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Outcomes of Stereotactic Radiosurgery As Primary Interventional Therapy for the Treatment of Trigeminal Neuralgia in Patients with Multiple Sclerosis
E514
International Journal of Radiation Oncology Biology Physics
form the PTV. SBRT plans were created to deliver 25 Gy in 1 fraction to the PTV. Treatment was delivered on an image-guided linear accelerator with onboard cone beam CT without requirement for fiducial placement. Outcomes of VT burden and complications were assessed by defibrillator (ICD) interrogations, clinical evaluation and repeat imaging, with particular attention to potential late efficacy and adverse events (AEs). Results: Five patients (4M/1F, 60-84 years) received ENCORE. Median follow-up of living patients is 22 mo (range, 16-22). Mean ablation volume was 49 cc (range 17-81). Mean beam-on time was 14 mins (range, 11-18). Reduction in VT occurred in all patients (mean 1315 [range, 5-4312] episodes before ENCORE to 1 [range, 0-2]), at a median of 1 wk (1d-6wk). No acute AEs were reported. Patient #5 (84y F) suffered an embolic stroke 2 wks after treatment and died at 3 wks, with no clear relationship to treatment on autopsy. Patient #4 (62y M) had incomplete reduction in VT (>2000 episodes to 450), and required salvage catheter ablation at 4 wks. Patient #1 (61y M) developed recurrent VT outside of the previously treated target at 13 months, and underwent cardiac transplant at 18 months. No decline in left-ventricular ejection fraction (LVEF) was seen at 1 year. Mild adjacent lung inflammatory changes (grade 1) were observed at 3 months, which resolved by 1 year. All 4 living patients were free of VT at last follow-up. Conclusion: Entirely noninvasive VT ablation with SBRT is feasible in high-risk patients with refractory VT, with promising efficacy and no significant therapy related toxicity with almost 2 years of follow-up. Further long-term follow-up is required. A phase I/II trial (NCT02919618) is ongoing at our institution. Author Disclosure: C.G. Robinson: Research Grant; Elekta, Varian Medical Systems. Consultant; Varian Medical Systems. Speaker’s Bureau; DFINE. Advisory Board; Radialogica. Travel Expenses; DFINE, Varian Medical Systems. Stock Options; Radialogica. R. Kashani: Travel Expenses; Varian. S. Mutic: Honoraria; American Society for Radiation Oncology (ASTRO), Varian Medical Systems, Inc, ViewRay Inc. Advisory Board; ViewRay Inc. Travel Expenses; American Society for Radiation Oncology (ASTRO), Varian Medical Systems, Inc, ViewRay Inc. Stock; Radialogica. Partnership; TreatSafely. ; Radialogica, LLC. D.E. Hallahan: Research Grant; MGS, LLC. Stock; MGS, LLC, GenVac. Chairman; Washington University. P. Cuculich: Consultant; Varian.
treatment intent, radiation dose, and concomitant treatments. High risk subgroups for “likely” HZ events were explored using the Fisher’s exact test. Results: Two thousand nine hundred fifty three patients were eligible in this study. Seventy three patients (2.5%) experienced HZ after RT. Relevance between RT and HZ was judged as “likely” in 41 (1.4%), “possible” in 7 (0.2%) and “unlikely” in 25 (0.8%) patients, respectively. Median interval between the initiation of RT and the onset of HZ was 4.4 months, and 73% of the cases were diagnosed within 6 months. HZ within radiation field were more frequently observed among the patients with head and neck cancer (4.7%, pZ0.002) and gastrointestinal cancer (2.9%, pZ0.05) than other population. Usage of concurrent chemotherapy (2.4%, pZ0.01) and definitive intent treatment (2.2% pZ0.0004) were statistically significant risk factors for “likely” HZ event. Conclusion: In this population, considerable proportion of patients experienced HZ after RT. Majority of HZ events were observed within the radiation field and the incidence of HZ and RT were temporally close to each other. Our results indicate that HZ should be recognized as one of the toxicity of RT. Author Disclosure: T. Shimizuguchi: None. K. Nihei: None. K. Ito: None. H. Ogawa: None. T. Kawamoto: None. H. Kuramoto: None. S. Hayakawa: None. K. Fuse: None. Y. Shibata: None. Y. Machitori: None. M. Fujii: None. K. Karasawa: None.
