- Email: [email protected]
Stereotactic Body Radiation Therapy (SBRT) for Prostate Cancer in Men with a High International Prostate Symptom Score (IPSS > 15)
E538 Conclusion: Family and home dynamics were a source of significant distress for patients undergoing radiation therapy. Marital and living status showed no significance in causing distress. All four social influence factors showed no correlation with survival. Reliance and responsibility of care for the patient and family is a significant social stressor, which is not always adequately addressed in the clinic. Patients undergoing significant strain at home can benefit from social services referred by the physician. Our results show that social issues in regards to home care should be focused on in the clinic in order to reduce distress for patients undergoing daily treatment. Author Disclosure: T. Kaleem: None. C. Brett: None. D. Miller: None. G. Strong: None. N. Jagadesh: None. A. Whitaker: None. R.C. Miller: Consultant; ASTRO, Belluscura Ltd, Tekcapital, Plc. Stock; Belluscura Ltd., Tekcapital Plc.. Stock Options; Belluscura Ltd., Tekcapital Plc.. Member, Board of Directors; Tekcapital, Plc.. Board of Trustees member; Mayo Clinic Health System - Albert Lea/Austin. Non-Executive Director and Chair; Belluscura, Ltd..
3278 Prospective Validation and Instrumental Comparison of the MD Anderson Symptom InventorydHead and Neck Module for Assessment of Radiation TherapyeAttributable Late Xerostomia M. Kamal,1,2 A. Dursteler,1,3 B.P. O’Donnell,1,4 S. Eraj,1 A.S.R. Mohamed,1,5 C. Cardenas,1 M.A.M. Meheissen,1,5 A.S. Garden,1 T.R. Mendoza,1 E.M. Sturgis,1 K.A. Hutcheson,1 C. Lu,1 M. Aristophanous,1 S.J. Frank,1 W.H. Morrison,1 D.I. Rosenthal,1 C.D. Fuller,1 and G.B. Gunn1; 1MD Anderson Head and Neck Cancer Symptom Working Group, The University of Texas MD Anderson Cancer Center, Houston, TX, 2Clinical Oncology and Nuclear Medicine Department, Ain Shams University, Cairo, Egypt, 3McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston, TX, 4The University of Texas Health Science Center at Houston, Houston, TX, 5Clinical Oncology and Nuclear Medicine Department, Alexandria University, Alexandria, Egypt Purpose/Objective(s): Instrumental validation of single item dry mouth of the MD Anderson Symptom Inventory-Head and Neck Questionnaire (MDASI-HN-DM), with extant patient reported outcomes, global quality of life (QOL), and dosimetric parameters of the salivary glands (SG), and oral mucosa (OM). Materials/Methods: A total of 210 HNC survivors completed simultaneously the MDASI-HN-DM, health visual analog scale (VAS) of the EuroQol Five Dimension Questionnaire (EQ5D) and University of Michigan Hospital 8-item self-reported xerostomia-specific questionnaire (XQ) after a median of 88 months post-RT. Factors predicting the XQ scores were analyzed.Overall XQ scores were correlated with MDASI-HN eDM and EQ5D VAS by multivariate analysis.Dose volume histograms were collected for the parotid glands (PG), submandibular glands (SMG), and OM .For dosemetric correlation, patients were divided into 2 groups; “group (1)” vs. “group (2)” by scoring any item with 7. Mean RT doses were plotted across the two groups in Table (1). Results: Median age was 57.79 years and 45% were former smokers. Oropharynx was the tumor origin for 70% , and 66% had a positive nodal disease. Concurrent and induction chemotherapy were used for 47% and 35% respectively. IMRT was utilized in 86%, and median RT dose was 70 Gy. Overall XQ item mean was 2.95 (1.14). The highest mean scores were sipping liquids to aid swallowing while eating (5.1, 3.86), or not eating (3.9 3.43), and dryness while eating (3.173). Only 10% rated all XQ items by “0” score, while 48% had at least one item of XQ rated 7.Univariate analysis showed that the elderly, smokers, and patients with nodal disease scored XQ worse than others (p < 0.05). Smoking and nodal status maintained significance (p <0.05) in multivariate regression. Multivariate analysis comparing XQ composite score with VAS of EQ5D showed an inverse relationship (Spearman’s correlation (r) Z - 0.34, p <0.001) and linear relationship with MDASI-HN-DM (r Z 0.80, p <0.001). The MDASI-HN-DM showed improved model performance for
