- Email: [email protected]
Cancer-Related Distress Screening in a Radiation Oncology Clinic: A 3-Year Review of a Single Veterans Administration (VA) Institution Screening Program
Volume 99 Number 2S Supplement 2017 Results: 48 patients (18 low, 20 intermediate, and 10 high risk per the D’Amico criteria) at a median age of 71 years (range 53-90 years) received SBRT with a median follow up of 4.5 years. The median prostate size was 39.5 cm3 (range 13.5-108 cm3) and 31% patients received ADT. A mean baseline IPSS score of 19 significantly decreased to 16 at 1 month (p Z 0.037) and 12 at 6 months (p < 0.001). A mean baseline EPIC-26 obstructive/irritative score of 71 significantly increased to 80 at 6 months (p < 0.001). There was no significant change from the mean baseline EPIC-26 urinary incontinence score at any point during follow up. The 3-year cumulative incidence rate of late urinary symptom flare was 19%. The 3-year rate of grade 2 GU toxicities was 35%; no grade 3 GU toxicities were observed. Conclusion: SBRT for clinically localized prostate cancer was well tolerated in men with baseline IPSS > 15. Surprisingly, urinary quality of life improved following treatment. Late urinary symptom flares were observed, but the majority resolved with conservative management. GU toxicity rates were comparable to men with normal baseline IPSS scores. Author Disclosure: S. Kataria: None. J. Chew: None. S. Lei: None. M.J. Ayoob: None. M. Danner: None. T. Yung: None. B.T. Collins: Paid Talks; Accuray. S. Suy: None. A. Dritschilo: None. J.H. Lynch: None. S.P. Collins: None.
3280 Encouraging Exercise Through Wearable Activity Tracker With Daily Text Feedback: Lessons Learned in Developing the ICanSTEP Program B.F. Koontz,1 L. Sutton,2 E. Levine,3 X. Li,4 F. McSherry,4 B. Peterson,4 T. Dale,1 M. Streicher,3 M. Abouamara,5 M. Ahmed,5 I. Altomare,5 R. Anderson,5 J.P. Chino,4 C.R. Kelsey,6 D. Vicente,5 and L. Owen5; 1 Duke Cancer Institute, Durham, NC, 2Duke University, Durham, NC, 3 Duke Global Digital Health Science Center, Durham, NC, 4Duke University Medical Center, Durham, NC, 5Duke Cancer Network, Durham, NC, 6Duke University Department of Radiation Oncology, Durham, NC Purpose/Objective(s): Purpose/Objectives: Most cancer patients are sedentary. Among the cancers with the most survivors, less than half meet physical activity guidelines. Prior research suggests that outcomes including quality of life, disease free and overall survival correlate with engagement in physical activity. Interventions to improve physical activity are needed. Materials/Methods: ICanSTEP (Increasing physical activity in Cancer Survivors through a Text-messaging Exercise motivation Program) is a pilot study to determine whether daily personalized text-based feedback based on data from a wearable activity tracker improves the activity level and physical fitness of both active cancer patients and cancer survivors. Using real-time FitbitÔ data as the activity tracking platform, personalized daily motivational text messages are sent to each patient at 8AM. Lack of activity results in a text alert to the patient to charge device / check sync and an email alert to research staff. Patients with any adult cancer are eligible for this pilot if currently receiving treatment or have completed treatment within a year prior to enrollment, have a life expectancy of 12+months, have access to a smartphone, and are sedentary ( dedicated physical activity 2 or less days per week). Outcomes include program compliance, change in step count from week 1 of program to week 12, change in distance walked during 6-minute walk, and patient-reported quality of life measures. Results: ICanSTEP was initiated at both an NCI-designated Comprehensive Cancer Center and 2 affiliated community practices. Substantial rollout issues were effectively addressed through training of both staff and patients. At 40% of projected enrollment the following cancers are represented: breast, colon, lymphoma, and prostate. Enrollment of patients completing treatment within 12 months has outpaced that of active treatment patients (12 vs 5). Of the 17 patients enrolled, only 2 (11.8%) have withdrawn from the program. Among the 12 patients with FitbitÔ step data at 6 weeks, the median age is 56 years (range 29-69). At 6 and 12 weeks, the number and percentage of patients who increased their step count by 20% was 4 out of 12 (33%) and 4 out of 9 (44%), respectively. Fifty percent had a 20% increase in 6-minute distance walked. Conclusion: While deployment of this technology-based motivational program to increase cancer patient activity encountered several hurdles, these were effectively addressed by educating providers, staff, and patients about the
