- Email: [email protected]
218 Prognostic expectations for patients with glioblastoma multiforme in a population-based cohort
CARO 2 0 0 6
volume, 24-72 hours following initiation of radiation therapy treatment. Seventy-eight percent of RO reported the incidence of flare pain was <20%. Flare pain was thought to occur less often after multiple than single fractions, and the majority did not feel this was related to the treatment volume or bony site treated. Eighty-eight percent of RO manage flare pain by altering medication and/or dosing regimens, however 91% do not premedicate patients thought to be at risk for flare pain. Conclusions: Flare pain is a recognized phenomenon occurring after palliative radiation therapy of bone metastases. While there was a general consensus among RO in Ontario on the incidence, duration and management of flare pain, this study highlights the need for further work on the etiology of flare pain, and how to identify and manage patients at risk. 215 Phase I Study of Hypofractionated Dose-Escalated Thoracic Radiotherapy for Limited-Stage Small Cell Lung Cancer D. Yee I, R. Halperin 2, J. Hanson 1, T. Nijjar z, C. Butts 1, M. Smylie 1, 7-. Reiman 1, W. Roa 1 Cross Cancer Institute, University of Alberta, Edmonton, Alberta'; Centre for the Southern Interior, Kelowna, British Columbia 2 don vee ~cancerboard. ab. ca
Purpose: To determine the maximal tolerated dose of hypofractionated thoracic radiotherapy given with concurrent chemotherapy for limited-stage small cell lung cancer patients. Methods and Materials: Patients received one of three radiotherapy dose levels. Radiotherapy was given in two phases: patients initially received 20 Gy in 10 fractions to gross tumour plus uninvolved mediastinal nodes followed by a boost to gross disease of 30, 38 or 42 Gy in 15 fractions. Accrual to the next highest radiotherapy dose level was done sequentially based on rates of radiotherapy-related acute toxicities observed at the current dose level. Radiotherapy was planned using conformal techniques. All patients received four cycles of Cisplatin (25 mg/m 2) and Etoposide (100 mg/m 2) chemotherapy. Radiotherapy commenced with day one of cycle two of chemotherapy. All complete/near complete responders were offered prophylactic cranial irradiation. The maximal tolerated dose of radiotherapy was based on the dose which caused unacceptably high rates of radiotherapy-related toxicity. Disease-free and overall survival rates were calculated from the date of registration onto the trial. Results: Thirteen patients were accrued. The trial was stopped after patients in the 58 Gy group completed all treatments due to excessive rates of radiotherapy toxicities observed in this group. All patients who commenced radiotherapy received all prescribed chemo- and radiotherapy. There were no treatmentrelated deaths. There was one Grade 3 acute non-hematologic toxicity in the 50 Gy group. Three of the six patients given 58 Gy experienced acute Grade 3 esophagitis. Median overall survival and disease-free survival was 10.9 and 9.4 months, respectively. There were no significant differences in diseasefree or overall survival between patients receiving 50 Gy or 58 Gy. Conclusions: The maximal tolerated d o s e of thoracic radiotherapy with concurrent chemotherapy on this trial was 50 Gy in 25 daily fractions. 216 Patient Expectation of the Partial Response And Response Shift in Bone Metastases E. Chow I, H. Chiu I, M. Doyle ~, G. Hruby 2, L. Holden 1, E. Barnes ~, M. Tsao ~, C. Danjoux ~ Toronto Sunnybrook Regional Cancer Centre, Toronto, Ontario'; Royal Prince Alfred Hospital, Carnperdown, Australia 2 Edward. chow@sunnybrook, ca
Purpose: To define the minimum reduction in pain level patients would expect and to examine if response shift exists in the treatment of bone metastases with palliative radiotherapy. Methods: Patients with bone metastases were asked to quantify the minimal level of pain reduction by two months that
