Citations

465 Background: Molecular testing is crucial in advancing precision medicine, enabling oncologists to tailor targeted treatment strategies for cancer patients (pts). The National Comprehensive Cancer Network (NCCN) and ASCO guidelines recommend comprehensive biomarker testing for pts with mPC. However, compliance can vary considerably among institutions. This study aimed to assess current practices of molecular testing in diverse healthcare settings across the state of Florida and identify opportunities for improvement to optimize outcomes for pts diagnosed with mPC. Methods: We conducted a detailed 12-question survey, distributed both electronically and in-person to evaluate the molecular testing practices of healthcare providers throughout the state. The survey assessed multiple parameters including adherence to testing, reviewing test results to guide treatment decisions, and the availability of different supportive resources in biomarker testing. This initiative was executed in partnership with the Florida Society of Clinical Oncology and industry partners. Results: A total of 40 responses were collected from 11 institutions in Florida, including 5 academic centers and 6 community-based hospitals. Notably, 22.5% of respondents reported that their institutions either do not fully comply with NCCN guidelines or lack protocols to identify eligible pts and 67.5% stated they are responsible for their own biomarker education and updates. Only 56.4% consistently review molecular testing results during disease progression to guide treatment decisions. Nearly all institutions lack clinical decision support tools in the electronic medical records (EMR) to support testing, and 82.5% receive biomarker results outside the EMR. Additionally, 38.5% lack a standard process for obtaining prior authorization for testing. Furthermore, 38.5% lack a multidisciplinary review process for genetic test results, and 76.3% reported that their biomarker testing process does not involve geneticists or genetic counselors. Conclusions: Our study identified critical gaps in adherence to biomarker testing guidelines with many practices lacking decision support tools across healthcare institutions in Florida. Potential areas for improvement include better standardization of result integration into EMR, targeted educational initiatives, and stronger multidisciplinary collaborations. The implementation of these measures aims to improve the quality of care and outcomes for pts with mPC.

511 Background: Long-term survivorship care is essential for cancer patients, encompassing surveillance, symptom management, psychosocial effects, chronic condition care and health promotion. In low-resource settings such as Peru, financial toxicity (FT) is a pervasive challenge that may hinder access to these services. However, the extent of FT and its association with survivorship care gaps remains understudied in Latin America. Methods: A cross-sectional online survey was conducted among 218 adult cancer survivors in Peru (2024). FT was assessed using the validated COST-FACIT tool. Survivorship care was evaluated across five domains: (1) recurrence and new cancer surveillance, (2) physical effects, (3) psychosocial effects, (4) health promotion, and (5) chronic conditions. Data included demographics, cancer history, monthly income and type of insurance. Multivariable logistic regression identified predictors of severe FT, adjusting for demographics, income, insurance, and urban/rural residence. Results: Participants were predominantly female (78%), aged 45–64 (50.5%), and urban-dwelling (50.9% reside in the capital city). Breast (42.2%), cervical (18.3%), and ovarian (12.4%) cancers were most common. All respondents reported FT, with 66.5% severe and 30.3% moderate. Only 4.1% received care in all five domains. Gaps were highest in chronic condition care (20.2%) and health promotion (22.9%). Insurance coverage included public (70.7%), private (15.8%), and none (13.4%). In adjusted analysis, survivors reporting perceived adequate survivorship care (OR = 0.27, p = 0.002) and recurrence surveillance (OR = 0.30, p = 0.013) had lower odds of severe FT. Higher income was protective (OR = 0.15, p = 0.024). Conclusions: FT is universal among Peruvian cancer survivors and linked to critical gaps in survivorship care, particularly chronic disease and preventive health. The inverse association between comprehensive care and FT severity suggests that structured survivorship programs that integrate financial navigation, care coordination, and insurance expansion could mitigate FT. Findings underscore the urgency of policy reforms to reduce out-of-pocket costs and adapt survivorship models tested in low- and middle-income countries. While this cross-sectional study identifies strong associations, it cannot establish causality, and findings may be subject to selection bias inherent in online surveys.

