In contrast to traditional chemotherapy, patients responding to biological or targeted therapies often are treated indefinitely until progression or toxicity. This therapeutic model, however, increases treatment costs, may induce greater toxicity and theoretically could select for earlier emergence of drug resistance. Moreover, little data are available regarding the outcomes of patients who discontinue targeted therapies after achieving remission. In this regard, we report 2 patients with relapsed/refractory chronic lymphocytic leukemia (CLL) who chose to stop therapy unrelated to toxicity or disease status after the induction of remission by the BTK inhibitor ibrutinib.

Patient A started ibrutinib for progressive CLL at an absolute lymphocyte count (ALC) of 137,000 mm3 and recurrent hemolytic anemia. After 5 months, the hemolysis had resolved (Hgb 15.6 g/dL), while the ALC had declined to 9,200 mm3. Treatment was then interrupted due to patient preference. One month after drug discontinuation, the ALC was in the normal range at 1,400 mm3 and remained within or near the normal range for a total of 12 months. Two months later, the ALC was again markedly elevated at 68,000 mm3 and anemia recurred. The patient then agreed to restart ibrutinib. After 4 months of re-treatment, he has had prompt resolution of the anemia and achieved a partial remission thus far.

Patient B was started on ibrutinib for a rising ALC (26,000 mm3) and severe hemolytic anemia. After 9 months of treatment, the hemoglobin was 13 g/dL and the ALC was in the normal range at 3,300 mm3. Due to unrelated medical problems, ibrutinib therapy was stopped. Currently, 6 months since drug discontinuation, the ALC remains in the normal range, and no other signs of CLL are present.

These clinical observations suggest that interruption of ibrutinib may be feasible in at least some CLL patients who achieve remission. Even if flow cytometry were performed at monthly intervals to detect early recurrence and ensure prompt re-institution of therapy, the cost savings would still be considerable. Of course, clinical trials will be necessary to confirm equivalent long-term efficacy and overall survival for intermittent versus continuous ibrutinib therapy in CLL.

In contrast to traditional chemotherapy, patients responding to biological or targeted therapies often are treated indefinitely until progression or toxicity. This therapeutic model, however, increases treatment costs, may induce greater toxicity and theoretically could select for earlier emergence of drug resistance. Moreover, little data are available regarding the outcomes of patients who discontinue targeted therapies after achieving remission. In this regard, we report 2 patients with relapsed/refractory chronic lymphocytic leukemia (CLL) who chose to stop therapy unrelated to toxicity or disease status after the induction of remission by the BTK inhibitor ibrutinib.

Patient A started ibrutinib for progressive CLL at an absolute lymphocyte count (ALC) of 137,000 mm3 and recurrent hemolytic anemia. After 5 months, the hemolysis had resolved (Hgb 15.6 g/dL), while the ALC had declined to 9,200 mm3. Treatment was then interrupted due to patient preference. One month after drug discontinuation, the ALC was in the normal range at 1,400 mm3 and remained within or near the normal range for a total of 12 months. Two months later, the ALC was again markedly elevated at 68,000 mm3 and anemia recurred. The patient then agreed to restart ibrutinib. After 4 months of re-treatment, he has had prompt resolution of the anemia and achieved a partial remission thus far.

Patient B was started on ibrutinib for a rising ALC (26,000 mm3) and severe hemolytic anemia. After 9 months of treatment, the hemoglobin was 13 g/dL and the ALC was in the normal range at 3,300 mm3. Due to unrelated medical problems, ibrutinib therapy was stopped. Currently, 6 months since drug discontinuation, the ALC remains in the normal range, and no other signs of CLL are present.

These clinical observations suggest that interruption of ibrutinib may be feasible in at least some CLL patients who achieve remission. Even if flow cytometry were performed at monthly intervals to detect early recurrence and ensure prompt re-institution of therapy, the cost savings would still be considerable. Of course, clinical trials will be necessary to confirm equivalent long-term efficacy and overall survival for intermittent versus continuous ibrutinib therapy in CLL.

In contrast to traditional chemotherapy, patients responding to biological or targeted therapies often are treated indefinitely until progression or toxicity. This therapeutic model, however, increases treatment costs, may induce greater toxicity and theoretically could select for earlier emergence of drug resistance. Moreover, little data are available regarding the outcomes of patients who discontinue targeted therapies after achieving remission. In this regard, we report 2 patients with relapsed/refractory chronic lymphocytic leukemia (CLL) who chose to stop therapy unrelated to toxicity or disease status after the induction of remission by the BTK inhibitor ibrutinib.

Patient A started ibrutinib for progressive CLL at an absolute lymphocyte count (ALC) of 137,000 mm3 and recurrent hemolytic anemia. After 5 months, the hemolysis had resolved (Hgb 15.6 g/dL), while the ALC had declined to 9,200 mm3. Treatment was then interrupted due to patient preference. One month after drug discontinuation, the ALC was in the normal range at 1,400 mm3 and remained within or near the normal range for a total of 12 months. Two months later, the ALC was again markedly elevated at 68,000 mm3 and anemia recurred. The patient then agreed to restart ibrutinib. After 4 months of re-treatment, he has had prompt resolution of the anemia and achieved a partial remission thus far.

Patient B was started on ibrutinib for a rising ALC (26,000 mm3) and severe hemolytic anemia. After 9 months of treatment, the hemoglobin was 13 g/dL and the ALC was in the normal range at 3,300 mm3. Due to unrelated medical problems, ibrutinib therapy was stopped. Currently, 6 months since drug discontinuation, the ALC remains in the normal range, and no other signs of CLL are present.

These clinical observations suggest that interruption of ibrutinib may be feasible in at least some CLL patients who achieve remission. Even if flow cytometry were performed at monthly intervals to detect early recurrence and ensure prompt re-institution of therapy, the cost savings would still be considerable. Of course, clinical trials will be necessary to confirm equivalent long-term efficacy and overall survival for intermittent versus continuous ibrutinib therapy in CLL.

In an effort to decrease the timeline from suspicion and/or cancer diagnosis to treatment, the Oncology Disease Management RNs incorporated a streamlined and integrated clinical approach. A Disease Case Management (DM) team model is a useful approach to enhance the veteran experience and expedite health care delivery. In 2007, the DM program was begun. The team consisted of 3 registered nurses (RN) who worked under the Quality Management Department rather than the oncology clinic in order to have a more wide ranged approach in both treatment and interventions.

Methods: All patients who had either a suspicion for, or an actual diagnosis of cancer were followed by the DM RNs. We assessed the timeline in days for veterans to get scheduled for recommended tests and consults before and after the DM team involvement. We reviewed timeline data for patients diagnosed during fiscal years 2009 to 2015. The percentage change was calculated for Oncology Consults and Intra-facility Consults to DM team. Times from diagnosis to treatment intervention pre and post DM implementation were reviewed for Primary liver, colon and lung cancers.

Results: Rate of change: Oncology consults for Disease Management team intervention: 62% increase. Reduction in time from diagnosis to treatment intervention: Colon cancer and Lung Cancer 50% and 46% respectively. Reduction in the time required for getting primary Liver cancer patients into diagnostic tests and tumor board presentations for treatment intervention – days shortened from 92 to 31 days from baseline data 2010/11 to 2015. This reflected a 66% decrease in time to treatment /intervention.

Conclusion: The data reflect that in a VA healthcare setting, the Disease Management team model is feasible for facilitating an integrated and coordinated approach in reducing timelines for treatment. The data support that the early introduction of the disease management team model shortened the number of days from diagnosis to treatment by facilitating referrals, clinical testing, and/or treatment initiation in Veteran cancer patients resulting in timely care intervention.