September 13-16
$63
they considered would justify the palliative radiotherapy based on their current pain (on a scale of 0 - 10 and a four point scale of none, mild, moderate or severe). At the two month follow up, they were asked the conventional "post-test" question -e.g. what is your level of pain now? In addition, they were asked to retrospectively re-evaluate their baseline "pre-test" level of pain - which is referred to as a "then test" e.g. how would you now rate your level of pain prior to radiotherapy? Results: A total of 217 patients were enrolled. The median minimum pain reduction they would expect from the radiation treatment at the time of consultation was four. Patient expected a reduction of 50 - 70% in their baseline pain following radiation treatment. At two months, 114 patients participated in the response shift study. Only 31 patients reported no change in the "pre-test" and "then test" pain scores. The other 83 patients (73%) did demonstrate a response shift but in opposing directions. Conclusions: Patients with bone metastases expected a 5070% reduction of pain score from baseline with the palliative radiotherapy. Response shift was observed in this group of patients. 217 Investigating New Models of Patient Self-Management: Evaluation of the Princess Margaret Hospital Lymphedema Clinic J. Nyhof-Young, K. Moore, P. Catton Princess Margaret Hospital, Toronto, Ontario joyce, nyhof-young@uhn, on. ca
Background: Lymphedema is a serious complication of breast cancer management. Its incidence following surgery _++radiation is 5-20%. For most of our patients, lymphedema is an unexpected complication and the lack of available or effective treatment has been dissatisfying (Ingber, Nyhof-Young, Gilhooly, Levin, 2004). In response, a Lymphedema Clinic was established within the Breast Cancer Survivorship Program at a major cancer hospital in Toronto (http://survivorship.ca). A "360 degree" formative program evaluation involving hospital, community and patient stakeholders was implemented to understand how to best promote effective patient selfmanagement of lymphedema, while most effectively leveraging limited program, hospital and community resources. Purpose: We describe the Lymphedema Clinic and its model of patient-centred care, document the evaluative process, and share lessons learned during program development and evaluation. Methods: 1) Needs/Barrier Assessments: semi-structured interviews with community service providers (12 of garment fitters, community oncologists, etc.) and referring family physicians (five) to improve patient access to support services. The support needs of male breast cancer patients (five interviews); Focus groups (n=4 patients) about functional apparel needs; semi-structured interviews about patient treatment choices (eight patients); 2) Development and evaluation of resources: daily self-management diary of home self-care (six patients). Lymphedema Risk Reduction educational pamphlet (six patients; ten multidisciplinary hospital staff); 3) Program Evaluations: Investigating the health outcomes and quality of life of patients in the Lymphedema Clinic (eight patients). Survey of overall program (13 patients), patient satisfaction with the Look Good Feel Better Skin and Nail Care Educational Workshop (ten patients). Results/Conclusions: The Lymphedema Clinic is providing an innovative and replicable template for the provision of information, as well as psychosocial and clinical support to lymphedema patients and their caregivers. Recommendations will be made to improve the support, education and coaching for the self-management of lymphedema. 218 Prognostic Expectations for Patients with Glioblastoma Multiforme in a Population-Based Cohort A. Mahmud, M. Brundage, A. Caissie, J. Tonita, H. Chalchal Cancer Centre of Southeastern Ontario, Queen's University, Kingston, Ontario
$64
September 13-16
