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// Derrick S. Haslem 1 , Ingo Chakravarty 2 , Gail Fulde 1 , Heather Gilbert 1 , Brian P. Tudor 1 , Karen Lin 1 , James M. Ford 3 and Lincoln D. Nadauld 1, 3 1 Precision Genomics Program, Intermountain Healthcare, Saint George, UT, United States of America 2 Navican Genomics, Intermountain Healthcare, San Diego, CA, United States of America 3 Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States of America Correspondence to: Lincoln D. Nadauld, email: lincoln.nadauld@imail.org Keywords: precision medicine, oncology, outcomes, costs, overall survival Received: May 17, 2017 Accepted: September 15, 2017 Published: February 02, 2018 ABSTRACT The impact of precision oncology on guiding treatment decisions of late-stage cancer patients was previously studied in a retrospective analysis. However, the overall survival and costs were not previously evaluated. We report the overall survival and healthcare costs associated with precision oncology in these patients with advanced cancer. Building on a matched cohort study of 44 patients with metastatic cancer who received all of their care within a single institution, we evaluated the overall survival and healthcare costs for each patient. We analyzed the outcomes of 22 patients who received genomic testing and targeted therapy (precision oncology) between July 1, 2013 and January 31, 2015, and compared to 22 historically controlled patients (control) who received standard chemotherapy ( N = 17) or best supportive care ( N = 5). The median overall survival was 51.7 weeks for the targeted treatment group and 25.8 weeks for the control group ( P = 0.008) when matching on age, gender, histological diagnosis and previous treatment lines. Average costs over the entire period were $2,720 per week for the targeted treatment group and $3,453 per week for the control group, ( P = 0.036). A separate analysis of 1,814 patients with late-stage cancer diagnoses found that those who received a targeted cancer treatment ( N = 93) had 6.9% lower costs in the last 3 months of life compared with those who did not. These findings suggest that precision oncology may improve overall survival for refractory cancer patients while lowering average per-week healthcare costs, resource utilization and end-of-life costs.

Purpose: The advent of genomic diagnostic technologies such as next-generation sequencing has recently enabled the use of genomic information to guide targeted treatment in patients with cancer, an approach known as precision medicine. However, clinical outcomes, including survival and the cost of health care associated with precision cancer medicine, have been challenging to measure and remain largely unreported. Patients and Methods: We conducted a matched cohort study of 72 patients with metastatic cancer of diverse subtypes in the setting of a large, integrated health care delivery system. We analyzed the outcomes of 36 patients who received genomic testing and targeted therapy (precision cancer medicine) between July 1, 2013, and January 31, 2015, compared with 36 historical control patients who received standard chemotherapy (n = 29) or best supportive care (n = 7). Results: The average progression-free survival was 22.9 weeks for the precision medicine group and 12.0 weeks for the control group ( P = .002) with a hazard ratio of 0.47 (95% CI, 0.29 to 0.75) when matching on age, sex, histologic diagnosis, and previous lines of treatment. In a subset analysis of patients who received all care within the Intermountain Healthcare system (n = 44), per patient charges per week were $4,665 in the precision treatment group and $5,000 in the control group ( P = .126). Conclusion: These findings suggest that precision cancer medicine may improve survival for patients with refractory cancer without increasing health care costs. Although the results of this study warrant further validation, this precision medicine approach may be a viable option for patients with advanced cancer.

e14153 Background: Cancer treatment is becoming more complex, necessitating subspecialty expertise and multidisciplinary approaches to treatment planning. Simultaneously, there is increasing demand to provide care as close to home as possible. Oncology services are in high demand with a geographical mismatch between where oncologists work and where patients live. Traditionally, patients have been required to travel long distances to seek care outside of their communities resulting in increased financial expense and emotional distress caused by leaving the comforts of their support system. Leveraging existing technologies, most of modern cancer care, including infusions can be delivered through a coordinated effort from consulting/ordering oncologists, onsite administrators, physicians, nurses and ancillary staff. Methods: Using a secure video-conferencing platform, Intermountain Healthcare has implemented 5 tele-oncology clinics (Site A- Sevier, UT; B- Cassia, ID; C- Teton, ID; D- Uintah Basin, UT, E- Star Valley, WY) in rural communities of Utah, Idaho and Wyoming. Patients are referred to the clinic by local providers. With the assistance of a nurse navigator, oncologists meet with patients via video conference for initial consults, follow-up, supportive care, survivorship care and systemic treatment including chemotherapy, immunotherapy, and targeted therapy. Standard NCCN/ASCO guidelines are followed in the treatment strategies for these patients. Care is taken to ensure any treatment that can safely be delivered in the local facility/community is coordinated to take place there. Based on distances from the rural facility to nearest tertiary cancer center, we calculated the mileage avoided and hours traveled avoided by using tele-oncology. Results: Since 2017, the tele-oncology service has managed 269 unique patients (A- 200; B- 21, C- 22, D- 18, E- 8) with 1,237 total tele-oncology visits (A- 1,068; B- 69; C- 39; D- 32; E- 29). In total, there were 397,326 driving miles avoided (A- 326,808; B- 26,358; C- 22,932; D- 9,280; E- 11,948). Travel hours avoided in total were 6,062 hours (A- 4,989; B- 380; C- 341; D- 155; E- 197). Conclusions: Intermountain Healthcare’s tele-oncology program benefits patients and communities by easing travel burden and improving quality of life by making cancer care more convenient and providing the care closer to home. Work is ongoing to prospectively evaluate the effects on the communities in addition to cancer related outcomes.

e23162Background: Cholangiocarcinoma is an uncommon gastrointestinal malignancy that remains relatively understudied even as its worldwide incidence continues to climb. The treatment options for pa...