In an effort to decrease the timeline from suspicion and/or cancer diagnosis to treatment, the Oncology Disease Management RNs incorporated a streamlined and integrated clinical approach. A Disease Case Management (DM) team model is a useful approach to enhance the veteran experience and expedite health care delivery. In 2007, the DM program was begun. The team consisted of 3 registered nurses (RN) who worked under the Quality Management Department rather than the oncology clinic in order to have a more wide ranged approach in both treatment and interventions.

Methods: All patients who had either a suspicion for, or an actual diagnosis of cancer were followed by the DM RNs. We assessed the timeline in days for veterans to get scheduled for recommended tests and consults before and after the DM team involvement. We reviewed timeline data for patients diagnosed during fiscal years 2009 to 2015. The percentage change was calculated for Oncology Consults and Intra-facility Consults to DM team. Times from diagnosis to treatment intervention pre and post DM implementation were reviewed for Primary liver, colon and lung cancers.

Results: Rate of change: Oncology consults for Disease Management team intervention: 62% increase. Reduction in time from diagnosis to treatment intervention: Colon cancer and Lung Cancer 50% and 46% respectively. Reduction in the time required for getting primary Liver cancer patients into diagnostic tests and tumor board presentations for treatment intervention – days shortened from 92 to 31 days from baseline data 2010/11 to 2015. This reflected a 66% decrease in time to treatment /intervention.

Conclusion: The data reflect that in a VA healthcare setting, the Disease Management team model is feasible for facilitating an integrated and coordinated approach in reducing timelines for treatment. The data support that the early introduction of the disease management team model shortened the number of days from diagnosis to treatment by facilitating referrals, clinical testing, and/or treatment initiation in Veteran cancer patients resulting in timely care intervention.

In an effort to decrease the timeline from suspicion and/or cancer diagnosis to treatment, the Oncology Disease Management RNs incorporated a streamlined and integrated clinical approach. A Disease Case Management (DM) team model is a useful approach to enhance the veteran experience and expedite health care delivery. In 2007, the DM program was begun. The team consisted of 3 registered nurses (RN) who worked under the Quality Management Department rather than the oncology clinic in order to have a more wide ranged approach in both treatment and interventions.

Methods: All patients who had either a suspicion for, or an actual diagnosis of cancer were followed by the DM RNs. We assessed the timeline in days for veterans to get scheduled for recommended tests and consults before and after the DM team involvement. We reviewed timeline data for patients diagnosed during fiscal years 2009 to 2015. The percentage change was calculated for Oncology Consults and Intra-facility Consults to DM team. Times from diagnosis to treatment intervention pre and post DM implementation were reviewed for Primary liver, colon and lung cancers.

Results: Rate of change: Oncology consults for Disease Management team intervention: 62% increase. Reduction in time from diagnosis to treatment intervention: Colon cancer and Lung Cancer 50% and 46% respectively. Reduction in the time required for getting primary Liver cancer patients into diagnostic tests and tumor board presentations for treatment intervention – days shortened from 92 to 31 days from baseline data 2010/11 to 2015. This reflected a 66% decrease in time to treatment /intervention.

Conclusion: The data reflect that in a VA healthcare setting, the Disease Management team model is feasible for facilitating an integrated and coordinated approach in reducing timelines for treatment. The data support that the early introduction of the disease management team model shortened the number of days from diagnosis to treatment by facilitating referrals, clinical testing, and/or treatment initiation in Veteran cancer patients resulting in timely care intervention.

Background: Prognostic biomarkers are increasingly important in the management of advanced colorectal cancer (ACRC). The aim of the present study was to evaluate the correlation of Kirsten rat sarcoma-2 virus oncogene (KRAS) mutation status with elevated carcinoembryonic antigen (CEA) levels in ACRC patients and their association with patients’ survival.

Methods: Patients with metastatic colorectal cancer were identified by a retrospective review of the Albany Medical Center cancer registry data from January 2006 to December 2014. Demographic, clinical, laboratory, and treatment data were retrieved after a manual review of patients’ electronic medical records. Only patients with complete data on CEA levels and KRAS mutation status were included in our analysis. Elevated CEA levels were defined as more than 3 ng/mL.

Results: Sixty-one patients with complete data were identified. Mean age was 58 years (SD 13.7, range 26-87), and 33 of them (54.1%) were male. In 23 out of 61 patients (37.7%), the rectum was involved. The pathologic diagnosis for all the patients was adenocarcinoma. Thirty-nine of 61 patients (63.9%) had wild-type KRAS (wKRAS) and 22 (36.1%) mutated KRAS (mKRAS). Out of 22 patients with mKRAS, 21 (95.5%) had elevated CEA levels prior to first treatment compared to 26 out of 39 (66.7%) with wKRAS (P = 0.011). The median CEA levels prior to treatment for patients with mKRAS was 57.5 ng/mL (IQR 12.6-79.8, range 1.8-16,512) compared to 7.8 ng/mL (2.13-17.7, 0.2-2,027; P = .037) in patients with wKRAS. Among patients with mKRAS and elevated CEA levels, the 1- and 5-year survival rates were 61.9% (13/21) and 0%, respectively, while the mean survival was 16.5 months (SD 10.6, range 1-42). The 1- and 5-year survival rates as well as mean survival for patients with wKRAS and elevated CEA levels were 84.6% (22/26), 3.8% (1/26), and 29.1 months (17.9, 8-84; P = .005) while for those with wKRAS and normal CEA levels were 91.7% (11/12), 25% (3/12), and 43.6 months (29.8, 1-108; P = .14), respectively.

Conclusion: Almost all ACRC patient with mKRAS have elevated CEA levels prior to first systemic therapy. ACRC patients with mKRAS and elevated CEA levels have lower survival rates.

Background: Prognostic biomarkers are increasingly important in the management of advanced colorectal cancer (ACRC). The aim of the present study was to evaluate the correlation of Kirsten rat sarcoma-2 virus oncogene (KRAS) mutation status with elevated carcinoembryonic antigen (CEA) levels in ACRC patients and their association with patients’ survival.

Methods: Patients with metastatic colorectal cancer were identified by a retrospective review of the Albany Medical Center cancer registry data from January 2006 to December 2014. Demographic, clinical, laboratory, and treatment data were retrieved after a manual review of patients’ electronic medical records. Only patients with complete data on CEA levels and KRAS mutation status were included in our analysis. Elevated CEA levels were defined as more than 3 ng/mL.

Results: Sixty-one patients with complete data were identified. Mean age was 58 years (SD 13.7, range 26-87), and 33 of them (54.1%) were male. In 23 out of 61 patients (37.7%), the rectum was involved. The pathologic diagnosis for all the patients was adenocarcinoma. Thirty-nine of 61 patients (63.9%) had wild-type KRAS (wKRAS) and 22 (36.1%) mutated KRAS (mKRAS). Out of 22 patients with mKRAS, 21 (95.5%) had elevated CEA levels prior to first treatment compared to 26 out of 39 (66.7%) with wKRAS (P = 0.011). The median CEA levels prior to treatment for patients with mKRAS was 57.5 ng/mL (IQR 12.6-79.8, range 1.8-16,512) compared to 7.8 ng/mL (2.13-17.7, 0.2-2,027; P = .037) in patients with wKRAS. Among patients with mKRAS and elevated CEA levels, the 1- and 5-year survival rates were 61.9% (13/21) and 0%, respectively, while the mean survival was 16.5 months (SD 10.6, range 1-42). The 1- and 5-year survival rates as well as mean survival for patients with wKRAS and elevated CEA levels were 84.6% (22/26), 3.8% (1/26), and 29.1 months (17.9, 8-84; P = .005) while for those with wKRAS and normal CEA levels were 91.7% (11/12), 25% (3/12), and 43.6 months (29.8, 1-108; P = .14), respectively.

