Conference Proceedings for the Fourth International Forum on Quality Cancer Care (IFQCC2020) April 4 and 5, 2020, Abstracts, Queens College, Oxford University, Oxford, UK

Queens College Oxford University


Introduction:
Oral therapies are increasingly developed in oncology, they are a response to a threefold requirement: to improve the quality of life of patients, to give a greater autonomy to the patient, while guaranteeing an equal effectiveness of the treatment. However, these chemotherapies raise new problems, starting with non-adherence to medication, the impact of these therapies on toxicity and quality of life has been little studied, the prescription of oral therapies has become a common practice in oncology, yet little is known about the extent of the variability and diversity of practices by each prescriber. To our knowledge this is the first study in Morocco evaluating adherence of capecitabine.

Methods:
We conducted a prospective, multicenter, observational study in three teaching hospitals. Patients treated with capecitabine for advanced or early stage cancers were included. The primary endpoint was to evaluate the adherence to capecitabine and quality of life. The secondary endpoints included reasons for the preference of patients for oral treatment, and safety of capecitabine. The adherence was evaluated during three consecutive cycles of capecitabine using indirect assessment methods: self-report and pill count; a patient was considered to be adherent to treatment if he achieved an overall percentage of adherence more than 95% using the two indirect methods. The quality of life was assessed by the EORTC quality of life questionnaire "QLQ 30" In its validated version translated into Moroccan dialect. The practice of medical oncologists was evaluated using a semi-structured questionnaire designed for the study.
Results: 125 patients were enrolled between February 2016 and January 2017, the median of age was 51 ± 11,5 years old, 62.4% were male, 71.2% with colorectal cancer, and 19.2% had breast cancer, 60.8% and 37.6% had capecitabine as a first line chemotherapy and in monotherapy respectively. 58.4% of patients preferred oral therapy, the reasons for this preference included: less frequent travelling (52%), avoiding intravenous injection (12%), improved tolerance (14.4%), availability of treatment (4%), better quality of life (1.6%). The detected side effects were mainly of grade 1 and 2. The overall adherence rates were 92% and 90.4% when using self-report, and with pills count respectively. 88% were considered to be adherent (with an overall of adherence > 95% by two indirect methods). Reasons for non-adherence were forgetting to take treatment, and side effects. Factors correlated with non-adherence were living location (p = 0.04) and age (p = 0.07). The involvement of family members was reported in 54.6% of the cases. The overall health score is estimated at 58.88, financial problems were very common, and it was the most affected dimension with a score average of 79.2. Patients with more symptoms tended to be less adherent. 91 medical oncologists were included in the evaluation of the practice of capecitabine prescribing, participation rate among the regional centers practitioners was 100%. Manual prescription forms are still very common (32%), most physician (92.3%) assess adherence through patient interview, 87.9% of them never received specific training in patient therapeutic education.

Conclusion:
Capecitabine based therapy is associated with a nonneglectable risk of non-adherence. There is a great variability among oncologists in regard of capecitabine in prescribing and follow-up practices. Thus, it's necessary to promote adherence to oral antineoplastic, mainly by developing local strategies that fit our context. MODC advanced its operation from six-bed capacity increased to 20 beds, accommodating an increasing number of referred cancer patients. In 2018, the oncology quality improvement team (Onco-QIT) reviewed the occupancy rate (87%) and perceived as below optimum bed utilization despite a 300% increase in bed-capacity. Many factors were identified through root cause analysis (e.g., delay in chemotherapy schedules, unnecessary chemotherapy inpatient admissions, no clear bed management pathway, and a high rate of no show on appointment (NSoA) (15%). The aim was to achieve 100% optimum bed utilization through BUMP within six months that will impact on lowering the rate of highcost unnecessary patient's admission.

