A standardized set of patient-centered outcome measures to inform value-based health care in colorectal cancer was developed. Pilot efforts are under way to measure the standard set among members of the working group.

A framework for the oral chemotherapy management process with standardized outcome definitions is needed to ensure constructive research. Existing data suggest that a monitoring program should include personal contact with patients within the first weeks of treatment. Whether such contact can be enhanced by technology is uncertain.

97 Background: With the growing use of oral chemotherapy, there is an urgent need to develop safe and effective systems to administer and manage these agents. A comprehensive synthesis of literature on oral chemotherapy care delivery programs to which clinicians can look for best practices is lacking. Methods: We performed a systematic review of PubMed, EMBASE and CINAHL from 1/1995- 5/2016 and the grey literature to identify publications describing oral chemotherapy care delivery programs. Our population of interest was cancer patients of all ages prescribed cytotoxic or targeted anti-cancer oral agents. Interventions could address any part of the oral chemotherapy delivery process from prescribing through disposal but had to report outcomes (adherence and/or safety or toxicity) in relation to a control group. Results: From 7,984 abstracts in the peer-reviewed and 9 from the grey literature, 16 studies met inclusion criteria (7 of these randomized) with 3,612 patients represented. Interventions focused on prescribing (n = 1), preparation/dispensing (n = 2), education (n = 11), administration (n = 5), monitoring (n = 14), and storage/disposal (n = 1). Of the 10 articles with adherence as an outcome, four different measurement methods were used. Many articles lacked formal statistical testing. In the 6 studies with statistically significant improvement in outcomes, 3 utilized nursing phone calls to patients within the first few days of treatment initiation, which resulted in less toxicity (n = 2) or better adherence (n = 1). None of the four studies that evaluated eHealth strategies to increase patient to care team contact demonstrated a statistically significant improvement in outcomes. Conclusions: Limitations in study design impair our ability to draw definitive conclusions on best practices for oral chemotherapy care delivery. A framework for conducting research in this area that defines the processes of oral chemotherapy delivery and standardizes outcomes of success is needed to address this gap. Existing studies suggest that interventions focusing on education and remote phone-based monitoring of patients at therapy initiation may decrease toxicity, and possibly improve adherence.

Introduction Genomic aberrations involving erb-b2 receptor tyrosine kinase 2 (ERBB2) are driver oncogenes in ∼2% of lung adenocarcinomas. However, the use of daily dosing of ERBB2 tyrosine kinase inhibitors (TKIs) - including afatinib - has been fraught by plasma concentrations that barely achieve preclinical model inhibition, significant patient-reported toxicities and limited clinical activity. We hypothesized that alternative dosing strategies could improve tolerability and efficacy. Methods We profiled lung cancer cell lines against TKIs and retrospectively evaluated the toxicity/response to pulse afatinib (280mg once weekly) in lung cancers with ERBB2 mutations. Results An ERBB2 exon 20 insertion mutated lung cancer cell line had 50% inhibitory concentration to afatinib higher than the reported plasma concentration of afatinib 40mg daily. Three patients with advanced ERBB2 mutated lung adenocarcinomas were treated with off-label pulse afatinib. The 280mg weekly dose was well tolerated with no reported rash and minimal diarrhea. One TKI-naïve patient achieved a partial response for 5 months and another stable disease for 11 months. Conclusions Pulse afatinib at a weekly dosing scheme induced anti-tumor activity in ERBB2 exon 20 insertion mutated lung adenocarcinomas. Future clinical trials of alternative dosing schemes of ERBB TKIs as monotherapy or in combination with other therapies are warranted for ERBB2 mutated tumors.

Using a quality improvement (QI) paradigm, the authors conducted 11 multidisciplinary conferences throughout 2013-2014 at two tertiary academic cancer centers and a satellite community-based oncology practice. They present their approach including key components and an example case.

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PURPOSE: The development of strategies to prevent or mitigate cancer treatment–related adverse events (AEs) is necessary to improve patient experience, safety, and cost containment. To develop a strategy to easily identify and mitigate AEs, we sought to understand the frequency and severity of those that resulted in hospitalizations. METHODS: We retrospectively characterized hospitalizations of ambulatory adult patients with solid tumor cancers within 30 days of chemotherapy administration using medical record data abstraction. Hospitalizations were categorized as caused by cancer symptoms, a noncancer medical condition, or a medical oncology treatment-related AE. Severity of the treatment-related AE hospitalization was rated using the National Patient Safety Agency risk assessment matrix scale. RESULTS: Between May and October 2016, 116 patients experienced 197 hospitalizations (per-patient mean, 1.7 AEs; range, 1 to 7 AEs). Sixty-six percent (n = 130) of hospitalizations were related to cancer symptoms, whereas 19.3% (n = 38) were treatment-related AE hospitalizations. The median length of stay of hospitalizations that resulted from an AE was 6 days (interquartile range, 3 to 9 days), and 36.8% had more than 1 AE. GI symptoms accounted for 48.1% of AEs, and neutropenic fever accounted for 11.1%. Sixty-one percent of treatment-related AE hospitalizations were characterized as moderate severity. CONCLUSION: Hospitalizations in patients with solid tumors as a direct result of their medical oncology care treatment are not uncommon. These findings argue for novel approaches, such as automated trigger tools, to identify and manage complications of medical oncology treatment before hospitalization is needed. Improved outpatient management of cancer symptoms may have a dramatic impact on hospitalizations for patients with cancer.