LBA Category II: Care Coordination/Care Transitions

November 2023 Vol 14, No 11 —November 22, 2023

C1 A Retrospective Study of Patients Treated With Oral and Injectable Anticancer Medications: Evaluation of Hospital Outcomes

Julia A. Agafonova1,2; Anton V. Snegovoy2,3; Vitaly V. Omelyanovskiy1,4

1Center for Healthcare Quality Assessment and Control, Moscow, Russia; 2A.I. Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia; 3N. Lopatkin Scientific Research Institute of Urology and Interventional Radiology, branch of the National Medical Research Radiological Centre, Moscow, Russia; 4Federal State Budgetary Educational Institution of Further Professional Education, Russian Medical Academy of Continuous Professional Education, Moscow, Russia

Background: The use of oral and injectable forms of drugs in patients with malignancies is predominantly performed as outpatient care. This approach improves the quality of patients’ life as long as the necessary safety aspects are respected. The results of the study should help to decide whether such forms of medications can be transferred from the daycare center and whether patients can be safely managed at home.

Objective: To analyze the hospitalization outcomes of patients who received oral or injectable medications at daycare centers.

Methods: A retrospective secondary data analysis was conducted using a data set including the hospitalizations of cancer patients with the oral, injectable, or a combination of oral and injectable anticancer drugs from outpatient departments of the medical centers of the Russian Federation in 2021. The primary end point of the study was the hospitalization outcomes. Daycare hospital discharge was defined as a favorable outcome. Adverse outcomes of hospitalization included treatment interruption, transfer of patients to inpatient care (hospital care), and patient’s death.

Results: The study included 261,591 hospitalizations. The median age of the patients was 66 (57-73) years. The study group consisted of 48.1% men and 51.9% women. The most frequent malignant neoplasms in the study group were breast cancer (33.0%), prostate cancer (30.6%), and renal cancer (7.6%). Oral medications were used in 48.0%, injectables in 43.0%, and the combination of oral drugs and injectables in 9.1% of patients. In 98.6% of cases, there was a daycare hospital discharge. Adverse outcomes, such as treatment interruption or transfer of patients to inpatient care were found in 1.2% (95% CI, 1.1-1.2) and 0.2% (95% CI, 0.2-0.2), respectively. Patient death occurred in 4 hospitalizations (oral medication group). A significant association was noted when analyzing the adverse outcome of hospitalization depending on how the drug had been administered.

Conclusion: Currently, such strategies as the specialized oral therapy centers and the anticancer drug management programs are actively implemented for the patients under study. The results suggest the relative safety of the oral and injectable forms of the anticancer drugs in most cases. The findings support a home-based management strategy for these patients, subject to further identification of risk groups for adverse outcomes.

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C2 Bridging the Gap: Overcoming Transportation Barriers for Oncology Patients

Shonna Andrews, BSN, RN; Nicole Bravo, MSN, BS, RN, ONN-CG; Carol Kirton, MBA, BSN, RN, OCN, ONN-CG; Reshma Mistry, BSN, RN; Valerie Patterson, MSN, BSN, RN; Janet Pollard, MSW, LCSW, OSW-C

HCA Houston Healthcare Medical Center/Sarah Cannon Cancer Center, Houston, TX

Background: Transportation insecurity is a major barrier for many oncology patients undergoing treatment due to the practical and financial impacts of a cancer diagnosis.1 Beginning in March 2020, COVID-19 contributed to the lack of transportation resources resulting from a shortage of volunteer drivers available. This obstacle created an even larger need for healthcare providers, administration, and communities to identify transportation resources to meet oncology patient needs. In response to this challenge posed, a national cancer resource awarded a grant to a community hospital to bridge the gap to provide transportation assistance during cancer treatment.

Objectives: To provide a descriptive analysis of the impact of the facility’s grant-enabled transportation program. In addition, these data are intended to highlight the ongoing need for the availability of transportation resources for all oncology patients, regardless of health insurance status.

Methods: A community hospital tracked the transportation grant assistance provided for cancer patients for a grant cycle of 1 year (2022-2023). Assistance was categorized by method of transportation, county of residence, number of rides, type of treatment, insurance status, and tumor site treated. A process was implemented to communicate the availability of this resource to all oncology patients receiving treatment at the cancer center. All patients who expressed a need were eligible to receive assistance.