Methods:
The Onco-QIT selected the FOCUS-PDCA model. Its nine steps stand for F = find a problem, O = organize a team, C = clarify the problem, U = understand a problem, S = select an intervention, P = plan, D = do, S = study, and A = act. The sources of data collection were key performance indicators on bed occupancy rate and no show on appointment.
Result: There were two positive outcome results of this quality improvement initiative. The average bed occupancy rate was 98%, and NSoA was 7% within three quarters. The BUMP consists of comprehensive strategies and interventions that were measurable by outcome indicators. First, the Onco-QIT developed and implemented a bed management pathway to improve bed utilization in MODC from pre-admission, admission, bed management, and discharge/transfer. Second, the center hired an oncology case manager is an integral part of bed management in triaging and allocating the patient's bed on admission. The case manager increases the frequency of bed utilization for short term and intermediate chemotherapy beds more than once per day. Third, the Pharmacy interventions consist of compliance of single-agent and long term protocol guidelines, periodic communication of unavailable chemotherapy drug list to MODC, and acquiring new oncology satellite pharmacy. Fourth, there was a significant reduction of No Show in MODC after the implementation of a reminder system by the admission clerk via mobile messages or calls to the patient for the appointment confirmation. Since the program is a continuous dynamic development, all nurses were chemotherapy certified. Lastly, the OQT developed five policies based on the accreditation standard of cancer care services.

Conclusion:
Overall, the implementation of the bed utilization management program is vital in managing cancer patients. It minimizes the high rate of admission cost and maintains the chemotherapy time table plan of the patient.

Trends of Patients Perception About Cancer Causes and Risk Factors Over Time
Mohammad Alkaiyat 1 , Khadega Ahmed 1 , Hussam Ardah 2 , Abdul Rahman Jazieh 1 1 Department of Oncology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, KSA; 2 King Abdullah International Medical Research Center, Ministry of National Guards Health Affairs, Riyadh, KSA Introduction: Patient perception and prevalent myths about cancer are very important to recognize as they may interfere with cancer management and control efforts. In this study, we evaluated patient's perceptions about cancer causes and risk factors and its evolution over time.

Methods:
Patients with cancer were enrolled in a crosssectional study about the perception of cancer and the use of complementary and alternative medicine (CAM). The patients were enrolled between 2006 and 2018 in two cohorts. Cohort 1 enrolled between 2006 and 2008 and cohort 2 were enrolled between 2016 and 2018. The perception about causes of cancer and cancer prognosis were obtained and analyzed with comparison between two cohorts of patients.
Results: A total of 1416 patients were enrolled in the two cohorts (Cohort 1 N = 464 patients and cohort 2 N = 952). The two cohorts matched in age and gender. 224 patients (23.5%) of cohort 2 gave scientific causes for cancer compared to 63 (13.6%) of cohort 2. Females were more likely to give mythical causes of cancer. There was significant increase in the belief of evil eye (1.29% to 33.09%), evil spirit (0.2% to 5.15%) and reduction in jealousy (29.74% to 5.57%) from Cohort 1 to Cohort 2. Considering smoking as cancer risk increased from 1.29 % to 4.52% only.

Conclusion:
Our study revealed common misperceptions about cancer that require systemic approaches for patients and public education to minimize any negative impact of these misconceptions on patient's management, quality of life, and outcome.
Results: 41% of patients were taking 10 more medications, 35% were taking 6-9 medications, and 16% were taking up to 5 medications. Only 2% were taking 1-4 medications. 59 diabetic patients have documented clinical hypoglycemia while on diabetic agents. Other clinical findings were hypotension, dehydration, bleeding, acute renal damage, and falls. Most common medications were anti-hypertensive, diuretics, diabetic medication, over the counter pain medications, narcotics, and anticoagulants.
Conclusion: In our cohort of 100 patients, there is an alarming prevalence of poly-pharmacy in last 60 days of life, our finding is tip of the iceberg for this widespread quality of care issue. Due to fragmented presence of primary care in geographical diverse areas of Saudi Arabia, elderly patients with cancer are bearing the most burdens and significant side effects related to absence of this robust primary care oversight during the course of cancer treatment. About 15% of patients who have emergency room visits and eventual admissions to hospital, were found to have potential side effects of these non-indicated therapeutics.

