PURPOSE: Cancer trial participants do not reflect the racial and ethnic diversity in the population of people with cancer in the United States. As a result of multiple system-, patient-, and provider-level factors, including implicit bias, cancer clinical trials are not consistently offered to all potentially eligible patients. MATERIALS AND METHODS: ASCO and ACCC evaluated the utility (pre- and post-test knowledge changes) and feasibility (completion rates, curriculum satisfaction metrics, survey questions, and interviews) of a customized online training program combined with facilitated peer-to-peer discussion designed to help research teams identify their own implicit biases and develop strategies to mitigate them. Discussion focused on (1) specific elements of the training modules; (2) how to apply lessons learned; and (3) key considerations for developing a facilitation guide to support peer-to-peer discussions in cancer clinical research settings. We evaluated discussion via a qualitative assessment. RESULTS: Participant completion rate was high: 49 of 50 participating cancer programs completed training; 126 of 129 participating individuals completed the training (98% response rate); and 119 completed the training and evaluations (92% response rate). Training increased the mean percentage change in knowledge scores by 19%-45% across key concepts (eg, causes of health disparities) and increased the mean percentage change in knowledge scores by 10%-31% about strategies/actions to address implicit bias and diversity concerns in cancer clinical trials. Knowledge increases were sustained at 6 weeks. Qualitative evaluation validated the utility and feasibility of facilitated peer-to-peer discussion. CONCLUSION: The pilot implementation of the training program demonstrated excellent utility and feasibility. Our evaluation affirms that an online training designed to raise awareness about implicit bias and develop strategies to mitigate biases among cancer research teams is feasible and can be readily implemented in cancer research settings.
e24164 Background: Biomarker testing has advanced precision medicine in cancer. However, not all eligible patients benefit from biomarker-driven therapies due to suboptimal testing rates. A working group of 20 patient advocacy groups representing solid/hematologic malignancies, three professional societies, and 18 pharmaceutical and diagnostics companies identified patient confusion inconsistent testing terms as a possible contributing factor to biomarker testing underutilization. The group aimed to address patients’ confusion by identifying and adopting consistent, plain language terms for biomarker and germline genetic testing that are applicable across cancer types. Methods: Following a stakeholder roundtable discussion on barriers to precision medicine, working group members participated in interviews on their goals for consistent testing terminology for their constituents. We then conducted a framework analysis covering five themes: available testing by cancer type; purpose of test; biospecimen source; terms used in patient education; and preferred plain language term. Working group members were surveyed on preferences for germline testing terminology and also deployed a preliminary patient survey to their constituents to gain insight on preferences for germline testing terms. Results: Interviews, framework analysis, and surveys revealed notable differences across cancer communities. We identified at least 33 different terms related to biomarker, genetic and genomic testing being used in patient education and clinical care among the different cancer communities and stakeholders. Terminology was complicated by the variety of testing modalities and gene mutations tested for across cancers. Following multiple discussions, working group members agreed on two umbrella terms to distinguish between somatic and germline testing with additional context for specific cancer communities. “Biomarker testing” was selected as the somatic testing term. “Genetic testing for an inherited mutation” and “genetic testing for inherited cancer risk” were selected as preferred germline testing terms. Conclusions: Our findings highlight the disparate testing terminology landscape and the need for consistent terms to reduce patient confusion, improve communication, facilitate shared decision-making and assure concordance in policy development.
Safety-net hospitals are resource-constrained and serve complex patients yet are innovators in chronic disease care. Their strategies include personalized care, multidisciplinary teams, and information systems yielding real-time data. Safety-net providers are prime examples from which the health care community can learn to improve the delivery of chronic disease care.
93 Background: In 2019, the Association of Community Cancer Centers (ACCC) developed an immuno-oncology (IO) wallet card to address the continuous need for immune-related adverse event education and resources, particularly for IO patients and the non-oncology providers from whom they receive care. The wallet card was distributed to ACCC’s membership of cancer programs via mailings and online, which included a short survey for users to complete at time of download. Methods: To better understand the demographics and motivations of individuals who access the IO wallet card, an exploratory analysis was performed on data collected through the download survey. Data included the survey responses from all downloads between March and September 2019 (n = 141), which was then cleaned to remove duplicates, incomplete responses, and responses from ACCC staff, international users, pharmaceutical representatives, consultants, and patients. Analysis was then performed on the resulting data set of downloads from US-based health care providers (n = 86). Results: Cancer program administrators and nurses accounted for the majority of downloads (30% and 20%, respectively), as well as individuals from comprehensive community cancer programs (44%) and NCI-designated comprehensive cancer programs (16%). Fewer downloads came from other oncology disciplines (2-9%) and small practices (2-6%). Survey responses indicated that the majority of downloads were due to the cancer program not already having the resource (47%), or for comparison with a wallet card developed by the cancer program (15%) or another organization (10%). Patient education materials provided by these institutions included wallet cards (45%), as well as print materials developed by the cancer program (16%), another professional organization (7%), or distributed by drug companies (5%). Conclusions: These finding shed light on the primary audiences accessing the IO wallet card, how this resource may complement other IO patient education materials, and areas where additional education may be needed. Specifically, IO wallet card dissemination or related education may need to be tailored to better reach specific oncology disciplines as well as those practicing in smaller clinics.
BackgroundThe landscape for clinician education in immuno-oncology (IO) has changed dramatically since the first approval of an immune checkpoint inhibitor (ICI) in 2011. Educational initiatives have had to evolve with the multitude of new IO approvals and indications, as well as continuous integration of these therapies in patient care. As such, an IO census survey was administered and analyzed to better assess the current knowledge and educational needs of the oncology care team at the start of a new decade in IO.MethodsIn June 2020, the Association of Community Cancer Centers launched an online survey to its membership of multidisciplinary oncology providers. The survey included questions related to demographic information, current IO practices, and top priorities and challenges in IO. In August 2020, an interim, descriptive analysis was conducted on complete survey responses (n=38).ResultsAt the time of interim analysis, survey respondents represented the full multidisciplinary cancer care team (e.g., advanced practice providers [18%], pharmacists [16%], medical and surgical oncologists [14%]), as well as diverse practice settings (e.g., community cancer program [28%], physician practice [20%]). In addition, the majority (67%) of respondents treated more than 20 patients per week with immunotherapies across most cancer types. When assessing familiarity with IO agents, most respondents were ‘moderately familiar’ or ‘extremely familiar’ with ICIs (26% and 53%, respectively). However, many respondents were ‘not at all familiar’ or only ‘slightly familiar’ with chimeric antigen receptor (CAR) T-cell therapy (5% and 42%, respectively) and bispecific antibody therapies (16% and 42%, respectively). The top challenges (i.e., ‘very challenging’ or ‘extremely challenging’) for respondents included the expansion of indications for IO agents (45% and 11%, respectively), coordinating care with non-oncology providers (29% and 18%, respectively), and financial toxicity (32% and 26%, respectively). Regarding future education topics, respondents expressed most interest (i.e., ‘very interested’ or ‘extremely interested’) in biomarker and molecular testing (71% and 18%, respectively), patient access, advocacy, and financial impact (61% and 24%, respectively), and evidence, data, and publication updates (55% and 26%, respectively).ConclusionsThese interim results from a representative cohort strongly indicate that clinicians desire more clinical and operational support on use of IO agents and associated testing, easing patients‘ and programs‘ associated financial strain, and coordinating care across specialties. Additional analysis will focus on if/how respondents’ specific disciplines or practice settings influence the results.
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