Background: Transitioning low-risk cancer survivors back to their primary care provider (PCP) has been shown to be safe but the effect on health system resources and costs has not been examined. Methods: A Well Follow-Up Care Initiative (WFCI) was implemented in the publicly funded health system. Low-risk breast cancer (BC) survivors in the WFCI intervention group were transitioned from oncologist-led cancer clinics to PCPs. We compared health system costs ($2,014 in Canadian dollars) and resource utilization in this intervention group with that in propensity-score–matched nontransitioned BC survivors (ie, controls) diagnosed in the same year, with similar disease profile and patient characteristics using publicly funded administrative databases. Results: A total of 2,324 BC survivors from the WFCI intervention group were 1:1 matched to controls and observed for 25 months. Compared with controls, survivors in the intervention group incurred a similar number of PCP visits (6.9 v 7.5) and fewer oncologist visits (0.3 v 1.2) per person-year. Fewer survivors in the intervention group (20.1%) were hospitalized than in the control group (24.4%). There were no differences in emergency visits. More survivors in the intervention group had mammograms (82.6% v 73.1%), but other diagnostic tests were less frequent. There was a 39.3% reduction in overall mean annual costs ($6,575 v $10,832) and a 22.1% reduction in overall median annual costs ($2,261 v $2,903). Overall survival in the intervention group was not worse than controls. Conclusion: Transitioning low-risk BC survivors to PCPs was associated with lower health system resource use and a lower annual cost per patient than matched controls. The WFCI model represents a reasonable approach at the population level to delivering quality care for low-risk BC survivors that seems to be cost effective.

1 Background: The provincial cancer agency in Ontario developed and implemented a model of care (MOC) for breast cancer (BC) survivors to transition from oncology-lead care to primary care in a publically funded health care environment (2010-2013). Transition options included direct to primary care and stepped transition. The objective of our study was to examine the health system resources used by the women in the MOC group and compare them to those used by women who did not transition. Methods: A propensity score matched, quasi-experimental approach was used to compare the healthcare resource utilization and costs between BC survivors in the MOC program (case) and those receiving usual care (control). All MOC cases were linked using unique identifiers and linked into the provincial health system databases. Cases and controls were matched 1:1 on year of diagnosis and location of care and were followed from an index date to the earliest of her death date, date of last contact in the database, one day before another cancer diagnosis or the end of study available databases. The primary study outcome was overall health system utilization and mean cost during the follow-up period. Results: There were 2324 women in the MOC program. Demographic information (age, region, stage) were well balanced between cases and controls. Transitioned cases had lower hospitalizations (20.1% vs. 24.4%, p<0.05), fewer cancer clinic visits (6.0% vs. 15.1%, p<0.05), fewer medical oncologist visits (0.39 vs. 1.29, p<0.05) and fewer diagnostics (CT, MRI, ultrasound, x-rays) over an average of 25 months of follow-up. There was a trend for fewer family practice (7.35 vs. 7.91, p=0.08) and internal medical and hematology visits (0.81 vs. 1.03, p=0.08). Annual emergency visits were similar between the two groups (0.76 vs. 0.82, p=0.2). There was a $4300 (2012 $CAN) difference in the mean annual cost between cases and controls. Conclusions: Survivors in the MOC transition program used fewer health system resources and had lower health system costs when compared to controls. These findings provide real world evidence to inform transition policies for cancer survivors.

124 Background: Ontario’s cancer system faces many challenges, including a rising incidence of cancer, aging population, increasingly complex cancer treatment, and health human resource (HHR) constraints. In response, Cancer Care Ontario and the Ontario Ministry of Health and Long Term Care collaborated on a project to assess whether a new advanced practice radiation therapist role – the ‘Clinical Specialist Radiation Therapist’ (CSRT) – could enhance access to high quality, innovative care by optimizing the use of HHR. Methods: This innovative model of care aims to enable radiation therapists with advanced training and accreditation (CSRTs) to assume responsibility for certain activities traditionally performed by radiation oncologists (ROs) while maintaining and improving the quality, accessibility and efficiency of radiotherapy (RT) for patients. To assess CSRTs’ impacts standardized metrics, including efficiency (access, wait times (WTs), team function) and quality (new/enhanced services, patient experience) measures, were used. Results: Currently there are 24 CSRTs in 9 of 14 regional cancer centres. 2014/15 data demonstrated that CSRTs can improve the efficiency of referral processes and clinic operations, decrease WTs, and increase capacity (2-28 additional patients seen in clinic/month). Optimized team function and time savings (5-66 RO hours/month) have been achieved through CSRTs’ assumption of certain patient assessment and treatment planning activities. Efficiencies have improved patient experience by facilitating quicker, more coordinated flow through the RT process, and greater continuity of care. Further, CSRTs have enhanced access to high quality RT, through > 75 innovative initiatives (rapid access clinics, telemedicine consults). Conclusions: The CSRT role demonstrates how innovative models of care can improve patient access to high quality cancer care. With 24 CSRTs implemented, opportunities for analysis of factors which facilitate achievement of maximal impact and position sustainability exist. Such investigations could inform the refinement and further implementation of CSRTs in Ontario and other jurisdictions, improving patients’ access to RT more broadly.

