(P 77) BARRIERS TO GUIDELINE CONCORDANT CARE IN AYA PATIENTS WITH BONE SARCOMAS

Objective: Adolescents and young adults (AYA ages 15-39) with bone sarcomas (Ewing sarcoma and osteosarcoma) have worse survival when compared to children, but treatment with guideline concordant care (GCC) can improve survival. However, many AYAs with cancer do not receive GCC, especially older AYAs and those with limited resources. We therefore sought to elucidate the barriers to delivery of GCC to AYA patients with bone sarcomas through semi-structured interviews with healthcare providers caring for this patient population.

Methods: Semi-structured virtual interviews with 18 healthcare providers were conducted to elicit their experiences and to explore the complexities surrounding the multimodal and multidisciplinary care often required to effectively treat AYA patients with bone sarcomas. A purposive sample of participants were recruited based on type of institution, geographical location and specialty. Data were coded deductively and analyzed iteratively using qualitative thematic analysis with two trained qualitative researchers. Themes were identified by comparing both within transcripts and across transcripts using the CFIR 2.0 Framework.

Results: Semi-structured interviews were conducted with 8 pediatric oncologists, 4 medical oncologists, 2 orthopedic surgeons, 2 nurses and 2 social workers, providing over 500 minutes of data. Thirteen interviews were from National Cancer Institute (NCI) designated cancer centers and 5 were from NCI Community Oncology Research Program (NCORP) sites.

Provider-reported patient-level barriers to delivery of GCC included comorbidities, treatment side effects, competing demands to treatment, financial strains, parenting young children, lack of parental/family support and mental health support. In addition, inadequate communication and coordination between patients and providers, and between providers across different treating institutions were reported as barriers.

Suggested solutions to these barriers included placing patients on a clinical trial when possible, centralizing care at one institution when possible, integration of multidisciplinary oncology teams to include radiologists, pathologists, social workers and dietitians.

Conclusion: These interviews provide critical information, laying the foundation for development of cancer care delivery interventions to reduce survival disparities in AYAs with bone sarcomas.