Results: The transportation grant served 59 patients with 181 rides. Patient demographics were as follows: gender: 36% male, 64% female; race: 41% White, 24% African American, 22% other, and 13% Asian; ethnicity: 81% non-Hispanic, 19% Hispanic. The grant served patients throughout 4 different counties, spanning more than 4213 square miles. Cancer diagnoses of the patients served included 54% breast, 14% prostate, 20% lung, 5% gynecologic, 7% other types. The grant enabled 95 appointments to be kept by the patients. Appointment types included 61% radiation, 34% chemotherapy, and 5% imaging. Forty-two percent of patients who received grant assistance had private health insurance, 8% Medicare plus private, 5% Medicaid, 12% Medicare, 25% combined Medicare and Medicaid, and 5% Medicare plus other.

Conclusions: The transportation grant assisted in removing transportation barriers for oncology patients from various demographics. There is an ongoing need for transportation assistance for all patients despite insurance status to ensure access to care and adherence to oncology treatments. Based on the success of this program, a proven need exists to continue the partnership between the national cancer resource and community hospital to bridge the transportation gap. Additionally, future opportunities to expand the grant to other facilities across the division will be explored in order to serve more cancer patients.


  1. Chaiyachati KH, Krause D, Sugalski J, Graboyes EM, Shulman N. A survey of the National Comprehensive Cancer Network on approaches toward addressing patients’ transportation insecurity. J Natl Compr Canc Netw. 2023;21(1):21-26.
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C3 Oncology Nurse Navigator Use of Clinical Decision Support Pathways to Support Remote Symptom Management of Oncology Patients

April Boyd, RN, BSN, OCN; Carrie Wines-Larch, RN, BSN, ONN-CG; Emma Gilham, RN, BSN; Kara Smith, RN; Karin Ritchie, RN, BSN, OCN; Lori Russell, RN, BSN, OCN; MaLorelee S. Wilkes, RN, BSN, BA, BSW, OCN

Charleston Area Medical Center Cancer Center/Vandalia Health, Charleston, WV

Background: Clinical decision support (CDS) is a key process for enhancing health-related decisions and actions with pertinent organized clinical knowledge and patient information to improve health and healthcare delivery. CDS pathways can supply timely information at the point of care to inform oncology nurse navigator (ONN) decisions about symptom management.

Objective: To implement and evaluate an electronic, interactive oncology CDS pathway tool in a real-world setting to provide ONN support in supplying dynamic, algorithm-driven, evidence-based care recommendations to patients experiencing cancer treatment side effects.

Methods: Nurse navigation in a community-based oncology clinic used an electronic patient-reported outcome platform called PROmpt to test the feasibility of using oncology CDS pathways to screen, assess, and provide evidence-based interventions for 8 common side effects of cancer treatment (ie, nausea, vomiting, diarrhea, constipation, pain, sleep disturbance, psychiatric distress, and rash). Eligible patients had breast, colorectal, head and neck, lung, or other cancers. Using the PROmpt platform, patients communicated symptoms weekly and were asked if they wanted to receive follow-up from their team about the symptoms reported. The ONN called the patients requesting follow-up and, using the CDS tool, assessed the problem and provided recommendations for mitigation. Data collected included number of patients per diagnosis, number of times each pathway was used, time in each pathway for each patient episode, acceptance of evidence-based recommendations, and times a symptom assessment was sent for provider disposition. ONNs were interviewed to obtain feedback on use.

Results: Six ONNs used the CDS system with 24 patients of the 79 enrolled in PROmpt. The majority of patients were breast (n=20) and lung (n=20), and the most commonly reported symptoms (by both number and severity) were fatigue and pain. The average number of times each of the 8 pathways was used was 3. ONNs had the most experience with the constipation and pain pathways (n=5, each) and the least with diarrhea (n=1). The mean time in each pathway for each patient episode was 2.6 minutes (range, 1-17 min). Two hundred thirty-four evidence-based interventions were recommended. The number of times a symptom assessment was sent for provider disposition was 1. During interviews, the ONN expressed high levels of satisfaction with tool elements, noting the following benefits: logic-driven question presentation, ability to incorporate added assessment notes, and actionability of recommendations.

Conclusions: CDS for addressing oncology symptom presentation and mitigation can be effectively incorporated into clinical workflows. ONNs completed comprehensive assessments and delivered evidence-based recommendations in a few minutes and were supported in working to the top of their licensure with confidence via the CDS system. Acceptance of recommendation rates shows usefulness. Consistent, standardized data inputs allowed for workflow and population insights. Evaluation of the tool will be expanded to include other nursing roles (eg, triage or clinic nurse) and added oncology clinical workflows.

