AVAHO

Background: Coordinating cancer care can prove especially challenging because of the complexity of both the disease and its treatment. Typically, the care of cancer patients involves multiple types of therapies and providers (surgery, radiation therapy, chemotherapy) and ongoing treatment of cancer and other health conditions. Cancer care coordination depends upon effective, regular communication among physicians, support staff, and the patient. The objective of this study is to explore veteran patients’ experiences of cancer care coordination in order to develop a deeper understanding of the issues veterans consider important and actionable.

Methods: Semi-structured interviews were conducted among patients diagnosed with cancer types and stages that commonly receive inter-disciplinary care (eg, colorectal [stage II and up], prostate [high risk], head and neck [all stages], and lung [all stages] cancer) were eligible to participate in the study. The constant comparison technique was used to identify emerging themes.

Results: Twenty-five veteran cancer patients participated in this study. Our analysis identified four general categories representing different parts of the trajectory of the patient cancer care experience in need of coordination. Each phase had a distinct set of needs and challenges. Diagnosis: After receiving a diagnosis of cancer, Veterans reported initial feelings of shock and fear. Pre-Treatment: This phase was characterized as busy and chaotic, consisting of many appointments in different locations, and ultimately left many veterans feeling a lack of control. Onset of Treatment: Uncertainty about what to expect when receiving advanced treatments, like radiation and chemotherapy, was often exacerbated by poor provider-provider communication issues. Ongoing Treatment: As treatment progressed, many veterans experienced a growing familiarity with their routine, and simultaneously, began to regain a sense of control. Care Team: Nurse navigators were considered vital to cancer care coordination. Veterans valued honesty and transparency from their providers which built a sense of trust.

Conclusion: Veterans expressed a need to have care coordination needs and steps more explicitly addressed early, as well as active mechanisms to meet those needs. The patient experience of coordination gradually improved over the course of the care trajectory, often facilitated by relationships fostered with members of the healthcare team.

Background: Coordinating cancer care can prove especially challenging because of the complexity of both the disease and its treatment. Typically, the care of cancer patients involves multiple types of therapies and providers (surgery, radiation therapy, chemotherapy) and ongoing treatment of cancer and other health conditions. Cancer care coordination depends upon effective, regular communication among physicians, support staff, and the patient. The objective of this study is to explore veteran patients’ experiences of cancer care coordination in order to develop a deeper understanding of the issues veterans consider important and actionable.

Methods: Semi-structured interviews were conducted among patients diagnosed with cancer types and stages that commonly receive inter-disciplinary care (eg, colorectal [stage II and up], prostate [high risk], head and neck [all stages], and lung [all stages] cancer) were eligible to participate in the study. The constant comparison technique was used to identify emerging themes.

Results: Twenty-five veteran cancer patients participated in this study. Our analysis identified four general categories representing different parts of the trajectory of the patient cancer care experience in need of coordination. Each phase had a distinct set of needs and challenges. Diagnosis: After receiving a diagnosis of cancer, Veterans reported initial feelings of shock and fear. Pre-Treatment: This phase was characterized as busy and chaotic, consisting of many appointments in different locations, and ultimately left many veterans feeling a lack of control. Onset of Treatment: Uncertainty about what to expect when receiving advanced treatments, like radiation and chemotherapy, was often exacerbated by poor provider-provider communication issues. Ongoing Treatment: As treatment progressed, many veterans experienced a growing familiarity with their routine, and simultaneously, began to regain a sense of control. Care Team: Nurse navigators were considered vital to cancer care coordination. Veterans valued honesty and transparency from their providers which built a sense of trust.

Conclusion: Veterans expressed a need to have care coordination needs and steps more explicitly addressed early, as well as active mechanisms to meet those needs. The patient experience of coordination gradually improved over the course of the care trajectory, often facilitated by relationships fostered with members of the healthcare team.

