central Research Laboratory, Peking Union Medical College Hospital, Beijing, China
1
Background: The challenge faced by the cancer patient is access to care and for the health system, thenon-availability of qualified personnel. Besides financial issues, patients face challenges of finding a cancer center. Governments are keen to offer universal health coverage but are in need of sustainable systems. A novel healthcare delivery system was designed and has been operational in several states of India. Methods: General duty medical officers and nurses from government district hospitals were trained in oncology for one month. Various administrative reforms, restructuring and techno-mentoring (constant, 24x7, mentorship using WhatsAppR, Telephonic communication, regular continuing medical education) were used to create a system of health care delivery in oncology. The drug distribution system was changed to include essential oncology drugs.
v676 | Public Policy
Background: The number of Chinese cancer survivors is increasing due to the trend of an aging population and improved cancer survival. It is urgently required to estimate the health status of cancer survivors and provide scientific evidence for future health care reform. This study aimed to evaluate the general health status of cancer survivors older than 45 years in China. Methods: We identified cancer survivors (n ¼ 354) and participants without cancer (n ¼ 16,664) in the China Health and Retirement Longitudinal Study (CHARLS).
Volume 30 | Supplement 5 | October 2019
Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_5/mdz263.018/5576798 by guest on 25 October 2019
1645P
Annals of Oncology