3219 Herpes Zoster Following Radiation Therapy: A Single-Institutional Epidemiological Analysis from Patient Database T. Shimizuguchi,1 K. Nihei,1 K. Ito,1 H. Ogawa,1 T. Kawamoto,1 H. Kuramoto,1 S. Hayakawa,1 K. Fuse,1 Y. Shibata,1 Y. Machitori,1 M. Fujii,1 and K. Karasawa2; 1Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, Tokyo, Japan, 2Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, 3-18-22, Bunkyo-ku, Tokyo, Japan Purpose/Objective(s): Herpes zoster (HZ) is common comorbidity among cancer patients, however the relationship between HZ and radiation therapy (RT) has hardly been studied. Here we evaluated the frequency and clinical features of HZ after RT to find the relationship between them. Materials/Methods: We screened 3192 patients who received any type of external beam radiation therapy in our institute from May 2013 through November 2015. Of those, patients with leukemia were exempted from the study, since bone marrow transplantation is known strong risk factor of HZ. Based on diagnosis database for insurance claim, we identified patients who were diagnosed with HZ by May 2016. All HZ cases were confirmed to have either diagnosis by dermatologists or description of typical skin rash by reviewing patient’s records. Two datasets were integrated to evaluate the incidence rate of HZ after RT. The relevance between the distribution of HZ and the radiation field extent was classified to one of the following: “likely” (rash within or overlapping the radiation field), “possible” (rash related to irradiated nerve root) or “unlikely” (rash without relationship to the radiation field). Information of patient baseline characteristics were gathered, including age, gender, primary cancer site,
3220 Outcomes of Stereotactic Radiosurgery As Primary Interventional Therapy for the Treatment of Trigeminal Neuralgia in Patients with Multiple Sclerosis S. Singh,1 S. Rahnema,2 D. Atkinson,3 and S.T. Kahn4; 1Emory University, Atlanta, GA, 2Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, 3Emory St. Joseph’s, Atlanta, GA, United States, 4Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA Purpose/Objective(s): Trigeminal neuralgia (TN) is a debilitating pain disorder affecting 4% of patients with multiple sclerosis (MS). Whether gamma knife stereotactic radiosurgery (GKSRS) provides equivalent versus inferior outcomes for patients with MS continues to be debated, while the volume of published patient reported outcomes remains limited. The purpose of this study is to evaluate patient reported outcomes of GKSRS as an initial interventional therapy for the treatment of TN in patients with MS. Materials/Methods: We evaluated patient reported outcomes using the Barrow Neurologic Institute (BNI) pain intensity score in 11 patients with MS and medically refractory TN. All patients were treated at the Emory Saint Joseph’s Gamma Knife Center between 2005 and 2016. GKSRS was the first intervention beyond medical management for all 11 patients. The median dose delivered was 80 Gy (range 79.5-85.5). Median follow up was 48 months (range 5-110). Results: Complete pain relief without use of medications (BNI I) was achieved by 9 patients (81%) initially, and was maintained in 3 patients (27%) at last follow up. Reasonable pain control (BNI I-IIIb) was achieved by all 11 patients at some point after treatment, and was maintained in 7 patients (64%) at last follow up. The median time to pain relief was 30 days (range 1- 180 days). 4 patients (36%) had pain recurrence (BNI IV-V) and underwent a second procedure- 1 had repeat gamma knife, 1 had repeat gamma knife and percutaneous balloon compression, 1 had balloon compression, and 1 underwent radiofrequency rhizotomy. The median time to recurrence was 41.5 months (range 6- 84 months). 6 patients (50%) had facial numbness following GKSRS, with 5 having mild facial numbness (BNI II) and 1 having very bothersome numbness (BNI class IV) along with mild corneal dryness. All 6 patients with facial numbness reported a preference for numbness over pain. 1 patient reported hair loss 2 weeks following the procedure. Conclusion: GKSRS is an effective initial procedure for medically-refractory trigeminal neuralgia in patients with multiple sclerosis, resulting in low morbidity, extended pain control, and lower rates of recurrence
Volume 99 Number 2S Supplement 2017 compared to published outcomes for alternative procedures. GKRS should be considered as a first-line intervention in patients with a dual diagnosis of MS and medically-refractory TN. Author Disclosure: S. Singh: None. S. Rahnema: None. D. Atkinson: None. S.T. Kahn: None.