Improving Coordination of Lung Cancer Care at Ministry of National Guard Health Affairs -Central Region
Abeer Alkhathlan 1 , Razan Alfaiz 1 , Ghaida Almusallam 1 , Esraa Arabi 1 , Mohammad Alkaiyt 2 , Abdul Rahman Jazieh 2 1 College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, KSA; 2 Department of Oncology, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, KSA Introduction: The improvement of healthcare outcomes is the ultimate aim for any health institution. Coordination of care is very critical for providing safe and efficient care. The aim of this study is to improve the care coordination for cancer care which involves patients flow in the healthcare system and providing care that is safe, timely, efficient, effective, and patient-centered.

Methods:
We conducted a prospective study to collect data to be used as baseline for a rapid cycle of improvement PDSA (plan-do-study-act) project. We began with collecting and analyzing data for lung cancer patients who were diagnosed in 2016/2017, collecting information about their demographics, the interval between suspecting cancer and confirming diagnosis, the interval between cancer diagnosis and receiving definitive cancer therapy, tumor board (TB) data (presentation, adherence to recommendations, TB compliance), and palliative care.
Results: A total of 60 cases of lung cancer were evaluated in 41 males and 19 females. The majority of these cases had adenocarcinoma (63.3%) and squamous cell carcinoma (23.3%). The stages of the tumors were as follows: 42 stage IV (70%), 7 stage II (11.7%), 6 stage III (10%), 2 stage I (3.3%), and 3 stages were missing (5%). Adherence to guideline of EGFR testing was 100%, while it was 82% for ALK, and 71.4% for ROS1. PDL-1 testing was done for 59.5% in stage IV patients. The median number of days from first visit to oncologist and the palliative care referral is 35 days [0-643]. Specifically, for stage IV patients, 32 (76.2%) were referred to palliative care. For presentation in tumor board, 40 (66.7%) of all patients had presented in the tumor board, some of these cases presented multiple times; the total presentation in tumor board is 65 times. Of these presentations, 31 (51.7%) were before treatment and 9 (15%) were after. The presentation of these cases revealed new findings in pathology 3 (7.5%), in radiology 7 (17.5%) and 5 (12.5%) had stage related new findings. In total, these new findings appeared in 11 (27.5%) unique cases. Tumor board discussion had shown an impact in 14 (37.5%) out of 40 patients presented, while the impact reduced to 14 (21.5%) out of 65 for each time the patient were presented in tumor board.

Conclusion:
The molecular testing for actionable targets beyond EGFR was limited by the inadequate tissue which was minimized by the implementation of next generation sequencing (NGS). Better processes for referral to palliative care and tumor board presentation are being implemented.
Introduction: Cancer-related terminal illness brings many uncertainties for patients and families, which further creates enormous psychosocial, physical, and existential burden, and it is of an imperative value to learn and implement complex advance care planning via team approach in all metastatic cancer patients on early basis.

Methods:
We conducted a retrospective analysis of a cohort of 103 patients who died in the palliative care unit during the year 2018. There were 43 males and 60 females, among them 101 of Saudi citizens and 2 patients were other nationalities.

Results:
In this cohort, advance care planning was made during last few weeks of life. Our data analysis revealed that 66% (68 patients) died within 30 days, among them 46.6% (48 patients) within 14 days, 28% (28 patients) within 7 days, 14.5% (15 patients) within 3 days, and 4% (4 patients) died during same day of transfer to palliative care service.
Conclusion: Complex advance care planning was made quite late in these terminally sick patients with advance malignancies, which resulted in tremendous burden of futile management and poor quality of life for patients and caregivers.
In a recent study published online on Nov.16 in JAMA Oncology, several quality indicators were identified which have highest potential to reduce spending without compromising high-quality oncology care, one of the quality indicators was "early discussion of limitations and consequences of treatment" i.e., advance planning.

Introduction:
The palliative care needs are on the rise across Gulf countries with economical and quality of health-care implications. Our study aimed at conducting cost analysis of a hospital-based palliative care program for patients with cancer in tertiary cancer hospital in Saudi Arabia.
Methods: Retrospectively, we collected the data of patients who passed away in the palliative section of the oncology department in 2017-2018. Using standardized data collection tool that focusses on the patients' resources utilization science their transfer to palliative care.

