Background: Addressing patients’ social determinants of health is a national priority for cancer treatment centers. Transportation insecurity is one major challenge for patients undergoing active cancer treatment, and missing treatments can result in worse cancer treatment outcomes, including worse morbidity and mortality. How cancer treatment centers are addressing transportation insecurity is understudied. Methods: In January and February 2022, the NCCN Best Practices Committee conducted a survey of NCCN’s 31 Member Institutions (currently 32 member institutions as of April 2022) to assess how centers were addressing patient transportation insecurity: how they screen for transportation insecurity, coordinate transportation, and fund transportation initiatives, and their plans to address transportation insecurity in the future. Results: A total of 25 of 31 (81%) NCCN Member Institutions responded to the survey, of which 24 (96%) reported supporting the transportation needs of their patients through screening, coordinating, and/or funding transportation. Patients’ transportation needs were most often identified by social workers (96%), clinicians (83%), or patients self-declaring their needs (79%). Few centers (33%) used routine screening approaches (eg, universal screening of social risk factors) to systematically identify transportation needs, and 54% used the support of technology platforms or a vendor to coordinate transportation. Transportation was predominantly funded via some combination of philanthropy (88%), grants (63%), internal dollars (63%), and reimbursement from insurance companies (58%). Over the next 12 months, many centers were either going to continue their current transportation programs in their current state (60%) or expand existing programs (32%). Conclusions: Many NCCN Member Institutions are addressing the transportation needs of their patients. Current efforts are heterogeneous. Few centers have systematic, routine screening approaches, and funding relies on philanthropy more so than institutional dollars or reimbursement from insurers. Opportunities exist to establish more structured, scalable, and sustainable programs for patients’ transportation needs.
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A Survey of the National Comprehensive Cancer Network on Approaches Toward Addressing Patients’ Transportation Insecurity
Krisda H. Chaiyachati, Diana Krause, Jessica Sugalski, Evan M. Graboyes, and Lawrence N. Shulman
Plenary Session—The Patient Journey: Access to Cancer Care
Presented by: Diane K. Hammon, Elizabeth A. Souza, Anne Chiang, and Lawrence N. Shulman
Moderated by: Timothy Kubal
As difficult as it may be to comprehend, quality affordable healthcare, particularly cancer care, is not accessible to every individual in every region of the United States. Without timely use of the full range of cancer care services, the best health outcomes cannot be achieved. To explore the scope of this contemporary scenario in cancer care and share ongoing efforts to improve access to cancer care for all, a distinguished panel shared their views at the NCCN 2022 Annual Conference. From the varied perspectives of patients, providers, and researchers, the panel featured a discussion of shared-care models at Massachusetts General Hospital and Penn Medicine Cancer Care to enable patients to expand their access to cancer care and receive that care closer to where they live. In addition, the panel explored initiatives to build and expand the network of clinical trials to enable patients to access such trials in their communities.
Privacy on the Road to Personalized Medicine
Daniel J. Boffa, Heidi Nelson, Timothy Mullett, Frank Opelka, Patricia L. Turner, and Lawrence N. Shulman
BPI22-009: Providing Value-Based Care Using a Novel Cancer Clinical Pathways Tool Embedded in Electronic Health Record
Erin Bange, Aditi Singh, Caroline Nightingale, Peter Gabriel, Rebecca Maniago, Lawrence N Shulman, and Christopher D'Avella
COVID-19 and Cancer Center Operations: Lessons Learned From the NCCN Best Practices Committee
Jessica M. Sugalski, Theresa Franco, Lawrence N. Shulman, Elizabeth Souza, Ephraim Hochberg, Anne Chiang, Scott Lawrence, Diana Krause, and Timothy Kubal
The NCCN Best Practices Committee, which is composed of senior physician, nursing, and administrative leaders from NCCN Member Institutions, evaluated the status of cancer center operations after 1 year of operating during the COVID-19 pandemic. Two major initiatives stood out: the increase in the utilization of network sites, and the gains made in telemedicine operations and reimbursement. Experts from NCCN Member Institutions participated in a webinar series in June 2021 to share their experiences, knowledge, and thoughts on these topics and discuss the impact on the future of cancer care.