Conclusion: Almost all ACRC patient with mKRAS have elevated CEA levels prior to first systemic therapy. ACRC patients with mKRAS and elevated CEA levels have lower survival rates.

Background: Prognostic biomarkers are increasingly important in the management of advanced colorectal cancer (ACRC). The aim of the present study was to evaluate the correlation of Kirsten rat sarcoma-2 virus oncogene (KRAS) mutation status with elevated carcinoembryonic antigen (CEA) levels in ACRC patients and their association with patients’ survival.

Methods: Patients with metastatic colorectal cancer were identified by a retrospective review of the Albany Medical Center cancer registry data from January 2006 to December 2014. Demographic, clinical, laboratory, and treatment data were retrieved after a manual review of patients’ electronic medical records. Only patients with complete data on CEA levels and KRAS mutation status were included in our analysis. Elevated CEA levels were defined as more than 3 ng/mL.

Results: Sixty-one patients with complete data were identified. Mean age was 58 years (SD 13.7, range 26-87), and 33 of them (54.1%) were male. In 23 out of 61 patients (37.7%), the rectum was involved. The pathologic diagnosis for all the patients was adenocarcinoma. Thirty-nine of 61 patients (63.9%) had wild-type KRAS (wKRAS) and 22 (36.1%) mutated KRAS (mKRAS). Out of 22 patients with mKRAS, 21 (95.5%) had elevated CEA levels prior to first treatment compared to 26 out of 39 (66.7%) with wKRAS (P = 0.011). The median CEA levels prior to treatment for patients with mKRAS was 57.5 ng/mL (IQR 12.6-79.8, range 1.8-16,512) compared to 7.8 ng/mL (2.13-17.7, 0.2-2,027; P = .037) in patients with wKRAS. Among patients with mKRAS and elevated CEA levels, the 1- and 5-year survival rates were 61.9% (13/21) and 0%, respectively, while the mean survival was 16.5 months (SD 10.6, range 1-42). The 1- and 5-year survival rates as well as mean survival for patients with wKRAS and elevated CEA levels were 84.6% (22/26), 3.8% (1/26), and 29.1 months (17.9, 8-84; P = .005) while for those with wKRAS and normal CEA levels were 91.7% (11/12), 25% (3/12), and 43.6 months (29.8, 1-108; P = .14), respectively.

Conclusion: Almost all ACRC patient with mKRAS have elevated CEA levels prior to first systemic therapy. ACRC patients with mKRAS and elevated CEA levels have lower survival rates.

Purpose: To utilize a distress screening tool that can be used across VAMCs that fulfills cancer center requirements and accreditation standards.

Background: The American College of Surgeon’s (ACOS) Commission on Cancer (COC), Standard 3.2 Distress Screening requires all new cancer diagnoses be screened at diagnosis and at pivotal points across the cancer care continuum. The Louis Stokes Cleveland VAMC (LSCVAMC) used the NCCN DT from May 2012 through March 2016. Collaborating with the Durham VAMC, the LSCVAMC began to pilot the VSAS screening tool in place of the NCCN DT. This initiative was an attempt to use 1 tool that could satisfy both ACOS COC accreditation standards as well as the American Society of Clinical Oncology (ASCO) Quality Oncology Practice Initiative (QOPI) Certification.

Methods: An interdisciplinary team composed of an oncology social worker, oncology psychologist, medical oncologist, survivorship advanced practice nurse and the Cancer Center Program Administrator gathered to compare elements of both the NCCN DT and the VSAS tool. Social elements of distress related to transportation, housing and insurance deemed important to our veteran population were incorporated into the existing VSAS tool.

Data Analysis: During March through June 2016 there have been 47 VSAS tools completed on 47 unique patients. Nursing staff administer, document, and order applicable consults for the screening process. The time required to complete the screen is approximately 2-4 minutes depending on the complexity of the patient. Preliminary data regarding specific elements of the VSAS will be forthcoming at the time of poster presentation.

Results: Patients with a new diagnosis of cancer were asked to complete the form at their initial visit. Initial results from the team piloting the VSAS found that the tool actually allowed providers to hone in on more of the areas that were causing the Veteran the most distress. Whereas, with DT only having 1 thermometer made narrowing down what was causing the most distress more difficult.

Implications: Finding tools that can be implemented across VA facilities for both COC and QOPI initiatives will streamline processes and allow for multicenter data collection benefiting the VA as a whole and decreasing variability in cancer care between facilities.

Purpose: To utilize a distress screening tool that can be used across VAMCs that fulfills cancer center requirements and accreditation standards.

Background: The American College of Surgeon’s (ACOS) Commission on Cancer (COC), Standard 3.2 Distress Screening requires all new cancer diagnoses be screened at diagnosis and at pivotal points across the cancer care continuum. The Louis Stokes Cleveland VAMC (LSCVAMC) used the NCCN DT from May 2012 through March 2016. Collaborating with the Durham VAMC, the LSCVAMC began to pilot the VSAS screening tool in place of the NCCN DT. This initiative was an attempt to use 1 tool that could satisfy both ACOS COC accreditation standards as well as the American Society of Clinical Oncology (ASCO) Quality Oncology Practice Initiative (QOPI) Certification.

Methods: An interdisciplinary team composed of an oncology social worker, oncology psychologist, medical oncologist, survivorship advanced practice nurse and the Cancer Center Program Administrator gathered to compare elements of both the NCCN DT and the VSAS tool. Social elements of distress related to transportation, housing and insurance deemed important to our veteran population were incorporated into the existing VSAS tool.

Data Analysis: During March through June 2016 there have been 47 VSAS tools completed on 47 unique patients. Nursing staff administer, document, and order applicable consults for the screening process. The time required to complete the screen is approximately 2-4 minutes depending on the complexity of the patient. Preliminary data regarding specific elements of the VSAS will be forthcoming at the time of poster presentation.

Results: Patients with a new diagnosis of cancer were asked to complete the form at their initial visit. Initial results from the team piloting the VSAS found that the tool actually allowed providers to hone in on more of the areas that were causing the Veteran the most distress. Whereas, with DT only having 1 thermometer made narrowing down what was causing the most distress more difficult.

Implications: Finding tools that can be implemented across VA facilities for both COC and QOPI initiatives will streamline processes and allow for multicenter data collection benefiting the VA as a whole and decreasing variability in cancer care between facilities.

Purpose: To utilize a distress screening tool that can be used across VAMCs that fulfills cancer center requirements and accreditation standards.

Background: The American College of Surgeon’s (ACOS) Commission on Cancer (COC), Standard 3.2 Distress Screening requires all new cancer diagnoses be screened at diagnosis and at pivotal points across the cancer care continuum. The Louis Stokes Cleveland VAMC (LSCVAMC) used the NCCN DT from May 2012 through March 2016. Collaborating with the Durham VAMC, the LSCVAMC began to pilot the VSAS screening tool in place of the NCCN DT. This initiative was an attempt to use 1 tool that could satisfy both ACOS COC accreditation standards as well as the American Society of Clinical Oncology (ASCO) Quality Oncology Practice Initiative (QOPI) Certification.