Poster Viewing E539 importance of exercise, how to exercise safely, strategies to increase activity, and technology utilization/logistics. The program is ongoing but early results show a significant positive impact on patients’ daily activity level. Follow-up will determine whether progress is maintained. Author Disclosure: B.F. Koontz: Employee; Duke University Medical Center. Research Grant; Janssen Services LLC. Advisory Board; Blue Earth Diagnostics. Travel Expenses; ASTRO. Royalty; UpToDate. ASTRO, IHE-RO. L. Sutton: Independent Contractor; Duke University. Research Grant; Genentech. Educational Grant; Pfizer. same; North Carolina Oncology Association. E. Levine: None. X. Li: None. F. McSherry: None. B. Peterson: None. T. Dale: None. M. Streicher: None. M. Abouamara: None. M. Ahmed: Employee; South Eastern Health. I. Altomare: Consultant; Incyte, Novartis, Amgen, Bayer Pharmaceuticals. Chair; Scotland Memorial Hospital. R. Anderson: Johnston Hematology Oncology Associates. J.P. Chino: Partner; Duke University Cancer Center. Research Grant; Varian Medical Systems. Stock; NanoScint. C.R. Kelsey: None. D. Vicente: None. L. Owen: None.
3281 Trends in Head and Neck Cancer Post-Treatment Rehabilitation C. Lewis,1 Z. Nurgalieva,1 G.B. Gunn,1 H. Zhao,2 S. Giordano,2 M. Bhayani,3 and K.A. Hutcheson4; 1UT MD Anderson Cancer Center, Houston, TX, 2Department of Health Service Research, The University of Texas MD Anderson Cancer Center, Houston, TX, 3NorthShore University HealthSystem, Evanston, IL, 4MD Anderson Head and Neck Cancer Symptom Working Group, The University of Texas MD Anderson Cancer Center, Houston, TX Purpose/Objective(s): Little is known about patterns of surveillance in head and neck cancer (HNC) survivorship care. Using a national database, we aimed to evaluate trends in post-treatment utilization of rehabilitation services for HNC survivors. Materials/Methods: Using Surveillance, Epidemiology and End Results (SEER)-Medicare data for HNC patients treated between 2002 and 2011 to evaluate post-treatment rehabilitation use. Results: A total of 16,194 eligible patients underwent treatment for HNC between January 1, 2002, and December 31, 2011. During the first 2 post-treatment years, 25.7% (NZ4,155) of patients received any rehabilitation services, while 20.6% (NZ3,328) specifically received speech pathology services. The use of rehabilitation services increased in the second post-treatment year over the first (3.6% versus 3.1%, respectively, p<0.02). Patients who underwent multimodality therapy were more likely to utilize speech pathology services than those who received single modality therapy (28.1% versus 55.9%, P < 0.0001). Multivariate analysis demonstrated that speech pathology utilization increased on average 7% for each increasing year of diagnosis (ORZ1.07, 95% CI 1.05-1.09); this was most prominent for patients who received radiation as part of their therapy (OR 2.3, 95% CI 2.02-2.7). Conclusion: We evaluated national trends of post-treatment use of rehabilitation services. The use of services increased in the second posttreatment year, indicating an increasing need for long-term treatment effects. The frequency of post-treatment speech pathology services increased annually over the study period; further study is needed to identify benefits of this increased resource utilization. Author Disclosure: C. Lewis: None. Z. Nurgalieva: None. G.B. Gunn: MD Anderson Cancer Center - Proton Therapy. H. Zhao: None. S. Giordano: None. M. Bhayani: None. K.A. Hutcheson: None.