Results:
We collected the data of 103 patients who died in palliative care unit (PCU) during the study period. Mean length of stay in PCU was 18 days. 73.5% of patients had at least one invasive procedure, 20.6% of patients had two procedures, 2.9% had three invasive procedures and another 2.9% had up to six invasive procedures. 82.5% visited ER one time, 15.5% have two ER visits, and 1.9% has 3 ER visits. Substantial number of patients were transferred to PCU in just 10 days before death. 80.6% of patients have no outpatient visit after enrollment to Palliative Care Services while remaining patients visited only one time to outpatient palliative care. Complex advance care planning was made during last few weeks of life. Most patients have multiple daily labs and radiological investigations.

Conclusion:
Palliative care is very much needed nowadays across Saudi Arabia, and having cost-effective care requires step-down programs. Early complex advance care planning is an essential tool to combat futile management. Deaths in hospital may reflect limitations for palliative care providers for alternate placements. Current evidence for high prevalence of futile management at the end of life would increase the cost of palliative care program sky high while having no evidence of potential benefits in terms of reduction of morbidity and mortality and would also increase poor quality of life for terminally ill patients with cancer and their caregivers. Introduction: Documentation of goals of care for patients with advanced cancer is known to be poor worldwide. At King Abdulaziz Medical City Oncology Center, we observed that many patients with advanced cancer undergo critical care interventions which have limited benefit, more cost and stress to patients, families, and providers. The main reason for that is lack of timely decision and documentation of goal of care. Our quality improvement project aims to assess the magnitude of the problem in order to improve the practice.

Prevalence of Futile Acute
Methods: A multidisciplinary team reviewed retrospectively the records of cancer patients who died in hospital at our department from November 2017 until May 2018. The collected data included stage, type of cancer, aim of therapy, causes of death, need for critical care interventions and the time of documentation of goal of care. Our definition for the timely documentation of goal of care is the availability of electronic documentation for code status before the patient needs critical care response team (CCRT), code blue or intensive care unit (ICU) admission.

Results:
A total of 161 case were reviewed, 90% of the patients had advanced cancer, 90% died due to disease progression; however, only 52.8% had timely goal of care documentation and 26.7% of them died in ICU. The intent of treatment was palliative for 83% (n = 135). Analysis of those 135 cases showed that the goal of care was timely documented in only 59.3% of them and 31.4% died within 7 days of the goal of care documentation, 25.2% and 31.9% of them had CCRT activation and ICU admissions, respectively. 70.4% were referred to palliative care, 64.2% of those referred to palliative care died within 30 days of referral.
Conclusion: Delayed goal of care documentation resulted in improper utilization of ICU beds, intubations, and mechanical ventilation. Interventions to reduce this futile practice are underway.

Straight to CT: A Review of the Lung Cancer Diagnostic Pathway in Patients with Suspected Lung Cancer Alexander Sheeka, Susannah Bloch
St. Marys Hospital, London, UK Introduction: The National Optimal Lung Cancer Pathway (NOLCP) is the current gold standard for investigating patients with suspected lung cancer. As part of the pathway, a 6-day time-limit is recommended from acquisition of a chest x-ray to patient attendance in clinic with a reported chest CT-Scan. The purpose of this paper is to compare the lung cancer diagnostic pathway at our hospital to the set NOLCP standard.

Methods:
The clinical records of 55 patients (33 outpatients, 22 inpatients) referred through the lung cancer pathway between September and December 2018 were reviewed. Data was Glob J Qual Saf Healthc 2020 -Abstracts http://www.jqsh.org acquired regarding the time from initial x-ray acquisition to reporting, time from x-ray reporting to CT chest acquisition, and the total time from x-ray acquisition to CT chest reporting.
Results: Of the 33 outpatients median time from x-ray acquisition to report was 12.6 hours, from x-ray report to CT completion was 173 hours, and x-ray report to CT report was 213 hours. Of the 22 inpatients median time from x-ray acquisition to report was 18 hours, from x-ray report to CT completion was 215 hours, and x-ray report to CT report was 317 hours.
Conclusion: Based on this preliminary review the total time from lung cancer suspicion to CT reporting is significantly longer than the currently recommended national guidelines. As a result, funding has been given to triple the dedicated lung cancer CT scanning slots at our hospital trust. Currently data is being collected for a re-audit to assess the necessary number of scanning slots to achieve the NOLCP guideline time.