501 Background: Targeted treatment options have significantly improved outcomes for patients with chronic lymphocytic leukemia (CLL), but oncology healthcare professionals (HCPs) who provide care for fewer numbers of patients with CLL are challenged to remain current with continuously changing treatment paradigms. To assess ongoing educational needs, we analyzed the treatment choices made by HCPs in an online survey for select cases of poor-prognosis CLL and compared these with the choices of experts in CLL treatment for the same clinical scenarios. Methods: As part of a CME program, HCPs could access an online algorithm to enter specific characteristics of a CLL case scenario and receive treatment recommendations from 5 US-based CLL experts. Experts made recommendations in July 2024 for 146 possible case patients built into the algorithm. After entering their case characteristics, HCPs were asked to enter their planned treatment prior to viewing the expert recommendations. We compared expert and HCP treatment choices across various case scenarios that were entered into the algorithm, with a focus on previously untreated CLL with del(17p)/mutated TP53 or R/R CLL. Results: Between August 2024 and February 2025, 346 cases were entered into the algorithm by 174 HCPs. Among responding HCPs, 38% were based in the UK/EU, 24% in the US, and 10% in Asia; 62% treated ≤10 patients with CLL per month and 49% sought recommendations for a specific patient in their practice. Among 231 cases of previously untreated CLL entered, 91 (39%) sought recommendations for del(17p)/mutated TP53 disease. For cases with no major comorbidities and previously untreated CLL with del(17p)/mutated TP53 , all experts recommended acalabrutinib or zanubrutinib; in 19 cases submitted by HCPs practicing in locations where second-generation BTK inhibitors (BTKi) are approved for CLL (including the US, EU, and Japan), 58% planned 1 of these treatments for this case scenario, 17% planned ibrutinib-based therapy, and 11% planned venetoclax-based therapy. Among case scenarios requiring third-line therapy after progressing with 2 regimens including a covalent BTKi and venetoclax plus an anti-CD20 Ab (with progression <2 years after completing treatment), all experts would recommend a noncovalent BTKi (eg, pirtobrutinib), with 1 expert indicating they would also consider CAR T-cell therapy. For the same case scenario among 6 US-based HCPs, 1 planned pirtobrutinib and 3 planned CAR T-cell therapy. Overall, after reviewing expert recommendations, 61% of HCP respondents whose planned treatment differed from the experts indicated that they would change their approach, and 20% indicated barriers to implementing the recommendations. Conclusions: Our findings provide insight into potential educational needs among HCPs who manage patients with CLL, suggesting that targeted expert-led education could benefit these HCPs.

262 Background: According to the American Cancer Society, nearly half (47%) of cancer patients and survivors incurred medical debts to pay for cancer care, although most (98%) had health care coverage (2024 Survivor Views Survey). The financial toxicity from high cost of cancer care is itself a risk factor for cancer mortality – hazard ratio of 1.8 among those requiring bankruptcy protection (Ramsey SD, J Clin Oncol 2016). Charity care, also known as financial assistance, plays a vital role in alleviating the medical debt for low-income patients. The Affordable Care Act requires non-profit hospitals to publish charity care policies to maintain their tax-exempt status. We studied the criteria for hospital charity care among NCI-designated cancer centers in the US. Methods: We included all NCI-designated cancer centers with a clinical program as of December 1, 2024. We searched their cancer center websites for charity care eligibility policies in 2024 and obtained the following information: income limit as percentage of the federal poverty guidelines (FPG), eligibility criteria beyond income, and supporting documents required for charity care application. Cancer centers were grouped into the following regions based on US Census classification: Northeast, Midwest, South, and West. Results: We found 64 NCI-designated clinical cancer centers - all non-profit institutions. Charity care policies were readily available. The median income cutoffs for free and discounted care were 200% of the FPG (range, 100%-600%) and 400% of the FPG (range, 200%-800%), respectively. These income cutoffs were similar among the four geographic regions. Most centers (52%) allowed not only uninsured but also underinsured or insured patients experiencing hardship. A minority of the policies (13%) applied different rules for insured patients. Majority of the centers (52%) allowed financial assistance when medical bills exceed a certain hardship limit even if income cutoffs were not met. Only 3 centers (5%) required medical bills to exceed a minimum threshold for eligibility. Residency requirements included US citizenship or permanent residency (27%), state (33%), service area (14%), county (2%), not necessary (11%) or not stated (34%). Most policies (64%) mentioned investigating a patient's assets. Specific documents required for submission included income (98%), pay stub (88%), tax return (84%), asset (73%), proof of residency/citizenship (44%), and bank account (61%). Conclusions: NCI-designated cancer centers apply a relatively uniform range of financial eligibility criteria for free and discounted charity care. Approximately 1 in 4 centers require evidence of US citizenship or permanent residency while 1 in 2 centers restrict eligibility to in-state residents. Future studies into the awareness, accessibility, and utilization of charity care will provide insight into how to optimize this resource for the neediest population.