3221 Feasibility and Pilot Study Evaluating the Impact of Clinician-Measured Breast Length on Radiodermatitis and the Value of Multiple Longitudinal Skin Assessments in the Treatment Field L.A. Beamer; University of Utah, College of Nursing, Salt Lake City, UT, Northern Illinois University, School of Nursing, DeKalb, IL Purpose/Objective(s): We explored the role of clinician-measured breast length and bra cup size in the development of radiodermatitis over time on treatment and the efficacy of using multiple measurements of skin toxicity during radiotherapy as an outcome in a pilot study. The feasibility of measures to be used in a larger future study was assessed then described quantitatively and narratively. Materials/Methods: We studied women receiving normofractionated or accelerated external radiotherapy provided in the supine position using 3-dimensional conformal techniques at a community cancer center in northwestern Illinois in this descriptive study. Acute skin toxicity was assessed using the RTOG scale in 7 areas within the treatment field across 6 time-points. The total score for the 7 areas was calculated each week. Breast length was measured by the PI, used as a variable to describe its role in the development of acute radiodermatitis in the 7 areas within the treatment field, and compared against patient-reported bra cup size. Repeated-measure ANOVAs examined radiodermatitis using maximum skin toxicity and 7 sites in the radiation treatment field over 6 time-points. Kendall’s tau correlation was implemented to explore the relationship between study variables. Results: Forty women (39 non-Hispanic White, 1 Asian) consented to this study. Increase in breast length significantly correlated with increase in maximum RTOG score (p Z .04); increased RTOG score in the upper medial breast quadrant (p Z .04), upper lateral quadrant (p Z .02), lower lateral quadrant (p Z .02), inframammary fold (p Z .001); with increasing BMI (p Z .002) and bra cup size (p Z .0003). The measured breast lengths and reported bra cup sizes were discordant. A woman with a breast length of 5 cm reported wearing a C cup. Another with a 6.5 cm length wore an AA-sized bra cup. Women with 10.5 cm breast lengths reported wearing a D, DD, or DDD-sized bra cup. No data were missing. Conclusion: Our results suggest that measuring breast length and multiple areas in the treatment field is feasible and may increase the sensitivity of skin toxicity assessment. Additional larger studies among diverse populations are needed to determine both the clinical significance of the sum of RTOG scores for 7 areas in the radiation treatment field and the utility of multiple individual scores in the treatment field and clinician-measured breast length. Author Disclosure: L.A. Beamer: None.
3222 The Impact of Motivational Dialogue on Patient Self-Advocacy for Hand Hygiene: A Feasibility Study D.R. Cohen,1 T. Chen,2 T.Y. Eng,1 and P.G. Grota3; 1UT Health San Antonio MD Anderson Cancer Center, San Antonio, TX, 2University of Texas Health Science Center San Antonio, San Antonio, TX, 3UT Health School of Nursing, San Antonio, TX Purpose/Objective(s): The importance of hand hygiene (HH) in the healthcare setting is universally accepted. It is of particular importance in the realm of oncology in which a large percentage of patients are immunocompromised. While most patients have a good understanding of HH practices, for a variety of reasons patients rarely question their healthcare
Poster Viewing E515 providers (HCP) about HH. In this feasibility study, in order to promote patient empowerment with regards to HH we used an innovative strategy called a Patient Motivational Dialogue (PMD), a scripted dialogue where physicians encourage patients to ask HCPs to wash their hands at every clinic visit. It was hypothesized that patients would feel more comfortable and advocate more often for proper HH once encouraged and instructed to do so by a physician. Materials/Methods: Eligible study participants included all patients currently undergoing radiation therapy at our institution. The PMD was administered on initial clinic visit and PMDPlus, a shortened version of the PMD, was used for all follow up visits to reinforce HH self-advocacy. Through a semi-structured interview and a 10-question yes/no survey, consented patients’ pre and post-intervention impressions of HH were assessed. Answers to these surveys in addition to comments regarding participation in the program were recorded. Results: At the time of writing, 22 of a projected 30 participants have enrolled in the study. 11 patients have completed the study, 10 patients are actively participating, and 1 patient has withdrawn from study. On prestudy survey, almost all patients expressed an understanding of appropriate HH practice and 96.2% (127/132) of questions directed at understanding HH were answered correctly. Similarly, almost all patients felt it was important that their HCP practiced good HH habits with 97.7% (43/44) of questions directed at appropriate hygeine practice confirming this. Despite all patients having a very good understanding and desire for proper HH practices and 77% (17/22) of patients responding that they felt comfortable asking a HCP to wash their hands, only 27.3% (6/22) of patients had ever explicitly asked their HCP to do so. Of the patients who had completed the study, 100% (11/11) of patients had asked their HCP to wash their hands and similarly 91% (10/11) of patients stated they felt comfortable asking in the future. Conclusion: Nearly all patients recognize the importance of HH, but patients rarely confront their HCP about it. The initial analysis of this feasibility study shows that by establishing a relationship in which it is the HCP that stresses the importance of HH, the PMD is effective at empowering patients to advocate for their own care and, more importantly, it gives them the tools to do so. While this study focuses specifically on HH, we strongly believe that these tools give patients the ability to advocate for other aspects of their care as well. Author Disclosure: D.R. Cohen: None. T. Chen: None. T.Y. Eng: Stock; Amgen. P.G. Grota: None.
