Our study highlights the difficulty of accessing information about appointment availability. Although not statistically significant, inquiries regarding first available appointments for Medicaid patients resulted in longer estimated or actual wait times than those for patients with private insurance, and Medicaid shoppers noted qualitative differences. Although our study was limited by small sample size and imperfect analytic methods, our results suggest the need for more efficient and accessible care for patients at our nation's top cancer centers.

283 Background: Many cancer centers have developed and fostered several supportive care services to ease the stress of a cancer diagnosis. The availability of such services is key to Commission on Cancer (CoC) for accreditation, which many cancer centers pursue and patients seek as a measure of quality. Despite the stated availability of supportive care services, we wondered how easily new patients could access these services when first contacting a major cancer center. Methods: We used a ‘mystery shopper’ format to simulate calls made by a family member of a recently diagnosed patient to 40 NCI-designated cancer centers. We called each center four times on different days, twice with the caller reporting Medicaid insurance, twice with private insurance. We evaluated quantitative and qualitative components of the call, including time to next available appointment and reported availability of the 7 supportive services reported to the CoC. Descriptive statistics were calculated for each quantitative measure. Results: We placed 160 calls to 40 NCI-designated cancer centers. 38.2% of callers were unable to receive complete information about the number of supportive care services offered, whether because they were unable to reach a person or because the person they reached did not know whether one or more of the services was offered. Overall, only 37.6% of callers (60.8% of those who reached a person who could answer their questions) were told that all seven supportive care services were offered. Call recipients responded with an answer other than yes to whether the cancer center offered a multidisciplinary team approach (14.6%), patient navigation services (12.1%), genetic assessment/counseling (9.5%), palliative care (9.5%), counseling/psychological services (7.6%), or cancer education services (6.4%). Conclusions: Despite the stated availability of seven key supportive care services, we were unable to access all services during a call to establish an appointment about one-third of the time. For individual services, about 10% of the time we were told such services did not exist at the cancer center. Further research is needed to close the availability vs. accessibility gap in oncology supportive care.

55 Background: Newly diagnosed cancer patients face fear and uncertainty regarding their prognosis and treatment options. As a first step, these patients and their family members may reach out to top-tier, comprehensive cancer centers for evaluation and treatment; however, recent literature reveals barriers to access. To identify these barriers, we evaluated obstacles patients and caregivers face in accessing services at major cancer centers. Methods: We used a ‘mystery shopper’ format to contact 40 NCI-designated, comprehensive cancer centers. We simulated a patient’s family member calling to make an initial consultation appointment using a standardized script. Each center received four calls on separate dates – two calls presented a patient with private insurance; two with Medicaid. Call order and patient name were randomized. We evaluated quantitative and qualitative components of the call, including time to next available appointment and availability of supportive services. Descriptive statistics were calculated for each quantitative measure. Results: We placed 160 calls to 40 NCI-designated cancer centers. 117 (73%) of calls were first answered by electronic prompts or voicemail, not a live person. Mean call duration was 9.4 minutes, with a range of 1 to 31.9 minutes. On average, callers spent 7.1 minutes speaking to an attendant and spent 2.4 minutes on hold or being transferred. Only a minority of callers (19.3%) were able to obtain an actual date for a next-available appointment without first registering into the cancer center’s records system. 51.3% were given an estimated date for a next-available appointment and 29.4% were told that a date for an appointment could not be estimated unless the patient was registered. When an appointment date was given (estimated or actual), only 27% were within a week. Specifically, only 1.3% of next-available appointments were within 1-2 days, 25.7% were within 3-7 days, 57.5% were within 7-14 days, 15% were not available until > 14 days. At the most extreme, the next-available appointment was not for 37 days. Conclusions: NCI-designated cancer centers often place significant roadblocks in front of patients and caregivers seeking an appointment.

122 Background: All NCI-designated, comprehensive cancer centers report having consultative palliative care services alongside six other supportive care services. Inaccuracies in the understanding of these services among frontline office staff may undermine their accessibility to patients. We investigated how easily new patients could access these services when first contacting a major cancer center. Methods: We used a ‘mystery shopper’ format to simulate calls made by a family member of a recently diagnosed patient. We used a standardized call script, describing a female patient, age 58, recently diagnosed with inoperable liver cancer. We called each center four times on different days and evaluated quantitative and qualitative components. Descriptive statistics were calculated for each quantitative measure. Results: We placed 160 calls to 40 NCI-designated cancer centers. 38.2% of callers were unable to receive complete information about supportive care services. Overall, only 37.6% of callers (60.8% of those reaching someone who could answer questions) were told all 7 supportive care services were offered. In 9.5% of calls, call recipients gave an answer other than “yes” to whether the cancer center offered palliative care. Callers were told regarding palliative care: that it was for end of life patients only (2 calls), that there weren’t doctors who focused on symptom management (3), its availability depends on review of medical records (2), or that the call recipient was unsure either of the availability of palliative care (10), or did not know what the term meant (2). Availability responses other than “yes” were obtained in the following frequencies: multidisciplinary approach (14.6%), patient navigation (12.1%), genetic assessment (9.5%), psychological services (7.6%), and cancer education services (6.4%). Conclusions: Despite the stated availability of seven key supportive care services, accessibility was limited in one-third of calls. In about 10% of cases where a person was reached, the call recipient was unable to confirm that palliative care was offered. Further research is needed to close the availability vs. accessibility gap in oncology palliative and supportive care.