585 Background: Pancreatic cancer is the third leading cause of cancer death in the United States; it is a complex disease requiring coordinated patient care. Multidisciplinary tumor boards (MTB) are today's gold standard in pancreatic cancer but are frequently criticized for being time-intensive and inefficient. To address this issue, Cancer Collective and Hive Networks have developed a novel patient-information visualization tool designed to improve the communication and efficiency of multidisciplinary tumor board meetings. This pilot study investigated the patient-information visualization tool's usability, efficiency, and feasibility in pancreatic cancer tumor board meetings. Methods: A prospective multi-center pilot study was conducted at Northwell Health (a comprehensive community cancer program [NCCCP] in the Northeastern United States) and the University of California San Diego (an NCI-designated comprehensive cancer center in [NCCC] in the Southwestern United States. The feasibility of the tool was assessed by measuring the percentage of MTB cases discussed that used the patient-information visualization tool. The usability and efficiency of the tool were assessed via Likert scale questions. Acceptable usability and effectiveness were defined as a 70% score or higher. Additionally, MTB participants were queried for input on design improvements for future iterations and expected future directions of tool use. Results: The patient-information visualization tool was rolled out on 07/22/2022 at the NCCP and NCCC. From 07/22/2022-05/31/2023, 170 (92%) MTB cases were reviewed at the NCCP. From 07/22/2022-05/31/2023, 74 cases (100%) of MTB cases were reviewed using the patient-information visualization tool at the NCCP. The NCCP (n=9) mean scores for usability and efficiency were 4.31 (86%) and 4.17 (83%) respectively. The NCCC (n=6) mean scores for usability and efficiency were 4.04 (81%) and 3.96 (79%) respectively. Qualitative feedback, reported on survey open-ended questions, included suggested enhancements to improve the tool’s usability, such as leveraging data automation to reduce data entry burden, improving the user interface for ease of data visualization, and adding additional data elements (e.g., specific procedure and appointment details) to improve decision-making utility. Conclusions: Implementing the novel digital dashboard to visualize pancreatic cancer patient data was highly feasible, usable, and efficient. Future directions of tool use include refining based on qualitative feedback from end users and planning for data automation and interoperability with the EMR.

695 Background: Significant variation exists in the management of potentially resectable pancreatic ductal adenocarcinoma (PDAC) across healthcare systems. We describe the results of a newly implemented neoadjuvant therapy pathway (NATP) in New York’s largest, most diverse health care system. Methods: The NATP was established in June 2019, consisting of a single-day pancreas multi-disciplinary clinic (PMDC) visit, followed by neoadjuvant therapy (NAT), imaging at specific intervals, and PMDC re-reviews at two and four months, prior to consideration of radiation and surgical resection. We conducted an IRB-approved retrospective analysis of patients enrolled in this pathway. Primary endpoints included completion of NATP and overall survival (OS). Results: The cohort consisted of 67 patients reviewed at PMDC and planned for NAT: 45% men, mean age 69.9 years, and 43% non-White between June 2019 and February 2022. Surgical stage at diagnosis was locally advanced (LAPC) 48%, borderline resectable (BRPC) 37% and resectable (RPC) 15%. Of 67 patients, 55 began the NATP (9 transferred care, and 3 declined NAT) and 28 (51%) completed NATP and underwent surgical exploration. Ten completed NATP and did not become surgical candidates, and 2 are still undergoing NAT. NATP was not completed in 15 patients due to 11 metastases (73.3%), 3 deaths (20%) and 1 local progression (6.7%) during NAT. NAT consisted of gemcitabine/nab-paclitaxel (GnP, 28%; 201 total cycles), FOLFIRINOX (45%; 251 total cycles), or a combination of both regimens (26%) with 31 (56%) patients receiving radiotherapy (97% SBRT). Of 28 patients who were explored, 86% underwent successful resection (62.5% R0, 16.7% R1 < 1mm and 20.8% R1). With median follow-up of 12.6 months, there were 17 deaths (31%) and median OS was reached at 20.9 mo (95% CI 10.5, 31.2); GnP vs. FOLFIRINOX median OS were 12.7 mo (95% CI 7.8, 17.6) vs. 26.1 mo (95% CI 9.3, 42.9) (p = 0.026). Median OS was not reached for the resected patients vs.16.3 months for non-resected (p = 0.006). Pathway adherence was seen in 28 (53%), with adherence improving median OS 20.9 mo vs. 16.3 mo (p = 0.039). NATP completion improved median OS 26.1 mo vs. 15.9 mo (p < 0.001). The percentage of patients that remained within the Northwell Health system for their post-NAT was higher among patients in the pathway, compared to prior (87% versus 44%). Conclusions: Implementation of NATP for pancreatic cancer within a single healthcare system increased the percentage of PDAC patients who underwent surgical resection and improved patient retention rate. Our data lay the foundation for further analysis of long-term outcomes of NAT in these patients.