3223 Early Establishment of Supportive Care for Completion of Therapy in Locally Advanced Esophageal Cancer Patients M. Davenport,1 B. Laughlin,2 J. Frankl,2 K. Ruth,3 L. Ali-Akbarian,4 H. Patel,5 E. Elquza,4 S. Malangone,4 and K.J. Howell3; 1Banner University Medical Center Tucson, Tucson, AZ, 2University of Arizona, Tucson, AZ, 3Fox Chase Cancer Center, Philadelphia, PA, 4Banner University of Arizona, Tucson, AZ, 5University of California - San Diego Moores Cancer Center, San Diego, CA Purpose/Objective(s): Baseline nutritional parameters are associated with tumor response in locally advanced esophageal cancers treated by definitive chemoradiotherapy (CRT).1 Pathways have been developed to identify early and regular nutrition assessments and interventions.2 The supportive care needs inclusive of, and in addition to, nutritional support are substantial. We hypothesized that early intervention by a dedicated supportive care team improves patient outcome. Herein, our objective is to review the value of the early supportive care consult. Materials/Methods: We retrospectively analyzed data on patients with esophageal cancer from 7/1/12 e 7/10/16. Eligibility criteria included >18 years of age, squamous cell carcinoma or adenocarcinoma, planned neoadjuvant chemoradiotherapy (nCRT) or CRT. The median dose was 50.4Gy and Carboplatin/Paclitaxel the most common regimen. Based upon response and performance status, eligible patients had surgery. All patients
International Journal of Radiation Oncology Biology Physics
form the PTV. SBRT plans were created to deliver 25 Gy in 1 fraction to the PTV. Treatment was delivered on an image-guided linear accelerator with onboard cone beam CT without requirement for fiducial placement. Outcomes of VT burden and complications were assessed by defibrillator (ICD) interrogations, clinical evaluation and repeat imaging, with particular attention to potential late efficacy and adverse events (AEs). Results: Five patients (4M/1F, 60-84 years) received ENCORE. Median follow-up of living patients is 22 mo (range, 16-22). Mean ablation volume was 49 cc (range 17-81). Mean beam-on time was 14 mins (range, 11-18). Reduction in VT occurred in all patients (mean 1315 [range, 5-4312] episodes before ENCORE to 1 [range, 0-2]), at a median of 1 wk (1d-6wk). No acute AEs were reported. Patient #5 (84y F) suffered an embolic stroke 2 wks after treatment and died at 3 wks, with no clear relationship to treatment on autopsy. Patient #4 (62y M) had incomplete reduction in VT (>2000 episodes to 450), and required salvage catheter ablation at 4 wks. Patient #1 (61y M) developed recurrent VT outside of the previously treated target at 13 months, and underwent cardiac transplant at 18 months. No decline in left-ventricular ejection fraction (LVEF) was seen at 1 year. Mild adjacent lung inflammatory changes (grade 1) were observed at 3 months, which resolved by 1 year. All 4 living patients were free of VT at last follow-up. Conclusion: Entirely noninvasive VT ablation with SBRT is feasible in high-risk patients with refractory VT, with promising efficacy and no significant therapy related toxicity with almost 2 years of follow-up. Further long-term follow-up is required. A phase I/II trial (NCT02919618) is ongoing at our institution. Author Disclosure: C.G. Robinson: Research Grant; Elekta, Varian Medical Systems. Consultant; Varian Medical Systems. Speaker’s Bureau; DFINE. Advisory Board; Radialogica. Travel Expenses; DFINE, Varian Medical Systems. Stock Options; Radialogica. R. Kashani: Travel Expenses; Varian. S. Mutic: Honoraria; American Society for Radiation Oncology (ASTRO), Varian Medical Systems, Inc, ViewRay Inc. Advisory Board; ViewRay Inc. Travel Expenses; American Society for Radiation Oncology (ASTRO), Varian Medical Systems, Inc, ViewRay Inc. Stock; Radialogica. Partnership; TreatSafely. ; Radialogica, LLC. D.E. Hallahan: Research Grant; MGS, LLC. Stock; MGS, LLC, GenVac. Chairman; Washington University. P. Cuculich: Consultant; Varian.