Rani Qassem, Eman Alshmmeri, Lubna Alhydan, Atheer Alkeraidees, Amjad Abdullah
King Saud bin Abdulaziz University for Health Sciences, Riyadh, KSA Introduction: Liquid chromatography-mass spectrometry (LC-MS) is a novel method which can measure the acetate content in different pharmaceutical peptides, as well as amino acids sequence, mass, and purity. The objective in this study is to assess the sensitivity and specificity of the LC-MS/MS method in comparison to high-performance liquid chromatography (HPLC) method in measuring the acetate content in cetrorelix, which is the drug used as synthetic deca-peptide with gonadotropin-releasing hormone (GnRH) antagonist effect.

Methods:
We studied the acetate content in injectable cetrorelix by the two methods (HPLC and LC-MS/MS). In LC-MS/MS method, cetrorelix was the active pharmaceutical ingredient (API) and formic acid was the solvent. The method uses gases to run the experiment with added C13 labeled acetate. 12 samples were prepared containing 10 ug/mL C13 and 1 mL C12 acetate with different API concentrations. LC-MS/MS method require to switch the ionized mode into a negative mode in order to measure the acetate content, then switch it to positive mode in order to detect other impurities.

Results:
In the LC-MS/MS method average concentration for acetate is 0.0810 and 0.0836 in milligrams per vails for all samples, which were similar in both methods with recovery percentage accuracy 98.8%. The method was linear for acetate concentrations with a coefficient of determination (r2) equal to 0. The relative error of the calculated concentrations and actual ones were less than 5% for all reading. According to the chromatogram, the drug purity is 95%. In addition, the calculated molecular weight was equal to 1429.5 g/mol. Acetate peak retention time was 7.5 min using the HPLC method compared with 13 minutes using the LC-MS/MS.

Conclusion:
LC-MS/MS method is multiplexed method that help collecting quality criteria required in regulatory submissions such as the Food and Drug Administration in a single experimental setting. As a result, this helps in minimizing the cost and save time and effort.
Introduction: Organ dysfunction in cancer patients is common. It poses a dilemma for the treating physicians who should tailor the doses while prescribing chemotherapy. Caution is compulsory since most cytotoxic drugs exhibit a narrow therapeutic index; this implies that an inappropriate reduction in dose may lead to undertreatment of patients. In contrast, the absence of dose reduction, when clinically indicated, may lead to excessive toxicity.

Methods:
The published dosing recommendations are available on the networks. They were reviewed and compared to find out their shortcomings and the strategies in which the physician-incharge are using in daily practice.
Results: Several shortcomings were found: They are largely empiric. They are frequently based on case studies or retrospective observations in small numbers of non-homogeneous patients.
There is paucity of formal Phase I studies on pharmacokinetics and clinical toxicity. Most of the time, organ-impaired patients have been excluded from clinical trials. They are derived from clinical data that are decades old and preceding the routine use of supportive drugs, e.g., colony-stimulating factors. There is inconsistency in the definitions used for organ dysfunction, e.g., there is no standardized system with which to define liver or renal dysfunction. In oncology drug labels, the statement insufficient data available in renal and hepatic impaired patients, caution should be exercised presents a subjective approach rather than personalized medicine for cancer patients. To improve the patient experience and to try and alleviate pressure on the preparation pharmacy and nursing services during peak times we investigated the feasibility of an early medication preparation and release program. This would enable rapid admission, assessment and administration of the pre-prepared treatment and in turn have a positive impact on patient flow and equalize the pressure felt by the preparation pharmacy.