Methods: An interdisciplinary team composed of an oncology social worker, oncology psychologist, medical oncologist, survivorship advanced practice nurse and the Cancer Center Program Administrator gathered to compare elements of both the NCCN DT and the VSAS tool. Social elements of distress related to transportation, housing and insurance deemed important to our veteran population were incorporated into the existing VSAS tool.

Data Analysis: During March through June 2016 there have been 47 VSAS tools completed on 47 unique patients. Nursing staff administer, document, and order applicable consults for the screening process. The time required to complete the screen is approximately 2-4 minutes depending on the complexity of the patient. Preliminary data regarding specific elements of the VSAS will be forthcoming at the time of poster presentation.

Results: Patients with a new diagnosis of cancer were asked to complete the form at their initial visit. Initial results from the team piloting the VSAS found that the tool actually allowed providers to hone in on more of the areas that were causing the Veteran the most distress. Whereas, with DT only having 1 thermometer made narrowing down what was causing the most distress more difficult.

Implications: Finding tools that can be implemented across VA facilities for both COC and QOPI initiatives will streamline processes and allow for multicenter data collection benefiting the VA as a whole and decreasing variability in cancer care between facilities.

Purpose: This study sought to characterize the incidence of cisplatin-induced hearing change by cancer location and aspects of the treatment regimen in a sample of Veterans undergoing chemotherapy at the VA Portland HCS. An additional goal was to characterize the severity of hearing loss prior to treatment and the contributions of cisplatin-induced hearing loss in relation to the need for auditory rehabilitation.

Background: Between 2008 and 2014, 17,173 Veterans were treated with cisplatin chemotherapy. Many began treatment with pre-existing hearing loss and up to half likely sustained ototoxicity. Even minor shifts in hearing, left untreated, can constrain effective provider-Veteran treatment partnerships, family and workplace communication, and can significantly limit optimal quality of life following cancer.

Methods: Serial hearing testing and medical records data were obtained prospectively from 2011-2016 in N = 87 cancer patients. Baseline hearing tests were completed within 24 hours of the first cisplatin treatment, during and after treatment. The primary outcome was a shift in the audiogram based on the NCI Common Terminology Criteria for Adverse Events (CTCAE) Grades 1-4 and American Speech-Language-Hearing Association (ASHA) guidelines for a significant ototoxic shift. Hearing shifts that met criteria for CTCAE Grade 1 were further evaluated in relation to cisplatin cumulative dose, initial dose, concurrent radiation and cancer location.

Data Analysis: Descriptive statistics characterize the severity of pre-existing hearing loss and ototoxic changes. Effects of cisplatin dose, cancer location, and radiation on the risks for CTCAE Grade 1 ototoxic event were estimated using hierarchical logistic regression.

Results: Ototoxicity meeting CTCAE grade 3 were found at a rate of 19% for head and neck cancers. This group warrants priority surveillance. Less severe (Grade 1) shifts were found at high rates across other cancer locations assessed in this study. CTCAE Grade 1 ototoxicity is associated with cancer location, starting dose, and concurrent radiation. Importantly, Grade 1 exceeds the magnitude of an ASHA-significant hearing shift by definition. These Veterans are a high priority group for hearing monitoring and rehabilitation service provision by Audiology.

Implications: CTCAE Grade 1 ototoxicity is a commonly occurring toxicity that may limit Veteran-provider communication and quality of life.

Purpose: This study sought to characterize the incidence of cisplatin-induced hearing change by cancer location and aspects of the treatment regimen in a sample of Veterans undergoing chemotherapy at the VA Portland HCS. An additional goal was to characterize the severity of hearing loss prior to treatment and the contributions of cisplatin-induced hearing loss in relation to the need for auditory rehabilitation.

Background: Between 2008 and 2014, 17,173 Veterans were treated with cisplatin chemotherapy. Many began treatment with pre-existing hearing loss and up to half likely sustained ototoxicity. Even minor shifts in hearing, left untreated, can constrain effective provider-Veteran treatment partnerships, family and workplace communication, and can significantly limit optimal quality of life following cancer.

Methods: Serial hearing testing and medical records data were obtained prospectively from 2011-2016 in N = 87 cancer patients. Baseline hearing tests were completed within 24 hours of the first cisplatin treatment, during and after treatment. The primary outcome was a shift in the audiogram based on the NCI Common Terminology Criteria for Adverse Events (CTCAE) Grades 1-4 and American Speech-Language-Hearing Association (ASHA) guidelines for a significant ototoxic shift. Hearing shifts that met criteria for CTCAE Grade 1 were further evaluated in relation to cisplatin cumulative dose, initial dose, concurrent radiation and cancer location.

Data Analysis: Descriptive statistics characterize the severity of pre-existing hearing loss and ototoxic changes. Effects of cisplatin dose, cancer location, and radiation on the risks for CTCAE Grade 1 ototoxic event were estimated using hierarchical logistic regression.

Results: Ototoxicity meeting CTCAE grade 3 were found at a rate of 19% for head and neck cancers. This group warrants priority surveillance. Less severe (Grade 1) shifts were found at high rates across other cancer locations assessed in this study. CTCAE Grade 1 ototoxicity is associated with cancer location, starting dose, and concurrent radiation. Importantly, Grade 1 exceeds the magnitude of an ASHA-significant hearing shift by definition. These Veterans are a high priority group for hearing monitoring and rehabilitation service provision by Audiology.

Implications: CTCAE Grade 1 ototoxicity is a commonly occurring toxicity that may limit Veteran-provider communication and quality of life.

Purpose: This study sought to characterize the incidence of cisplatin-induced hearing change by cancer location and aspects of the treatment regimen in a sample of Veterans undergoing chemotherapy at the VA Portland HCS. An additional goal was to characterize the severity of hearing loss prior to treatment and the contributions of cisplatin-induced hearing loss in relation to the need for auditory rehabilitation.

Background: Between 2008 and 2014, 17,173 Veterans were treated with cisplatin chemotherapy. Many began treatment with pre-existing hearing loss and up to half likely sustained ototoxicity. Even minor shifts in hearing, left untreated, can constrain effective provider-Veteran treatment partnerships, family and workplace communication, and can significantly limit optimal quality of life following cancer.

Methods: Serial hearing testing and medical records data were obtained prospectively from 2011-2016 in N = 87 cancer patients. Baseline hearing tests were completed within 24 hours of the first cisplatin treatment, during and after treatment. The primary outcome was a shift in the audiogram based on the NCI Common Terminology Criteria for Adverse Events (CTCAE) Grades 1-4 and American Speech-Language-Hearing Association (ASHA) guidelines for a significant ototoxic shift. Hearing shifts that met criteria for CTCAE Grade 1 were further evaluated in relation to cisplatin cumulative dose, initial dose, concurrent radiation and cancer location.

Data Analysis: Descriptive statistics characterize the severity of pre-existing hearing loss and ototoxic changes. Effects of cisplatin dose, cancer location, and radiation on the risks for CTCAE Grade 1 ototoxic event were estimated using hierarchical logistic regression.

Results: Ototoxicity meeting CTCAE grade 3 were found at a rate of 19% for head and neck cancers. This group warrants priority surveillance. Less severe (Grade 1) shifts were found at high rates across other cancer locations assessed in this study. CTCAE Grade 1 ototoxicity is associated with cancer location, starting dose, and concurrent radiation. Importantly, Grade 1 exceeds the magnitude of an ASHA-significant hearing shift by definition. These Veterans are a high priority group for hearing monitoring and rehabilitation service provision by Audiology.

Implications: CTCAE Grade 1 ototoxicity is a commonly occurring toxicity that may limit Veteran-provider communication and quality of life.