aamer, mahmud@krcc, on. ca Objectives: To compare the survival outcomes of a population-based cohort of glioblastoma multiforme (GBM) patients (patients) treated with radiotherapy to that predicted by prognostic stratification based on patients treated in a clinical trial setting. Methods: The medical records of 248 pts diagnosed with GBM were reviewed using the Saskatchewan Cancer Registry. The patients treated with radiation therapy (RT) were then divided into four groups (gps) based on prognostic factors of age (<50 & >50 years), performance status (ECOG) and surgical procedure (biopsy alone & complete or subtotal resection). The survival outcomes of each group were then contrasted to those identified by the RTOG recursive partitioning database reports. Results: All 248 patients had pathologically proven disease. Two-hundred and three patients were >50 and 45 were <50 years old at the time of diagnosis. One-hundred and fifty-six patients had an ECOG status of 0 or 1 whereas 92 had ECOG of 2, 3 or 4. Fifty-one patients had complete or near complete resection, 115 had subtotal resection, and 82 had biopsy alone. Only 12 patients had chemotherapy. Two hundred and eleven patients received RT. Forty-four received a dose of 40Gy, 25, 41-50 Gy and t42, >50 Gy. Median survival (MS) of patients who received RT was 8 months. Of these, 29, 88, 70 and 24 patients met the criteria for RTOG class III, IV, V, and VI respectively. The observed median survival durations in these groups were 12, 9, 7 and 3 months respectively (p<0.001). These median survivals were substantively less than the corresponding rates reported in patients treated on clinical trials (RTOG class III: MS=17.9 months [lower 95%C.I.= 15.5 months]; class IV 11.1 [10.4]; class V 8.9 (8.3) and class VI 4.6 [4.3] months. Conclusions: The classification of GBM patients into groups based on prognostic factors remains valid, but the observed median survivals in a population-based cohort fall below the bounds estimated for those in patients treated on clinical trials. The findings have important implications for counselling patients in the community setting. 219 Globally-Targeted Undergraduate Medical Education: The Virtual Experience in Radiation Oncology (VERO) J. Kamra I, J. Nyhof-Young 2, L. Holden 1, G. Gillies 1, C. Hayter j Toronto Sunnybrook Regional Cancer Centre, Toronto, Ontariol ; Princess Margaret Hospital, Toronto, Ontario 2 ]uh u. kamra @sw. ca
Background: Many patients receive radiotherapy (RT) as cancer treatment. All physicians need some knowledge of radiation oncology (RO), given the significance of cancer as a health problem. North American medical students receive little or no exposure to RO (Hayter and Nyhof-Young, 2002). As introduction of new content into a crowded medical curriculum is difficult, we have developed VERO to allow students to learn about this specialty from their computer (http://www.radiationoncoloav.ca). Objective: We will review the evidence-informed development and formative evaluation of VERO and showcase r e c e n t developments. Methods: Five focus groups and additional new user sessions (n=4 students; n=5 residents), revealed enthusiasm for VERO, generated ideas for content and format, produced learning objectives and resulted in the creation of a VERO prototype, which has been formatively evaluated (Hayter and NyhofYoung, 2003; Nyhof-Young and Hayter, 2004). Experts working with medical students have developed final website content. Results: A website covering 17 domains of RO allows students to: 1) explore RO career choices, research opportunities and the roles of the Radiation Oncologist in the multidisciplinary team; and 2) learn basic principles of RO. The learning section features both pre-clinical topics (e.g., basic radiobiology and physics) and clinical topics, where interactive case scenarios covering common tumour sites illustrate principles of decisionmaking and RT treatment management.