International Journal of Radiation Oncology Biology Physics Abstract 3278; Table 1
Mean RT dose to SG and OM across the groups Mean dose(Gy) XQ score
Structure Ipsilateral PG SMG ContraPG lateral SMG OM
MDASI-HN-DM score
group (1) group (2) P value group (1) group (2) P value 29.2 56.5 14.7 29 37.6
34.5 64.3 23.4 52.9 45.7
0.047 0.004 <0.0001 <0.0001 0.0001
31.8 58.7 18.3 43.1 29.6
34.1 64.2 23.7 54.3 46.4
0.044 <0.0001 <0.0001 <0.0001 <0.0001
association with EQ5D compared to the XQ (Bayesian information criteria of1818.2 vs. 2019.9, respectively) indicative of “very strong” (post. prob. >99%) statistical evidence that MDAS-HN-DM is more parsimonious for discrimination of late QOL-altering xerostomia. Mean RT doses to SGs and OM were higher in group “2” as shown in Table (1). Conclusion: A minority reported no xerostomia with w50% reporting potentially problematic levels. MDASI-HN-DM correlated with XQ , VAS of EQ5D ,and mean RT doses to SG and OM. We recommend MDASIHN-DM as a screening tool for late QOL-altering xerostomia. Author Disclosure: M. Kamal: None. A. Dursteler: None. B.P. O’Donnell: None. S. Eraj: None. A.S. Mohamed: None. C. Cardenas: None. M.A. Meheissen: None. A.S. Garden: None. T.R. Mendoza: None. E.M. Sturgis: None. K.A. Hutcheson: None. C. Lu: None. M. Aristophanous: None. S.J. Frank: Independent Contractor; MD Anderson Physicians Network. Research Grant; C4 Imaging, ELEKTA, U19. Founder and Director; C4 Imaging. Honoraria; ELEKTA, Varian Medican Systems, Inc. Consultant; Varian Medican Systems, Inc. Advisory Board; Varian Medican Systems, Inc. Stock; C4 Imaging. Royalty; C4 Imaging. Patent/License Fees/Copyright; C4 Im. W.H. Morrison: None. D.I. Rosenthal: None. C.D. Fuller: Research Grant; Elekta AB, National Institutes of Health, National Science Foundation. Consultant; Elekta AB. Travel Expenses; Elekta AB. Grants Referee; Radiological Society of North America. Manuscript editing; Radiographics. Facilitation of multi-site data sharing for a multi-institutional Consortium; MR-LinAc Consortium. G.B. Gunn: MD Anderson Cancer Center - Proton Therapy.
3279 Stereotactic Body Radiation Therapy (SBRT) for Prostate Cancer in Men with a High International Prostate Symptom Score (IPSS > 15) S. Kataria,1 J. Chew,2 S. Lei,1 M.J. Ayoob,1 M. Danner,1 T. Yung,1 B.T. Collins,1 S. Suy,1 A. Dritschilo,1 J.H. Lynch,3 and S.P. Collins1; 1 Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, 2Georgetown University School of Medicine, Washington D.C., DC, 3Department of Urology, Georgetown University Hospital, Washington, DC Purpose/Objective(s): Patients with a high pretreatment IPSS may have higher rates of late urinary morbidity after radiation therapy for prostate cancer. Stereotactic body radiation therapy (SBRT) delivers fewer high-dose fractions of radiation, which may be radiobiologically favorable to the conventional lowdose external beam fractions commonly used for prostate cancer radiotherapy. The urinary toxicity associated with SBRT, however, remains unclear in treated patients with a high IPSS. We report our early experience using SBRT for localized prostate cancer in patients with pretreatment IPSS > 15. Materials/Methods: Localized prostate cancer patients with pre-treatment IPSS > 15 and a minimum follow up of 3 years treated with SBRT from January 2009 to December 2012 were included in this retrospective review of prospectively collected data from our institutional database. These patients were treated to 35-36.25 Gy in 5 fractions. Urinary quality of life was assessed before and after treatment using the Expanded Prostate Cancer Index Composite (EPIC-26). The EPIC urinary domain is scored on a range from 0 to 100 with higher values representing more favorable urinary symptoms. Late urinary symptom flare was defined as having an IPSS score increase of 5 points above baseline 6 months after the completion of SBRT. Toxicities were scored using the CTCAE v4.