606 Background: NCCN guidelines are among the most comprehensive and widely adopted clinical practice standards in oncology, frequently used by both clinicians and payors across the United States. Theys encompass three main categories: treatment, detection/prevention/risk reduction, and supportive care. While the evidence base for treatment recommendations has been examined in prior studies—and early detection guidelines largely align with those from other major medical societies—the strength of evidence supporting recommendations in supportive care guidelines remains poorly characterized. Methods: We conducted a systematic analysis of the categories of evidence and consensus (EC) supporting recommendations in 5 widely utilized NCCN supportive care guidelines (versions 2025): antiemesis, cancer-related fatigue, distress management, hematopoietic growth factors, and smoking cessation. Recommendations were classified into the following EC levels: category 1 (high-level evidence with uniform consensus [>85%]), category 2A (lower-level evidence with uniform consensus), category 2B (lower-level evidence with moderate consensus [50–84%]), and category 3 (any level of evidence with major disagreement). Results: Of the 120 recommendations found in the 5 guidelines of supportive care, the proportions of category I, IIA, IIB, and III EC were 18%, 82%, and 0%, and 0%, respectively. Recommendations with category I EC were found in antiemesis supportive care (30%), cancer-related fatigue (21%), distress management (12%), hematopoietic growth factors (20%), and smoking cessation (13%) guidelines. Conclusions: A substantial proportion of recommendations in the NCCN supportive care guidelines are derived from lower levels of evidence. While these guidelines are invaluable in standardizing care and guiding clinical decision-making, their reliance on expert opinion underscores a critical gap in the oncology evidence base. This situation presents both a challenge and a compelling opportunity to design and conduct rigorous clinical research that can validate current practices, inform future recommendations, and further improve patient outcomes. Level of recommendation by guideline. Guideline Recommendations I IIA IIB III Antiemesis 23 30% 70% 0% 0% Cancer-related fatigue 19 21% 79% 0% 0% Distress management 43 12% 88% 0% 0% Growth factors 19 20% 80% 0% 0% Smoking cessation 16 13% 87% 0% 0%

560 Background: Early diagnosis remains a critical challenge in oncology, particularly for the five deadliest cancers: lung, breast, prostate, colorectal, and pancreatic. These cancers often present with nonspecific symptoms, leading to repeated healthcare visits without a timely suspicion of malignancy. Artificial intelligence (AI) offers an opportunity to augment clinical decision-making and support earlier identification of cancer. C the Signs , an AI cancer prediction platform, has been widely adopted across the UK with substantial evidence supporting its ability to identify cancer at earlier stages. Methods: This retrospective study assessed the performance of C the Signs in intercepting cancer earlier than physician diagnosis. De-identified electronic medical records were accessed via the Mayo Data Platform, spanning a 20-year period from January 1, 2002 to December 31, 2021. The study cohort included 55,375 patients diagnosed with lung, breast, prostate, colorectal or pancreatic cancer. The primary outcome was the proportion of cases identified earlier by the AI model, measured in annual increments up to five years prior to physician diagnosis. Additional analyses were conducted across the five target cancer types. Results: The C the Signs platform identified 14,528 patients (26.2%) with cancer earlier than the original physician diagnosis. Early identification occurred across multiple time points: 8.9% in year 1, 4.7% in year 2, 4.4% in year 3, 4.3% in year 4, and 3.9% in year 5. Across cancer types, the highest early interception rate was observed in prostate cancer (31.7%), while breast cancer showed the lowest impact (21.0%). Conclusions: Use of the C the Signs AI cancer prediction platform demonstrated meaningful improvements in early cancer interception, particularly for lung and prostate cancers. These findings highlight the potential of AI tools to enhance early diagnosis and support timely clinical interventions, offering a scalable solution to improve cancer outcomes across populations.

