MA12.01 A Novel Program Offering Remote, Asynchronous Subspecialist Input in Thoracic Oncology: Early Experience During a Pandemic

Introduction: AccessHope (AH) is a program developed initially by City of Hope to provide remote subspecialist input on cancer care for patients as a supplemental benefit for specific payers and employers. While offering several platforms, the leading one has been an asynchronous model of review of medical records followed by a detailed assessment of past and current management along with discussion of potential future options in a report sent to the local oncologist. The intent of this program is that the patient can continue to have most or all management in their home environment, with the input and support of a subspecialist in that tumor type available “on demand”. This summary describes an early period of development and growth of this service, focusing in cases of lung cancer, particularly relevant during the COVID-19 pandemic. Methods: Appropriate cases for the eligible “at risk” population were identified by a trigger list of cancer diagnoses associated with a significant degree of risk of poor outcomes that included non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). Medical records were solicited from the local medical team, from which a summary narrative and chronology was developed by a team of nurses at AH. This was shared with a physician specialist in thoracic oncology from AH who wrote a summary report within several days that was sent to the local physician, followed by a direct discussion with the recipient. Using descriptive statistics, case metrics focusing on concordance with the current or proposed management plan were tracked, along with recommended changes and clinical trial options, as well as potential cost savings from suggested changes. Results: Over a 19-month period from 4/19 through 11/20, 110 cases were reviewed: 55% male, median age 62.5 yrs (range 33-92);82% NSCLC (12% stage I/II, 16% stage III, 57% stage IV) and 17% SCLC (4% limited, 14% extensive). Median turnaround time for send out of report of 5.0 days. The AccessHope review agreed with the proposed or ongoing treatment in 79 (72%) cases and disagreed in 31 (28%) cases. Even with general agreement in the treatment approach, specific additional recommendations were associated with evidence-based anticipated improvements in efficacy in 76 cases (65%) and improvement in potential for cure in 14 cases (12%, only feasible in patients with curable disease). Specific recommendations associated with cost savings were identified in 14 cases (12%), associated with a total cost savings of $2,096,859. Molecular testing was ordered rarely for SCLC;for NSCLC, NGS was strongly favored and more commonly associated with more advanced stage and non-squamous histology. Conclusion: We have implemented a novel program of asynchronous reviews of cases of patients with lung cancer by thoracic oncology subspecialists and have demonstrated the feasibility of completing reports for a growing volume over the course of the pandemic without requiring travel and enabling patients to receive their care close to home. More than a quarter of these case reviews include recommendations associated with evidence to support improved clinical outcomes, as well as potentially significant cost savings from low value practices unsupported by evidence. Keywords: remote care, pandemic, expert review