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
3278 Prospective Validation and Instrumental Comparison of the MD Anderson Symptom InventorydHead and Neck Module for Assessment of Radiation TherapyeAttributable Late Xerostomia M. Kamal,1,2 A. Dursteler,1,3 B.P. O’Donnell,1,4 S. Eraj,1 A.S.R. Mohamed,1,5 C. Cardenas,1 M.A.M. Meheissen,1,5 A.S. Garden,1 T.R. Mendoza,1 E.M. Sturgis,1 K.A. Hutcheson,1 C. Lu,1 M. Aristophanous,1 S.J. Frank,1 W.H. Morrison,1 D.I. Rosenthal,1 C.D. Fuller,1 and G.B. Gunn1; 1MD Anderson Head and Neck Cancer Symptom Working Group, The University of Texas MD Anderson Cancer Center, Houston, TX, 2Clinical Oncology and Nuclear Medicine Department, Ain Shams University, Cairo, Egypt, 3McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth), Houston, TX, 4The University of Texas Health Science Center at Houston, Houston, TX, 5Clinical Oncology and Nuclear Medicine Department, Alexandria University, Alexandria, Egypt Purpose/Objective(s): Instrumental validation of single item dry mouth of the MD Anderson Symptom Inventory-Head and Neck Questionnaire (MDASI-HN-DM), with extant patient reported outcomes, global quality of life (QOL), and dosimetric parameters of the salivary glands (SG), and oral mucosa (OM). Materials/Methods: A total of 210 HNC survivors completed simultaneously the MDASI-HN-DM, health visual analog scale (VAS) of the EuroQol Five Dimension Questionnaire (EQ5D) and University of Michigan Hospital 8-item self-reported xerostomia-specific questionnaire (XQ) after a median of 88 months post-RT. Factors predicting the XQ scores were analyzed.Overall XQ scores were correlated with MDASI-HN eDM and EQ5D VAS by multivariate analysis.Dose volume histograms were collected for the parotid glands (PG), submandibular glands (SMG), and OM .For dosemetric correlation, patients were divided into 2 groups; “group (1)” vs. “group (2)” by scoring any item with 7. Mean RT doses were plotted across the two groups in Table (1). Results: Median age was 57.79 years and 45% were former smokers. Oropharynx was the tumor origin for 70% , and 66% had a positive nodal disease. Concurrent and induction chemotherapy were used for 47% and 35% respectively. IMRT was utilized in 86%, and median RT dose was 70 Gy. Overall XQ item mean was 2.95 (1.14). The highest mean scores were sipping liquids to aid swallowing while eating (5.1, 3.86), or not eating (3.9 3.43), and dryness while eating (3.173). Only 10% rated all XQ items by “0” score, while 48% had at least one item of XQ rated 7.Univariate analysis showed that the elderly, smokers, and patients with nodal disease scored XQ worse than others (p < 0.05). Smoking and nodal status maintained significance (p <0.05) in multivariate regression. Multivariate analysis comparing XQ composite score with VAS of EQ5D showed an inverse relationship (Spearman’s correlation (r) Z - 0.34, p <0.001) and linear relationship with MDASI-HN-DM (r Z 0.80, p <0.001). The MDASI-HN-DM showed improved model performance for
International Journal of Radiation Oncology Biology Physics Abstract 3278; Table 1
Mean RT dose to SG and OM across the groups Mean dose(Gy) XQ score
Structure Ipsilateral PG SMG ContraPG lateral SMG OM
MDASI-HN-DM score
group (1) group (2) P value group (1) group (2) P value 29.2 56.5 14.7 29 37.6
34.5 64.3 23.4 52.9 45.7
0.047 0.004 <0.0001 <0.0001 0.0001
31.8 58.7 18.3 43.1 29.6
34.1 64.2 23.7 54.3 46.4
0.044 <0.0001 <0.0001 <0.0001 <0.0001