3282 Cancer-Related Distress Screening in a Radiation Oncology Clinic: A 3-Year Review of a Single Veterans Administration (VA) Institution Screening Program T. Lomauro,1 G.A. Dawson,2 L. Magda,3 K. Tobias,4 and M.D. Kelly5; 1 VANJ Heath Care System, East Orange, NJ, 2James J. Peters VA Medical Center, Bronx, NY, 3VANJ Health Care System -, East Orange, NJ, 4VANJ
E540
International Journal of Radiation Oncology Biology Physics
Health Care System, East Orange, NJ, 5VA New Jersey Health Care System, East Orange, NJ
with clinically elevated distress. We examined this relationship further by age group. Correlations remained significant among patients grouped by the age categories 50 years and older and 65 years and older, respectively (r Z -.230 and -.290; p < 0.05) but were nonsignificant among patients younger than these thresholds. In the age 65 and older group, 56% (nZ14) of unmarried patients reported clinically elevated distress compared to 44% (nZ11) of married patients (c2, p Z 0.045). Among those younger than 65, these proportions were reversed, with 44% (nZ16) of unmarried patients reporting clinically elevated distress compared to 56% (nZ20) of married patients (c21.48, p Z .229). Conclusion: Distress is common among head and neck cancer patients. Being married is associated with sub-clinical levels of distress among older head and neck cancer patients but does not appear to be protective among younger patients. The Distress Thermometer provides a quick and easy way for screening that can facilitate conversations between patients and providers about a range of psychosocial problems. Routine distress screening can be used to identify patients in need of additional psychosocial assessment and mental health triage. This can also help predict tolerance to subsequent treatment. 1. Bultz BD. Patient Care and Outcomes: Why Cancer Care Should Screen for Distress, the 6(th) Vital Sign. Asia Pac J Oncol Nurs. 2016 Jan-Mar;3(1):21-24. 2. O’Donnell E. The distress thermometer: a rapid and effective tool for the oncology social worker. Int J Health Care Qual Assur. 2013;26(4):353-9. Author Disclosure: C.E. Lominska: None. J. Hamilton: None. L. Murray: None. P. Neupane: None. L. Shnayder: None. K. Kakarala: None. A.M. Chen: None.
Purpose/Objectives: The emotional and psychosocial stress experienced by cancer patients significantly impacts treatment outcomes and patient quality of life. Increased emphasis upon programmatic approaches to identifying distress has evolved to current established evidenced-based treatment guidelines, including those of the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN). This report provides an overview of the results of distress screenings from a single VA institution. Materials/Methods: For this quality improvement effort we reviewed 400 patients undergoing radiotherapy in the - Radiation Oncology clinic for the calendar years of 2014, 2015, and 2016. Our goal was to determine the effectiveness of our new psychosocial distress screening process. Screenings were completed utilizing the NCCN Distress Thermometer. Our goal was to administer distress screenings to all patients at the time of their initial consultation, and at follow-up. Results: Mean age of the patients was 67.1 years; 95.6% were male. The treatment population was 55.8% Caucasian, 37.4% African-American, 3.4% Hispanic, and 3.4% other/unknown. The most prevalent cancer diagnoses were: Prostate, 52.5%; Lung, 13.7%; Head & Neck Cancer, 10.9%, Skin, 4.8%; Breast 4.2%; and Esophageal or Gastric Cancer, 1.6%. Screenings were completed on 416 of 505 (82.4%) new consults in Radiation Oncology; 60.5% of patients screened scored at or above the established cut score of 4. Referrals to Oncology Psychology were initiated for 31.1% of the total treatment population. Significant mental health co-morbidities were identified: 57.4% of patients had at least one mental disorder diagnosis. Examples: PTSD, Major Depressive Disorder, Substance Use Disorder, and Adjustment Disorder. Conclusion: Results reflect the usefulness of the distress screening process in identifying adjustment issues specific to cancer patients’ experiences, as well as exacerbations of existing mental health conditions. The screening process facilitated referral to specialty (Oncology Psychology) and general (Mental Health Clinic) services. Author Disclosure: T. Lomauro: None. G.A. Dawson: None. L. Magda: None. K. Tobias: None. M.D. Kelly: member of executive committee, organize astro/aawr luncheon; AAWR. organize rad onc luncheon at ASTRO, participate in board work; AAWR.