55 Background: Prior authorization (PA) processes are known to create administrative burdens and delays in care, but little is known about how these challenges impact rural oncology patients and practice settings. Methods: To understand the broad impact of prior authorization on rural oncology patients and practices, we conducted this study across three community oncology practices serving majority rural patient populations with distinct geography, healthcare infrastructure, and models of care. Sites included one critical access hospital system located in a highly-rural community (Lakewood Health System; Staples, Minnesota), a community-based hub-and-spoke hospital system-based practice located in a mid-sized community (Mayo Clinic Health System – Northfield; Northfield, Minnesota), and a standalone referral level III trauma center serving a highly rural patient base (Self Regional Healthcare; Greenwood, South Carolina). This retrospective cohort study examined all intravenous and subcutaneous cancer-directed therapy plans (no oral therapy) that required PA submission at these locations over a three-month period from October 1, 2024 to December 31, 2024. Results: 129 PA submissions were required during the study period. 82 were due to cancer-directed therapy agents (of which 14 were immunotherapy agents), and 47 were due to adjunctive therapies (of which 22, 16, and 9 were due to granulocyte stimulation, bone preservation, and anti-emesis agents, respectively). All 129 PA submissions ultimately resulted in approval of the desired medication or formulary-approved biosimilar. Delays from PA submission to approval ranged from 0 to 18 days. A total of 209 patient-days were delayed due to PA during the study period, which did not ultimately result in change of care or denial of care in any instance. Conclusions: At all sites included in this study, all PA submissions were eventually authorized. The PA process was found to introduce inconsistent and potentially avoidable delays for hundreds of patients and their care teams. These findings highlight the inefficiency of current PA processes among rural cancer populations and the practices that care for them, underscoring the need for ongoing efforts directed at state and federal PA reform.

53 Background: Language barriers affect millions in the US, where nearly 8% of individuals (~ 26 million) have limited English proficiency, making it harder to access, understand, and engage with healthcare services. As clinical trials enroll increasingly diverse participants, ensuring the accessibility and clarity of consent forms is critical. Understanding translation costs can improve budgeting and prevent enrollment delays for non-English-speaking participants. This study evaluates the costs of translating consent forms into three of the most widely spoken non-English languages in the U.S. Methods: In February 2025, we queried ClinicalTrials.gov to identify publicly available consent forms for phase 3 interventional trials in lung, breast, GI, & GU cancers from 2013–2024. In total, 18 consent forms were identified. The U.S. News top 20 U.S. cancer centers were contacted to identify commonly used certified translation companies. We obtained quotes from 8 IRB-certified agencies via online portal for Spanish, Simplified Chinese, and Tagalog translations. Results: The 18 informed consent forms were on average 14 pages long (range: 3-29 pages). Across the 8 translation companies, translating documents into Spanish (average price per document [$pD]: 1088.58) was cheaper than Chinese (average $pD: $1253.94, p < 0.001) and Tagalog (average $pD: $1399.07, p < 0.001). Costs varied significantly by company (p < 0.001). Quality assurance measures, including dual translation and proofreading, were included in 87.5% of quotes. The average turnaround time for translating one consent into 3 different languages was 4 business days (range: 2-8 business days). Conclusions: The cost of translating informed consent forms for oncology clinical trials varies significantly by language and translation company, with Spanish translations being the least expensive and Tagalog the most costly. While translation costs represent a small fraction of overall trial expenses, variability in pricing and turnaround times underscores the need for structured budgeting and standardized translation processes. Translations of informed consents should ideally be completed prior to trial initiation to avoid the delayed recruitment or exclusion of non-English speaking patients. Our results are valuable for researchers & sponsors involved in oncology clinical trials, helping them make informed decisions in budgeting regarding language translation services. Company ID Average $pD, Spanish Average $pD, Chinese Average $pD, Tagalog Spanish $pW Chinese $pW Tagalog $pW 1 840.11 1,054.07 1,054.07 0.16 0.20 0.20 2 1,109.63 1,553.49 1,775.41 0.22 0.28 0.32 3 945.00 1,081.50 1,422.33 0.10 0.17 0.12 4 1,880.56 1,880.56 2,131.94 0.30 0.30 0.34 5 875.35 875.35 875.35 0.15 0.15 0.15 6 1,029.98 1,367.56 1,472.93 0.27 0.36 0.39 7 929.72 978.65 1,125.45 0.14 0.15 0.17 8 1,042.39 1,184.50 1,279.22 0.33 0.37 0.41