association with EQ5D compared to the XQ (Bayesian information criteria of1818.2 vs. 2019.9, respectively) indicative of “very strong” (post. prob. >99%) statistical evidence that MDAS-HN-DM is more parsimonious for discrimination of late QOL-altering xerostomia. Mean RT doses to SGs and OM were higher in group “2” as shown in Table (1). Conclusion: A minority reported no xerostomia with w50% reporting potentially problematic levels. MDASI-HN-DM correlated with XQ , VAS of EQ5D ,and mean RT doses to SG and OM. We recommend MDASIHN-DM as a screening tool for late QOL-altering xerostomia. Author Disclosure: M. Kamal: None. A. Dursteler: None. B.P. O’Donnell: None. S. Eraj: None. A.S. Mohamed: None. C. Cardenas: None. M.A. Meheissen: None. A.S. Garden: None. T.R. Mendoza: None. E.M. Sturgis: None. K.A. Hutcheson: None. C. Lu: None. M. Aristophanous: None. S.J. Frank: Independent Contractor; MD Anderson Physicians Network. Research Grant; C4 Imaging, ELEKTA, U19. Founder and Director; C4 Imaging. Honoraria; ELEKTA, Varian Medican Systems, Inc. Consultant; Varian Medican Systems, Inc. Advisory Board; Varian Medican Systems, Inc. Stock; C4 Imaging. Royalty; C4 Imaging. Patent/License Fees/Copyright; C4 Im. W.H. Morrison: None. D.I. Rosenthal: None. C.D. Fuller: Research Grant; Elekta AB, National Institutes of Health, National Science Foundation. Consultant; Elekta AB. Travel Expenses; Elekta AB. Grants Referee; Radiological Society of North America. Manuscript editing; Radiographics. Facilitation of multi-site data sharing for a multi-institutional Consortium; MR-LinAc Consortium. G.B. Gunn: MD Anderson Cancer Center - Proton Therapy.
3279 Stereotactic Body Radiation Therapy (SBRT) for Prostate Cancer in Men with a High International Prostate Symptom Score (IPSS > 15) S. Kataria,1 J. Chew,2 S. Lei,1 M.J. Ayoob,1 M. Danner,1 T. Yung,1 B.T. Collins,1 S. Suy,1 A. Dritschilo,1 J.H. Lynch,3 and S.P. Collins1; 1 Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, 2Georgetown University School of Medicine, Washington D.C., DC, 3Department of Urology, Georgetown University Hospital, Washington, DC Purpose/Objective(s): Patients with a high pretreatment IPSS may have higher rates of late urinary morbidity after radiation therapy for prostate cancer. Stereotactic body radiation therapy (SBRT) delivers fewer high-dose fractions of radiation, which may be radiobiologically favorable to the conventional lowdose external beam fractions commonly used for prostate cancer radiotherapy. The urinary toxicity associated with SBRT, however, remains unclear in treated patients with a high IPSS. We report our early experience using SBRT for localized prostate cancer in patients with pretreatment IPSS > 15. Materials/Methods: Localized prostate cancer patients with pre-treatment IPSS > 15 and a minimum follow up of 3 years treated with SBRT from January 2009 to December 2012 were included in this retrospective review of prospectively collected data from our institutional database. These patients were treated to 35-36.25 Gy in 5 fractions. Urinary quality of life was assessed before and after treatment using the Expanded Prostate Cancer Index Composite (EPIC-26). The EPIC urinary domain is scored on a range from 0 to 100 with higher values representing more favorable urinary symptoms. Late urinary symptom flare was defined as having an IPSS score increase of 5 points above baseline 6 months after the completion of SBRT. Toxicities were scored using the CTCAE v4.
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