Background: The 5-year survival rate for individuals with surgically resected, early-stage non-small cell lung cancer (NSCLC) is around 50%. Recent availability of biomarker-driven therapy after surgery offers the promise of improved outcomes. However, current gaps in the quality of diagnostic evaluation, delivery of evidence-based treatment, coordination of care, and availability of biomarker testing remain barriers to optimal outcomes. Methods: The Association of Cancer Care Centers (ACCC) conducted a survey of providers who treat NSCLC to assess current patterns in the diagnosis and treatment of patients with early-stage (IB-IIIA) disease. The survey, distributed to ACCC members and their associated networks, collected information about each respondent and their cancer program processes around diagnosis, treatment planning, and care delivery. It was administered in Qualtrics XM; results were analyzed using SAS 9.4 (SAS Institute). Results: There were 124 survey respondents from 33 US states. Respondents' institutions were reported as 60% urban, 23% suburban, and 17% rural; 53% were reported as community cancer programs, 37% as academic/National Cancer Institute (NCI)-designated cancer programs, and 9% as private practice. On average, an initial tissue biopsy was performed by interventional radiologists in 29% of cases, by interventional pulmonologists in 22%, and by thoracic surgeons in 16%. For patients with stage IIA-IIIA disease, 50% of respondents typically performed invasive mediastinal staging before surgery, 20% during surgery, and 20% did not typically perform invasive mediastinal staging. The most frequent barriers to optimal staging and diagnosis included scheduling (73%), cost (51%), tissue quantity (46%), limited access to tests or procedures (42%), and missed appointments (36%). Use of multidisciplinary tumor boards varied- there was 40% participation in a general cancer tumor board, 65% involvement in a thoracic-specific tumor board, and 19% engagement in a dedicated molecular tumor board. Certain sites offered multiple options. Tumor board meetings occurred weekly in 57% of institutions, 2 to 3 times per month in 22%, and once a month in 11% of institutions. In all, 66% of respondents had a standard biomarker testing protocol in place for resected NSCLC. Testing involving epidermal growth factor receptor (EGFR) was typically ordered in 51% of respondents' institutions, and programmed death ligand 1 (PD-L1) testing for patients with resected NSCLC was regularly ordered in 62%. The largest barriers to optimal care included: scheduling of procedures and surgery (23%), patient refusal (19%), communication breakdowns (17%), inadequate staffing (15%), and limited access to subspecialties (14%). Many survey respondents (83%) agreed that their cancer practice had the staff and resources to help patients in navigating the health system. However, only 45% typically assigned a nurse navigator to individuals with early-stage NSCLC. Palliative care-service referrals for early-stage NSCLC were considered in 48% of sites, while 51% of sites rarely or never referred patients. Conclusions: In this broad sample of oncology practices across the United States (US), ACCC identified several strengths and barriers to optimal care for individuals with early-stage NSCLC. Improved care coordination and standardized staging and diagnosis practices can optimize care in this dynamic treatment landscape.

e13547 Background: Despite expanding therapeutic options and clinical guidelines for relapsed/refractory follicular lymphoma (R/R FL), optimal care delivery remains challenging due to complex treatment decisions and system-level barriers. This study explored perceived barriers and facilitators to R/R FL care and clinical trial access from both provider and patient perspectives. Methods: Using an explanatory sequential mixed-methods approach, the Association of Cancer Care Centers (ACCC), in partnership with patient advocacy organizations, convened an expert advisory committee to support study design. Two focus groups and 6 key informant interviews were conducted May-June 2025. One focus group and 2 interviews included patients with R/R FL, caregivers, and patient advocacy representativesother focus group and remaining interviews included multidisciplinary healthcare professionals (HCP) involved in R/R FL care in the U.S. Qualitative data were stratified by stakeholder group and analyzed thematically. Results: Focus group participants (n = 25) included HCPs (n = 12), patients (n = 8), advocacy representatives (n = 3) and caregivers (n = 2). Interviews included HCPs (n = 4) and patients (n = 2). Providers prioritized individualized treatment sequencing, assessment for transformation, and use of newer therapies when feasible. Clinical trials were viewed as important but limited by geography, health literacy, and eligibility criteria, with variability in when trials were introduced across treatment lines. Insurance and geographic barriers were cited as the most common challenges to timely, guideline-concordant care. Providers emphasized shared decision-making (SDM), patient education, and coordination between community and tertiary centers as best practices. Yet, patients perceived varying degrees of SDM. Some patients felt empowered to make decisions while others received limited options. Emotional support was inconsistently addressed, often absent unless patients or caregivers sought it out. Regarding clinical trials, participants noted limited targeted information for refractory disease and inequitable access to trials and specialty centers, though some overcame barriers through self-advocacy and persistence. Patients identified key supports for informed SDM, including trusting provider relationships, access to accurate information, and engagement with patient advocacy organizations for peer support. Conclusions: Although providers emphasized SDM as central to R/R FL care, patient experiences revealed inconsistent implementation in practice. This disconnect highlights the need for intentional strategies to operationalize SDM across care settings, including improved communication, patient education, and structural supports to ensure patient values meaningfully inform treatment and clinical trial decisions.