CARO 2 0 0 6
Conclusions: The final website will be advertised through medical schools and professional/research/ educational organizations. New-user sessions and an on-line user survey will evaluate VERO. Benefits to the medical community include (1) greater knowledge of RO by generalist physicians for better cancer patient care and more educated RO referrals, (2) increased awareness by medica) students of RO careers, and (3) increased web-based educational skills among RO faculty. 220 The Development of an Interprofessional Mentorship Program for Faculty at the Department of Radiation Oncology, University of Toronto - A New Beginning E. Szumacher ~, L. Manchu/2, R. Barker ~, G. Kane 2, C. Palmer 2, J. Ringash 2 Toronto Sunnybrook Regional Cancer Centre, Toronto, Ontario1; Princess Margaret Hospital, Toronto, Ontario 2 Ewa.zurnacher@sunn ybrook, ca
Background: Mentoring is essential for a successful career in academic medicine. It has been shown to improve career satisfaction and have a positive impact on academic promotion of faculty members. The UT DRO Executive Committee identified mentorship as a priority issue to be explored and developed to support career development of its academic faculty members. Methodology: A review of the literature was conducted. In addition, a mentorship working group within the UT DRO was formed to explore mentorship needs across the three disciplines and two clinical sites represented within the university department. Results: Recurrent themes that emerged from the literature review confirmed the importance of mentoring for professional success and the importance of mentor-mentee relationships. Descriptions of different models of mentoring programs were identified. A 17-member mentorship working group consisting of radiation oncologists (12), radiation therapists (3) and physicists (2) identified priorities for the development of a formal mentorship program within the UT DRO. One priority was to establish an orientation package and/or session for new members of the department. All agreed that an interprofessional program would be most desirable to allow better options for matching mentors and mentees according to individual needs. In particular, interprofessional mentorship was determined to be necessary for radiation therapists, who currently have limited academic mentorship opportunities within their profession. Different mentoring needs were highlighted for new (<5years), mid-career (5-10 years) and senior (>10 years) faculty members. For mid-career members, a more "active" mentorship style (e.g. a mentor actively recommending the mentee for opportunities) may be needed to accelerate academic promotion. Senior members will be looked to as mentors but may also need mentoring. Conclusions: The literature and the results from the working group identified a need for developing a comprehensive interdisciplinary mentorship program within the UT DRO. Among many recommendations, conducting a survey assessing the needs of different groups and development of an orientation program for the new faculty members are the current priorities. 221 The Radiation Oncology "Cyber-Department": Realizing the Paperless and Filmless Environment D. Payne, 7-. Michaelson, G. Disney, S. Rose, B. Gu/bord Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, Ontario david, payne~rrnn, uhn. on. ca
Background: Provision of reliable, efficient resource management in today's radiation oncology requires support for a vast flow of information. Methods: A strategy of incremental implementation was developed so as to minimize disruption to care and optimize staff expertise and adoption. User committees were formed at all stages to provide direction. The hardware infrastructure
volume, 24-72 hours following initiation of radiation therapy treatment. Seventy-eight percent of RO reported the incidence of flare pain was <20%. Flare pain was thought to occur less often after multiple than single fractions, and the majority did not feel this was related to the treatment volume or bony site treated. Eighty-eight percent of RO manage flare pain by altering medication and/or dosing regimens, however 91% do not premedicate patients thought to be at risk for flare pain. Conclusions: Flare pain is a recognized phenomenon occurring after palliative radiation therapy of bone metastases. While there was a general consensus among RO in Ontario on the incidence, duration and management of flare pain, this study highlights the need for further work on the etiology of flare pain, and how to identify and manage patients at risk. 215 Phase I Study of Hypofractionated Dose-Escalated Thoracic Radiotherapy for Limited-Stage Small Cell Lung Cancer D. Yee I, R. Halperin 2, J. Hanson 1, T. Nijjar z, C. Butts 1, M. Smylie 1, 7-. Reiman 1, W. Roa 1 Cross Cancer Institute, University of Alberta, Edmonton, Alberta'; Centre for the Southern Interior, Kelowna, British Columbia 2 don vee ~cancerboard. ab. ca
