64 Background: PC combined with cancer care has been shown to improve patient outcomes and caregiver satisfaction while lessening unnecessary health care utilization. 85% of cancer patients receive their oncology care in the communities they live. Establishing a viable and sustainable outpatient PC service in the community oncology setting is challenging and rare nationwide. We present our 18-month PC services since its implementation at Morrison Cancer Center, a community oncology practice. Methods: Cancer patients were referred to PC by oncologists for symptom management, psychosocial support, and Advanced Care Planning (APC). PC visits were provided at the oncology clinic, home, nursing home, or hospital by our PC team (APRN, Social Workers, Chaplain and RN's). Palliative Care Prognostic Index (PPI), time to PC consultation, proportion of patients --on chemotherapy, switching to hospice care, receiving chemotherapy within the last 30 days of life, visiting ER and/or being admitted to hospital within the last 30 days of life-- were studied. Results: Over an 18-month period 72 patients were referred for a total of 470 visits. Lung, pancreas, gastroesophageal, and head and neck cancers were topmost sites. PC referrals per quarter increased from an initial 4 to an 18 at 18 months. Mean time from diagnosis to PC referral was 5.6 months (range: 1-36). Referral reasons included symptom management/support (58%), goals of care (50%), and/or predetermined triggers (15%). Mean PPI score was 50% (range 30-70). All patients had ACP. While 83% of patients were able to continue on active cancer treatment, only 5% received chemotherapy within the last 30 days of life, and 4 % had two or more ER visits with or without a hospital admission. Eventually, 17% of PC patients transitioned to hospice care. Conclusions: A PC program fostering expert symptom management, seamless communication, and trusting relationships between oncologists, palliative care team, and patients, without prematurely stopping active cancer treatments, is feasible and can be incorporated into a community oncology practice as demonstrated by the growth and success of our program. Our model may set an example for similar practices in the community oncology setting.
e14728 Background: MGT forms the basis of precision oncology. More and more community oncology practices are utilizing MGT to identify somatic Actionable Alterations (AA) in solid tumors. This information is increasingly being used to choose FDA and/or guideline approved treatment options, or clinical trials. Methods: From July 2014 to July 2018, MGT (Foundation Medicine) data of patients (pts) with solid tumors at two community hospital-based oncology practices in central rural Nebraska were retrospectively analyzed. Study population consisted of advanced solid tumor pts (ECOG 0-2) with an available MGT result who had progressed on standard treatment regimens. Treating community oncologists directed treatment choices based on MGT results. Results: 360 pts underwent MGT. Average (avg) turn-around time from order to reporting was 20.19 days. Reimbursements were through commercial insurance (27 %), Medicare (66%), Medicaid (3%), self-pay (2 %) and financial assistance by company (2%). Most common cancer types were non-small cell lung (27%), pancreas (9%), colon (8%), unknown primary (4%), sarcoma (4%), breast (4%), gastro-esophageal (2%) and kidney (1%). 79% of samples had at least one AA. In 69 (19%) pts these alterations were matched to one or more on/off label FDA and/or guideline approved targeted therapies. Only 26/69 pts (37%) in this group were able to have a therapy that was new. 43 (12%) of pts qualified and went on locally available clinical trials (MATCH, LUNG-MAP and TAPUR). Conclusions: Our analysis reflects a 4-year real-world MGT experience in two community oncology practices in central rural Nebraska. In addition to established barriers of cost, long turnaround time, adequate tissue, the low yield of new FDA and/or guideline approved treatments decreases the utility of MGT. Increased variety and availability of precision medicine clinical trials with improved patient access in the rural setting may improve this shortcoming.[Table: see text]
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