e13648 Background: Artificial intelligence (AI) in cancer care offers opportunities to reduce administrative burden, improve efficiency, and support care delivery, yet it prompts questions around safety, equity, and clinical judgment. To assess real-world perspectives, the Association of Cancer Care Centers (ACCC) conducted a national survey examining how oncology professionals engage with AI, their perceived value, and the barriers to adoption. Methods: ACCC, with guidance from an expert committee, created a national online survey of multidisciplinary staff at US cancer programs from May and August 2025. The 26-item survey assessed experiences and perceptions of AI, organizational adoption and governance, and implementation barriers and facilitators. Completed responses were analyzed using descriptive and stratified statistics in Stata 18, with qualitative data examined using rapid inductive thematic analysis. Results: Respondents (N=168) from 36 states included 61% in care delivery and 39% in administrative/operational roles, primarily from community (46%) and NCI-designated or academic (44%) programs. Care delivery staff were less confident than administrative/operations respondents in describing AI use (21% vs 4% “not at all [confident]”), discussing benefits of AI use (18% vs 7%), and critically evaluating AI systems (26% vs 13%). Administrative/operations respondents reported higher confidence contributing to AI implementation (45% vs 32%) and a higher likelihood to adopt/expand AI for treatment planning (52% vs 34%), clinical trial matching (49% vs 32%), and prior authorization (52% vs 35%). Rural respondents were more likely to express concern about declines in patient-provider communication (63% vs 22% suburban and 30% urban), as were those without AI experience (54% vs 24%). Academic respondents rated improving clinical decision-making/diagnostic accuracy, and establishing performance benchmarks and evaluating AI systems, as higher motivators for integration (0.82 vs 0.41; 0.53 vs 0.26), whereas community respondents rated patient engagement higher (0.36 vs 0.13). Respondents with AI experience reported a higher likelihood to adopt/expand AI for chatbots and virtual assistants (52% vs 16%), real-time alerts (35% vs 14%), personalized patient education (46% vs 27%), and individualized patient navigation (38% vs 11%). Qualitative responses reinforced these findings, highlighting stakeholder engagement, evidence of effectiveness, training, integration, and governance as critical for AI implementation. Conclusions: The results reveal broad AI use despite limited AI tools and governance implementation. Respondents were confident acknowledging AI’s limitations but less confident in evaluating its utility, highlighting opportunities for ACCC to support adoption, governance, and AI integration focused on efficiency and patient outcomes.

131 Background: Expanding clinical trial access in community oncology settings is critical for improving access and representation in cancer research. The Association of Cancer Care Centers (ACCC) initiated a program to identify and support cancer centers that were research naïve or less experienced in oncology clinical research with regionally, racially, and ethnically diverse catchment areas. This initiative aimed to build research capacity, leveraging ACCC and Association of Clinical Research Professionals (ACRP) resources to enhance clinical trial infrastructure while fostering inclusion. Methods: A survey was deployed to ACCC members in 2022 and 2023 to understand clinical trial activity and research capacity of member programs. The survey identified programs that self-proclaimed research naivety or low capacity. Key informant interviews, conducted in mid-2024, were used to identify potential pilot sites interested in initiating or expanding their research programs. Selected sites received access to a 10-week clinical research course focused on oncology trials, participation in a collaborative online learning environment for peer-to-peer engagement, access to clinical trial tools, including implicit bias training and clinical trials glossary, as well as the ability to participate in future mentorship training for site feasibility and trial enrollment. Results: Nine pilot sites were identified, and 16 professionals completed the training course. Centers were from urban (4), suburban (3), and rural sites (2). Average research FTE per program was 1.75 and all sites had less than 10 open trials in oncology at the start of the program. Through pre- and post-intervention self-reported assessments, pilot sites reported they strongly agreed that the training: Increased understanding of clinical trial infrastructure needs and workflows for clinical trial initiation (75%). Increased understanding of methods to increase engagement of diverse patient populations in trials (83%) Heightened confidence and commitment to sustaining research activities beyond the program’s duration (90%). Conclusions: This initiative underscores the feasibility of enhancing clinical trial capacity in community oncology settings. The program provides a scalable model for fostering broader representation in cancer research while addressing barriers to clinical trial participation. Future efforts will focus on engaging pilot sites in a mentorship to conduct their first industry feasibility assessments to enroll in oncology-focused industry-sponsored trials.