3283 Distress is Common Among Head and Neck Cancer Patients, with Marriage Protective for Older but Not Younger Patients C.E. Lominska,1 J. Hamilton,2 L. Murray,2 P. Neupane,3 L. Shnayder,4 K. Kakarala,4 and A.M. Chen1; 1University of Kansas School of Medicine, Department of Radiation Oncology, Kansas City, KS, 2University of Kansas Cancer Center, Kansas City, KS, 3The University of Kansas School of Medicine, Kansas City, KS, 4University of Kansas Medical Center, Kansas City, KS Purpose/Objective(s): Distressdincluding symptoms of depression and anxiety as well as physical, spiritual, and practical concernsdimpairs patients’ quality of life and ability to cope with cancer and its treatment. Prior estimates from studies in the United States and Canada suggest that 35 to 45% of cancer patients experience significant distress.1 Our objective was to assess distress among index case head and neck cancer patients presenting for initial treatment at a tertiary cancer center. Materials/Methods: Retrospective chart abstraction was conducted following approval by the Institutional Review Board. Distress was assessed via patient-report on the National Comprehensive Cancer Network Distress Thermometer, a validated visual analogue scale ranging from 0 to 10 that asesses how much distress patients experienced in the past week.2 Based on instrument recommendations, the cutpoint 4 was used to designate clinically elevated distress.2 Results: A total of 122 consecutive patients with newly-diagnosed head and neck cancer with available data from 2016 were used in this data abstraction. 79% (nZ96) were men, and most (81%, nZ99) were white. The mean (standard deviation) age was 60.9 (15.3.) Half of the sample (nZ61) reported clinically elevated distress. Being married was negatively correlated (r Z-.203, p Z 0.027)
3284 Patient-Preferred Conditions for Collecting Patient Reported Outcomes in the Radiation Oncology Outpatient Setting: Towards Improving Quality of Care C.D. Marquez, S.E. Braunstein, O. Morin, and S.E. Fogh; University of California, San Francisco, San Francisco, CA Purpose/Objective(s): Patient reported outcomes (PROs) are increasingly recognized as a valuable tool for assessing the side effects of cancer treatment. Understanding how to incorporate collection of patient reported outcomes, which have been successfully piloted in the context of randomized controlled trials, into outpatient clinical settings can provide a valuable baseline on which we can build future quality assurance efforts in order to improve patient quality of life during cancer treatments. However, the feasibility of collecting PROs has been limited in the outpatient setting. Understanding these limitations from the patients’ perspective may allow us to create optimal conditions for collecting and responding to this data. Materials/Methods: 41 consecutively treated patients with malignant and nonmalignant, primary and metastatic disease were surveyed within the a single Radiation Oncology department using electronic EORTC QLQ C30 forms displayed on a touch screen tablet. At the initial consultation, PRO data was collected and survey was administered with questions to assess patients’ perceived value of their PRO survey, as well as data collection preferences. Results: The majority of patients found the EORTC QLQ C30 survey to be of value. 25/41 (61%) felt EORTC QLQ C30 was of highest value to their care 5/5. 8/41 (20%) rated it at 4/5 value, 4/41(10%) rated it at 3/5 value, 2/41 (5%) did not know if it was valuable, 1/41 (2%) rated it at 1/4 value, 1/41 (2%) found it offered no value (0/5) to their care. Regarding preferences for human or electronic contact 18/41 (44%) preferred electronic, 16/41 (39%) preferred human and 5/41 (12%) preferred a combination, 1/41 (2%) preferred paper, 1/41 (2%) did not know. Regarding the preferred frequency of survey 21/41 (51%) preferred once per week, 10/41 (24%) preferred every 2 weeks, 4/41 (10%) preferred other interval, 3/41 (7%) preferred once per month, 2/41 (5%) preferred no follow up. 1/41 (2%) preferred every 2 months. Regarding amount of time taken to complete the survey, the majority of patients 27/41 (66%) preferred less than 5min, 9/41 (22%) said it depends/did not know, 3/41 (7%) chose 30 min and 2/41 (5%) felt 10min should be the maximum time spent. Conclusion: Understanding barriers to data collection and optimization based on patient preferences will allow practitioners in the outpatient setting to systematically collect PROs.
