Transfer of care after virtual oncology second opinions.

Abstract

e23212 Background: Virtual oncology second opinions have expanded access to subspecialty expertise, potentially reducing geographic and structural barriers to care. However, their impact on management decisions and transfer of care (TOC) remains poorly understood. We evaluated patient characteristics, diagnostic and treatment changes, and factors associated with TOC following virtual oncology second opinions at a large academic cancer center. Methods: This retrospective study included patients with an oncologic diagnosis who sought virtual second opinions at Stanford Cancer Institute (SCI) between January 2018 and December 2024. This study was approved by the Stanford Institutional Review Board. Collected variables included age, sex, zip code, oncologic diagnosis, year of consult, diagnosis change, whether there was treatment change, and transfer of care. Geographic distance to SCI, rurality (RUCA code), and social vulnerability index (SVI and subscales) were derived from zip codes. Statistical analyses were performed in R (version 4.5.1), using chi-squared tests for categorical variables and Mann-Whitney U tests non-normally distributed continuous variables. Results: Of the 3,669 patients in this cohort, 697 (19.0%) transferred their care to Stanford. This did not differ by age, sex, or rurality. Patients who transferred care were more likely to live in California (70.7% vs. 33.1%, p < 0.001) and live within 100 miles of SCI (59.8% vs 24.0%, p < 0.001). Overall, SVI and socioeconomic or household composition SVI subscales did not differ, while higher vulnerability in housing/transportation (21.1% vs 15.5%, p = 0.02) and racial/ethnic and language status SVI subscales (29.6% vs 17.1%, p < 0.001) were observed among those who transferred care (Table 1). There was no difference in rate of diagnosis change. Although major and minor treatment changes were more frequent among those who transferred care (54.4% vs 49.4%), this difference did not reach statistical significance. Conclusions: TOC after virtual oncology second opinions appears to be driven primarily by geographic proximity rather than demographics or diagnostic change, with higher social vulnerability observed among patients who transitioned care. Ongoing analyses will further characterize factors influencing TOC following virtual second opinions. Patient characteristics by transfer of care status. Transfer of Care N (%) Yes (N = 697) No (N = 2972) Average age (years) 57.8 56.6 Gender Female 375 (53.8) 1613 (54.3) Male 268 (38.5) 1146 (38.6) Other/Unknown 54 (7.7) 213 (7.2) California Residence 493 (70.7) 985 (33.1) Less than 100 miles from SCI 417 (59.8) 714 (24.0) High Social Vulnerability Index Subscales Socioeconomic Status 28 (4.0) 140 (4.7) Housing 29 (4.2) 152 (5.1) Race/Ethnicity & Language 206 (29.6) 507 (17.1) Housing & Transportation 147 (21.1) 462 (15.5) Diagnosis Change 47 (6.7) 212 (7.1) Treatment Change (major or minor) 379 (54.4) 1467 (49.4)