Methods:
In this quality improvement project we formed a committee that met on biweekly basis, this committee included representatives from nursing, quality, pharmacy, data analysis and was led by a consultant physician. We studied the baseline data of patient waiting times from January to March 2019 and factors that caused patient delays in being treated. Patient selection criteria were prepared to identify patients that could safely have their medication released early in the morning at 7 am enabling pharmacy to dispense at 8 am without their actual presence being required in the infusion suite. Multiple PDSA (plan-do-study-act) cycles with several process changes and educational interventions were implemented to achieve our goal. The data collected included check-in time, chair time, vital signs time, administration time and discharge time, finally we collected data on any patients who did not receive medication that had already been prepared which resulted in drug wastage and the reasons why.
Results: Baseline data identified that the average waiting time for patients receiving similar medications to those identified in the medication early release program (MERP) was 2.27 hrs a with a range of waiting times between 33 minutes to 5.07 hrs. After the first intervention the average waiting time reduced to 1 hr and 24 minutes through each PDSA cycle we could see small improvements in the average time. The major breakthrough appeared following the intensive patient education program and enforcement of strict compliance with the criteria in selecting patients appropriate for the early release program. We reached our goal of 1 hr in the 8th month of the programs. We identified drug wastage for patients who did not show up for treatment as a balancing measure. We were successful in reducing the drug wastage by applying several changes and patient education measures.

Conclusion:
A positive impact has been seen with a significant reduction in the average waiting time from 2.24 hours to 1 hour exactly. With further interventions relating to patient education and root cause analysis of any patients who are spending longer than necessary in the waiting area we aim to improve this further, an expansion of the pharmacy´s capacity to prepare more than 10-15 preparations between 7-8 am may give rise to a further expansion of the criteria for patients to be included in the MERP pathway.

Results:
One hundred and four patients with H score < 2 were negative for ERCC1 (57.5%) and 77 patients with H score ≥ 2 were positive for ERCC1 (42.5%). Disease-free survival (DFS) showed no difference between ERCC1-negative and positive cases. The median progression-free survival (PFS) for patients receiving oxaliplatin-based chemotherapy in the metastatic setting is higher in ERCC1-negative cases (median: 11 months, 95% CI: 7-14 months) than ERCC1-positive cases, and overall survival (OS) showed no difference between ERCC1-negative and positive cases. KRAS was positive in 89 patients (49.2%) and negative in 92 patients (50.8%). The DFS showed no difference between KRAS-negative and positive cases, and the median OS is significantly prolonged in KRAS-negative cases. BRAF was positive in 46 patients (25.4%), which is higher percentage in Egyptian patient than other patients, and negative 135 patients (74.6%). The 3 and 5 years DFS is higher in BRAF-negative cases. However, the difference is not statistically significant, and the median OS is significantly longer in BRAF-negative vs. positive cases.
Conclusion: ERCC1 is predictive factor for response to oxaliplatin and PFS in metastatic diseases. BRAF may have higher percentage among Egyptian patients (25%), and BRAF score is a prognostic factor of DFS. KRAS and BRAF are prognostic factors for OS.