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C4 Utilizing Patient Navigation in Care Coordination for Older Adults With Cancer Using G8 Screening

Rebecca Whitney, BA1*; Sherri Smith, LSW, OPN-CG1*; Pooja Vibhakar, BDS, MPH, CCRC2; Madison Grogan, MPH2; Electra Paskett, PhD1,2; Chasity Washington, MPH, CHES2; Bibiana Bishop, MSW, LISW-S2; Ashley Rosko, MD1; Nicole Williams, MD1; Carolyn J. Presley, MD, MHS1,2 *Co-first authorship.

1The Ohio State University Comprehensive Cancer Center, Columbus, OH; 2The Ohio State University Comprehensive Cancer Center/The James Cancer Hospital & Solove Research Institute, Columbus OH

Background: The Ohio State University Comprehensive Cancer Center has developed the multidisciplinary Cancer and Aging Resiliency (CARE) Clinic to focus on caring for older adults with cancer. The clinic providers evaluate, educate, and intervene within the following components: physician, pharmacy, audiology, psychosocial, cognitive, physical functioning, case management, and nutrition.

Objectives: To reduce healthcare inequalities by utilizing patient navigators to identify older adults with cancer who would benefit from being seen in the CARE Clinic and to improve patient accessibility through increasing referral rates and the completion of CARE Clinic referrals.

Methods: Navigators identified new patients coming to the breast and thoracic oncology clinics who were older than 65 years of age. Patient navigators contacted the patient or the patient’s representative via phone or in person to perform an initial assessment utilizing the G8 geriatric screening tool. This screening tool is used to identify frailty among older adults and has been validated in older adults with cancer. It includes questions regarding nutrition, weight loss, mobility, cognition, comorbidities, and medications. Based on the formula built in to the G8 screening tool, patient navigators used a cutoff score of <15 to identify patients who may benefit from a referral to the CARE Clinic. The referral recommendation was then sent to the patient’s treating oncologist by an in-basket message in EPIC electronic health records. Navigators followed up with providers to ensure referrals were placed and followed up with patients to navigate them to their appointment.

Results: From January 2023 to July 2023, 29 older adults with breast cancer were screened; the number of breast cancer patients positive for referral was 8 (27.6%); the number of breast cancer patients referred to the CARE Clinic was 2 (25%), with 2 referrals pending. The number of older adults with thoracic cancer screened was 203; the number of thoracic patients who screened high-risk and recommended a referral was 163 (80.3%); the number of referrals placed to the CARE Clinic was 32 (19.6%), with 37 referrals pending. The number of referrals from the thoracic clinic to the CARE Clinic increased from 5 referrals in December 2022 to 17 referrals in January 2023, with monthly referral averages consistently higher in 2023 versus 2022. To further improve referrals, navigators could place these referrals directly and include G8 results to simplify follow-up and remove delays through the streamlining of provider communications.

Conclusions: While there has been an increase in referrals to the CARE Clinic from patient navigation efforts, the potential to increase the referral rate is far greater. One solution would be to allow the patient navigators to place the referral directly. Discussions about the CARE Clinic could happen at other times than the new patient appointment, and navigators could meet with returning patients as well as new patients. Allowing navigators to place the referral directly would become a billable service and a way to promote the benefits of patient navigation to reduce healthcare inequities for older adults with cancer.


Dharmarajan KV, Presley CJ, Wyld L. Care disparities across the health care continuum for older adults: lessons from multidisciplinary perspectives. American Society of Clinical Oncology Educational Book. 2021;41:e215-e224.

Okoli GN, Stirling M, Racovitan F, et al. Integration of geriatric assessment into clinical oncology practice: a scoping review. Curr Probl Cancer. 2021;45(3):100699.

Petit-Monéger A, Rainfray M, Soubeyran P, Bellera CA, Mathoulin-Pélissier S. Detection of frailty in elderly cancer patients: improvement of the G8 screening test. J Geriatr Oncol. 2016;7(2):99-107.

Rocque GB, Taylor RA, Acemgil A, et al, and Patient Care Connect Group. Guiding lay navigation in geriatric patients with cancer using a distress assessment tool. J Natl Compr Cancer Netw. 2016;14(4):407-414.

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Last modified: November 29, 2023

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