Purpose: To determine the maximal tolerated dose of hypofractionated thoracic radiotherapy given with concurrent chemotherapy for limited-stage small cell lung cancer patients. Methods and Materials: Patients received one of three radiotherapy dose levels. Radiotherapy was given in two phases: patients initially received 20 Gy in 10 fractions to gross tumour plus uninvolved mediastinal nodes followed by a boost to gross disease of 30, 38 or 42 Gy in 15 fractions. Accrual to the next highest radiotherapy dose level was done sequentially based on rates of radiotherapy-related acute toxicities observed at the current dose level. Radiotherapy was planned using conformal techniques. All patients received four cycles of Cisplatin (25 mg/m 2) and Etoposide (100 mg/m 2) chemotherapy. Radiotherapy commenced with day one of cycle two of chemotherapy. All complete/near complete responders were offered prophylactic cranial irradiation. The maximal tolerated dose of radiotherapy was based on the dose which caused unacceptably high rates of radiotherapy-related toxicity. Disease-free and overall survival rates were calculated from the date of registration onto the trial. Results: Thirteen patients were accrued. The trial was stopped after patients in the 58 Gy group completed all treatments due to excessive rates of radiotherapy toxicities observed in this group. All patients who commenced radiotherapy received all prescribed chemo- and radiotherapy. There were no treatmentrelated deaths. There was one Grade 3 acute non-hematologic toxicity in the 50 Gy group. Three of the six patients given 58 Gy experienced acute Grade 3 esophagitis. Median overall survival and disease-free survival was 10.9 and 9.4 months, respectively. There were no significant differences in diseasefree or overall survival between patients receiving 50 Gy or 58 Gy. Conclusions: The maximal tolerated d o s e of thoracic radiotherapy with concurrent chemotherapy on this trial was 50 Gy in 25 daily fractions. 216 Patient Expectation of the Partial Response And Response Shift in Bone Metastases E. Chow I, H. Chiu I, M. Doyle ~, G. Hruby 2, L. Holden 1, E. Barnes ~, M. Tsao ~, C. Danjoux ~ Toronto Sunnybrook Regional Cancer Centre, Toronto, Ontario'; Royal Prince Alfred Hospital, Carnperdown, Australia 2 Edward. chow@sunnybrook, ca
Purpose: To define the minimum reduction in pain level patients would expect and to examine if response shift exists in the treatment of bone metastases with palliative radiotherapy. Methods: Patients with bone metastases were asked to quantify the minimal level of pain reduction by two months that
September 13-16
$63
they considered would justify the palliative radiotherapy based on their current pain (on a scale of 0 - 10 and a four point scale of none, mild, moderate or severe). At the two month follow up, they were asked the conventional "post-test" question -e.g. what is your level of pain now? In addition, they were asked to retrospectively re-evaluate their baseline "pre-test" level of pain - which is referred to as a "then test" e.g. how would you now rate your level of pain prior to radiotherapy? Results: A total of 217 patients were enrolled. The median minimum pain reduction they would expect from the radiation treatment at the time of consultation was four. Patient expected a reduction of 50 - 70% in their baseline pain following radiation treatment. At two months, 114 patients participated in the response shift study. Only 31 patients reported no change in the "pre-test" and "then test" pain scores. The other 83 patients (73%) did demonstrate a response shift but in opposing directions. Conclusions: Patients with bone metastases expected a 5070% reduction of pain score from baseline with the palliative radiotherapy. Response shift was observed in this group of patients. 217 Investigating New Models of Patient Self-Management: Evaluation of the Princess Margaret Hospital Lymphedema Clinic J. Nyhof-Young, K. Moore, P. Catton Princess Margaret Hospital, Toronto, Ontario joyce, nyhof-young@uhn, on. ca
Background: Lymphedema is a serious complication of breast cancer management. Its incidence following surgery _++radiation is 5-20%. For most of our patients, lymphedema is an unexpected complication and the lack of available or effective treatment has been dissatisfying (Ingber, Nyhof-Young, Gilhooly, Levin, 2004). In response, a Lymphedema Clinic was established within the Breast Cancer Survivorship Program at a major cancer hospital in Toronto (http://survivorship.ca). A "360 degree" formative program evaluation involving hospital, community and patient stakeholders was implemented to understand how to best promote effective patient selfmanagement of lymphedema, while most effectively leveraging limited program, hospital and community resources. Purpose: We describe the Lymphedema Clinic and its model of patient-centred care, document the evaluative process, and share lessons learned during program development and evaluation. Methods: 1) Needs/Barrier Assessments: semi-structured interviews with community service providers (12 of garment fitters, community oncologists, etc.) and referring family physicians (five) to improve patient access to support services. The support needs of male breast cancer patients (five interviews); Focus groups (n=4 patients) about