3280 Encouraging Exercise Through Wearable Activity Tracker With Daily Text Feedback: Lessons Learned in Developing the ICanSTEP Program B.F. Koontz,1 L. Sutton,2 E. Levine,3 X. Li,4 F. McSherry,4 B. Peterson,4 T. Dale,1 M. Streicher,3 M. Abouamara,5 M. Ahmed,5 I. Altomare,5 R. Anderson,5 J.P. Chino,4 C.R. Kelsey,6 D. Vicente,5 and L. Owen5; 1 Duke Cancer Institute, Durham, NC, 2Duke University, Durham, NC, 3 Duke Global Digital Health Science Center, Durham, NC, 4Duke University Medical Center, Durham, NC, 5Duke Cancer Network, Durham, NC, 6Duke University Department of Radiation Oncology, Durham, NC Purpose/Objective(s): Purpose/Objectives: Most cancer patients are sedentary. Among the cancers with the most survivors, less than half meet physical activity guidelines. Prior research suggests that outcomes including quality of life, disease free and overall survival correlate with engagement in physical activity. Interventions to improve physical activity are needed. Materials/Methods: ICanSTEP (Increasing physical activity in Cancer Survivors through a Text-messaging Exercise motivation Program) is a pilot study to determine whether daily personalized text-based feedback based on data from a wearable activity tracker improves the activity level and physical fitness of both active cancer patients and cancer survivors. Using real-time FitbitÔ data as the activity tracking platform, personalized daily motivational text messages are sent to each patient at 8AM. Lack of activity results in a text alert to the patient to charge device / check sync and an email alert to research staff. Patients with any adult cancer are eligible for this pilot if currently receiving treatment or have completed treatment within a year prior to enrollment, have a life expectancy of 12+months, have access to a smartphone, and are sedentary ( dedicated physical activity 2 or less days per week). Outcomes include program compliance, change in step count from week 1 of program to week 12, change in distance walked during 6-minute walk, and patient-reported quality of life measures. Results: ICanSTEP was initiated at both an NCI-designated Comprehensive Cancer Center and 2 affiliated community practices. Substantial rollout issues were effectively addressed through training of both staff and patients. At 40% of projected enrollment the following cancers are represented: breast, colon, lymphoma, and prostate. Enrollment of patients completing treatment within 12 months has outpaced that of active treatment patients (12 vs 5). Of the 17 patients enrolled, only 2 (11.8%) have withdrawn from the program. Among the 12 patients with FitbitÔ step data at 6 weeks, the median age is 56 years (range 29-69). At 6 and 12 weeks, the number and percentage of patients who increased their step count by 20% was 4 out of 12 (33%) and 4 out of 9 (44%), respectively. Fifty percent had a 20% increase in 6-minute distance walked. Conclusion: While deployment of this technology-based motivational program to increase cancer patient activity encountered several hurdles, these were effectively addressed by educating providers, staff, and patients about the
Poster Viewing E539 importance of exercise, how to exercise safely, strategies to increase activity, and technology utilization/logistics. The program is ongoing but early results show a significant positive impact on patients’ daily activity level. Follow-up will determine whether progress is maintained. Author Disclosure: B.F. Koontz: Employee; Duke University Medical Center. Research Grant; Janssen Services LLC. Advisory Board; Blue Earth Diagnostics. Travel Expenses; ASTRO. Royalty; UpToDate. ASTRO, IHE-RO. L. Sutton: Independent Contractor; Duke University. Research Grant; Genentech. Educational Grant; Pfizer. same; North Carolina Oncology Association. E. Levine: None. X. Li: None. F. McSherry: None. B. Peterson: None. T. Dale: None. M. Streicher: None. M. Abouamara: None. M. Ahmed: Employee; South Eastern Health. I. Altomare: Consultant; Incyte, Novartis, Amgen, Bayer Pharmaceuticals. Chair; Scotland Memorial Hospital. R. Anderson: Johnston Hematology Oncology Associates. J.P. Chino: Partner; Duke University Cancer Center. Research Grant; Varian Medical Systems. Stock; NanoScint. C.R. Kelsey: None. D. Vicente: None. L. Owen: None.
