Network-enabled rapid growth of a US-based remote asynchronous oncology subspecialist case review service.

Howard Jack West City of Hope, Duarte, CA info_outline Howard Jack West, Debra A. Wong, Nitya Nathwani, Carol Wright, Crystal Liang, Todd M. Sachs, Afsaneh Barzi

Authors Howard Jack West City of Hope, Duarte, CA info_outline Howard Jack West, Debra A. Wong, Nitya Nathwani, Carol Wright, Crystal Liang, Todd M. Sachs, Afsaneh Barzi Organizations City of Hope, Duarte, CA, City of Hope Cancer Center, Duarte, CA, AccessHope, Los Angeles, CA, AccessHope, Irwindale, CA, City of Hope Cancer Center, Los Angeles, CA Abstract Disclosures Research Funding No funding received None. Background: AccessHope (AH) is a company that provides remote subspecialist insight on cancer care for patients via an asynchronous model of review of medical records followed by a detailed assessment of current and potential future management options sent to the patient’s local oncologist. This summary characterizes the rapid and ongoing scaling and growth as demand for this service has expanded and as AccessHope has transitioned from a single site to a geographically diverse US-based network of National Cancer Institute-designated comprehensive cancer centers (NCI-CCCs) as foundational partners. Methods: Cases were identified based on a trigger list of high complexity cancers or by request for case review by participating patients with cancer. Using descriptive statistics, we assessed measures of eligible patient, completed case volumes, and number of unique expert reviewers over time; the distribution of cancer types; the extent of concordance between care outlined by the local care team and that recommended by the reviewing expert; and potential cost savings from recommended changes. Results: From 1/2019-9/2022, the number of sponsor organizations and eligible “covered lives” increased by 1462% and 393% respectively; case volume increased from 42 to 525 cases/quarter over this interval. The most common cancer diagnoses were gastrointestinal (30%), hematologic/lymphoid (18%), lung (14%), and breast (12%). While reviewers recommended an alternative treatment in 29% of cases and agreed overall with current management in 71%, only 4% agreed and had no proposed refinements associated with anticipated evidence-based improvements. Recommendations leading to cost savings if adopted were identified in 16.1% of cases, translating to projected cost savings of $13,008/patient. Conclusions: After initially demonstrating 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 has grown from a single institution to a network of five NCI-CCCs around the US. Demand for this service has rapidly escalated, so that AH has been able to provide input and support to local oncologists for many-fold more physicians and patients over the past few years.