57 Background: In 2023, the Association of Cancer Care Centers (ACCC) introduced expert consensus-based Financial Advocacy Services (FAS) guidelines. These guidelines offer a framework to ensure equitable financial advocacy (FA) services, encompassing three areas: service functions, program management, and partner engagement. To facilitate the implementation of patient-centric FA, the ACCC's Financial Advocacy Network developed an open-source assessment tool designed for cancer centers to identify quality improvement (QI) opportunities and advance research on organizational FA practices across the U.S. Methods: The assessment tool enables users to assess their organization's performance against the 43 FAS guidelines, with scores from 1 (not performing) to 4 (reliable performance across all areas). The assessment generates total and average scores for each guideline across FA domains and subdomains and incorporates unscored questions regarding organizational demographics, barriers, and readiness. The assessment was distributed to member cancer programs from March 2024 to May 2025, with data analyzed using descriptive statistics to evaluate guideline adherence. Results: Thirty-one cancer programs participated, with 86% classified as community-based and 13% as academic. Only 39% of respondents had a dedicated financial advocate for patient assistance. High adherence was noted for benefits verification, with 78-84% achieving Levels 3 and 4 compliances respectively, reflecting effective insurance verification processes. However, financial distress screening adherence was starkly lower, with only 38-45% of programs conducting regular screenings at Levels 3 and 4 respectively, indicating a notable gap in addressing patients' financial burdens. Staff training on financial advocacy practices was only reported at 30-39% at levels 3 and 4 respectively, revealing insufficient ongoing education for personnel involved in financial counseling. Barriers to effective implementation emerged from qualitative feedback. Challenges included staffing shortages limiting FA service capacity, a lack of standardized screening processes leading to inconsistencies in support, and communication gaps hindering timely financial assistance. Conclusions: There is significant variation in the execution of FA services, indicating that many programs are ill-equipped to address the complex financial needs of cancer patients effectively. Investment in these areas can enhance the overall patient experience, reducing the stress associated with financial burdens and improving treatment adherence. By addressing barriers, cancer programs can create a more supportive environment that empowers patients to focus on their health and recovery, while ensuring that financial toxicity does not hinder access to essential care.

e23027 Background: Oncology clinical trials often lack ethnic and regional diversity , limiting the generalizability of findings across real-world patient populations. The Association of Cancer Care Centers (ACCC) Community Oncology Research Institute (ACORI) hosted the ACORI Community Oncology Inclusive Clinical Trial Design Summit on October 29–30, 2024 to convene multidisciplinary stakeholders to identify and address barriers to participation among underrepresented groups in clinical trials in the community settings. Methods: The summit featured didactic sessions, case-based presentations, and moderated interactive discussions with 76 participants, including 24 cancer center practitioners and researchers, 17 professional and patient advocacy organizations, industry representatives, and leaders from the FDA, NCORP, and the National Cancer Institute. The summit focused on identifying actionable solutions to expand access to clinical trials by enhancing clinical trial design, employing innovative operational delivery of trial opportunities, and building consensus on effective strategies around engagement, recruitment, and retention of participants and communities. Results: Discussions yielded the following recommendations to increase trial diversity: Strengthening the clinical trial workforce: Expand APP and clinical pharmacist roles as principal investigators through education and advocacy and strengthen training pathways for trial navigators/coordinators. Optimizing trial design and infrastructure for diverse populations: Broaden eligibility criteria, simplify protocols, and incorporate patient-friendly tools like e-consent and multilingual resources. Fostering community engagement: Build trust through local partnerships, establish patient education programs, and address systemic biases in trial recruitment. Advancing Decentralized Clinical Trials (DCTs): Advocate for flexible regulatory frameworks, educate practitioners through a DCT implementation playbook, and utilize community-based healthcare infrastructure. Leveraging AI and digital tools for trial efficiency: Apply AI for patient matching, protocol simplification, and remote monitoring, while improving transparency and interoperability with EHRs. Conclusions: Inclusive trial design and delivery of trial opportunities are essential to achieving equitable cancer care. Addressing systemic barriers and adopting innovative approaches can enhance diversity and improve the generalizability of clinical research. Through ACORI, ACCC will continue to foster collaboration among stakeholders. This remains critical to ensuring sustainable progress in community oncology research.

