Reducing delays to neoadjuvant chemotherapy in triple negative or Her2+ breast cancer.

473 Background: Retrospective chart review identified variation in initiation of neoadjuvant chemotherapy in our breast cancer population, leading to reduced patient and provider satisfaction and increased patient anxiety. We aim to decrease the percentage of eligible triple-negative or Her2+ breast cancer patients with ≥14-day delay from the initial medical oncology consult to start neoadjuvant chemotherapy by 50% by June 2024. Methods: Through participation in the ASCO Quality Training Program, our multidisciplinary team identified key barriers to timely care, specifically around the lack of pre-consultation preparation. Six months of retrospective analysis, cause and effect mapping, and Pareto chart indicated two primary causes for the delay: port placement/imaging delays with outside entities and lack of coordination between RN and MD to prepare anticipated needs. To address this, our breast cancer physician committee developed a neoadjuvant pathway aligned with National Comprehensive Cancer Network (NCCN) guidelines. Utilizing Plan-Do-Study-Act (PDSA) framework, the Oncology Nurse Navigator (ONN) screens patients for eligibility ensuring prompt identification. ONN educates patients on their tumor characteristics, pathology, and neoadjuvant treatment rationale. An order set was initiated, including echo, chemotherapy education visit, labs, and port placement scheduled to occur following initial medical oncology consultation. Results: Retrospective data (n=28) showed a mean of 16.4 days with 40% of this population starting chemotherapy > 14 days from consult. Initiation of the PDSA cycle with ONN pathway and order sets reduced the mean start to 11.5 days (n=15), reduced the upper control limit (UCL) from 45.4 to 23.9 days, with a 50% reduction in patients starting chemotherapy >14 days from consult. Conclusions: Developing disease-specific clinical pathways, and engaging ONN to identify patients for pathway eligibility, utilizing order sets, and educating patients about upcoming visits and anticipation for neoadjuvant chemotherapy resulted in a significant reduction in time to initiate neoadjuvant therapy for our cohort of breast cancer patients.