Purpose: Describe symptom burden and distress among Veteran cancer survivors.

Background: Survivorship is an important component of cancer care as patients transition from treatment to surveillance and cope with long-term effects of therapy. Veterans receiving care at the VA are quite different from those described in existing survivorship literature, with lower income and health literacy, poorer physical andmental health, and more comorbidities compared to the general population. Survivorship needs have not been well defined in this population.

Methods: Veterans are referred or recruited to survivorship clinic after completing definitive therapy. An NCCN distress thermometer (DT) is completed in survivorship clinic as part of routine clinical care.

Data Analysis: This analysis was restricted to cancer survivors meeting Commission on Cancer guidance for survivorship care eligibility. Descriptive statistics summarized findings from the DT. To place symptom burden in context, a comparison group was selected consisting of Veterans with comparable cancer site and stage who completed a DT at their first treatment appointment. Reported symptoms were compared to those from survivors with chi-square analysis.

Results: The DT was completed by 47 lung, colorectal, anal, and head and neck cancer survivors between February 2015 and April 2016. Most were white males, with an average age of 66. Of 39 practical, family, emotional, and physical problems included on the DT, survivors reported an average of 9.2 issues (range 0-22). The most common problems were dyspnea (64%), fatigue (60%), pain (57%), sleep (45%), worry (43%), and depression (40%). The average distress score was 3.6 (range 0-9).

The comparison group contained 147 Veterans; they reported an average of 7.4 issues as sources of distress.

Survivors were significantly more likely to report difficulty with breathing, constipation, depression, anhedonia, sadness, sleep concerns, and tingling in the hands and feet. The only issues more common in patients at the start of treatment compared to survivors were nervousness and transportation concerns. There was no difference in concerns regarding treatment decisions, pain, or finances.

Implications: Veteran cancer survivors reported significant symptom burden, particularly concerning mental health and side effects of treatment. Cancer survivorship clinic can play an important role in identifying and addressing the significant symptom burden. A multidisciplinary approach, particularly one including mental health services, is very important.

Purpose: Describe symptom burden and distress among Veteran cancer survivors.

Background: Survivorship is an important component of cancer care as patients transition from treatment to surveillance and cope with long-term effects of therapy. Veterans receiving care at the VA are quite different from those described in existing survivorship literature, with lower income and health literacy, poorer physical andmental health, and more comorbidities compared to the general population. Survivorship needs have not been well defined in this population.

Methods: Veterans are referred or recruited to survivorship clinic after completing definitive therapy. An NCCN distress thermometer (DT) is completed in survivorship clinic as part of routine clinical care.

Data Analysis: This analysis was restricted to cancer survivors meeting Commission on Cancer guidance for survivorship care eligibility. Descriptive statistics summarized findings from the DT. To place symptom burden in context, a comparison group was selected consisting of Veterans with comparable cancer site and stage who completed a DT at their first treatment appointment. Reported symptoms were compared to those from survivors with chi-square analysis.

Results: The DT was completed by 47 lung, colorectal, anal, and head and neck cancer survivors between February 2015 and April 2016. Most were white males, with an average age of 66. Of 39 practical, family, emotional, and physical problems included on the DT, survivors reported an average of 9.2 issues (range 0-22). The most common problems were dyspnea (64%), fatigue (60%), pain (57%), sleep (45%), worry (43%), and depression (40%). The average distress score was 3.6 (range 0-9).

The comparison group contained 147 Veterans; they reported an average of 7.4 issues as sources of distress.

Survivors were significantly more likely to report difficulty with breathing, constipation, depression, anhedonia, sadness, sleep concerns, and tingling in the hands and feet. The only issues more common in patients at the start of treatment compared to survivors were nervousness and transportation concerns. There was no difference in concerns regarding treatment decisions, pain, or finances.

Implications: Veteran cancer survivors reported significant symptom burden, particularly concerning mental health and side effects of treatment. Cancer survivorship clinic can play an important role in identifying and addressing the significant symptom burden. A multidisciplinary approach, particularly one including mental health services, is very important.

Purpose: Describe symptom burden and distress among Veteran cancer survivors.

Background: Survivorship is an important component of cancer care as patients transition from treatment to surveillance and cope with long-term effects of therapy. Veterans receiving care at the VA are quite different from those described in existing survivorship literature, with lower income and health literacy, poorer physical andmental health, and more comorbidities compared to the general population. Survivorship needs have not been well defined in this population.

Methods: Veterans are referred or recruited to survivorship clinic after completing definitive therapy. An NCCN distress thermometer (DT) is completed in survivorship clinic as part of routine clinical care.

Data Analysis: This analysis was restricted to cancer survivors meeting Commission on Cancer guidance for survivorship care eligibility. Descriptive statistics summarized findings from the DT. To place symptom burden in context, a comparison group was selected consisting of Veterans with comparable cancer site and stage who completed a DT at their first treatment appointment. Reported symptoms were compared to those from survivors with chi-square analysis.

Results: The DT was completed by 47 lung, colorectal, anal, and head and neck cancer survivors between February 2015 and April 2016. Most were white males, with an average age of 66. Of 39 practical, family, emotional, and physical problems included on the DT, survivors reported an average of 9.2 issues (range 0-22). The most common problems were dyspnea (64%), fatigue (60%), pain (57%), sleep (45%), worry (43%), and depression (40%). The average distress score was 3.6 (range 0-9).

The comparison group contained 147 Veterans; they reported an average of 7.4 issues as sources of distress.

Survivors were significantly more likely to report difficulty with breathing, constipation, depression, anhedonia, sadness, sleep concerns, and tingling in the hands and feet. The only issues more common in patients at the start of treatment compared to survivors were nervousness and transportation concerns. There was no difference in concerns regarding treatment decisions, pain, or finances.

Implications: Veteran cancer survivors reported significant symptom burden, particularly concerning mental health and side effects of treatment. Cancer survivorship clinic can play an important role in identifying and addressing the significant symptom burden. A multidisciplinary approach, particularly one including mental health services, is very important.

Purpose: To evaluate the utilization of national drug Criteria for Use documents for oncologic drugs in VHA.

Background: VHA National Pharmacy Benefits Management (PBM) has been developing Criteria for Use (CFU) documents for oncologic therapies since 2001. There is no formalized mechanism to track the utilization of these documents.

Methods: A sample of clinical oncology pharmacy specialists participated in an online survey of five questions regarding recollection of CFU use. A total of 23 active CFU documents were included: 11 for oral and 12 for injectable drugs. 5 questions focused on pharmacist’s recollection of the following: 1) general use of CFU documents as a reference in the past month; 2) use of particular CFU document(s) in the past month; 3) useful document(s); 4) useless document(s); and 5) specific subsections of outdated CFU that need to be updated.

Results: Nineteen pharmacists were surveyed. Responses were provided by 11 for a response rate of 58%. The majority (70%) recall using the ibrutinib CFU in the past month, followed by use of the abiraterone CFU (60%). On average, 36% recall referring to national CFU documents 3-5 times when evaluating drug orders, and 18% recall referring to them more than 5 times. The abiraterone CFU were considered to be useful by 50% of those surveyed. Both abiraterone and enzalutamide were ranked as useful documents (Q#3, n = 10) by 50%, followed by regorafenib and ibrutinib (each 40%). Aprepitant and capecitabine documents were considered to be no longer useful (Q#4, n = 6). When asked about specific areas of the CFU that are in need of update, the overwhelming majority of question responders (Q#5, n = 5) agreed that both Inclusion Criteria (100%) and Exclusion Criteria (80%) were the areas on which to focus. CFU documents for oral therapies were used more often, compared to the injectable therapies (34 vs 15%).