Hematological and Digestive Toxicity Profile of Platinum Salts Zoubir Derbouz, Aimene Melzi, Sarah Henni Manseur, Nora Kessi, Adda Bounedjar
Blida University Hospital, Blida, Algeria Introduction: The toxicity of platinum salts is a factor that can hinder the proper use of treatment and put at risk the vital prognosis of patients including hematological digestive and toxicity. Given the absence of this type of national clinical research, we took this initiative to describe the profile of the hematological and digestive toxicity of platinum salts in the Algerian population. The purpose is to describe and evaluate the hematological and digestive toxicity profile of platinum salts (cisplatin, carboplatin, and oxaliplatin), both biologically and clinically.
Methods: This is a prospective descriptive study, which was conducted at the medical oncology department of Blida University Hospital between January 2017 and May 2017. We included patients receiving one of the three platinum salt molecules. The evaluation of different grades of toxicity was made based on the World Health Organization (WHO) toxicity rating is noted with the class of platinum salts. It is more marked for oxaliplatin and cisplatin (41% and 42%, respectively) compared to carboplatin (19%). The depth of decrease in hemoglobin between the baseline and the fourth cycle is greater for cisplatin (15%) and carboplatin (12%) than for oxaliplatin (6%). The platelet reduction rate variation between the baseline and the fourth cycle with oxaliplatin and carboplatin is 16% and 14% respectively. A slight increase of 2% is observed with Cisplatin. About 20% of patients had Grade I or II leukopenia and neutropenia, and only 10% had Grade III or IV. Cytopenic grades I and II are similar for all three molecules, but no grade III and IV toxicity with cisplatin. Grade I and II anemia is very common with carboplatin (31%) and oxaliplatin (19%) and rare with cisplatin, whereas severe grade III and IV anemia is exclusive for carboplatin. The digestive toxicity of platinum salts is more pronounced with carboplatin and oxaliplatin. More than half of the patients have CINV (chemo-induced nausea and vomiting), 44% diarrhea, and 34% constipation (all grades combined). Grade I and II mucositis and stomatitis are very common with carboplatin while Grade III and IV stomatitis are observed only with oxaliplatin and cisplatin (3% and 1%). Grade I and II nausea and vomiting are present with all molecules at the same frequency, while grades III and IV are more marked with carboplatin.

Conclusion:
A carboplatin is the most hematotoxic molecule with an occurrence frequency of 8% leukopenia, 12% neutropenia, 2% thrombocytopenia, and 33% anemia. Cases of thrombocytopenia have been observed exclusively with carboplatin with a frequency of 2% (grade I and II). It is estimated that there is more than 40% incidence of mucositis according to the literature. For our population, the incidence is 65%.

Faculty of Medicine of the University of Porto, Porto, Portugal
Introduction: Risk-sharing agreements (RSA) are typically implemented to manage uncertainty related to clinical benefits and cost-effectiveness in the real world. Thus, they allow the patient to have faster access to innovative medicines since there is a financial risk sharing between payer and the pharmaceutical industry. This type of agreements is used internationally in cancer medicines, as this is a constantly developing area. Gonçalves FR et al. (2018), mention that in Portugal, 40% of the RSA are in Oncology. This work aims: (1) to assess the knowledge and experience about the RSA from professionals who work in the Portuguese Health Care System; (2) to determine the experience of Health Institutions with this type of agreements; and (3) to identify the barriers that exist for the application of the RSA.

Methods:
A literature review was performed to develop the questionnaire to apply in our study. Afterwards the questionnaire was refined with the help of experts in the area and a pre-test was performed. This questionnaire will be sent to all Portuguese hospitals in February 2020 via a Google form and will be available for 1 month. It will be addressed to hospital administrators, hospital management staff and hospital pharmacists. An adapted version of the questionnaire will also be sent to the National Authority of Medicines and Health Products, I.P (INFARMED).

Results:
We expected to observe that Portuguese Health Care System professionals are familiar with the RSA. We also target to quantify the number of RSA in Portugal and to classify their type. We think the results will show that RSA are not being used in most of the Health Institutions, although surveyed professionals recognize the potential value in their use. The two biggest barriers we expect to find in the application of RSA are the lack of human resources and computer systems that allow quick and simple information acquisition and assessment.

Conclusion:
The questionnaire will be very useful for gathering information on the topic of RSA and understanding the perception of the healthcare system professionals in Portugal, particularly regarding the application of RSA. It will also increase understanding about barriers/challenges that this type of agreement face, allowing the development of strategies to improve their use.

Access to Cancer Therapeutics in Private Practice Setting in Algeria
Houda Jamous, Nezha Benharrats, Aicha Ikash The Hope Oncopole Center, Oran, Algeria Introduction: Being the second cause of mortality and considering its incidence and the cost of its management which are evolving in an exponential way, cancer becomes a real public health problem in Algeria. Although the Algerian government finances cancer management with billions of dinars, it still cannot offer to all citizens suitable healthcare services regularly and continually. This reason opened timidly the doors to private clinics to alleviate the load and to facilitate and accelerate patients' access to care in better circumstances. The Hope Oncopole, Hope Cancer Care Center (CCC), Oran, Algeria, is a private cancer care center which started offering its services of radiation therapy about 2 years ago and chemotherapy from a few months ago. This study aims to describe the access of Algerians to private cancer care and cancer therapy, and the resources used and impact on patients.

