PROJECT SUMMARY/ABSTRACT Each year >500,000 Americans diagnosed with cancer have tumors that could be targeted with an FDA- approved drug to treat their disease more effectively. However, there is wide variation in use of these treatments in clinical practice. Rural patients, who are more likely to die from cancer than their non-rural counterparts, are less likely to receive targeted cancer therapies and could benefit greatly from interventions to address this quality gap. This study will test the effectiveness of our Multi-TEAM Systems Framework Precision Oncology Reflex Testing (TEAMSPORT) intervention to standardize delivery of targeted cancer therapy and adapt it for use in rural and non-rural community cancer programs, where the majority of cancer patients receive their care. Our experienced multidisciplinary team of molecular pathologists, medical oncologists, rural implementation scientists, and team system scientists will be augmented by a Community Advisory Board of community-based pathologists, oncologists, cancer program administrators, and cancer network leaders representing approximately 1,000 community oncology programs. Together they will ensure the most cutting-edge, evidence- based precision oncology science will be supported by best practices in effective inter-team coordination and packaged for optimal uptake by rural and non-rural community cancer programs. In this modular R01, responsive to NCI priorities to evaluate geographic disparities in technology dispersion and further team system science, we will conduct an interrupted time series study to test the effectiveness of the TEAMSPORT intervention on guideline-concordant genomic testing and team coordination. We will simultaneously work with community collaborators to adapt the intervention to community settings and test its acceptability, feasibility, appropriateness, and adoptability among a large sample of community cancer programs. This scientific study will result in: 1) An evidence-based toolkit to increase appropriate use of genomic testing and targeted cancer therapy, suitable for rural and non-rural community cancer programs 2) One of the first tests of the effectiveness of a multi-team system intervention, and the impact of relational coordination, a validated measure of team connectedness, on quality of care 3) Effect sizes of a multi-team system intervention for use in future practice-randomized trials 4) Locally-endorsed, best practice protocols for precision oncology testing and reporting 5) A novel audit and feedback platform for institutions to assess adherence to national guideline recommended precision oncology practices Ultimately, this study has potential to lead to greater job satisfaction among cancer care providers; wider and more timely use of genomic testing and appropriate cancer therapies; better cancer outcomes for patients; reduced harms from unnecessary treatment; and a reduction in rural-urban cancer disparities.

PUBLIC HEALTH SIGNIFICANCE Each year >500,000 Americans diagnosed with cancer have tumors that could be targeted with an FDA- approved drug to treat their disease more effectively. However, there is wide variation in use of these treatments in clinical practice. Rural patients, who are more likely to die from cancer than their non-rural counterparts, are less likely to receive targeted cancer therapies and could benefit greatly from interventions to address this quality gap.