An APP-led intake model to expedite diagnostic workup for patients with suspected lymphoma.

Abstract

e19111 Background: Lymphoma is a rare, heterogeneous malignancy that often presents with symptoms resembling benign, autoimmune, or other malignant conditions. At large academic centers, rapid clinical assessment is essential to improve outcomes, yet a “biopsy first” approach can delay diagnosis, heighten anxiety, and fragment care. To address this gap, we launched an Advanced Practice Provider (APP) intake clinic for patients with Suspicion of Lymphoma (SoL) to expedite workup and triage before physician evaluation. Methods: The SoL APP intake clinic launched on 10/21/24, with twice weekly sessions to prepare patients for a full diagnostic workup. Eligible patients had “Green” insurance and resided in licensed states (TX, OK, LA, FL). The APP led evaluation included labs, CT or PET imaging, and ordering core needle and/or bone marrow biopsies. Patients with benign findings but ongoing clinical concern remained under surveillance, including those with small volume, non biopsiable adenopathy or atypical lymphocytes. Confirmed lymphoma cases were classified as aggressive or indolent, and timelines to diagnosis, first physician visit, and treatment initiation were recorded. Aggressive lymphomas included Hodgkin, diffuse large B cell, mantle cell, and T cell lymphomas; indolent lymphomas included nodular lymphocyte predominate Hodgkin, marginal zone, mucosa-associated lymphoid tissue, and follicular lymphomas. Results: Between 10/21/24–1/14/26, 99 patients were evaluated (age 18–98, mean 58; 48 female, 51 male). 40 patients (40.4%) were diagnosed with lymphoma (20 aggressive, 20 indolent). One aggressive case had a prolonged 74 day diagnostic interval due to patient driven delays. Among the remaining 19 aggressive cases, median time to imaging was 1.5 days (range 1–10), to diagnosis 7 days (2–18), to physician visit 10 days (3–35), and to treatment start 19 days (5–49). For the 20 indolent cases, median time to imaging was 4 days (1–28), to diagnosis 9 days (1–25), and to physician visit 17 days (3–29). 15 indolent cases required treatment, with a median time to treatment initiation of 36 days (14–66). Conclusions: This pilot analysis shows that an APP led SoL intake clinic is feasible and accelerates lymphoma workup and treatment initiation. The model achieved shorter diagnostic timelines compared with historical physician led pathways and efficiently redirected physician resources toward confirmed malignancies while maintaining surveillance for high suspicion benign cases. Future initiatives targeting broader community engagement and clearer insurance pathways are expected to strengthen patient access and program reach. SoL Clinic Diagnosis # patients (n=99) % of total patient evaluated Lymphoma 40 40.4% Benign with high suspicion and long term follow up 24 24.2% Benign with low suspicion of lymphoma 13 13.1% Other Hematologic malignancy/disorder 11 11.1% Solid tumor 7 7.1% Sarcoidosis 4 4.0%