Introduction The Coronavirus Disease 2019 (COVID-19) pandemic highlighted the importance of understanding patients’ goals, values, and medical care preferences given the high morbidity and mortality. We aimed to examine rates of advance care planning (ACP) documentation along with hospital course differences in the absence or presence of ACP among hospitalized patients with COVID-19. Methods This retrospective cohort study was performed at a single tertiary academic medical center. All adults admitted between March 1, 2020, and June 30, 2020, for COVID-19 were included. Demographics, ACP documentation rates, presence of ACP forms, palliative care consultation (PCC) rates, code status, and hospital outcome data were collected. Data were analyzed with multivariable analysis to identify predictors of ACP documentation. Results Among 356 patients (mean age 60.0, 153 (43%) female), 97 (27.2%) had documented ACP and 20 (5.6%) had completed ACP forms. In patients with documented ACP, 52.4% (n = 55) de-escalated care to do-not-resuscitate (DNR)-limited or comfort measures. PCC occurred rarely (<8%), but 78% (n = 21) of those consulted de-escalated care. Being admitted to the intensive care unit (ICU) (OR = 11.1, 95% CI = 5.9-21.1), mechanical intubation (OR = 15.8, 95% CI = 7.4-32.1), and discharge location other than home (OR = 11.3, 95% CI = 5.7-22.7) were associated with ACP documentation. Conclusions This study found low ACP documentation and PCC rates in patients admitted for COVID-19. PCC and completion of ACP were associated with higher rates of care de-escalation. These results support the need for pro-active ACP and PCC for patients admitted for serious illnesses, like COVID-19, to improve goal-informed care.

No abstract

e24110 Background: The American Society of Clinical Oncology recommends integration of palliative care in patients with advanced cancer. Studies have shown the availability of palliative care services, especially in outpatient settings, varies widely across practice sites; factors associated with outpatient palliative care clinic availability remain unknown. Our study describes the presence and characteristics of palliative care resources in community oncology practices. Methods: Analyses used data from the 2015 Cancer Care Delivery Research (CCDR) Landscape Assessment of National Cancer Institute Community Oncology Research Program (NCORP) practices (funding support provided by 2UG1CA189824). Oncology practices were surveyed regarding availability of specialty providers and supportive services, including palliative care, as reported by designated CCDR leads. Descriptive statistics describe availability of providers and services, and logistic regression models identify practice characteristics associated with supportive/palliative care specialist availability. Results: 216 non-pediatric exclusive NCORP practice groups were included in analyses. Characteristics are shown in Table. A majority of practices had palliative care specialists (76%), oncology certified nurses (95%), and advance practice providers (80%); 45% had nurse navigators for oncology. 76% of practices had inpatient palliative care consultation services, but only 36% had a dedicated outpatient palliative care clinic. Multivariable analyses demonstrated practices with Medicaid and/or uninsured patient volumes > 25% (Odds Ratio (OR) = 2.5, p = 0.020), more oncology providers (OR = 1.02, p = 0.025), survivorship clinic availability (OR = 2.5, p = 0.005), and who participated in the Quality Oncology Practice Initiative (QOPI) (OR = 2.0, p = 0.039) were significantly more likely to have an outpatient palliative care clinic. Conclusions: Most community oncology practices reported having palliative care specialists, although only a third had a dedicated outpatient palliative care clinic. Newly discovered factors associated with increased odds of having an outpatient palliative care clinic can inform future efforts to expand the availability of outpatient palliative care clinics within community oncology practices.[Table: see text]