3281 Trends in Head and Neck Cancer Post-Treatment Rehabilitation C. Lewis,1 Z. Nurgalieva,1 G.B. Gunn,1 H. Zhao,2 S. Giordano,2 M. Bhayani,3 and K.A. Hutcheson4; 1UT MD Anderson Cancer Center, Houston, TX, 2Department of Health Service Research, The University of Texas MD Anderson Cancer Center, Houston, TX, 3NorthShore University HealthSystem, Evanston, IL, 4MD Anderson Head and Neck Cancer Symptom Working Group, The University of Texas MD Anderson Cancer Center, Houston, TX Purpose/Objective(s): Little is known about patterns of surveillance in head and neck cancer (HNC) survivorship care. Using a national database, we aimed to evaluate trends in post-treatment utilization of rehabilitation services for HNC survivors. Materials/Methods: Using Surveillance, Epidemiology and End Results (SEER)-Medicare data for HNC patients treated between 2002 and 2011 to evaluate post-treatment rehabilitation use. Results: A total of 16,194 eligible patients underwent treatment for HNC between January 1, 2002, and December 31, 2011. During the first 2 post-treatment years, 25.7% (NZ4,155) of patients received any rehabilitation services, while 20.6% (NZ3,328) specifically received speech pathology services. The use of rehabilitation services increased in the second post-treatment year over the first (3.6% versus 3.1%, respectively, p<0.02). Patients who underwent multimodality therapy were more likely to utilize speech pathology services than those who received single modality therapy (28.1% versus 55.9%, P < 0.0001). Multivariate analysis demonstrated that speech pathology utilization increased on average 7% for each increasing year of diagnosis (ORZ1.07, 95% CI 1.05-1.09); this was most prominent for patients who received radiation as part of their therapy (OR 2.3, 95% CI 2.02-2.7). Conclusion: We evaluated national trends of post-treatment use of rehabilitation services. The use of services increased in the second posttreatment year, indicating an increasing need for long-term treatment effects. The frequency of post-treatment speech pathology services increased annually over the study period; further study is needed to identify benefits of this increased resource utilization. Author Disclosure: C. Lewis: None. Z. Nurgalieva: None. G.B. Gunn: MD Anderson Cancer Center - Proton Therapy. H. Zhao: None. S. Giordano: None. M. Bhayani: None. K.A. Hutcheson: None.
