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Background Aggressive large B-cell lymphomas (LBCLs) are curable, but previous studies have shown inferior outcomes in minorities. Nurse navigation programs can improve patient outcomes by providing patient support. This study presents the outcomes of White and minority patients with aggressive LBCL at an institution with an active nurse navigation program. Methods The authors prospectively collected baseline characteristics, treatment regimens, and outcome data for patients with aggressive LBCL. Navigation encounters were characterized as low or high intensity. Overall survival (OS) and progression-free survival (PFS) were calculated with Kaplan-Meier methods. Baseline characteristics were compared with Fisher exact tests. Results Two hundred four consecutive patients (47 minority patients and 157 White patients) were included. Results were presented as minorities versus Whites. There were no differences in prognostic scores (Revised International Prognostic Index score of 3-5, 43% vs 47%; P = .50), frontline chemotherapy (98% vs 96%; P = .68), or the incidence of relapsed/refractory disease (40% vs 38%; P = .74). For relapsed/refractory LBCL, similar proportions of patients underwent hematopoietic stem cell transplantation (32% vs 29%; P > .99) or chimeric antigen receptor T-cell therapy (16% vs 19%; P > .99). Enrollment in clinical trials was comparable (17% vs 14%; P = .64). More than 85% received nurse navigation, but minorities had higher intensity navigation encounters (42% vs 21%; P = .01). The 2-year OS rates were 81% and 76% for minorities and Whites, respectively (P = .27); the 2-year PFS rates were 62% and 65%, respectively (P = .78). Conclusions This study shows similar survival between Whites and minorities with aggressive LBCL, which was likely due to equal access to guideline-concordant therapy. Minorities received higher intensity navigation encounters, which may have helped them to overcome socioeconomic disadvantages.

Patient navigators have been around since the late 1970s, but in many clinics, the role is often misunderstood. The reasons vary but arise from a lack of standardisation across the country. Navigators are tasked with a wide variety of duties, based on what is lacking in the clinics where they work, not necessarily what their optimal role dictates. Often, there is no navigation ‘leadership’ and the responsibilities are determined ad hoc by physicians or clinic managers and not aligned with the true mission of patient navigation. Patient navigation was started by Freeman and Rodriguez, a breast surgeon in Harlem, New York, USA. He noted a significant difference in the 5-year survival of his patients, compared with the national average. Navigation was created to overcome the disparities prevalent in his community and 5 years later, survival rates had increased from 39% to 70%.1 ### What is the role of patient navigation? The primary role is to reduce disparities of care that patients with cancer face, by identifying barriers and providing resources. Lack of insurance, financial concerns, cultural issues, poor health literacy and fear are barriers that might prevent someone receiving cancer care. Navigators triage the needs of their patients. They may not always be able to fix issues or concerns that arise, but they can make referrals to people and services who can. These resources may exist in the facility, the community or be national. A second role is to provide education. Patients are often overwhelmed in the early stages of their diagnosis. It is known patients forget 40%–80% of what physicians discuss, either because too much medical terminology is used, and they …