1 Background: Cancer Care Ontario (CCO) implemented the Well Follow-up Care Initiative (WFCI) to transition low-risk breast cancer (BC) survivors from oncologist to primary care providers. The objective of this work was to compare both the health system resources utilized and their associated costs, among women in the WFCI (cases) and women who were not transitioned (controls). Methods: Cases were linked to provincial administrative databases and matched to a control group based on year of diagnosis, cancer stage, age, comorbidity, income, geographic area of residence, and prior health system use. Health system resource utilization (physician, hospitalization, diagnostics, medication, and homecare) was ascertained per group. The annual mean and median costs (CAD 2014) per patient were determined. Annualized incremental costs between cases and controls were estimated using generalized estimating equations, accounting for matched pairs. Results: Results are based on 2,324 cases and 2,324 controls (mean age 64.4 and 64.9 years, respectively). During an average of 2.5 years of follow-up since the transition date, there were significant differences between the two groups for mean annual visits per patient with a medical oncologist (0.4 vs. 1.3, p<0.001) and radiation oncologist (0.2 vs. 0.4, p<0.001). There was no significant difference in mean annual family physician visits per patient (7.4 vs. 7.9, p=0.082). The intervention group had fewer inpatient hospitalizations (75.6% vs. 79.9%) and cancer clinic visits (84.9% vs. 94.0%). While there was a higher number of mammograms for cases compared to controls, other diagnostic tests (bone scan, CT, MRI, ultrasound, and x-rays) were done less frequently. The model was associated with a 39.3% reduction in mean annual costs ($6,575 among cases and $10,832 among controls) and a 22.1% reduction in median annual costs ($2,261 among cases and $2,903 among controls). Conclusions: Transitioning BC survivors to primary care was associated with fewer health system resources and had a lower annual mean cost per patient than women who were not transitioned.

39 Background: The transitioning of well breast cancer patients, post-treatment, to family physicians is accepted as a safe and effective model of care. Numerous studies have focused on patients’ experience and health outcomes, but research has not examined the experience of oncologists who are practicing in this model of care. The purpose of this research is to explore the impact of a transition model of care on oncologists’ practice. Methods: Purposive sampling was employed to recruit and interview oncologists who have been transitioning patients to family physicians for two or more years. A total of 15 medical and radiation oncologists practicing in Ontario, Canada were interviewed. Data were analyzed using thematic analysis. Results: Most oncologists interviewed were confident that the transitioning of patients to family physicians is safe for many patients post-treatment. Despite some concerns about the feasibility of the model, namely acceptance of the model among patients and family physicians, oncologists perceived that the model enhances efficiency and sustainability of the cancer system. As the volume of patients in follow-up decreased, oncologists saw a variety of impacts including: a reduction in overbooking in their clinics; more new patients able to be seen in consultation each week; more flexibility in their schedules to accept urgent appointments; and an increased ability to spend more time with patients who are dealing with complex issues. For some oncologists, well patient appointments are a rewarding part of their work. Meanwhile, many experience challenges with increased intensity of workload. Oncologists recognize that some patients and family physicians may be reluctant but they believe that early communication with patients about eventual transition, and improved communication with family physicians can enhance the acceptability of this model of care. Conclusions: Oncologists interviewed in this study reported that the time they used to spend with well follow-up patients can now be spent on other activities that contribute to the enhancement of quality of care for cancer survivors and efficiency in the broader cancer system.