3282 Cancer-Related Distress Screening in a Radiation Oncology Clinic: A 3-Year Review of a Single Veterans Administration (VA) Institution Screening Program T. Lomauro,1 G.A. Dawson,2 L. Magda,3 K. Tobias,4 and M.D. Kelly5; 1 VANJ Heath Care System, East Orange, NJ, 2James J. Peters VA Medical Center, Bronx, NY, 3VANJ Health Care System -, East Orange, NJ, 4VANJ
E540
International Journal of Radiation Oncology Biology Physics
Health Care System, East Orange, NJ, 5VA New Jersey Health Care System, East Orange, NJ
with clinically elevated distress. We examined this relationship further by age group. Correlations remained significant among patients grouped by the age categories 50 years and older and 65 years and older, respectively (r Z -.230 and -.290; p < 0.05) but were nonsignificant among patients younger than these thresholds. In the age 65 and older group, 56% (nZ14) of unmarried patients reported clinically elevated distress compared to 44% (nZ11) of married patients (c2, p Z 0.045). Among those younger than 65, these proportions were reversed, with 44% (nZ16) of unmarried patients reporting clinically elevated distress compared to 56% (nZ20) of married patients (c21.48, p Z .229). Conclusion: Distress is common among head and neck cancer patients. Being married is associated with sub-clinical levels of distress among older head and neck cancer patients but does not appear to be protective among younger patients. The Distress Thermometer provides a quick and easy way for screening that can facilitate conversations between patients and providers about a range of psychosocial problems. Routine distress screening can be used to identify patients in need of additional psychosocial assessment and mental health triage. This can also help predict tolerance to subsequent treatment. 1. Bultz BD. Patient Care and Outcomes: Why Cancer Care Should Screen for Distress, the 6(th) Vital Sign. Asia Pac J Oncol Nurs. 2016 Jan-Mar;3(1):21-24. 2. O’Donnell E. The distress thermometer: a rapid and effective tool for the oncology social worker. Int J Health Care Qual Assur. 2013;26(4):353-9. Author Disclosure: C.E. Lominska: None. J. Hamilton: None. L. Murray: None. P. Neupane: None. L. Shnayder: None. K. Kakarala: None. A.M. Chen: None.
Purpose/Objectives: The emotional and psychosocial stress experienced by cancer patients significantly impacts treatment outcomes and patient quality of life. Increased emphasis upon programmatic approaches to identifying distress has evolved to current established evidenced-based treatment guidelines, including those of the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN). This report provides an overview of the results of distress screenings from a single VA institution. Materials/Methods: For this quality improvement effort we reviewed 400 patients undergoing radiotherapy in the - Radiation Oncology clinic for the calendar years of 2014, 2015, and 2016. Our goal was to determine the effectiveness of our new psychosocial distress screening process. Screenings were completed utilizing the NCCN Distress Thermometer. Our goal was to administer distress screenings to all patients at the time of their initial consultation, and at follow-up. Results: Mean age of the patients was 67.1 years; 95.6% were male. The treatment population was 55.8% Caucasian, 37.4% African-American, 3.4% Hispanic, and 3.4% other/unknown. The most prevalent cancer diagnoses were: Prostate, 52.5%; Lung, 13.7%; Head & Neck Cancer, 10.9%, Skin, 4.8%; Breast 4.2%; and Esophageal or Gastric Cancer, 1.6%. Screenings were completed on 416 of 505 (82.4%) new consults in Radiation Oncology; 60.5% of patients screened scored at or above the established cut score of 4. Referrals to Oncology Psychology were initiated for 31.1% of the total treatment population. Significant mental health co-morbidities were identified: 57.4% of patients had at least one mental disorder diagnosis. Examples: PTSD, Major Depressive Disorder, Substance Use Disorder, and Adjustment Disorder. Conclusion: Results reflect the usefulness of the distress screening process in identifying adjustment issues specific to cancer patients’ experiences, as well as exacerbations of existing mental health conditions. The screening process facilitated referral to specialty (Oncology Psychology) and general (Mental Health Clinic) services. Author Disclosure: T. Lomauro: None. G.A. Dawson: None. L. Magda: None. K. Tobias: None. M.D. Kelly: member of executive committee, organize astro/aawr luncheon; AAWR. organize rad onc luncheon at ASTRO, participate in board work; AAWR.