treatment intent, radiation dose, and concomitant treatments. High risk subgroups for “likely” HZ events were explored using the Fisher’s exact test. Results: Two thousand nine hundred fifty three patients were eligible in this study. Seventy three patients (2.5%) experienced HZ after RT. Relevance between RT and HZ was judged as “likely” in 41 (1.4%), “possible” in 7 (0.2%) and “unlikely” in 25 (0.8%) patients, respectively. Median interval between the initiation of RT and the onset of HZ was 4.4 months, and 73% of the cases were diagnosed within 6 months. HZ within radiation field were more frequently observed among the patients with head and neck cancer (4.7%, pZ0.002) and gastrointestinal cancer (2.9%, pZ0.05) than other population. Usage of concurrent chemotherapy (2.4%, pZ0.01) and definitive intent treatment (2.2% pZ0.0004) were statistically significant risk factors for “likely” HZ event. Conclusion: In this population, considerable proportion of patients experienced HZ after RT. Majority of HZ events were observed within the radiation field and the incidence of HZ and RT were temporally close to each other. Our results indicate that HZ should be recognized as one of the toxicity of RT. Author Disclosure: T. Shimizuguchi: None. K. Nihei: None. K. Ito: None. H. Ogawa: None. T. Kawamoto: None. H. Kuramoto: None. S. Hayakawa: None. K. Fuse: None. Y. Shibata: None. Y. Machitori: None. M. Fujii: None. K. Karasawa: None.
3219 Herpes Zoster Following Radiation Therapy: A Single-Institutional Epidemiological Analysis from Patient Database T. Shimizuguchi,1 K. Nihei,1 K. Ito,1 H. Ogawa,1 T. Kawamoto,1 H. Kuramoto,1 S. Hayakawa,1 K. Fuse,1 Y. Shibata,1 Y. Machitori,1 M. Fujii,1 and K. Karasawa2; 1Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, Tokyo, Japan, 2Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, 3-18-22, Bunkyo-ku, Tokyo, Japan Purpose/Objective(s): Herpes zoster (HZ) is common comorbidity among cancer patients, however the relationship between HZ and radiation therapy (RT) has hardly been studied. Here we evaluated the frequency and clinical features of HZ after RT to find the relationship between them. Materials/Methods: We screened 3192 patients who received any type of external beam radiation therapy in our institute from May 2013 through November 2015. Of those, patients with leukemia were exempted from the study, since bone marrow transplantation is known strong risk factor of HZ. Based on diagnosis database for insurance claim, we identified patients who were diagnosed with HZ by May 2016. All HZ cases were confirmed to have either diagnosis by dermatologists or description of typical skin rash by reviewing patient’s records. Two datasets were integrated to evaluate the incidence rate of HZ after RT. The relevance between the distribution of HZ and the radiation field extent was classified to one of the following: “likely” (rash within or overlapping the radiation field), “possible” (rash related to irradiated nerve root) or “unlikely” (rash without relationship to the radiation field). Information of patient baseline characteristics were gathered, including age, gender, primary cancer site,
3220 Outcomes of Stereotactic Radiosurgery As Primary Interventional Therapy for the Treatment of Trigeminal Neuralgia in Patients with Multiple Sclerosis S. Singh,1 S. Rahnema,2 D. Atkinson,3 and S.T. Kahn4; 1Emory University, Atlanta, GA, 2Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA, 3Emory St. Joseph’s, Atlanta, GA, United States, 4Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA Purpose/Objective(s): Trigeminal neuralgia (TN) is a debilitating pain disorder affecting 4% of patients with multiple sclerosis (MS). Whether gamma knife stereotactic radiosurgery (GKSRS) provides equivalent versus inferior outcomes for patients with MS continues to be debated, while the volume of published patient reported outcomes remains limited. The purpose of this study is to evaluate patient reported outcomes of GKSRS as an initial interventional therapy for the treatment of TN in patients with MS. Materials/Methods: We evaluated patient reported outcomes using the Barrow Neurologic Institute (BNI) pain intensity score in 11 patients with MS and medically refractory TN. All patients were treated at the Emory Saint Joseph’s Gamma Knife Center between 2005 and 2016. GKSRS was the first intervention beyond medical management for all 11 patients. The median dose delivered was 80 Gy (range 79.5-85.5). Median follow up was 48 months (range 5-110). Results: Complete pain relief without use of medications (BNI I) was achieved by 9 patients (81%) initially, and was maintained in 3 patients (27%) at last follow up. Reasonable pain control (BNI I-IIIb) was achieved by all 11 patients at some point after treatment, and was maintained in 7 patients (64%) at last follow up. The median time to pain relief was 30 days (range 1- 180 days). 