Status of Cancer Care at Network Sites of the Nation's Academic Cancer Centers.

BACKGROUND: Cancer care coordination across major academic medical centers and their networks is evolving rapidly, but the spectrum of organizational efforts has not been described. We conducted a mixed-methods survey of leading cancer centers and their networks to document care coordination and identify opportunities to improve geographically dispersed care. METHODS: A mixed-methods survey was sent to 91 cancer centers in the United States and Canada. We analyzed the number and locations of network sites; access to electronic medical records (EMRs); clinical research support and participation at networks; use of patient navigators, care paths, and quality measures; and physician workforce. Responses were collected via Qualtrics software between September 2017 and December 2018. RESULTS: Of the 69 responding cancer centers, 74% were NCI-designated. Eighty-seven percent of respondents were part of a matrix health system, and 13% were freestanding. Fifty-six reported having network sites. Forty-three respondents use navigators for disease-specific populations, and 24 use them for all patients. Thirty-five respondents use ≥1 types of care path. Fifty-seven percent of networks had complete, integrated access to their main center's EMRs. Thirty-nine respondents said the main center provides funding for clinical research at networks, with 22 reporting the main center provides all funding. Thirty-five said the main center provided pharmacy support at the networks, with 15 indicating the main center provides 100% pharmacy support. Certification program participation varied extensively across networks. CONCLUSIONS: The data show academic cancer centers have extensive involvement in network cancer care, often extending into rural communities. Coordinating care through improved clinical trial access and greater use of patient navigation, care paths, coordinated EMRs, and quality measures is likely to improve patient outcomes. Although it is premature to draw firm conclusions, the survey results are appropriate for mapping next steps and data queries.

Phase II study of dasatinib (BMS-354825) in patients with metastatic adenocarcinoma of the pancreas.

BACKGROUND: Src, EphA2, and platelet-derived growth factor receptors α and ß are dysregulated in pancreatic ductal adenocarcinoma (PDAC). METHODS: Dasatinib is an oral multitarget tyrosine kinase inhibitor that targets BCR-ABL, c-Src, c-KIT, platelet-derived growth factor receptor ß, and EphA2. We conducted a phase II, single-arm study of dasatinib as first-line therapy in patients with metastatic PDAC. METHODS: Dasatinib (100 mg twice a day, later reduced to 70 mg twice a day because of toxicities) was orally administered continuously on a 28-day cycle. The primary endpoint was overall survival (OS). Response was measured using the Response Evaluation Criteria in Solid Tumors. Circulating tumor cells (CTCs) were also collected. RESULTS: Fifty-one patients enrolled in this study. The median OS was 4.7 months (95% confidence interval [CI]: 2.8-6.9 months). Median progression-free survival was 2.1 months (95% CI: 1.6-3.2 months). In 34 evaluable patients, the best response achieved was stable disease in 10 patients (29.4%). One patient had stable disease while on treatment for 20 months. The most common nonhematologic toxicities were fatigue and nausea. Edema and pleural effusions occurred in 29% and 6% of patients, respectively. The number of CTCs did not correlate with survival. CONCLUSION: Single-agent dasatinib does not have clinical activity in metastatic PDAC.

The effects of integrating an advanced practice palliative care nurse in a community oncology center: a pilot study.

Despite the widespread recognition of the need for new models of care to better serve patients with advanced cancer, little evidence exists to document the effectiveness of these models. The purpose of this pilot study was to investigate the integration of an on-site palliative care (PC) advanced practice nurse (APRN) in the community oncology setting and the effect of PC services on patients with advanced cancer compared with usual care. This study utilized a descriptive, pre/post design with 101 adult patients with advanced cancer. Patient accrual occurred for 5 months in the usual care period (n=52), followed by 5 months of accrual after implementation of the PC APRN (n=49). Data were collected at enrollment and 4 months post enrollment. Data were analyzed using independent t-tests and logistic regression analyses. Controlling for health-related quality-of-life variables, 10 covariates were entered into two logistic regression models, with hospitalization and mortality as outcome measures. Patients who had palliative care had a significantly lower mortality rate at 4 months (odds ratio = 24.6; P = 0.02) and had an 84% decrease in the odds of being hospitalized (odds ratio = 0.16; P < 0.01). Contrary to popular belief, PC services can be effectively provided to patients as they receive chemotherapy treatment and are not associated with increased mortality. Access to a PC APRN integrated into the community oncology setting may be associated with measurable benefits.