e24147 Background: BIPN is a dose-limiting side effect of bortezomib therapy occurring in over three-quarters of bortezomib-treated patients and results in increased morbidity secondary to decreased quality of life and increased mortality due to treatment discontinuation or dose-reduction. Cryocompression therapy acts at the level of the nerve and does not limit bortezomib anti-tumor activity, making it ideal for clinical testing in patients with BIPN. This study evaluated the feasibility of cryocompression therapy in MM patients with BIPN. Methods: MM patients with Common Terminology Criteria for Adverse Event (CTCAE) Grade 1-3 BIPN who previously received a bortezomib-containing regimen (Arm 1) or were currently receiving a bortezomib-containing regimen (Arm 2) were enrolled at a Comprehensive Cancer Center outpatient clinic. Patients were instructed to complete daily home cryocompression treatments on non-dominant hand and foot for 30 continuous minutes for 8-weeks. Primary outcome was compliance measured by device-recorded data and defined as completion of at least 25 of 30 minutes, 60% of prescribed treatment days. Change in patient reported symptoms was assessed by the European Organization for Research and Treatment of Cancer (EORTC) QLQ-CIPN20 questionnaire. Proportion of compliant patients was calculated. Spearman’s rank correlation coefficients were used to evaluate the association between treatment compliance and QLQ-CIPN20 scores. Here we report on Arm 1. Results: 12 patients (median age 63.9+11.8 years, 41.7% female, 66.7% white, 25.0% black) participated in Arm 1. 75% of patients were compliant. The mean proportion of treatment-compliant days was 65.8% (95% CI 46.5% – 85.0%). Patient-reported BIPN symptoms improved with QLQ-CIPN20 total and sensory sub scores of 39.2+9.2 and 22.5+4.7 at baseline, 33.7+6.2 and 19+3.5 at week 4, and 34.1+7.8 and 19.9+5.5 at week 8. This accounted for a statistically significant decline in total QLQ-CIPN20 score at week 4 (-5.9+9.1, p = 0.035), week 8 (-4.6+5.0, p = 0.020), and sensory sub score at week 4 (-3.5+3.4, p = 0.008) and week 8 (-2.6+3.5, p = 0.050). There was no correlation between compliance and change in total QLQ-CIPN20 score (r = -0.31, p = 0.380) or sensory sub score (r = -.054, p = 0.109) in the per protocol analysis (N = 10). Using a last-time-point available analysis, no correlation was observed for total QLQ-CIPN20 score (r = -0.44, p = 0.149) but a moderate-to-strong inverse correlation was observed between amount of cryocompression use and change in QLQ-CIPN20 sensory sub score (r = -0.62, p = 0.031). Conclusions: Cryocompression therapy is feasible in MM patients with BIPN who previously received a bortezomib-containing regimen. The observed biologic gradient with greater improvement in patient-reported sensory neuropathy with longer duration of cryocompression treatment supports the rationale and further study. Clinical trial information: NCT03870451 .

e24125 Background: Palliative care promotes timely symptom management, and care planning and improves quality of life in oncology patients. About 60% of community oncology practices sampled in 2015 had outpatient palliative care. This study updates estimates of palliative care resources in community oncology. Methods: Questions from the 2022 Landscape Assessment of National Cancer Institute Community Oncology Research Program (NCORP) (funding provided by 2UG1CA189824) assessed the availability of specialist palliative care providers and ancillary care services, including utilization of advanced practice providers (APPs). Descriptive statistics describe availability of providers and services. Multivariable logistic regression was used to identify practice characteristics associated with palliative care specialist availability in 2022. Differences in rates of palliative care specialists, outpatient palliative care, APPs and patient portal use between 2015 and 2022 assessment results were assessed using Chi-Square tests, assuming independent time snapshots of general population characteristics. Results: Most community oncology practices sampled in 2015 had palliative care specialists (76%) and 62% of practices reported having outpatient palliative care. Of the 259 non-pediatric exclusive NCORP practice groups included in the 2022 analyses (Table 1), significantly more had palliative care specialists (86%; p = 0.003) and offered palliative care in the outpatient setting (76%; p = 0.001). Most practices utilized APPs (92%) and had a patient portal (95%), while only 41% had a survivorship clinic. Multivariable analyses demonstrated practices with more adult oncology providers (OR = 1.03, p = 0.039) and those with a designated survivorship clinic (OR = 3.16, p = 0.001), were significantly more likely to have specialty palliative care in the outpatient setting. Conclusions: More practices reported availability of palliative care specialists and outpatient services in community oncology practices in 2022 compared to 2015, with more oncology providers being associated with increased odds of having outpatient specialty palliative care in 2022. Smaller community oncology practices with fewer providers may need support to expand their capacity to provide palliative care. [Table: see text]