4 patients (36%) had pain recurrence (BNI IV-V) and underwent a second procedure- 1 had repeat gamma knife, 1 had repeat gamma knife and percutaneous balloon compression, 1 had balloon compression, and 1 underwent radiofrequency rhizotomy. The median time to recurrence was 41.5 months (range 6- 84 months). 6 patients (50%) had facial numbness following GKSRS, with 5 having mild facial numbness (BNI II) and 1 having very bothersome numbness (BNI class IV) along with mild corneal dryness. All 6 patients with facial numbness reported a preference for numbness over pain. 1 patient reported hair loss 2 weeks following the procedure. Conclusion: GKSRS is an effective initial procedure for medically-refractory trigeminal neuralgia in patients with multiple sclerosis, resulting in low morbidity, extended pain control, and lower rates of recurrence
Volume 99 Number 2S Supplement 2017 compared to published outcomes for alternative procedures. GKRS should be considered as a first-line intervention in patients with a dual diagnosis of MS and medically-refractory TN. Author Disclosure: S. Singh: None. S. Rahnema: None. D. Atkinson: None. S.T. Kahn: None.
3221 Feasibility and Pilot Study Evaluating the Impact of Clinician-Measured Breast Length on Radiodermatitis and the Value of Multiple Longitudinal Skin Assessments in the Treatment Field L.A. Beamer; University of Utah, College of Nursing, Salt Lake City, UT, Northern Illinois University, School of Nursing, DeKalb, IL Purpose/Objective(s): We explored the role of clinician-measured breast length and bra cup size in the development of radiodermatitis over time on treatment and the efficacy of using multiple measurements of skin toxicity during radiotherapy as an outcome in a pilot study. The feasibility of measures to be used in a larger future study was assessed then described quantitatively and narratively. Materials/Methods: We studied women receiving normofractionated or accelerated external radiotherapy provided in the supine position using 3-dimensional conformal techniques at a community cancer center in northwestern Illinois in this descriptive study. Acute skin toxicity was assessed using the RTOG scale in 7 areas within the treatment field across 6 time-points. The total score for the 7 areas was calculated each week. Breast length was measured by the PI, used as a variable to describe its role in the development of acute radiodermatitis in the 7 areas within the treatment field, and compared against patient-reported bra cup size. Repeated-measure ANOVAs examined radiodermatitis using maximum skin toxicity and 7 sites in the radiation treatment field over 6 time-points. Kendall’s tau correlation was implemented to explore the relationship between study variables. Results: Forty women (39 non-Hispanic White, 1 Asian) consented to this study. Increase in breast length significantly correlated with increase in maximum RTOG score (p Z .04); increased RTOG score in the upper medial breast quadrant (p Z .04), upper lateral quadrant (p Z .02), lower lateral quadrant (p Z .02), inframammary fold (p Z .001); with increasing BMI (p Z .002) and bra cup size (p Z .0003). The measured breast lengths and reported bra cup sizes were discordant. A woman with a breast length of 5 cm reported wearing a C cup. Another with a 6.5 cm length wore an AA-sized bra cup. Women with 10.5 cm breast lengths reported wearing a D, DD, or DDD-sized bra cup. No data were missing. Conclusion: Our results suggest that measuring breast length and multiple areas in the treatment field is feasible and may increase the sensitivity of skin toxicity assessment. Additional larger studies among diverse populations are needed to determine both the clinical significance of the sum of RTOG scores for 7 areas in the radiation treatment field and the utility of multiple individual scores in the treatment field and clinician-measured breast length. Author Disclosure: L.A. Beamer: None.