Background: Patients (pts) with malignancies are at increased risk of morbidity and mortality from COVID-19. Among these pts, some of the higher case fatality ratios (CFR) reported are among pts with myeloid malignancies, ranging from 37 to 50% (Mehta V, Cancer Discov 2020; Ferrara F, Leukemia 2020). Levine Cancer Institute (LCI) has a robust hematologic malignancy and cellular therapy program that serves many pts with myeloid malignancies, seeing nearly 100 new diagnoses of acute myeloid leukemia per year. A strategy to mitigate risks associated with COVID-19 was established at LCI in partnership with Atrium Health's (AH) Hospital at Home (HAH). HAH was a system wide platform using telemedicine and home health services to assess and monitor COVID-19 + pts at high risk of complications. To augment HAH for our medically complex cancer pts, a virtual health navigation process involving expertise from across LCI, including a specialized nurse navigation team, was developed to rapidly identify LCI pts + for SARS-CoV-2, monitor them under physician supervision, and escalate care as needed with AH HAH. Along with the navigation platform, data-driven guidelines for detecting, monitoring, and managing LCI pts + for SARS-CoV-2 were swiftly employed across the extensive LCI network. Herein we report on the outcomes for LCI pts with myeloid malignancies + for SARS-CoV-2 and outline the employed risk mitigation strategies and their potential impact on these outcomes. Methods: An automated daily list of LCI pts + for SARS-CoV-2 was provided by AH Information Services. Each pt's chart was reviewed by a nurse navigator for hematologic or oncologic diagnosis, outpatient or inpatient status, and COVID-19 symptoms. Pts without a cancer diagnosis were not assigned a navigator. If hospitalized, a pt was not assigned a navigator; following discharge, if enrolled in HAH, a navigator was assigned. In collaboration with HAH, an algorithm for directing care was utilized (Figure 1). A diagnosis-specific navigator contacted and screened the pt with an assessment tool, which scored pts for surveillance and treatment needs (Table 1). Documentation was forwarded to the primary hematologist/oncologist. Comprehensive guidelines for testing, scheduling, management of + pts, research, and process changes were created, disseminated, and actively updated through LCI's EAPathways. For outcome analysis for pts with myeloid malignancies, pt vital status was updated through data cutoff (7/3/21). Results: From inception on 3/20/20 to 12/2/20, 974 LCI patients were identified as SARS-CoV-2 + and reviewed for nurse navigation. Of the 974 pts, including pts with benign and malignant diagnoses, 488 were navigated. Among all SARS-CoV-2 + LCI pts, 145 (15%) had a hematologic malignancy, including 37 (4%) pts with myeloid malignancies. Characteristics are shown in Table 2. Of the 37 pts, 18 (49%) were navigated. 70% with myeloid malignancies were on active treatment at the time of + test. Nearly 50% of those on active treatment were navigated. 46% were hospitalized with COVID-19, with this being the main reason for no assigned navigator. 24% of hospitalized pts were eventually assigned a navigator. Only 3 pts had undergone allogeneic stem cell transplantation (allo-SCT) with a median time from transplant to detection of SARS-CoV-2 of 9 months (range, 7-23). 2 out of 3 cases post allo-SCT were asymptomatic. No pt died from COVID-19 following allo-SCT. Among the navigated pts with myeloid malignancies, there was no death related to COVID-19. 4 pts, all of whom were hospitalized, died from COVID-19 (N=2, myelodysplastic syndrome with 1 on azacitidine; N=2, myeloproliferative neoplasm, both on hydrea). A CFR of 11% was demonstrated for LCI pts with myeloid malignancies. Conclusions: A multidisciplinary response strategy liaising between AH HAH and LCI followed, assessed, and assisted cancer pts + for SARS-CoV-2. With our embedded nurse navigation team's specialized attention along with enhanced physician oversight and close collaboration with AH HAH, opportunities for care escalation or adjustments in cancer-focused care were promptly identified. In this setting, among the high-risk population of pts with myeloid malignancies, a lower CFR than has been reported was observed. A virtual navigation platform with HAH capabilities is a feasible, safe, and effective way to monitor and care for this high-risk population. Figure 1 Figure 1. Disclosures Moyo: Seattle Genetics: Consultancy. Chai: Cardinal Health: Membership on an entity's Board of Directors or advisory committees. Avalos: JUNO: Membership on an entity's Board of Directors or advisory committees. Grunwald: Amgen: Consultancy; Agios: Consultancy; Astellas: Consultancy; Daiichi Sankyo: Consultancy; Stemline: Consultancy; Bristol Myers Squibb: Consultancy; PRIME: Other; Trovagene: Consultancy; Blueprint Medicines: Consultancy; AbbVie: Consultancy; Med Learning Group: Other; Pfizer: Consultancy; Sierra Oncology: Consultancy; Janssen: Research Funding; Incyte: Consultancy, Research Funding; Gilead: Consultancy; MDEdge: Other; PER: Other; Cardinal Health: Consultancy; Karius: Consultancy. Copelan: Amgen: Consultancy.

1524 Background: Reports suggested cancer patients were at greater risk for increased morbidity and mortality from COVID-19. A process to mitigate these risks was established at Levine Cancer Institute (LCI) in partnership with Atrium Health’s (AH) Hospital at Home (HAH) initiative. This virtual health navigation process employed expertise from the departments of Hematologic Oncology and Blood Disorders, Oncology, and Supportive Oncology, including a specialized nurse navigation team, to rapidly identify COVID-19 positive LCI patients, monitor them under physician supervision, and escalate care as needed with AH HAH program. Methods: AH Information Services created an automated list of LCI COVID-19 positive patients with a daily database. Each patient was reviewed by a nurse navigator. Review included hematologic or oncologic diagnosis, outpatient or inpatient status, and any COVID-19 symptoms. Once a malignant diagnosis was confirmed, a diagnosis-specific navigator contacted and screened the patient with a COVID assessment tool. Documentation was forwarded to the primary oncologist/hematologist. The tool scored patients for surveillance and treatment needs. A score of 0-2 prompted phone assessment every 48-72 hours, and score of 3-5 required every 24-48 hour calls with physician involvement when appropriate. If score of ≥6, care was escalated to LCI nurse/physician for admission to AH acute care HAH or conventional inpatient admission. Results: From inception on 3/20/2020 to data review date of 12/2/2020, 974 LCI patients were identified as COVID-19 positive and reviewed for nurse navigation (Table). Of the 974, 488 were navigated. Given limited resources, patients with benign conditions were not assigned a navigator, though a similar process was created for sickle cell disease. Of the 974, 75 are now deceased. Only 25 are deceased among the 488 navigated. Conclusions: The COVID-19 pandemic presented unprecedented circumstances to our patients and their clinicians. LCI expeditiously put policies and procedures in place to mitigate the intersection of COVID-19 and cancer. The multidisciplinary response strategy liaising between AH HAH and LCI followed, assessed, and assisted LCI COVID-19 positive patients. With our embedded nurse navigation team’s specialized attention along with enhanced physician oversight and close collaboration with AH HAH, opportunities for care escalation or adjustments in cancer-focused care were promptly identified. Analysis is ongoing to elucidate the lower mortality rate observed among navigated patients.[Table: see text]