697 Background: Rates of guideline-concordant treatment for BLCA remain <50%, driven by access and care delivery barriers. The Association of Cancer Care Centers (ACCC) designed a 6-month QI program to identify and implement site-specific strategies to support equitable care delivery at cancer programs. We aim to characterize findings from participating sites’ pre-implementation assessments as well as initial directions for QI. Methods: The ACCC QI program was conducted with cancer programs between November 2023 – November 2024, guided by an advisory committee, patient advocacy partners, and multidisciplinary faculty. Each program completed a pre-assessment to characterize organizational resources, catchment population demographics, patient volume, sentiment regarding organizational culture, practice patterns and identified barriers. Open-ended questions and those regarding sentiment used a 5-point Likert scale. During each in-person workshop, participants discussed barriers and prioritized interventions using an impact-feasibility matrix. Descriptive summary data are presented. Results: Three programs (one in California, North Carolina and Kentucky) were selected; one in an urban setting and two suburban; two NCI-designated and one Comprehensive Community Cancer program. Annual case volumes ranged from 103-1439, with 167-220 new diagnoses; >50% of cases were non-muscle invasive at each site and male-predominant (up to 30% female), with variable patient diversity (up to 50% Asian and 15% Black). Insurance coverage varied across programs: 52-80% Medicare, 17-29% Private, 0-3% uninsured. All programs agreed/strongly agreed leadership, staff and multidisciplinary team members were committed to improving equitable care, but only 1 program had processes to regularly assess disparities and 1 felt they had adequate training or culturally appropriate educational materials. Program-specific barriers to care included limitations around transportation support, limited care coordination, few community practitioners providing specialized care, and limited awareness of available resources. Based on impact and feasibility ratings, intervention targets included assessing and aligning care coordination preferences, mapping supportive care resources and addressing gaps, and tailoring educational materials to patient populations. Conclusions: Our study demonstrates a strong recognition by health systems of disparities affecting BLCA care, shows the feasibility of developing a QI program focused on addressing disparities in diverse practice settings and highlights the importance of systems-level support. Implementing mitigation strategies require program-specific understanding of barriers to provide equitable care. Health systems level strategies require a community-based approach to address barriers and deliver equitable care tailored to the needs of communities served.

e14529 Background: The Association of Cancer Care Centers’ (ACCC) Immuno-Oncology (IO) Institute provides foundational IO education to multidisciplinary care teams and conducts a periodic census survey to understand evolving trends and needs of its members. Immune-related adverse events (irAEs) associated with treatment of cancer have variable clinical presentations and outcomes. This complexity, coupled with growing use of novel immunotherapies, poses challenges in practice, particularly in outpatient oncology settings. There is currently a lack of guidelines for management of irAEs in this environment. Methods: Guided by the IO Institute’s advisory committee, the census survey was developed based on literature reviews and validated instruments from prior surveys. Survey logic limited testing and treatment questions to providers. The survey was administered from August 1- November 4, 2024. Descriptive analyses were completed in R (version 4.4.1) and SAS Studio 3.8 on SAS 9.4. Results: Sixty-nine unique responses represented diverse program settings in urban, rural, and suburban areas. Physicians reported most confidence in applications of ICIs (82%), and combination therapies (73%). They reported the least confidence in applications of chimeric antigen receptor (CAR) T-cell (33%) therapy, tumor infiltrating lymphocytes (TIL) (33%) therapies, and cancer vaccines (24%). Toxicity discussions with patients were a frequent component of patient encounters. 77% of respondents indicated their institutions offered irAE-specific training. The top indicated institutional priorities regarding IO were staying informed of immunotherapy advancements and new treatment options (57%) and multidisciplinary collaboration (51%). Respondents identified multiple mechanisms for irAE reporting (Table 1). Conclusions: Despite widespread institutional training availability, inconsistencies in irAE reporting exist. Variability in confidence levels across therapy types coupled with institutional priorities highlight the need for irAE monitoring and management guidelines in the outpatient setting. Improved coordination with primary care and other specialties are critical to ensuring timely intervention for irAEs in diverse clinical settings. Reporting Mechanism Frequency (n) Myself, or a team member, follows up with patients as part of standard protocol 50 Patient's self-report (ie, patient portal, phone call, etc) 37 I rely on another treating provider to notify me 15 I rely on the patient's primary care physician to notify me 11 Not applicable to my role 10 Other (please specify): 2 N=125; multiple responses allowed