Background: Coordinating cancer care can prove especially challenging because of the complexity of both the disease and its treatment. Typically, the care of cancer patients involves multiple types of therapies and providers (surgery, radiation therapy, chemotherapy) and ongoing treatment of cancer and other health conditions. Cancer care coordination depends upon effective, regular communication among physicians, support staff, and the patient. The objective of this study is to explore veteran patients’ experiences of cancer care coordination in order to develop a deeper understanding of the issues veterans consider important and actionable.

Methods: Semi-structured interviews were conducted among patients diagnosed with cancer types and stages that commonly receive inter-disciplinary care (eg, colorectal [stage II and up], prostate [high risk], head and neck [all stages], and lung [all stages] cancer) were eligible to participate in the study. The constant comparison technique was used to identify emerging themes.

Results: Twenty-five veteran cancer patients participated in this study. Our analysis identified four general categories representing different parts of the trajectory of the patient cancer care experience in need of coordination. Each phase had a distinct set of needs and challenges. Diagnosis: After receiving a diagnosis of cancer, Veterans reported initial feelings of shock and fear. Pre-Treatment: This phase was characterized as busy and chaotic, consisting of many appointments in different locations, and ultimately left many veterans feeling a lack of control. Onset of Treatment: Uncertainty about what to expect when receiving advanced treatments, like radiation and chemotherapy, was often exacerbated by poor provider-provider communication issues. Ongoing Treatment: As treatment progressed, many veterans experienced a growing familiarity with their routine, and simultaneously, began to regain a sense of control. Care Team: Nurse navigators were considered vital to cancer care coordination. Veterans valued honesty and transparency from their providers which built a sense of trust.

Conclusion: Veterans expressed a need to have care coordination needs and steps more explicitly addressed early, as well as active mechanisms to meet those needs. The patient experience of coordination gradually improved over the course of the care trajectory, often facilitated by relationships fostered with members of the healthcare team.

Background: Stereotactic body radiotherapy (SBRT) is standard treatment for inoperable early-stage nonsmall cell lung cancer (NSCLC) . American College of Chest Physicians (ACCP) favors non-invasive mediastinal staging for peripheral Stage IA tumors for surgical patients. However, mediastinal staging guidelines for SBRT are still elusive and benefit of endobronchial ultrasound guided transbronchial needle biopsy (EBUS/ TBNA) in addition to positron emission tomographycomputed tomography (PET/CT) remains undefined for small peripheral NSCLC.

Purppose: To evaluate our SBRT- EBUS program by comparing survival and patterns of failure in SBRT patients staged with PET/CT and EBUS/TBNA vs. PET/ CT only for < 4cm peripheral NSCLC.

Methods: Patients with early NSCLC treated with Cyberknife (CK) from October 2010 to December 2016 were queried. Those treated definitively for single, < 4cm peripheral tumors were included. Local, regional, distant recurrences and survival outcomes were compared between patients staged with PET/CT and EBUS/TBNA vs. PET/CT only, using competing risk analysis.

Results: One hundred and fifty nine patients were treated during the study period. Mediastinum was staged using PET/CT only till 2013. Ninety one patients (mean age 69 years [64-78 years]; 99 [99%] males) had peripheral single tumors of < 4 cm2. Seventy two were staged with EBUS/TBNA and PET/CT( group I) and 19 with PET/CT only (group II). Patient ,tumor and treatment characteristics, except race, were not different. At median follow-up of 5.39 years, group I vs. group II pattern of recurrence was ;any recurrence 36.1%vs.36.1%, P=0.95; local recurrence 13.9%vs.21.1%, P=0.48; regional recurrence 13.9% vs.21.1%, P=0.48; distant recurrence 25% vs.15.8%, P=0.55 respectively .Median OS for group I and group II was 2.95 years (2.37-3.80 years, 95%CI ) and 4 years (2.01-7.08 years 95%CI); P=0.54 respectively.

Conclusion: Survival outcomes and pattern of failure were not different based on type of mediastinal staging. EBUS/TBNA use can be safely stratified based on tumor location and size in this population. Therefore, for patients with single, < 4 cm2, peripheral NSCLC, non-invasive mediastinal staging with PET/CT may suffice for definitive SBRT. Future prospective studies are needed to validate our findings.