Background: The advent of Next-Generation Sequencing (NGS), and other diagnostic technologies, has enabled the use of genomic information to guide targeted treatment in cancer patients. Utilizing these technologies, we established a precision medicine program within a large, integrated healthcare delivery system. We then monitored the outcomes, including progression free survival and treatment delivery costs, associated with the delivery of precision medicine for patients with advanced cancer. We report the structure of our program and an analysis of the clinical outcomes associated with precision cancer medicine. Methods: We conducted a matched cohort study of 72 patients from July 01, 2013 to December 31, 2014, with metastatic cancer of diverse subtypes. The outcomes of 36 patients treated with precision cancer medicine were compared to 36 historical control patients who received standard chemotherapy. Study and control patients were matched according to age, gender, histological diagnosis, and number of previous treatment lines. Progression free survival was compared between the two groups using a Cox Proportional Hazard model for survival and accounting for potential confounders. Costs included subsequent ED visits, hospitalizations, NGS costs, and costs for targeted treatment or standard therapy. Results: Establishing a precision cancer medicine program for advanced cancer patients was feasible and scalable. Evaluation of the outcomes revealed that progression free survival was 22.9 weeks for the treatment group and 12.0 weeks for the historical control group (p = 0.002). Patients receiving precision cancer medicine compared to conventional treatment patients had a hazard ratio of 0.47 (95% confidence interval of 0.29-0.75) when adjusting for age, gender, histological diagnosis and previous treatment lines. Cost per week was $3,204 in the treatment group and $3501 in the historical control group, p = 0.22 Conclusions: Precision cancer medicine appears to significantly improve survival for patients with advanced cancer when compared to control patients who received conventional chemotherapy. The additional survival is not associated with increased health care costs. While the results of this study warrant further investigation, this genomics-based approach appears to be a viable, and perhaps superior, option for patients with advanced or metastatic cancer. This abstract is also presented as Poster 16. Citation Format: Lincoln D. Nadauld, Burke Van Norman, Gail Fulde, David newman, Allison Butler, Brian Tudor, Heather Gilbert, Karen Lin, Gary Stone, Anish Konde, Iva Petrovchich, James M. Ford, Derrick Haslem. Precision genomic medicine improves clinical outcomes in advanced cancer patients. [abstract]. In: Proceedings of the AACR Precision Medicine Series: Integrating Clinical Genomics and Cancer Therapy; Jun 13-16, 2015; Salt Lake City, UT. Philadelphia (PA): AACR; Clin Cancer Res 2016;22(1_Suppl):Abstract nr PR07.

e17641 Background: The advent of Next-Generation Sequencing (NGS), and other diagnostic technologies, has enabled the use of genomic information to guide targeted treatment in cancer patients. The ...

12 Background: Personalized genomic cancer medicine is an approach that has long shown efficacy in molecularly-defined subsets of breast and lung cancers, amongst others, but has not been employed more broadly, in part, due to limitations in testing technologies. Recent advances in genomic technologies have increasingly alleviated these constraints, thereby enabling precision cancer medicine. Data regarding the quality outcomes of patients treated with precision cancer medicine is an important next step along the path to widespread employment of this approach. Methods: We performed an IRB-approved retrospective analysis evaluating the use of targeted therapies matched to patients’ molecular aberrations as determined by genomic testing and recommended by a Molecular Tumor Board (MTB). This study assessed whether a detailed molecular profile of advanced solid malignancies including, but not limited to, the lung, gastrointestinal tract, bladder, prostate, ovary, uterus and skin, that were subsequently treated with matched targeted therapies resulted in improvements in three quality outcome measures: 1) Progression Free Survival (PFS), 2) treatment related morbidity, and 3) cost of treatment. Results: Preliminary results of the cohort analysis suggest that the costs associated with genomic targeted therapy are comparable to standard therapies; however, the costs of treatment related morbidities is significantly lower for patients receiving genomic cancer medicine compared to standard chemotherapy approaches. In line with these findings, overall treatment related morbidities are significantly reduced in the genomic cancer medicine cohort compared to a control cohort. Data regarding the Progression Free Survival are pending at the time of this report. Conclusions: These retrospective data suggest that personalized genomic cancer medicine approaches result in decreased morbidities and cost savings compared to standard chemotherapeutic approaches. In patients with advanced cancer, genomic-based treatments appear to be cost-effective, safe and viable option for treating advanced cancer patients. Additional data regarding survival outcomes are required to determine efficacy of treatment.