266 Background: Social drivers of health (SDOH) can significantly impact health outcomes, functioning, and quality of life. To identify and address these barriers, the Association of Cancer Care Centers (ACCC) partnered with multidisciplinary cancer care teams, patient advocates, and health equity experts to develop and pilot a screening tool designed to help care teams customize treatment plans and connect patients to support services. Methods: An 18-question screening tool was developed to assess patient concerns related to housing, finances, employment, insurance, transportation, and social and emotional support. The tool was piloted from May to November 2024 across 5 cancer centers—Mosaic Life Care (Missouri), Seidman Cancer Center (Ohio), Tennessee Oncology, Christus Health (Texas), and AnMed Cancer Center (South Carolina). Quality improvement workshops introduced the tool with guidance on data collection and workflow integration. The tool, available in English and Spanish, was completed during patient visits, either independently by patients or with assistance from a provider, depending on site workflow. Results: Implementation across 5 diverse sites demonstrated the tool’s feasibility and impact, with 230 patients reached, and 253 screenings completed. Based on screening results, pilot sites identified and curated community-based resources to address the barriers patients reported. The most frequently identified issues were financial uncertainty, transportation challenges, and food insecurity. The tool provided a standardized approach to capturing patients’ unmet needs, allowing teams to tailor resources to better support the patient. For one patient, SDOH screening showed loss of hospitalization coverage, blocking access to needed inpatient surgery. The care team coordinated support through a financial counselor, social worker, and precertification team, ultimately securing state-funded coverage that enabled the procedure. Conclusions: This pilot demonstrates that a comprehensive SDOH screening tool can be successfully integrated into cancer care. The tool supported patient-centered communication, identified care barriers, and facilitated timely referrals to community-based services. These findings highlight the feasibility and clinical value of embedding SDOH screening into workflows. Future directions include scaling to additional programs, integrating with electronic health records (EHRs), and expanding the Spanish-language version. Overall, results underscore the potential of data-informed strategies to advance equity in cancer care delivery.

401 Background: As cancer care becomes increasingly complex, navigation services play a pivotal role in addressing gaps in care, improving adherence to care plans, facilitating coordination across multidisciplinary teams, and improving the overall patient experience. Despite their demonstrated value, navigation programs face inconsistent implementation and sustainability across practice settings, with ongoing reimbursement challenges posing significant barriers to their broader scalability. Methods: The Association of Cancer Care Centers (ACCC) in partnership with the Academy of Oncology Nurse & Patient Navigators (AONN+) assembled a working group of experts to guide the development of a survey. The survey was distributed to ACCC members in January 2025 to gather insights on the benefits and challenges of implementing navigation services in oncology clinical practice. Results: Survey respondents (n = 105) included physicians, administrators, supervisors, oncology nurse navigators, oncology social workers, oncology patient navigators, and financial navigators from 9 U.S. regions, reflecting 50 urban, 37 suburban, and 18 rural centers. Nearly all respondents reported that patient navigation services are very or extremely important in improving access to care (97%), addressing patient health-related social needs (100%), and increasing patient trust (94%) (Table 1). While Principal Illness Navigation (PIN) codes offer a pathway to support navigation reimbursement, adoption is low with only 7% of practices currently billing patient navigation codes. 26% have no plans to use PIN codes at all. Medicare requires the patient to pay a 20% coinsurance amount for patient navigation services. 96.4% of respondents indicated this is a barrier to access navigation services and 76.4% reported their organization is not currently helping the patient offset the cost share. Other barriers include site of care, funding, staffing, and role clarity. Conclusions: Patient navigation is crucial to quality cancer care, yet implementation remains inconsistent in part due to reimbursement gaps and cost-sharing concerns that shift the financial burden to the patient. To expand navigation equitably, efforts should focus on payment models that eliminate patient financial barriers and sustainably support the workforce. Future research should assess real-world implementation of PIN codes, cost-sharing mitigations, and outcome metrics to guide policy and practice. Survey question: From your perspective, how impactful is each benefit of patient navigation services to patients with cancer? Outcome Extremely important Very important Somewhat important Not very important Not at all important Improved access to care 77% 20% 3% 0% 0% Better management of treatment side effects 41% 38% 18% 3% 0% Increased patient trust 66% 28% 4% 1% 0% Better adherence to treatment plans 54% 34% 12% 1% 0% Addressing patient health–related social needs 74% 26% 0% 0% 0%

ImportanceWhile an overwhelming majority of patients diagnosed with cancer express willingness to participate in clinical trials, only a fraction will enroll onto a research protocol.ObjectiveTo identify critical barriers to trial enrollment to translate findings into actionable practice changes that increase cancer clinical trial enrollment.Design, Setting, and ParticipantsThis survey study included designated site contacts at oncology practices with teams who were highly involved with the Association of Community Cancer Centers (ACCC) Community Oncology Research Institute (ACORI) clinical trials activities, all American Society of Clinical Oncology (ASCO)–ACCC collaboration pilot sites, and/or sites providing care to at least 25% African American and Hispanic residents. To determine participation trends among health care practices in oncology-focused research, identify barriers to clinical trial implementation and operation, and establish unmet needs for cancer clinics interested in trial participation, a 34-question survey was designed. Survey questions were defined within 3 categories: cancer center demographic characteristics, clinical trial characteristics, and referral practices. The