431 Background: The National Adult and Influenza Immunization Summit (NAIIS) promoted clinical subspecialist efforts toward vaccination assessment and recommendation as one strategy to increase adult vaccination rates. Problem Statement: Between August 1, 2022, and May 31, 2023, 0% (n=0/100) of patients seen in medical oncology at Mayo Clinic (Rochester, MN) and receiving chemotherapy for breast cancer had a documented comprehensive vaccination status assessment by breast medical oncology staff. Aim Statements: (1) To increase the rate of comprehensive vaccination status assessment performed by breast medical oncology staff from 0% to 75% of patients receiving chemotherapy for breast cancer by September 2024. (2) To increase the rate of documented vaccination recommendation for patients who were not up to date with recommended vaccinations from 0% to 50% by September 2024. Methods: We deployed multiple interventions including physician and nurse education; development of patient education materials; and a standard operating procedure (SOP) for vaccination status assessment, vaccination recommendation, and vaccine-related documentation. Our SOP utilized an Epic SmartPhrase with following elements: (1) SmartLink that autopopulated overdue vaccinations, (2) hidden tip text permitting the use to hyperlink to Health Maintenance, (3) SmartLists that captured nurse actions (e.g., provided education) and encounter outcomes (e.g., patient endorsed plans to receive vaccinations), and (4) scripting for immunization education. Results: Multi-faceted interventions were associated with an improvement in the documented rate of comprehensive vaccination status assessment from 0% (n=0/100) to 82.8% (n=101/122). Most patients (77.2%, n=78/101) were not up to date with recommended vaccinations. Recommendations for appropriate vaccinations were made for 80.8% (n=63/78) of patients who were not up to date. Only 19.2% (n=15/78) of patients who were not up to date endorsed intention to receive missing/recommended vaccines. Counterbalance: Nurses were able to assess vaccination status and make appropriate recommendations in less than 5 minutes per patient. There was no difference in nurse-reported workflow burden related to vaccination status assessment, recommendation, or documentation after intervention. Conclusions: This quality project aligned our breast medical oncology practice with vaccination-related care promoted by NAIIS. We increased rates of vaccination status assessment and vaccination recommendations without impacting nurse-reported workflow burden. Medical subspecialty clinic engagement in vaccination efforts is feasible.

426 Background: Testing for DPYD gene variations prior to administration of fluoropyrimidines ([FP] e.g. 5-FU or capecitabine) can determine if patients are at risk of significant toxicity and may benefit from dose reduction or elimination of chemotherapy. Barriers to testing include lack of recommendations in US guidelines for routine DPYD testing, absence of insurance coverage, and limitations in provider support. We designed an electronic health record (EHR)-based intervention to support shared decision-making (SDM) between providers and patients regarding DPYD testing. Methods: We built an EHR alert identifying all patients initiating FP without DPYD testing. The alert fired to remind providers upon signing FP. Clinical decision support (CDS) was included in the alert to help with DPYD testing selection along with an educational note template containing the incidence of DPYD deficiency, rationale for testing, test costs, and turnaround time. Interactions with the EHR were recorded to determine why providers declined ordering pharmacogenomic testing. Testing rates and results for patients initiating FP were collected from the EHR. Finally, providers were surveyed to determine the impact of the alert on conversations with patients as well as the utility of the embedded CDS and educational note template. Results: Within the first 8 months after alert activation, 34 patients completed DPYD testing of 444 starting FP (testing rate of 7.7%) vs the baseline testing rate in the 3 months prior to alert go-live of 6.8% (p = 0.86 via chi-squared analysis, two-tailed). Of the 34 patients, 5 were intermediate DPYD metabolizers. Reasons for alert dismissal per provider selection were: “Patient already tolerated prior fluoropyrimidines” (15.7%), “Patient declines” (12.9%), “Will order separately” (5.7%), “Not discussed as not appropriate” (5.3%), and “Not discussed, deferred” (60.4%). Thirty-nine providers (n = 77 eligible) responded to the survey; 22 prescribed FP in their practice and had encountered the alert. 21 (95.5%) of these reported the alert was “Very Useful” or “Somewhat Useful” and 18 (81.8%) used the DPYD testing options available in the alert. Sixteen (72.7%) discussed DPYD testing more frequently with patients as a result of the alert. Barriers to DPYD testing were “Concerned about the impact of lowering FP dosing” and “Lack of knowledge about DPYD testing”, while “Cost of DPYD testing” was scored lowest. Conclusions: Utilizing an EHR alert with embedded CDS had a positive impact on provider awareness and led to more discussions regarding DPYD pharmacogenomic testing with patients in line with current FDA recommendations. Limitations in provider knowledge regarding DPYD testing and concerns about lowering chemotherapy doses posed barriers to ordering testing. Further interventions including additional education are required.