Background: Stereotactic body radiotherapy (SBRT) is standard treatment for inoperable early-stage nonsmall cell lung cancer (NSCLC) . American College of Chest Physicians (ACCP) favors non-invasive mediastinal staging for peripheral Stage IA tumors for surgical patients. However, mediastinal staging guidelines for SBRT are still elusive and benefit of endobronchial ultrasound guided transbronchial needle biopsy (EBUS/ TBNA) in addition to positron emission tomographycomputed tomography (PET/CT) remains undefined for small peripheral NSCLC.

Purppose: To evaluate our SBRT- EBUS program by comparing survival and patterns of failure in SBRT patients staged with PET/CT and EBUS/TBNA vs. PET/ CT only for < 4cm peripheral NSCLC.

Methods: Patients with early NSCLC treated with Cyberknife (CK) from October 2010 to December 2016 were queried. Those treated definitively for single, < 4cm peripheral tumors were included. Local, regional, distant recurrences and survival outcomes were compared between patients staged with PET/CT and EBUS/TBNA vs. PET/CT only, using competing risk analysis.

Results: One hundred and fifty nine patients were treated during the study period. Mediastinum was staged using PET/CT only till 2013. Ninety one patients (mean age 69 years [64-78 years]; 99 [99%] males) had peripheral single tumors of < 4 cm2. Seventy two were staged with EBUS/TBNA and PET/CT( group I) and 19 with PET/CT only (group II). Patient ,tumor and treatment characteristics, except race, were not different. At median follow-up of 5.39 years, group I vs. group II pattern of recurrence was ;any recurrence 36.1%vs.36.1%, P=0.95; local recurrence 13.9%vs.21.1%, P=0.48; regional recurrence 13.9% vs.21.1%, P=0.48; distant recurrence 25% vs.15.8%, P=0.55 respectively .Median OS for group I and group II was 2.95 years (2.37-3.80 years, 95%CI ) and 4 years (2.01-7.08 years 95%CI); P=0.54 respectively.

Conclusion: Survival outcomes and pattern of failure were not different based on type of mediastinal staging. EBUS/TBNA use can be safely stratified based on tumor location and size in this population. Therefore, for patients with single, < 4 cm2, peripheral NSCLC, non-invasive mediastinal staging with PET/CT may suffice for definitive SBRT. Future prospective studies are needed to validate our findings.

Background: Stereotactic body radiotherapy (SBRT) is standard treatment for inoperable early-stage nonsmall cell lung cancer (NSCLC) . American College of Chest Physicians (ACCP) favors non-invasive mediastinal staging for peripheral Stage IA tumors for surgical patients. However, mediastinal staging guidelines for SBRT are still elusive and benefit of endobronchial ultrasound guided transbronchial needle biopsy (EBUS/ TBNA) in addition to positron emission tomographycomputed tomography (PET/CT) remains undefined for small peripheral NSCLC.

Purppose: To evaluate our SBRT- EBUS program by comparing survival and patterns of failure in SBRT patients staged with PET/CT and EBUS/TBNA vs. PET/ CT only for < 4cm peripheral NSCLC.

Methods: Patients with early NSCLC treated with Cyberknife (CK) from October 2010 to December 2016 were queried. Those treated definitively for single, < 4cm peripheral tumors were included. Local, regional, distant recurrences and survival outcomes were compared between patients staged with PET/CT and EBUS/TBNA vs. PET/CT only, using competing risk analysis.

Results: One hundred and fifty nine patients were treated during the study period. Mediastinum was staged using PET/CT only till 2013. Ninety one patients (mean age 69 years [64-78 years]; 99 [99%] males) had peripheral single tumors of < 4 cm2. Seventy two were staged with EBUS/TBNA and PET/CT( group I) and 19 with PET/CT only (group II). Patient ,tumor and treatment characteristics, except race, were not different. At median follow-up of 5.39 years, group I vs. group II pattern of recurrence was ;any recurrence 36.1%vs.36.1%, P=0.95; local recurrence 13.9%vs.21.1%, P=0.48; regional recurrence 13.9% vs.21.1%, P=0.48; distant recurrence 25% vs.15.8%, P=0.55 respectively .Median OS for group I and group II was 2.95 years (2.37-3.80 years, 95%CI ) and 4 years (2.01-7.08 years 95%CI); P=0.54 respectively.