Incidence of Colorectal Cancer in Saudi Arabia: A Nationwide Analysis and Projection to 2030
Glob J Qual Saf Healthc 2020 -Abstracts http://www.jqsh.org Introduction: Patients' satisfaction with their cancer care is a critical issue in assessing the quality of cancer care. In Saudi Arabia, cancer patients' satisfaction at tertiary care hospitals of Riyadh city has not been reported. This study aimed to assess the level of satisfaction with cancer care and related factors at a tertiary care teaching hospital in Riyadh City, Saudi Arabia.
Methods: Data were collected from patients based on a validated questionnaire (Quality Health/National Health Service, UK). A total of 266 cancer patients aged (19-85 years) were sampled. Descriptive statistics were reported and regression analysis to estimate the likelihood of satisfaction among this sample.

Results:
The majority of respondents were females (74%), age 54-62 years, with employment status as homemakers. The majority of the patients were satisfied with overall care provided and reported that their care needs were met. However, others were not satisfied with the given amount of information given about their condition and the treatment. Main reports of satisfaction were for: the time they were seen; sensitivity of breaking bad news; involvement in treatment and care; satisfaction with the hospital staff for doing everything they could to help control their pain; and given enough emotional support from hospital staff.

Conclusion:
Most of the surveyed patients were satisfied with the cancer care. However, there were several factors that were reported as unsatisfactory such as the satisfaction with the amount of information given about condition and the treatment. Future research is needed to assess the health system and sociocultural determinants of patient satisfaction with cancer care in the country as a platform for policy makers and cancer guidelines formulation.

Health-Related Quality of Life and Perceived Social Support Among Patients Receiving Palliative Cancer Care in Saudi Arabia
Manal Banaser 1 , Sami Alshammari 2 1 Nursing Affairs General Department, Ministry of National Guards Health Affairs, Riyadh, KSA; 2 King Fahd Medical City, Riyadh, KSA Introduction: Palliative cancer care is becoming a core aspect of cancer treatment. Cancer patients are increasingly demanding a multidimensional approach to care, including physical, emotional, psychological, and spiritual dimensions. Healthrelated quality of life (HRQL) is essential to the attainment of these functions. At the end of life care, patients require improved quality of life through palliative care, involving symptoms control, family support, and satisfaction, as well as a patients' sense of purpose and meaning. This study aims to describe HRQL, identify factors associated with HRQL physical and mental health domains, and explore the perceived social supports for cancer palliative patients in Saudi Arabia.

Methods:
A cross-sectional study design was used. The validated European Organization for Research and Treatment of Cancer, EORTC QLQ-15 palliative care scale, and the Perceived Social Support Scale (PSSS) were used. Additional sociodemographic and health status data were collected, including age, gender, education level, residency area, social status, time of diagnosis, and cancer type. A convenience sample of 301 adult palliative cancer patients from two Saudi regional cancer centers in Riyadh was included. Data were analyzed using SPSS descriptive statistics and correlational analysis.
Results: Results indicates that overall quality of life showed a significant positive correlation with perceived family and friend support, sub-factors of perceived social support. Regression analysis showed that the overall model experienced 69.0% of the variance for global health statutes with F (4, 7) = 7.149 p < 0.01. Physical functioning, emotional functioning, and family support were found to be significant predictors of global health status, whereas diagnosis time was found to be a significant predictor of global health status. Family and Friend support were found to be significant positive predictors of emotional functioning, whereas education level and diagnosis time were found to be significant negative predictors of physical functioning. However, diagnosis time was found to be a significant positive predictor of emotional functioning.

Conclusion:
The inpatient and outpatient treatment can vary at different stages and in different areas, family and friend support has been highlighted as necessary in this context. Physical and emotional variables have been highlighted in older age (geriatric) patients as they may have debilitating diseases that can limit their functioning hence support the case for more palliative care.