functional apparel needs; semi-structured interviews about patient treatment choices (eight patients); 2) Development and evaluation of resources: daily self-management diary of home self-care (six patients). Lymphedema Risk Reduction educational pamphlet (six patients; ten multidisciplinary hospital staff); 3) Program Evaluations: Investigating the health outcomes and quality of life of patients in the Lymphedema Clinic (eight patients). Survey of overall program (13 patients), patient satisfaction with the Look Good Feel Better Skin and Nail Care Educational Workshop (ten patients). Results/Conclusions: The Lymphedema Clinic is providing an innovative and replicable template for the provision of information, as well as psychosocial and clinical support to lymphedema patients and their caregivers. Recommendations will be made to improve the support, education and coaching for the self-management of lymphedema. 218 Prognostic Expectations for Patients with Glioblastoma Multiforme in a Population-Based Cohort A. Mahmud, M. Brundage, A. Caissie, J. Tonita, H. Chalchal Cancer Centre of Southeastern Ontario, Queen's University, Kingston, Ontario
$64
September 13-16
aamer, mahmud@krcc, on. ca Objectives: To compare the survival outcomes of a population-based cohort of glioblastoma multiforme (GBM) patients (patients) treated with radiotherapy to that predicted by prognostic stratification based on patients treated in a clinical trial setting. Methods: The medical records of 248 pts diagnosed with GBM were reviewed using the Saskatchewan Cancer Registry. The patients treated with radiation therapy (RT) were then divided into four groups (gps) based on prognostic factors of age (<50 & >50 years), performance status (ECOG) and surgical procedure (biopsy alone & complete or subtotal resection). The survival outcomes of each group were then contrasted to those identified by the RTOG recursive partitioning database reports. Results: All 248 patients had pathologically proven disease. Two-hundred and three patients were >50 and 45 were <50 years old at the time of diagnosis. One-hundred and fifty-six patients had an ECOG status of 0 or 1 whereas 92 had ECOG of 2, 3 or 4. Fifty-one patients had complete or near complete resection, 115 had subtotal resection, and 82 had biopsy alone. Only 12 patients had chemotherapy. Two hundred and eleven patients received RT. Forty-four received a dose of 40Gy, 25, 41-50 Gy and t42, >50 Gy. Median survival (MS) of patients who received RT was 8 months. Of these, 29, 88, 70 and 24 patients met the criteria for RTOG class III, IV, V, and VI respectively. The observed median survival durations in these groups were 12, 9, 7 and 3 months respectively (p<0.001). These median survivals were substantively less than the corresponding rates reported in patients treated on clinical trials (RTOG class III: MS=17.9 months [lower 95%C.I.= 15.5 months]; class IV 11.1 [10.4]; class V 8.9 (8.3) and class VI 4.6 [4.3] months. Conclusions: The classification of GBM patients into groups based on prognostic factors remains valid, but the observed median survivals in a population-based cohort fall below the bounds estimated for those in patients treated on clinical trials. The findings have important implications for counselling patients in the community setting. 219 Globally-Targeted Undergraduate Medical Education: The Virtual Experience in Radiation Oncology (VERO) J. Kamra I, J. Nyhof-Young 2, L. Holden 1, G. Gillies 1, C. Hayter j Toronto Sunnybrook Regional Cancer Centre, Toronto, Ontariol ; Princess Margaret Hospital, Toronto, Ontario 2 ]uh u. kamra @sw. ca
Background: Many patients receive radiotherapy (RT) as cancer treatment. All physicians need some knowledge of radiation oncology (RO), given the significance of cancer as a health problem. North American medical students receive little or no exposure to RO (Hayter and Nyhof-Young, 2002). As introduction of new content into a crowded medical curriculum is difficult, we have developed VERO to allow students to learn about this specialty from their computer (http://www.radiationoncoloav.ca). Objective: We will review the evidence-informed development and formative evaluation of VERO and showcase r e c e n t developments. Methods: Five focus groups and additional new user sessions (n=4 students; n=5 residents), revealed enthusiasm for VERO, generated ideas for content and format, produced learning objectives and resulted in the creation of a VERO prototype, which has been formatively evaluated (Hayter and NyhofYoung, 2003; Nyhof-Young and Hayter, 2004). Experts working with medical students have developed final website content. Results: A website covering 17 domains of RO allows students to: 1) explore RO career choices, research opportunities and the roles of the Radiation Oncologist in the multidisciplinary team; and 2) learn basic principles of RO. The learning section features both pre-clinical topics (e.g., basic radiobiology and physics) and clinical topics, where interactive case scenarios covering common tumour sites illustrate principles of decisionmaking and RT treatment management.