Abstract Optimal management of patients with potentially resectable pancreatic ductal adenocarcinoma (PDAC) is controversial and variation exists within/across academic and healthcare systems. Herein we describe the initial results of a neoadjuvant therapy (NAT) pathway across one of New York’s largest, most diverse health care systems. The NATP was established at Northwell Health in June 2019, consisting of an initial, single-day pancreas multi-disciplinary clinic (PMDC) visit, followed by NAT, interval scans and PMDC re-reviews at two and four months, prior to consideration of radiation and of surgical resection. We conducted an IRB-approved retrospective analysis of patients enrolled to this pathway. Primary endpoints included completion of NAT pathway and overall survival (OS). Kaplan-Meier analysis was used to estimate OS. The cohort consisted of 55 patients: 44% men, mean age 69.7 years, and 48% non-White. Surgical stage at diagnosis was locally advanced (LAPC; 49%), borderline resectable (BRPC; 35%) and resectable (RPC; 16%). NAT consisted of gemcitabine/nab-paclitaxel (GnP, 41%; 147 total cycles), FOLFIRINOX (36%; 167 total cycles), and a combination of both regimens (23%). Eighteen (33%) received radiotherapy (94%, SBRT) and 72% received >=50 Gy. Average duration of NAT pathway (from biopsy to surgery) was 5.9 mo (IQR 4.7-7.6 mo): average time from biopsy to C1 of NAT was 25 days (IQR 18-39 days), from C1 to post NAT completion imaging was 3.9 mo (IQR 3.5-4.8 mo) and from RT to surgery was 36.0 days (IQR 30.5-43.8 days). Of 55 patients who began the pathway, 24 (44%; 6% RPC, 53% BRPC, 41% LAPC) completed the pathway and underwent surgical exploration; 22 did not complete the pathway and 9 are currently undergoing NAT. Reasons for not completing NAT included metastasis (24%), transfer of care (12%), local progression (5.5%), and death (3.6%). Out of 24 patients who were surgically explored, 71% underwent successful resection (53% R0, 18% R1<1mm and 30% R1) compared to prior institutional resection rate in NAT patients of 17% (p=0.015). There were 11 deaths (20%) and median OS was reached at 17.7 mo (95% CI 7.9, 27.6): 16.3 mo 95% CI 7.2, 25.4) and 26.1 mo (95% CI 3.2, 49) for GnP and FOLFIRINOX, respectively. Patients enrolled in the NAT pathway had a higher rate of germline mutation testing (52% vs 30%, p=0.002). The percentage of patients that remained within the Northwell Health system for their post-NAT was higher among patients in the pathway, compared to prior (87% versus 44%). Implementation of a standardized NAT approach at a large diverse healthcare system increased the percentage of PDAC patients who underwent surgical resection and improved patient retention rate. Citation Format: Ruwan Parakrama, Baho Sidiqi, Lyudmyla Demyan, Shamsher Pasha, Danielle Pinto, Tiffany Zavadsky, Xianghui Zhou, Sunita Patruni, Adrianna Kapusta, Oliver Standring, Matthew J. Weiss, Joseph M. Herman, Daniel A. King. Standardization of a neoadjuvant therapy (NAT) pathway for pancreatic cancer across a geographically large and diverse healthcare system improves patient outcomes and successful completion of NAT [abstract]. In: Proceedings of the AACR Special Conference on Pancreatic Cancer; 2022 Sep 13-16; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2022;82(22 Suppl):Abstract nr A022.

368 Background: Pancreas cancer (PC) survival is among the lowest of all malignancies. While limited advances in treatment are a major driver of this reality, ample opportunity exists to improve outcomes by reducing care variation, providingcoordinated, comprehensive care, and accelerating research. Learning health networks (LHNs) improve outcomes in pediatric diseases through such mechanisms, yet are not widely implemented in adult care. We aimed to develop, implement, and collect initial outcomes of the first oncology LHN, the Canopy Cancer Collective (CCC). Methods: In 2019, we established CCC to apply to PC the LHN model, including core tenets of continuous quality improvement (QI), data-sharing, empowered interdisciplinary teams and a stakeholder community including individuals with PC, and focus on community-defined improvable “outcomes that matter”. Six care centers were selected to join the LHN, and engaged in a collaborative design process to co-create a set of improvement aims and change ideas. Center team members received training in basic QI methods/tools guided by the IHI Model for Improvement and were coached to apply these to local improvement efforts. LHN infrastructure and technology enabled sharing of new ideas, best practices, and results amongst centers. Eight more centers joined in 2021, and an outcomes database built and implemented. Results generated by this database will inform center-specific and Network-wide improvement efforts and allow the LHN to undertake research. Results: Currently, 14 care centers are active participants in the CCC LHN. Five key outcomes have been defined as key targets, and centers have co-created and tested change ideas organized around key drivers of excellent PC care including proactive, timely care, aligned/prepared multidisciplinary teams, informed, activated patients, and accurate diagnosis and disease classification. 100% of care centers are trained in QI methods and actively testing change ideas. For example, in May 2022, 11 centers reporting on monthly QI activities met on average 4 times to advance QI projects, deploying a mean of 2.9 plan-do-study-act (PDSA) cycles (range, 0-5) focused on key drivers and outcomes, including reduced time to treatment, increased trial enrollment, assessment of patient experience, and improved data capture. Conclusions: Building a sustainable LHN for PC centers is feasible and has set the stage for improving patient and provider outcomes through iterative community-building, continuous improvement, and sharing of data and multidisciplinary best practices. Results lay the foundation for expansion not only in PC, but translation to other complex malignancies that will benefit from transformative, system-based approaches to outcome improvement.

The authors declare no conflicts of interest. Data sharing is not applicable to this article as no new data were created or analyzed in this study. Data S1: Timeline of PMDC formation and psycho-oncology integration. Data S2 Feasibility analysis. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.