Conclusion: Survival outcomes and pattern of failure were not different based on type of mediastinal staging. EBUS/TBNA use can be safely stratified based on tumor location and size in this population. Therefore, for patients with single, < 4 cm2, peripheral NSCLC, non-invasive mediastinal staging with PET/CT may suffice for definitive SBRT. Future prospective studies are needed to validate our findings.

Background: The prognostic implication of tumor location in breast cancer remains unclear. Previous studies suggested that inner and lower quadrant-located tumors were associated with decreased survival.

Methods: The NCDB was quired to identify AJCC clinical stage I-III first female breast cancer patients with unilateral disease who underwent breast-conserving surgery from 2010 to 2016. Three mutually exclusive groups were created based on tumor location, which included outer (upper and lower outer quadrants), central, and inner (upper and lower inner quadrants) zones of the breast. Clinical and demographic variables were obtained. Unadjusted survival differences were examined with Kaplan- Meier method. Multivariate Cox regression model was employed to examine the association between zone group and survival.

Results: 125,800 patients were identified including 83,558 (66.4%), 6,764 (5.4%), and 35,449 (28.2%) patients within the outer, central, and inner zones. There was evidence of a difference in age and tumor size based on site (P<0.001). It was also found that there was an association between tumor zone and each of the following (P<0.05): race and ethnicity, Charlson-Deyo score, insurance, income, education, facility type, laterality, histology, utilization of chemotherapy, ER status, PR status, and HER2 status. There was no relationship between site and unadjusted survival (P=0.905). After adjusting for all else, a 5.7% decreased the risk of death was found upon the comparison of the outer vs. inner zone of the breast (95% CI: 0.4%-11.8%; P=0.037). In general, older African American Medicaid patients with increased Charlson-Deyo scores and hormone receptor-negative breast cancers from lower-income areas had decreased survival.

Conclusion: Outer zone breast cancer has a more favorable survival advantage when compared with inner zone cancers. A finding that warrants re-evaluation of the management approach to inner zone breast cancer.

Background: The prognostic implication of tumor location in breast cancer remains unclear. Previous studies suggested that inner and lower quadrant-located tumors were associated with decreased survival.

Methods: The NCDB was quired to identify AJCC clinical stage I-III first female breast cancer patients with unilateral disease who underwent breast-conserving surgery from 2010 to 2016. Three mutually exclusive groups were created based on tumor location, which included outer (upper and lower outer quadrants), central, and inner (upper and lower inner quadrants) zones of the breast. Clinical and demographic variables were obtained. Unadjusted survival differences were examined with Kaplan- Meier method. Multivariate Cox regression model was employed to examine the association between zone group and survival.

Results: 125,800 patients were identified including 83,558 (66.4%), 6,764 (5.4%), and 35,449 (28.2%) patients within the outer, central, and inner zones. There was evidence of a difference in age and tumor size based on site (P<0.001). It was also found that there was an association between tumor zone and each of the following (P<0.05): race and ethnicity, Charlson-Deyo score, insurance, income, education, facility type, laterality, histology, utilization of chemotherapy, ER status, PR status, and HER2 status. There was no relationship between site and unadjusted survival (P=0.905). After adjusting for all else, a 5.7% decreased the risk of death was found upon the comparison of the outer vs. inner zone of the breast (95% CI: 0.4%-11.8%; P=0.037). In general, older African American Medicaid patients with increased Charlson-Deyo scores and hormone receptor-negative breast cancers from lower-income areas had decreased survival.

Conclusion: Outer zone breast cancer has a more favorable survival advantage when compared with inner zone cancers. A finding that warrants re-evaluation of the management approach to inner zone breast cancer.

Background: The prognostic implication of tumor location in breast cancer remains unclear. Previous studies suggested that inner and lower quadrant-located tumors were associated with decreased survival.