Implications: This pilot highlights variance in utilization and perceived usefulness of CFU documents. Expansion of this pilot with a larger sample size can help direct improvements to increase utilization.

Purpose: To evaluate the utilization of national drug Criteria for Use documents for oncologic drugs in VHA.

Background: VHA National Pharmacy Benefits Management (PBM) has been developing Criteria for Use (CFU) documents for oncologic therapies since 2001. There is no formalized mechanism to track the utilization of these documents.

Methods: A sample of clinical oncology pharmacy specialists participated in an online survey of five questions regarding recollection of CFU use. A total of 23 active CFU documents were included: 11 for oral and 12 for injectable drugs. 5 questions focused on pharmacist’s recollection of the following: 1) general use of CFU documents as a reference in the past month; 2) use of particular CFU document(s) in the past month; 3) useful document(s); 4) useless document(s); and 5) specific subsections of outdated CFU that need to be updated.

Results: Nineteen pharmacists were surveyed. Responses were provided by 11 for a response rate of 58%. The majority (70%) recall using the ibrutinib CFU in the past month, followed by use of the abiraterone CFU (60%). On average, 36% recall referring to national CFU documents 3-5 times when evaluating drug orders, and 18% recall referring to them more than 5 times. The abiraterone CFU were considered to be useful by 50% of those surveyed. Both abiraterone and enzalutamide were ranked as useful documents (Q#3, n = 10) by 50%, followed by regorafenib and ibrutinib (each 40%). Aprepitant and capecitabine documents were considered to be no longer useful (Q#4, n = 6). When asked about specific areas of the CFU that are in need of update, the overwhelming majority of question responders (Q#5, n = 5) agreed that both Inclusion Criteria (100%) and Exclusion Criteria (80%) were the areas on which to focus. CFU documents for oral therapies were used more often, compared to the injectable therapies (34 vs 15%).

Implications: This pilot highlights variance in utilization and perceived usefulness of CFU documents. Expansion of this pilot with a larger sample size can help direct improvements to increase utilization.

Purpose: To evaluate the utilization of national drug Criteria for Use documents for oncologic drugs in VHA.

Background: VHA National Pharmacy Benefits Management (PBM) has been developing Criteria for Use (CFU) documents for oncologic therapies since 2001. There is no formalized mechanism to track the utilization of these documents.

Methods: A sample of clinical oncology pharmacy specialists participated in an online survey of five questions regarding recollection of CFU use. A total of 23 active CFU documents were included: 11 for oral and 12 for injectable drugs. 5 questions focused on pharmacist’s recollection of the following: 1) general use of CFU documents as a reference in the past month; 2) use of particular CFU document(s) in the past month; 3) useful document(s); 4) useless document(s); and 5) specific subsections of outdated CFU that need to be updated.

Results: Nineteen pharmacists were surveyed. Responses were provided by 11 for a response rate of 58%. The majority (70%) recall using the ibrutinib CFU in the past month, followed by use of the abiraterone CFU (60%). On average, 36% recall referring to national CFU documents 3-5 times when evaluating drug orders, and 18% recall referring to them more than 5 times. The abiraterone CFU were considered to be useful by 50% of those surveyed. Both abiraterone and enzalutamide were ranked as useful documents (Q#3, n = 10) by 50%, followed by regorafenib and ibrutinib (each 40%). Aprepitant and capecitabine documents were considered to be no longer useful (Q#4, n = 6). When asked about specific areas of the CFU that are in need of update, the overwhelming majority of question responders (Q#5, n = 5) agreed that both Inclusion Criteria (100%) and Exclusion Criteria (80%) were the areas on which to focus. CFU documents for oral therapies were used more often, compared to the injectable therapies (34 vs 15%).

Implications: This pilot highlights variance in utilization and perceived usefulness of CFU documents. Expansion of this pilot with a larger sample size can help direct improvements to increase utilization.

Purpose: To determine the effect of Chemotherapy Review Subcommittee on cost savings at the ONCVAMC.

Background: Oncology costs have dramatically increased secondary to newly approved cancer drugs. To reduce or avoid the costs of cancer care, more Veterans are seeking treatment through the VA. ONCVAMC cancer patients under treatment have increased ~15%/year for 10 years. Antineoplastic medications are the most expensive component of the pharmacy IV budget. To reduce costs, ONCVAMC oncology providers have implemented cost savings initiatives (CSI).

Methods: CSI for oncology medications included: dose rounding to nearest available vial size; excluding antibody therapy from using actual body surface calculation in obese patients; grouping patients receiving the same drug to appointments on the same day; using multi-dose vials; purchasing generic or lower priced contract drugs. When appropriate, oral agents with comparable effectiveness were substituted for IV pre and post chemotherapy symptom management. Savings are reported as percentage of IV oncology drug expenditures. Cost savings were tracked and reported monthly to the subcommittee.

Data Analysis: Dose rounding to nearest commercially available vial- 58%; excluding antibody therapy from using actual body surface calculation in obese patients- 17%; rounding to nearest vial size- 8.1%; purchasing generic or lower cost contract drugs- 6.6%; grouping patients receiving the same drug to appointments on the same day- 4.9%; multi-dose vial drug formulations- 4.8%; switching to oral agents for pre and post chemotherapy management- 0.6% (implemented 4/2016).

Results: Savings from 10/2015 through 5/2016 were greater than 3% of the total IV oncology drug expenditures. By extrapolation 2016 cost savings will be ~5%. The overall cost savings from 10/1/2015 to 5/31/2016 was $97,061.

Implications: CSI by oncology providers resulted in significant cost savings. CPRS based chemotherapy order sets, implemented 4/2016, will further increase cost savings. However, since newer, more efficacious antineoplastics are more expensive and the ONCVAMC Veterans receiving treatment increase ~15%/year, CSI will not reduce the oncology related costs, but will reduce the rate of increase. Oncology CSI will lead to more efficient use of ONCVAMC expenditures.

Purpose: To determine the effect of Chemotherapy Review Subcommittee on cost savings at the ONCVAMC.

Background: Oncology costs have dramatically increased secondary to newly approved cancer drugs. To reduce or avoid the costs of cancer care, more Veterans are seeking treatment through the VA. ONCVAMC cancer patients under treatment have increased ~15%/year for 10 years. Antineoplastic medications are the most expensive component of the pharmacy IV budget. To reduce costs, ONCVAMC oncology providers have implemented cost savings initiatives (CSI).

Methods: CSI for oncology medications included: dose rounding to nearest available vial size; excluding antibody therapy from using actual body surface calculation in obese patients; grouping patients receiving the same drug to appointments on the same day; using multi-dose vials; purchasing generic or lower priced contract drugs. When appropriate, oral agents with comparable effectiveness were substituted for IV pre and post chemotherapy symptom management. Savings are reported as percentage of IV oncology drug expenditures. Cost savings were tracked and reported monthly to the subcommittee.

Data Analysis: Dose rounding to nearest commercially available vial- 58%; excluding antibody therapy from using actual body surface calculation in obese patients- 17%; rounding to nearest vial size- 8.1%; purchasing generic or lower cost contract drugs- 6.6%; grouping patients receiving the same drug to appointments on the same day- 4.9%; multi-dose vial drug formulations- 4.8%; switching to oral agents for pre and post chemotherapy management- 0.6% (implemented 4/2016).

Results: Savings from 10/2015 through 5/2016 were greater than 3% of the total IV oncology drug expenditures. By extrapolation 2016 cost savings will be ~5%. The overall cost savings from 10/1/2015 to 5/31/2016 was $97,061.