3283 Distress is Common Among Head and Neck Cancer Patients, with Marriage Protective for Older but Not Younger Patients C.E. Lominska,1 J. Hamilton,2 L. Murray,2 P. Neupane,3 L. Shnayder,4 K. Kakarala,4 and A.M. Chen1; 1University of Kansas School of Medicine, Department of Radiation Oncology, Kansas City, KS, 2University of Kansas Cancer Center, Kansas City, KS, 3The University of Kansas School of Medicine, Kansas City, KS, 4University of Kansas Medical Center, Kansas City, KS Purpose/Objective(s): Distressdincluding symptoms of depression and anxiety as well as physical, spiritual, and practical concernsdimpairs patients’ quality of life and ability to cope with cancer and its treatment. Prior estimates from studies in the United States and Canada suggest that 35 to 45% of cancer patients experience significant distress.1 Our objective was to assess distress among index case head and neck cancer patients presenting for initial treatment at a tertiary cancer center. Materials/Methods: Retrospective chart abstraction was conducted following approval by the Institutional Review Board. Distress was assessed via patient-report on the National Comprehensive Cancer Network Distress Thermometer, a validated visual analogue scale ranging from 0 to 10 that asesses how much distress patients experienced in the past week.2 Based on instrument recommendations, the cutpoint 4 was used to designate clinically elevated distress.2 Results: A total of 122 consecutive patients with newly-diagnosed head and neck cancer with available data from 2016 were used in this data abstraction. 79% (nZ96) were men, and most (81%, nZ99) were white. The mean (standard deviation) age was 60.9 (15.3.) Half of the sample (nZ61) reported clinically elevated distress. Being married was negatively correlated (r Z-.203, p Z 0.027)
3284 Patient-Preferred Conditions for Collecting Patient Reported Outcomes in the Radiation Oncology Outpatient Setting: Towards Improving Quality of Care C.D. Marquez, S.E. Braunstein, O. Morin, and S.E. Fogh; University of California, San Francisco, San Francisco, CA Purpose/Objective(s): Patient reported outcomes (PROs) are increasingly recognized as a valuable tool for assessing the side effects of cancer treatment. Understanding how to incorporate collection of patient reported outcomes, which have been successfully piloted in the context of randomized controlled trials, into outpatient clinical settings can provide a valuable baseline on which we can build future quality assurance efforts in order to improve patient quality of life during cancer treatments. However, the feasibility of collecting PROs has been limited in the outpatient setting. Understanding these limitations from the patients’ perspective may allow us to create optimal conditions for collecting and responding to this data. Materials/Methods: 41 consecutively treated patients with malignant and nonmalignant, primary and metastatic disease were surveyed within the a single Radiation Oncology department using electronic EORTC QLQ C30 forms displayed on a touch screen tablet. At the initial consultation, PRO data was collected and survey was administered with questions to assess patients’ perceived value of their PRO survey, as well as data collection preferences. Results: The majority of patients found the EORTC QLQ C30 survey to be of value. 25/41 (61%) felt EORTC QLQ C30 was of highest value to their care 5/5. 8/41 (20%) rated it at 4/5 value, 4/41(10%) rated it at 3/5 value, 2/41 (5%) did not know if it was valuable, 1/41 (2%) rated it at 1/4 value, 1/41 (2%) found it offered no value (0/5) to their care. Regarding preferences for human or electronic contact 18/41 (44%) preferred electronic, 16/41 (39%) preferred human and 5/41 (12%) preferred a combination, 1/41 (2%) preferred paper, 1/41 (2%) did not know. Regarding the preferred frequency of survey 21/41 (51%) preferred once per week, 10/41 (24%) preferred every 2 weeks, 4/41 (10%) preferred other interval, 3/41 (7%) preferred once per month, 2/41 (5%) preferred no follow up. 1/41 (2%) preferred every 2 months. Regarding amount of time taken to complete the survey, the majority of patients 27/41 (66%) preferred less than 5min, 9/41 (22%) said it depends/did not know, 3/41 (7%) chose 30 min and 2/41 (5%) felt 10min should be the maximum time spent. Conclusion: Understanding barriers to data collection and optimization based on patient preferences will allow practitioners in the outpatient setting to systematically collect PROs.