Department of Medical Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA.
AccessHope, Los Angeles, CA.
JCO Oncol Pract. 2022 Apr;18(4):e537-e550. doi: 10.1200/OP.21.00339. Epub 2021 Dec 3.
AccessHope is a program developed initially by City of Hope to provide remote subspecialist input on cancer care for patients as a supplemental benefit for specific payers or employers. The leading platform for this work has been an asynchronous model of review of medical records followed by a detailed assessment of past and current management along with discussion of potential future options in a report sent to the local oncologist. This summary describes an early period of development and growth of this service, focusing on cases of lung cancer, particularly during the COVID-19 pandemic.
Cases were primarily identified by a trigger list of cancer diagnoses that included non-small-cell lung cancer and small-cell lung cancer. After medical records were obtained, a summary narrative was provided to a thoracic oncology specialist who wrote a case review sent to the local physician, followed by a direct discussion with the recipient. We focused on feasibility as measured by case volumes, the rates of concordance between the subspecialist reviewer with the local team, and cost savings from recommended changes, using descriptive statistics.
From April 2019 to November 2020, 110 cases were reviewed: 55% male, median age 62.5 years (range, 33-92 years); 82% non-small-cell lung cancer (12% stage I or II, 16% stage III, and 57% stage IV), and 17% small-cell lung cancer (4% limited and 14% extensive). Median turnaround time for report send-out was 5.0 days. The review agreed with local management in 79 (72%) cases and disagreed in 31 (28%) cases; notably, specific additional recommendations were associated with evidence-based anticipated improvements in efficacy in 76 cases (69%) and improvement in potential for cure in 14 cases (13%). Recommendations leading to cost savings were identified in 14 cases (13%), translating to a projected cost savings of $19,062 (USD) per patient for the entire cohort of patient cases reviewed.
We demonstrate the feasibility of completing a rapid turnaround of cases of lung cancer either patient-initiated for review or prospectively triggered by diagnosis and stage. This program of asynchronous second opinions identified evidence-based management changes affecting current treatment in 28% and potential improvements to improve care in 92% of patients, along with cost savings realized by eliminating low-value interventions.
AccessHope 是由希望之城（City of Hope）最初开发的一个项目，旨在为特定的支付方或雇主提供癌症治疗的远程专科会诊服务，作为其补充福利。该项目的主要平台是对病历进行异步审查，然后对过去和当前的管理进行详细评估，并在向当地肿瘤医生发送的报告中讨论未来的潜在选择。本总结描述了该服务的早期发展和成长阶段，重点是肺癌病例，特别是在 COVID-19 大流行期间。
病例主要通过包括非小细胞肺癌和小细胞肺癌在内的癌症诊断触发清单确定。在获得病历后，向胸肿瘤专家提供一份总结叙述，由其撰写病例回顾并发送给当地医生，然后与接收方进行直接讨论。我们主要关注可行性，通过病例量、专科评审员与当地团队之间的一致性率以及推荐更改带来的成本节约来衡量，使用描述性统计。
从 2019 年 4 月至 2020 年 11 月，共审查了 110 例病例：男性占 55%，中位年龄为 62.5 岁（范围 33-92 岁）；82%为非小细胞肺癌（12%为 I 期或 II 期，16%为 III 期，57%为 IV 期），17%为小细胞肺癌（4%为局限期，14%为广泛期）。报告发出的平均周转时间为 5.0 天。在 79 例（72%）病例中，审查结果与当地管理一致，在 31 例（28%）病例中不一致；值得注意的是，具体的额外建议与预计在 76 例（69%）病例中提高疗效和在 14 例（13%）病例中提高治愈机会的证据相吻合。在 14 例（13%）病例中发现了可节省成本的建议，这意味着对整个病例组患者的每例患者可节省 19062 美元（USD）的费用。
我们证明了快速处理肺癌病例的可行性，无论是患者发起的审查还是通过诊断和分期前瞻性触发。这种异步二次意见项目确定了影响当前治疗的基于证据的管理变更，在 28%的患者中改善了当前治疗，在 92%的患者中改善了护理，并通过消除低价值干预实现了成本节约。