Implications: CSI by oncology providers resulted in significant cost savings. CPRS based chemotherapy order sets, implemented 4/2016, will further increase cost savings. However, since newer, more efficacious antineoplastics are more expensive and the ONCVAMC Veterans receiving treatment increase ~15%/year, CSI will not reduce the oncology related costs, but will reduce the rate of increase. Oncology CSI will lead to more efficient use of ONCVAMC expenditures.

Purpose: To determine the effect of Chemotherapy Review Subcommittee on cost savings at the ONCVAMC.

Background: Oncology costs have dramatically increased secondary to newly approved cancer drugs. To reduce or avoid the costs of cancer care, more Veterans are seeking treatment through the VA. ONCVAMC cancer patients under treatment have increased ~15%/year for 10 years. Antineoplastic medications are the most expensive component of the pharmacy IV budget. To reduce costs, ONCVAMC oncology providers have implemented cost savings initiatives (CSI).

Methods: CSI for oncology medications included: dose rounding to nearest available vial size; excluding antibody therapy from using actual body surface calculation in obese patients; grouping patients receiving the same drug to appointments on the same day; using multi-dose vials; purchasing generic or lower priced contract drugs. When appropriate, oral agents with comparable effectiveness were substituted for IV pre and post chemotherapy symptom management. Savings are reported as percentage of IV oncology drug expenditures. Cost savings were tracked and reported monthly to the subcommittee.

Data Analysis: Dose rounding to nearest commercially available vial- 58%; excluding antibody therapy from using actual body surface calculation in obese patients- 17%; rounding to nearest vial size- 8.1%; purchasing generic or lower cost contract drugs- 6.6%; grouping patients receiving the same drug to appointments on the same day- 4.9%; multi-dose vial drug formulations- 4.8%; switching to oral agents for pre and post chemotherapy management- 0.6% (implemented 4/2016).

Results: Savings from 10/2015 through 5/2016 were greater than 3% of the total IV oncology drug expenditures. By extrapolation 2016 cost savings will be ~5%. The overall cost savings from 10/1/2015 to 5/31/2016 was $97,061.

Implications: CSI by oncology providers resulted in significant cost savings. CPRS based chemotherapy order sets, implemented 4/2016, will further increase cost savings. However, since newer, more efficacious antineoplastics are more expensive and the ONCVAMC Veterans receiving treatment increase ~15%/year, CSI will not reduce the oncology related costs, but will reduce the rate of increase. Oncology CSI will lead to more efficient use of ONCVAMC expenditures.

Purpose: Palliative Care is essential to Oncology. The purpose of this abstract is to describe the AVAHO Palliative Care Research subcommittee, its objectives, and evidence of its productive multi-disciplinary and inter-institutional collaboration.

Background: The American Society of Clinical Oncology (ASCO) recommends Palliative Care for all patients with metastatic lung cancer and other symptomatic advanced malignancies. VA mandates Palliative Care inpatient consult teams for all medical facilities. It is not clearly known how Palliative Care is integrated into standard VA outpatient Oncology practice. In addition, questions remain regarding the optimal way(s) to provide Palliative Oncology Care. The AVAHO Palliative Care Research subcommittee was established in 2015 and currently has 7 members from 7 VA institutions. The mission of the subcommittee is to develop partnerships among VA clinicians, pharmacists, social workers, researchers, and VA leadership with the shared goal of providing optimal Palliative Oncology Care within the VA. In laying the groundwork for productive collaboration, we have identified a need to better understand the current interface between VA Oncology Clinics and Palliative Care teams. In particular, we seek to review the evidence for providing on-site Palliative Care to patients with advanced malignancies, and we seek to understand the current availability of outpatient Palliative Care within VA outpatient Oncology clinics.

Methods: We have identified 2 initial approaches to address these questions. First, we have submitted a proposal to the VA Evidence-Based Synthesis Program (ESP) to review the evidence regarding optimal Palliative Care delivery methods for patients with advanced malignancies and
the feasibility of providing on-site Palliative Care embedded into VA Oncology clinics. Second, we plan to survey current VA Oncology providers to understand their Palliative Care referral patterns, available on-site resources, and barriers to providing optimal Palliative Care for their patients.

Analysis/Results: At the AVAHO 2016 meeting, we will provide updated information on the ESP proposal and the Palliative Care in Oncology Survey.

Conclusion: The AVAHO Palliative Care Research subcommittee represents a multidisciplinary and inter-institutional collaboration with a common goal of optimizing VA Palliative Oncology Care. This subcommittee is a model of how AVAHO can foster productive collaborations. We welcome new members.

Purpose: Palliative Care is essential to Oncology. The purpose of this abstract is to describe the AVAHO Palliative Care Research subcommittee, its objectives, and evidence of its productive multi-disciplinary and inter-institutional collaboration.

Background: The American Society of Clinical Oncology (ASCO) recommends Palliative Care for all patients with metastatic lung cancer and other symptomatic advanced malignancies. VA mandates Palliative Care inpatient consult teams for all medical facilities. It is not clearly known how Palliative Care is integrated into standard VA outpatient Oncology practice. In addition, questions remain regarding the optimal way(s) to provide Palliative Oncology Care. The AVAHO Palliative Care Research subcommittee was established in 2015 and currently has 7 members from 7 VA institutions. The mission of the subcommittee is to develop partnerships among VA clinicians, pharmacists, social workers, researchers, and VA leadership with the shared goal of providing optimal Palliative Oncology Care within the VA. In laying the groundwork for productive collaboration, we have identified a need to better understand the current interface between VA Oncology Clinics and Palliative Care teams. In particular, we seek to review the evidence for providing on-site Palliative Care to patients with advanced malignancies, and we seek to understand the current availability of outpatient Palliative Care within VA outpatient Oncology clinics.

Methods: We have identified 2 initial approaches to address these questions. First, we have submitted a proposal to the VA Evidence-Based Synthesis Program (ESP) to review the evidence regarding optimal Palliative Care delivery methods for patients with advanced malignancies and
the feasibility of providing on-site Palliative Care embedded into VA Oncology clinics. Second, we plan to survey current VA Oncology providers to understand their Palliative Care referral patterns, available on-site resources, and barriers to providing optimal Palliative Care for their patients.

Analysis/Results: At the AVAHO 2016 meeting, we will provide updated information on the ESP proposal and the Palliative Care in Oncology Survey.

Conclusion: The AVAHO Palliative Care Research subcommittee represents a multidisciplinary and inter-institutional collaboration with a common goal of optimizing VA Palliative Oncology Care. This subcommittee is a model of how AVAHO can foster productive collaborations. We welcome new members.

Purpose: Palliative Care is essential to Oncology. The purpose of this abstract is to describe the AVAHO Palliative Care Research subcommittee, its objectives, and evidence of its productive multi-disciplinary and inter-institutional collaboration.

Background: The American Society of Clinical Oncology (ASCO) recommends Palliative Care for all patients with metastatic lung cancer and other symptomatic advanced malignancies. VA mandates Palliative Care inpatient consult teams for all medical facilities. It is not clearly known how Palliative Care is integrated into standard VA outpatient Oncology practice. In addition, questions remain regarding the optimal way(s) to provide Palliative Oncology Care. The AVAHO Palliative Care Research subcommittee was established in 2015 and currently has 7 members from 7 VA institutions. The mission of the subcommittee is to develop partnerships among VA clinicians, pharmacists, social workers, researchers, and VA leadership with the shared goal of providing optimal Palliative Oncology Care within the VA. In laying the groundwork for productive collaboration, we have identified a need to better understand the current interface between VA Oncology Clinics and Palliative Care teams. In particular, we seek to review the evidence for providing on-site Palliative Care to patients with advanced malignancies, and we seek to understand the current availability of outpatient Palliative Care within VA outpatient Oncology clinics.