Creative Strategies Implemented During the Coronavirus Pandemic That Will Impact the Future of Cancer Care
Jessica Sugalski, Theresa Franco, Lawrence N. Shulman, Pelin Cinar, James Bachman, Jennie R. Crews, MiKaela Olsen, Alyssa Schatz, and Timothy Kubal
The coronavirus pandemic has significantly impacted operations at leading cancer centers across the United States. In the midst of the chaos, at least one silver lining has emerged: the development of new, creative strategies for delivering cancer care that are likely to continue post pandemic. The NCCN Best Practices Committee, which is composed of senior physician, nursing, and administrative leaders at NCCN Member Institutions, conducted a webinar series in June 2020 highlighting the most promising and effective strategies to date. Experts from NCCN Member Institutions participated in the series to share their experiences, knowledge, and thoughts about the future of cancer care.
Safety at the Time of the COVID-19 Pandemic: How to Keep Our Oncology Patients and Healthcare Workers Safe
Pelin Cinar, Timothy Kubal, Alison Freifeld, Asmita Mishra, Lawrence Shulman, James Bachman, Rafael Fonseca, Hope Uronis, Dori Klemanski, Kim Slusser, Matthew Lunning, and Catherine Liu
The novel coronavirus, SARS-CoV-2, was first detected as a respiratory illness in December 2019 in Wuhan City, China. Since then, coronavirus disease 2019 (COVID-19) has impacted every aspect of our lives worldwide. In a time when terms such as social distancing and flattening the curve have become a part of our vernacular, it is essential that we understand what measures can be implemented to protect our patients and healthcare workers. Undoubtedly, healthcare providers have had to rapidly alter care delivery models while simultaneously acknowledging the crucial unknowns of how these changes may affect clinical outcomes. This special feature reviews strategies on how to mitigate transmission of COVID-19 in an effort to reduce morbidity and mortality associated with the disease for patients with cancer without infection, for patients with cancer with COVID-19 infection, and for the healthcare workers caring for them, while continuing to provide the best possible cancer care. [Editor’s Note: This article includes the most current information available at time of publication; however, recommendations regarding public safety and practice may change rapidly in this situation. Individuals should get the most up to date information from the CDC website.]
Occult Primary
David S. Ettinger, Mark Agulnik, Justin M. M. Cates, Mihaela Cristea, Crystal S. Denlinger, Keith D. Eaton, Panagiotis M. Fidias, David Gierada, Jon P. Gockerman, Charles R. Handorf, Renuka Iyer, Renato Lenzi, John Phay, Asif Rashid, Leonard Saltz, Lawrence N. Shulman, Jeffrey B. Smerage, Gauri R. Varadhachary, Jonathan S. Zager, and Weining (Ken) Zhen
Occult Primary, Version 3.2014
David S. Ettinger, Charles R. Handorf, Mark Agulnik, Daniel W. Bowles, Justin M. Cates, Mihaela Cristea, Efrat Dotan, Keith D. Eaton, Panagiotis M. Fidias, David Gierada, G. Weldon Gilcrease, Kelly Godby, Renuka Iyer, Renato Lenzi, John Phay, Asif Rashid, Leonard Saltz, Richard B. Schwab, Lawrence N. Shulman, Jeffrey B. Smerage, Marvaretta M. Stevenson, Gauri R. Varadhachary, Jonathan S. Zager, Weining (Ken) Zhen, Mary Anne Bergman, and Deborah A. Freedman-Cass
The NCCN Guidelines for Occult Primary tumors provide recommendations for the evaluation, workup, management, and follow-up of patients with occult primary tumors (cancers of unknown primary). These NCCN Guidelines Insights summarize major discussion points of the 2014 NCCN Occult Primary panel meeting. The panel discussed gene expression profiling (GEP) for the identification of the tissue of origin and concluded that, although GEP has a diagnostic benefit, a clinical benefit has not been demonstrated. The panel recommends against GEP as standard management, although 20% of the panel believes the diagnostic benefit of GEP warrants its routine use. In addition, the panel discussed testing for actionable mutations (eg, ALK) to help guide choice of therapy, but declined to add this recommendation.