survey was distributed through email and was open from June 20 through October 5, 2022.Main Outcomes and MeasuresParticipation in and barriers to conducting oncology trials in different community oncology settings.ResultsThe survey was distributed to 100 cancer centers, with completion by 58 centers (58%) across 25 states. Fifty-two centers (88%) reported that they conduct therapeutic clinical trials, of which 33 (63%) were from urban settings, 11 (21%) were from suburban settings, and 8 (15%) were from rural settings. Only 25% of rural practices (2 of 8) offered phase 1 trials, compared with 67% of urban practices (22 of 33) (P = .01). Respondents noted challenges in conducting research, including patient recruitment (27 respondents [52%]), limited staffing (27 [52%]), and nonrelevant trials for their patient population (25 [48%]). Among sites not offering therapeutic trials, barriers to research conduct included limited infrastructure, funding, and staffing. Most centers (46 of 58 [79%]) referred patients to outside centers for clinical trial enrollment, particularly in the context of late-stage disease and/or disease progression. Only 17 of these sites (37%) had established protocols for patient follow-up subsequent to outside referral.Conclusions and RelevanceIn this national survey study of barriers to clinical trial implementation, most sites offered therapeutic trials, but there were significant disparities in trial availability across care settings. Furthermore, fundamental deficiencies in trial support infrastructure limited research activity, including within programs currently conducting research as well as at sites interested in future clinical research opportunities. These results identify crucial unmet needs for oncology clinics to effectively offer clinical trials to patients seeking care.

Abstract Introduction: Triple-negative breast cancer (TNBC) presents unique challenges due to its aggressive nature and limited treatment options. Black women are disproportionately affected by TNBC, experiencing higher incidence rates and poorer outcomes compared to other racial/ethnic groups. This study aims to evaluate disparities in access to quality cancer care for Black women with TNBC from the perspective of oncology healthcare providers. Methods: From December 2022 to February 2023, the Association of Community Cancer Centers conducted a survey of 84 multidisciplinary care team members who provided care to Black patients with TNBC. The online survey captured quantitative and qualitative data on challenges related to accessing timely TNBC diagnosis and treatment services, care coordination for work-up and biomarker testing, confidence in TNBC treatment, clinical trial enrollment, supportive care services, and related referrals. Additionally, a follow-up focus group was conducted in May 2023 to further interpret select survey data, with a focus on shared decision-making, patient-provider communication, and ways to support cancer programs in improving screening, biomarker testing, and care coordination for individuals with TNBC. Results: Respondents reported several barriers to accessing timely diagnosis and treatment services for Black women with TNBC, including challenges in coordinating care for work-up and biomarker testing, providers' confidence in providing guideline-concordant comprehensive cancer care services for this patient population, enrolling patients in clinical trials, and making referrals for supportive care services. The survey revealed that community cancer programs treated an average of 21-50 patients with TNBC annually, with 31% of them being Black. Perceived patient-level factors contributing to challenges in accessing TNBC diagnosis and treatment included geographic distance to care facilities (14%), health literacy (18%), and insurance-related factors (21%). Practice-level barriers included limited accessibility of practice location (19%), capacity to accommodate new patients (27%), and insurance-related factors (34%). Additional findings highlighted slightly lower provider confidence in areas such as tobacco cessation (only 54% very confident), breast reconstruction (59% very confident), fertility counseling (52% very confident), and coordinating care across a fragmented healthcare system (52% very confident). Respondents identified the most commonly offered comprehensive cancer care services as palliative care (82%), nutrition support (77%), telemedicine (68%), psychological counseling (68%), and financial advocacy (68%). Less commonly offered services include recreational therapy (21%), legal aid (17%), and childcare (16%). Conclusion: This study highlighted the barriers faced by providers in delivering quality cancer care to Black women with TNBC. The findings underscore the importance of addressing challenges related to timely diagnosis and treatment services, care coordination, confidence in treatment options, clinical trial enrollment, and referrals for supportive care services. Insights from the focus group discussions further highlight the need for shared decision-making, improved patient-provider communication, and identification of opportunities to support cancer programs in addressing the specific needs of Black women with TNBC. To advance equity in cancer care, targeted interventions should focus on enhancing provider education, improving care coordination systems, and promoting cultural sensitivity. Efforts should also be made to overcome barriers related to limited accessibility of practice location, and insurance-related factors. By addressing these gaps, providers can play a crucial role in reducing disparities and improving outcomes for Black women with TNBC. Citation Format: Doreen Effange, Niharika Dixit, Ruth O'Regan, Ogori Kalu, Ryann Norcereto, Richard Simonds, Elizabeth Valencia, LaToya Bolds-Johnson, Aubrey Van Kirk Villalobos, Christie Mangir, Elana Plotkin, Karen Tacka, Leigh Boehmer. Evaluating Disparities in Access to Quality Cancer Care for Black Women with Triple Negative Breast Cancer in the US: A Provider Perspective [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-06-10.