Methods: We have identified 2 initial approaches to address these questions. First, we have submitted a proposal to the VA Evidence-Based Synthesis Program (ESP) to review the evidence regarding optimal Palliative Care delivery methods for patients with advanced malignancies and
the feasibility of providing on-site Palliative Care embedded into VA Oncology clinics. Second, we plan to survey current VA Oncology providers to understand their Palliative Care referral patterns, available on-site resources, and barriers to providing optimal Palliative Care for their patients.

Analysis/Results: At the AVAHO 2016 meeting, we will provide updated information on the ESP proposal and the Palliative Care in Oncology Survey.

Conclusion: The AVAHO Palliative Care Research subcommittee represents a multidisciplinary and inter-institutional collaboration with a common goal of optimizing VA Palliative Oncology Care. This subcommittee is a model of how AVAHO can foster productive collaborations. We welcome new members.

Purpose: To evaluate failure rates of patients from a single institution who underwent salvage and adjuvant radiation therapy (RT) following radical retropubic prostatectomy for adenocarcinoma of the prostate.

Methods: Between 2002 and 2015, 62 patients were treated with Intensity Modulated Radiation Therapy following Radical Retropubic Prostatectomy (RRP). Of these, 45 (72.6%) patients received salvage therapy, all of whom had a Prostate Specific Antigen (PSA) of > 0.2; while 17 (27.4%) patients underwent adjuvant RT at a median of 5 months following RRP, due to having either positive extracapsular extension (ECE) (65%), seminal vesicle invasion (SVI) (29%), and/or positive margins (65%). The median dose delivered to the prostate fossa, as per the Radiation Therapy Oncology Group guidelines for post-prostatectomy radiation therapy, was 6600c Gy at 180-200 cGy a fraction. In the salvage group, 9 patients ended up receiving androgen deprivation therapy (ADT) at some point following RRP, while 7 patients were prescribed ADT in the adjuvant group.

Results: With the median follow-up of 62 months, the median disease free survival rates were 10.8 and 4.3 years (P < 0.011) for the salvage and adjuvant groups, respectively. Biochemical progression free survival (bPFS) for the adjuvant groups was statistically significant (78.9%), when compared to 40% in the salvage group (P < 0.011). The patterns of failure in the salvage group were 9 patients had local failure (LF), 2 distant metastases (DM), and 3 patients had both LF and DM in the salvage group. On the other hand, in the adjuvant treatment group there was 1 patient with LF, 1 with DM and 1 patient with both LF and DM. Of those who failed following RT, the median time to failure was 25 and 99 months in the salvage and adjuvant groups, respectively. No patient experienced any sort of grade 3 toxicity following RT in either of the groups, per the CTCAE v3.0 criteria.

Conclusion: A retrospective review of 62 patients who received radiation therapy in either the salvage or adjuvant setting following prostatectomy revealed that adjuvant patients were with superior local control rates than salvage patients. We conclude that patients with high-risk features following prostatectomy receive adjuvant therapy and not delay radiation therapy until there is biochemical failure.

Purpose: To evaluate failure rates of patients from a single institution who underwent salvage and adjuvant radiation therapy (RT) following radical retropubic prostatectomy for adenocarcinoma of the prostate.

Methods: Between 2002 and 2015, 62 patients were treated with Intensity Modulated Radiation Therapy following Radical Retropubic Prostatectomy (RRP). Of these, 45 (72.6%) patients received salvage therapy, all of whom had a Prostate Specific Antigen (PSA) of > 0.2; while 17 (27.4%) patients underwent adjuvant RT at a median of 5 months following RRP, due to having either positive extracapsular extension (ECE) (65%), seminal vesicle invasion (SVI) (29%), and/or positive margins (65%). The median dose delivered to the prostate fossa, as per the Radiation Therapy Oncology Group guidelines for post-prostatectomy radiation therapy, was 6600c Gy at 180-200 cGy a fraction. In the salvage group, 9 patients ended up receiving androgen deprivation therapy (ADT) at some point following RRP, while 7 patients were prescribed ADT in the adjuvant group.

Results: With the median follow-up of 62 months, the median disease free survival rates were 10.8 and 4.3 years (P < 0.011) for the salvage and adjuvant groups, respectively. Biochemical progression free survival (bPFS) for the adjuvant groups was statistically significant (78.9%), when compared to 40% in the salvage group (P < 0.011). The patterns of failure in the salvage group were 9 patients had local failure (LF), 2 distant metastases (DM), and 3 patients had both LF and DM in the salvage group. On the other hand, in the adjuvant treatment group there was 1 patient with LF, 1 with DM and 1 patient with both LF and DM. Of those who failed following RT, the median time to failure was 25 and 99 months in the salvage and adjuvant groups, respectively. No patient experienced any sort of grade 3 toxicity following RT in either of the groups, per the CTCAE v3.0 criteria.

Conclusion: A retrospective review of 62 patients who received radiation therapy in either the salvage or adjuvant setting following prostatectomy revealed that adjuvant patients were with superior local control rates than salvage patients. We conclude that patients with high-risk features following prostatectomy receive adjuvant therapy and not delay radiation therapy until there is biochemical failure.

Purpose: To evaluate failure rates of patients from a single institution who underwent salvage and adjuvant radiation therapy (RT) following radical retropubic prostatectomy for adenocarcinoma of the prostate.

Methods: Between 2002 and 2015, 62 patients were treated with Intensity Modulated Radiation Therapy following Radical Retropubic Prostatectomy (RRP). Of these, 45 (72.6%) patients received salvage therapy, all of whom had a Prostate Specific Antigen (PSA) of > 0.2; while 17 (27.4%) patients underwent adjuvant RT at a median of 5 months following RRP, due to having either positive extracapsular extension (ECE) (65%), seminal vesicle invasion (SVI) (29%), and/or positive margins (65%). The median dose delivered to the prostate fossa, as per the Radiation Therapy Oncology Group guidelines for post-prostatectomy radiation therapy, was 6600c Gy at 180-200 cGy a fraction. In the salvage group, 9 patients ended up receiving androgen deprivation therapy (ADT) at some point following RRP, while 7 patients were prescribed ADT in the adjuvant group.

Results: With the median follow-up of 62 months, the median disease free survival rates were 10.8 and 4.3 years (P < 0.011) for the salvage and adjuvant groups, respectively. Biochemical progression free survival (bPFS) for the adjuvant groups was statistically significant (78.9%), when compared to 40% in the salvage group (P < 0.011). The patterns of failure in the salvage group were 9 patients had local failure (LF), 2 distant metastases (DM), and 3 patients had both LF and DM in the salvage group. On the other hand, in the adjuvant treatment group there was 1 patient with LF, 1 with DM and 1 patient with both LF and DM. Of those who failed following RT, the median time to failure was 25 and 99 months in the salvage and adjuvant groups, respectively. No patient experienced any sort of grade 3 toxicity following RT in either of the groups, per the CTCAE v3.0 criteria.

Conclusion: A retrospective review of 62 patients who received radiation therapy in either the salvage or adjuvant setting following prostatectomy revealed that adjuvant patients were with superior local control rates than salvage patients. We conclude that patients with high-risk features following prostatectomy receive adjuvant therapy and not delay radiation therapy until there is biochemical failure.