(P 182) A NOVEL MODEL FOR THE DIRECT REFERRAL OF ONCOLOGIC PATIENTS IN A PUBLIC HEALTH CARE SYSTEM

Objective: In 2023, 1,958,310 new cancer cases and 609,820 cancer deaths are projected to occur in the United States. The burden on the public health system can be devastating in economic terms but also for the house holds due to lost wages and expensive treatments that need to be covered by the governments. The NIH reported that the impact of cancer on the public health will continue to grow as the population ages. According to the NIH, Several studies are being conducted in order to investigate the behavioral patterns, occupational, medical, environmental exposures that can influence cancer risk factors; analyze the patterns of cancer care and outcomes; improving cancer control programs; screening strategies.
The public health systems around the world suffer from similar problems of misdiagnosis or delay in proper treatment due to the long waiting periods for imaging, shortage of professionals in the community, and different protocols of referrals among medical societies which cost the patients valuable time in case of cancer.
There have been several models for cancer patients management e.g. NICE guideline with the 2 week-wait period model in the UK, the national cancer pathways in Denmark, the Swedish National Board of Health and Welfare, yet the problems depicted above remains common.
Health-related-quality-of-life (HRQoL) encompasses the subjective experience of an individual's physical, mental, and social functioning, incorporating both objective evaluation of physical capabilities and subjective interpretation of their situation. In cancer, this variability can be attributed to factors such as negative patient-reported cognitive and emotional responses as well as diminished coping resources, which have been associated with lower levels of HRQoL. However, no study has yet examined HRQoL and outcomes and overall survival in the context of model of referral to the oncology unit (direct referral vs. indirect referral).

Methods: The Orthopedic oncology unit at the Barzilai Medical Center operates according to an innovative model that aims to provide rapid, immediate treatment for tumors and reduce the waiting period for visiting. The model's foundations are based on the education of primary car physicians, pediatricians and orthopedic surgeons in the community via by-annual course on musculoskeletal (MSK) pathologies and direct referral of these patients to the designated oncology unit. a prospective study with longitudinal mixed-methods approach for evaluation of the effects on prognosis, overall survival, function, quality of life will be evaluated on a period of 36 months in order to compare the groups of patients admitted via the model versus the indirect referral model.

Results: Preliminary data from 700 patients indicate promising outcomes. The average waiting time for the orthopedic oncology unit reduced to 2 days (range: 12 hours to 5 days), and referral-to-surgery time averaged 6 days (range: 1-14). Directly referred patients demonstrated improvements in function, overall survival, pain threshold, and quality of life.

Conclusion: This novel direct referral model for oncologic care is a streamlined lean process, anticipating a substantial reduction in waiting times, enhanced overall survival and recovery, reduced whoops procedures, alleviating stress on patients and public health systems. The innovative approach presents a potential solution to the persistent challenge of extended waiting periods in cancer care, offering a more efficient and patient-centered approach to oncologic referrals.