Introduction After 2 decades of research, bispecific antibodies (BsAbs) are an emerging treatment option for several hematologic malignancies. BsAbs are administered in multiple care settings (ie, community, academic, inpatient, and outpatient). While clinical trials have shown that FDA-approved BsAbs are safe and effective, there remains a need for additional research to inform real-world implementation in community cancer centers, where most cancer care is provided (Ellis et al, J Rural Health 2022). Patients need to be monitored for adverse events such as cytokine release syndrome (CRS), which must be promptly recognized and managed appropriately. Methods Semi-structured focus groups were facilitated to ascertain types of organizational resources needed for BsAbs implementation in the community setting. Topics addressed included effective delivery of high-quality care and patient safety considerations, with a particular focus on adverse event management. Multidisciplinary professionals (n=30) participated in 2 focus groups held in June 2024. Roles represented were administrators (n=13), pharmacists (n=8), nurses (n=2), advanced practice nurses (n=2), medical oncologists (n=2), financial advocacy managers (n=2), and other health care professionals (n=2). Community cancer programs (n=12), large academic/NCI-designated cancer centers (n=11), integrated health systems (n=4), and physician practices (n=3) were represented, inclusive of diverse geographic settings across the US. Participants had varying levels of experience with BsAbs (ie, already administering BsAbs, delivering maintenance doses only, currently exploring potential options). Predominant themes from the focus groups were identified by 2 co-investigators using Rigorous and Accelerated Data Reduction (RADaR), a robust technique utilized in qualitative research. Results Themes that emerged from the qualitative analysis included: lack of familiarity with BsAbs, importance of education and training, models of care, financial affordability and sustainability, and need for capacity building. Lack of familiarity with BsAbs In the community setting, BsAbs are often conflated with chimeric antigen receptor (CAR) T-cell therapy. Misconceptions persist regarding the frequency of adverse events during the maintenance phase of treatment. These factors contribute to a lack of confidence among providers and organizations hesitant to administer BsAbs. However, participants currently delivering BsAbs believe they are ready for administration in the community, with multiple models of care available (eg, offering both ramp-up and maintenance or working with another program to provide maintenance closer to patients' homes). To identify the best model, community centers should assess internal capacity and regional capabilities (eg, hospital partnerships, home health). Importance of education and training Focus group participants emphasized the importance of provider and patient/caregiver education to ensure safety (eg, internally housing recordings of provider education for easy reference, holding trainings with local emergency departments, and using EMR smart phrases to document delivery of patient education). Participants indicated the need for cross-organizational coordination (eg, sharing direct contact information and providing transition of care notes) to facilitate appropriate management adverse events. Models of care To ensure financial affordability and sustainability, participants acknowledged the importance of predetermining prior authorization structure and impact on BsAb delivery (ie, inpatient or outpatient). A community center should begin by selecting 1 or 2 BsAbs that best fit their institutional capacity. All participants emphasized the need for capacity-building resources (eg, staff needed to manage adverse events, selection criteria for patients/caregivers, and sample clinical workflows). Conclusions The findings of this qualitative pilot study suggest that common fears and misconceptions may be ameliorated through education. Various models of care can support BsAbs delivery in the community setting. Additional qualitative and quantitative health services research is warranted to provide practical guidance for BsAb delivery at community cancer centers, with a focus on patient safety and improved patient access.