3222 The Impact of Motivational Dialogue on Patient Self-Advocacy for Hand Hygiene: A Feasibility Study D.R. Cohen,1 T. Chen,2 T.Y. Eng,1 and P.G. Grota3; 1UT Health San Antonio MD Anderson Cancer Center, San Antonio, TX, 2University of Texas Health Science Center San Antonio, San Antonio, TX, 3UT Health School of Nursing, San Antonio, TX Purpose/Objective(s): The importance of hand hygiene (HH) in the healthcare setting is universally accepted. It is of particular importance in the realm of oncology in which a large percentage of patients are immunocompromised. While most patients have a good understanding of HH practices, for a variety of reasons patients rarely question their healthcare
Poster Viewing E515 providers (HCP) about HH. In this feasibility study, in order to promote patient empowerment with regards to HH we used an innovative strategy called a Patient Motivational Dialogue (PMD), a scripted dialogue where physicians encourage patients to ask HCPs to wash their hands at every clinic visit. It was hypothesized that patients would feel more comfortable and advocate more often for proper HH once encouraged and instructed to do so by a physician. Materials/Methods: Eligible study participants included all patients currently undergoing radiation therapy at our institution. The PMD was administered on initial clinic visit and PMDPlus, a shortened version of the PMD, was used for all follow up visits to reinforce HH self-advocacy. Through a semi-structured interview and a 10-question yes/no survey, consented patients’ pre and post-intervention impressions of HH were assessed. Answers to these surveys in addition to comments regarding participation in the program were recorded. Results: At the time of writing, 22 of a projected 30 participants have enrolled in the study. 11 patients have completed the study, 10 patients are actively participating, and 1 patient has withdrawn from study. On prestudy survey, almost all patients expressed an understanding of appropriate HH practice and 96.2% (127/132) of questions directed at understanding HH were answered correctly. Similarly, almost all patients felt it was important that their HCP practiced good HH habits with 97.7% (43/44) of questions directed at appropriate hygeine practice confirming this. Despite all patients having a very good understanding and desire for proper HH practices and 77% (17/22) of patients responding that they felt comfortable asking a HCP to wash their hands, only 27.3% (6/22) of patients had ever explicitly asked their HCP to do so. Of the patients who had completed the study, 100% (11/11) of patients had asked their HCP to wash their hands and similarly 91% (10/11) of patients stated they felt comfortable asking in the future. Conclusion: Nearly all patients recognize the importance of HH, but patients rarely confront their HCP about it. The initial analysis of this feasibility study shows that by establishing a relationship in which it is the HCP that stresses the importance of HH, the PMD is effective at empowering patients to advocate for their own care and, more importantly, it gives them the tools to do so. While this study focuses specifically on HH, we strongly believe that these tools give patients the ability to advocate for other aspects of their care as well. Author Disclosure: D.R. Cohen: None. T. Chen: None. T.Y. Eng: Stock; Amgen. P.G. Grota: None.
3223 Early Establishment of Supportive Care for Completion of Therapy in Locally Advanced Esophageal Cancer Patients M. Davenport,1 B. Laughlin,2 J. Frankl,2 K. Ruth,3 L. Ali-Akbarian,4 H. Patel,5 E. Elquza,4 S. Malangone,4 and K.J. Howell3; 1Banner University Medical Center Tucson, Tucson, AZ, 2University of Arizona, Tucson, AZ, 3Fox Chase Cancer Center, Philadelphia, PA, 4Banner University of Arizona, Tucson, AZ, 5University of California - San Diego Moores Cancer Center, San Diego, CA Purpose/Objective(s): Baseline nutritional parameters are associated with tumor response in locally advanced esophageal cancers treated by definitive chemoradiotherapy (CRT).1 Pathways have been developed to identify early and regular nutrition assessments and interventions.2 The supportive care needs inclusive of, and in addition to, nutritional support are substantial. We hypothesized that early intervention by a dedicated supportive care team improves patient outcome. Herein, our objective is to review the value of the early supportive care consult. Materials/Methods: We retrospectively analyzed data on patients with esophageal cancer from 7/1/12 e 7/10/16. Eligibility criteria included >18 years of age, squamous cell carcinoma or adenocarcinoma, planned neoadjuvant chemoradiotherapy (nCRT) or CRT. The median dose was 50.4Gy and Carboplatin/Paclitaxel the most common regimen. Based upon response and performance status, eligible patients had surgery. All patients