Objective: This study examined the utility of living room and church-based small group educational sessions on breast cancer and mammography, for under-served Latinas in North Carolina, USA. Design: Non-randomised, single arm design. Setting: A total of 329 self-selected Latinas participated in 31 small group educational classes in church and home locations in rural and urban settings, and underwent pre- and post-intervention testing of knowledge about breast cancer and mammography. Method: Participants completed educational surveys at baseline before intervention (329), immediately after intervention (329) and 3 months after intervention (223 participants). Results: Misconceptions still exist about breast cancer risk, prevalence and mammography use among Latinas, with the greatest knowledge deficit being in the domain of risk factors. Increases of knowledge were achieved when compared to baseline measures as a result of the interventions described in this paper, which were retained at 3 months re-testing. Many eligible women were not receiving mammograms due to financial barriers. Conclusions: Education sessions of the kind described in this paper are useful in enhancing retained knowledge in breast cancer education for US Latinas.

e19040 Background: Aggressive BCL is curable but previous studies have shown that minorities have inferior survival, partly due to socioeconomic barriers and poor access to care. NN programs are designed to reduce barriers to care via various methods. We present disease characteristics, treatment, and outcomes of Caucasian (C) & non-Caucasian (NC) pts with aggressive BCL at Levine Cancer Institute which has an active NN program. Methods: We collected demographic, insurance, disease characteristics, treatment, and outcomes for pts with aggressive BCL [diffuse large B cell lymphoma (DLBCL), primary mediastinal B cell lymphoma (PMBCL), or high grade B cell lymphoma (HGL)] between Jan 2016 and Jun 2019. Race (C or NC) was self-reported. NN encounters were characterized as low intensity (basic needs) or high (moderate/high needs). OS and PFS were calculated using Kaplan Meier. Demographics were compared using Fisher's Exact tests. Results: 204 pts (186 = DLBCL, 14 = PMBCL, 4 = HGL) were included (NC = 47; C = 157). NC were younger at diagnosis (median age 56 vs 62 yrs, p = 0.03) and more likely to be uninsured/Medicaid (26% vs 4%, p < 0.0001). There were no significant differences in prognostic scores (44% vs 50% R-IPI score 3-5, p = 0.5), incidence of double hit (11% vs 13%, p = 0.8), frontline rituximab/anthracycline containing chemotherapy (98% vs 96%, p = 0.9), and incidence of relapsed/refractory (R/R) disease (40% vs 37%, p = 0.7) for NC compared to C. For R/R BCL, similar % of pts underwent hematopoietic stem cell transplant (SCT) (32% NC vs 28% C, p = 0.8) or CAR-T cell therapy (16% NC vs 19% C, p = 0.9). Enrollment in clinical trials was comparable (17% NC vs 14% C, p = 0.6). The % of pts receiving NN was similar (81% NC, 87% C, p = 0.4) but NC had higher intensity NN encounters (42% vs 21%, p = 0.01). With median follow up of 35 mo, OS and PFS were comparable between both groups. The 2 yr OS was 81% for NC and 76% for C, p = 0.3; 2 yr PFS was 62% for NC and 64% for C, p = 0.8. Conclusions: We show equivalent survival between Caucasian and non-Caucasian pts with aggressive BCL. Disease biology and treatment patterns--including access to SCT, CAR-T and clinical trials--were similar in both groups. Differences in insurance coverage favored Caucasians. Similar proportion of pts in both groups received nurse navigation, but non-Caucasian pts had higher intensity navigation needs. Providing equal access to care and availability of an active nurse navigation program may overcome racial heath disparities. This study has implications for national health policy.

6510Background: Oncology patient navigation (PN) programs have been developed to improve outcomes and reduce disparities. Few data exist to describe the effect of PN on key clinical outcomes, such ...