6079 Background: Head and neck cancer (HNC) is a complex disease that requires multidisciplinary care and poses significant challenges for patients and healthcare providers. Despite the availability of evidence-based guidelines, achieving optimal HNC care faces many barriers. This mixed-methods study explores the perceived barriers by patients and clinicians to optimal HNC care. Methods: The Association of Cancer Care Centers (ACCC) collaborated with the Head and Neck Cancer Alliance and the American Society for Radiation Oncology (ASTRO), along with an expert steering committee of multidisciplinary roles representing diverse cancer care centers, to evaluate the current landscape of HNC care delivery. Using an explanatory sequential design, ACCC conducted patient (n= 247) and provider (n=206) surveys and four focus groups which included patients with HNC and clinicians to capture barriers to optimal HNC care. Results: Barriers were classified as patient-related, provider-related, and system-related factors. Survey highlights include: 32% of patients received multimodal treatment including surgery, radiation, and medications; 50% of clinicians were at centers that utilized multidisciplinary clinics for HNC; 60% of patients “strongly agreed” they were satisfied with their care; 48% of patients felt members of their treatment team communicated and coordinated care “very well”; and 56% of patients “strongly agreed” clinicians explained their diagnosis comprehensibly. Clinicians and patients differed in their perspectives on how care was delivered in a few areas: 52% of clinicians vs. 40% of patients agreed that side effects of treatment were explained in ways that patients could understand; 29% of clinicians vs. 21% of patients felt that emotional concerns and mental health needs were addressed. Clinicians identified key areas that needed improvement to provide more effective care: financial resources (62%), dedicated navigation (45%), and coordination across members of the care team (45%). Qualitative analysis of focus group responses identified travel logistics to care centers, inadequate health insurance coverage, and lack of dental insurance delaying care as major systems-related barriers to optimal HNC care. Conclusions: This study revealed insights into the delivery of optimal care in HNC in the US, including being a high-volume center, having dedicated HNC nurse navigators, and multidisciplinary meetings for care coordination. Multifactorial barriers to optimal HNC care were also identified and will be used to inform future educational programming and the development of interventions to improve care.

e13172 Background: The Association of Cancer Care Centers (ACCC) launched a quality improvement initiative in 2018 to address suboptimal germline BRCA1/2 testing rates and identify barriers impeding testing for patients with early-stage or metastatic breast cancer. Between 2018 and 2023, changes in clinical guidelines led to expanded testing criteria and increased referrals for genetic testing. A follow-up survey in 2023 aimed to assess changes in testing practices and challenges faced by cancer care teams, considering the evolving landscape of genetic testing and the impact of the COVID-19 pandemic. Methods: In 2018, a survey of 95 oncology providers was conducted to explore provider characteristics, testing characteristics, and challenges/barriers to germline BRCA 1/2 testing. The survey was conducted again in 2023 for comparative analysis with a response of 115 oncology providers. The surveys explored provider characteristics, testing practices, and challenges/barriers to germline BRCA1/2 testing. To comprehensively understand the patient's perspective, an additional survey was conducted in October 2023, involving 61 individuals recently diagnosed with breast cancer to evaluate the patient experience with germline BRCA 1/2 testing and subsequent follow-up. Results: The adoption of expanded testing criteria, which influenced changes in clinical guidelines, has led to a substantial increase in referrals for genetic testing. The utilization of genetic testing by medical oncologists experienced a notable surge with 64% of survey respondents in 2023 reporting that medical oncologists most often initiated tests for germline BRCA1/2 mutations, compared to 29% in 2018. Patients’ awareness and engagement were high, with 82% undergoing germline BRCA1/2 testing, 48% undergoing testing at diagnosis, 33% before treatment, and 13% during treatment. In 2023, 23% of providers reported routinely ordering germline BRCA1/2 testing for patients with early-stage breast cancer, marking a threefold increase from the 2018 survey results. For patients with metastatic breast cancer, 41% of providers routinely ordered BRCA mutation testing, a threefold increase from 14% in 2018. While testing rates improved, challenges and barriers persist such as patient concerns (47%), access to genetic counselors (42%), turnaround time for test results (36%), and reimbursement issues (28%). Conclusions: The comparative analysis revealed a moderate improvement in germline BRCA1/2 testing practices, with increased provider engagement and patient awareness. Despite progress, challenges persist, needing multi-pronged efforts to enhance testing uptake and distribute critical information on testing to patients. The results indicate positive trends but underscore the importance of addressing barriers for comprehensive patient care.