CARO 2 0 0 6
Conclusions: The final website will be advertised through medical schools and professional/research/ educational organizations. New-user sessions and an on-line user survey will evaluate VERO. Benefits to the medical community include (1) greater knowledge of RO by generalist physicians for better cancer patient care and more educated RO referrals, (2) increased awareness by medica) students of RO careers, and (3) increased web-based educational skills among RO faculty. 220 The Development of an Interprofessional Mentorship Program for Faculty at the Department of Radiation Oncology, University of Toronto - A New Beginning E. Szumacher ~, L. Manchu/2, R. Barker ~, G. Kane 2, C. Palmer 2, J. Ringash 2 Toronto Sunnybrook Regional Cancer Centre, Toronto, Ontario1; Princess Margaret Hospital, Toronto, Ontario 2 Ewa.zurnacher@sunn ybrook, ca
Background: Mentoring is essential for a successful career in academic medicine. It has been shown to improve career satisfaction and have a positive impact on academic promotion of faculty members. The UT DRO Executive Committee identified mentorship as a priority issue to be explored and developed to support career development of its academic faculty members. Methodology: A review of the literature was conducted. In addition, a mentorship working group within the UT DRO was formed to explore mentorship needs across the three disciplines and two clinical sites represented within the university department. Results: Recurrent themes that emerged from the literature review confirmed the importance of mentoring for professional success and the importance of mentor-mentee relationships. Descriptions of different models of mentoring programs were identified. A 17-member mentorship working group consisting of radiation oncologists (12), radiation therapists (3) and physicists (2) identified priorities for the development of a formal mentorship program within the UT DRO. One priority was to establish an orientation package and/or session for new members of the department. All agreed that an interprofessional program would be most desirable to allow better options for matching mentors and mentees according to individual needs. In particular, interprofessional mentorship was determined to be necessary for radiation therapists, who currently have limited academic mentorship opportunities within their profession. Different mentoring needs were highlighted for new (<5years), mid-career (5-10 years) and senior (>10 years) faculty members. For mid-career members, a more "active" mentorship style (e.g. a mentor actively recommending the mentee for opportunities) may be needed to accelerate academic promotion. Senior members will be looked to as mentors but may also need mentoring. Conclusions: The literature and the results from the working group identified a need for developing a comprehensive interdisciplinary mentorship program within the UT DRO. Among many recommendations, conducting a survey assessing the needs of different groups and development of an orientation program for the new faculty members are the current priorities. 221 The Radiation Oncology "Cyber-Department": Realizing the Paperless and Filmless Environment D. Payne, 7-. Michaelson, G. Disney, S. Rose, B. Gu/bord Princess Margaret Hospital, University Health Network, University of Toronto, Toronto, Ontario david, payne~rrnn, uhn. on. ca
Background: Provision of reliable, efficient resource management in today's radiation oncology requires support for a vast flow of information. Methods: A strategy of incremental implementation was developed so as to minimize disruption to care and optimize staff expertise and adoption. User committees were formed at all stages to provide direction. The hardware infrastructure