Methods: The NCDB was quired to identify AJCC clinical stage I-III first female breast cancer patients with unilateral disease who underwent breast-conserving surgery from 2010 to 2016. Three mutually exclusive groups were created based on tumor location, which included outer (upper and lower outer quadrants), central, and inner (upper and lower inner quadrants) zones of the breast. Clinical and demographic variables were obtained. Unadjusted survival differences were examined with Kaplan- Meier method. Multivariate Cox regression model was employed to examine the association between zone group and survival.

Results: 125,800 patients were identified including 83,558 (66.4%), 6,764 (5.4%), and 35,449 (28.2%) patients within the outer, central, and inner zones. There was evidence of a difference in age and tumor size based on site (P<0.001). It was also found that there was an association between tumor zone and each of the following (P<0.05): race and ethnicity, Charlson-Deyo score, insurance, income, education, facility type, laterality, histology, utilization of chemotherapy, ER status, PR status, and HER2 status. There was no relationship between site and unadjusted survival (P=0.905). After adjusting for all else, a 5.7% decreased the risk of death was found upon the comparison of the outer vs. inner zone of the breast (95% CI: 0.4%-11.8%; P=0.037). In general, older African American Medicaid patients with increased Charlson-Deyo scores and hormone receptor-negative breast cancers from lower-income areas had decreased survival.

Conclusion: Outer zone breast cancer has a more favorable survival advantage when compared with inner zone cancers. A finding that warrants re-evaluation of the management approach to inner zone breast cancer.

Background: Cancer diagnosis is a devastating and painful process for patients and their families, resulting in significant stress and uncertainty. Chemotherapy treatments may provide a cure, control or palliate symptoms caused by cancer. However, delivery of chemotherapy in outpatient clinics is challenging and timeconsuming. Long wait is a common patient complaint, affects work-flow and chair time usage, increases costs, and compromises safety. We sought to review our system and implement changes that may result in decrease wait time.

Methods: Utilizing the Institute for Healthcare Improvement (IHI) model, the plan-do-study-act (PDSA) method to test and implement changes, we established a preintervention Ishikawa diagram over a 4 weeks period to study the process and determine cause of delay. Changes were implemented in a stepwise fashion, assess for improvement and revised our process over another 4 week period. We collect and analyze data for a total of 2 months. The objective of the study was to decrease wait-time to initiate chemotherapy treatment from the end of clinic visit to start of chemotherapy infusion by 20-30 minutes for 50% of patients in the oncology clinic over a three-month period.

Results: Pre-intervention data was collected on 245 patients. 55% (n=136) of these patients waited an average of 90 minutes and 45% (n=110) waited an average of 42 minutes from check-in to infusion clinic to start of chemotherapy. Identified barriers causing delayed chemotherapy administration included no consent, no prior authorization, unwritten/unsigned orders, pharmacy release delay, incomplete required labs, delay drug delivery from pharmacy, and difficulty with IV access. After the first cycle of PDSA, post-intervention data reveal a small improvement. 52% (n=199) patients waited an average of 87 minutes and 48% (n=183) average wait was 41 minutes.

Conclusions: By utilizing the PDSA cycle to test the modification of the revised workflow system and eliminate barriers to release of chemotherapy we could potentially reduce wait times for patient receiving chemotherapy at the Minneapolis VA. Updated data will be presented at the AVAHO Annual Meeting.

Background: Cancer diagnosis is a devastating and painful process for patients and their families, resulting in significant stress and uncertainty. Chemotherapy treatments may provide a cure, control or palliate symptoms caused by cancer. However, delivery of chemotherapy in outpatient clinics is challenging and timeconsuming. Long wait is a common patient complaint, affects work-flow and chair time usage, increases costs, and compromises safety. We sought to review our system and implement changes that may result in decrease wait time.

Methods: Utilizing the Institute for Healthcare Improvement (IHI) model, the plan-do-study-act (PDSA) method to test and implement changes, we established a preintervention Ishikawa diagram over a 4 weeks period to study the process and determine cause of delay. Changes were implemented in a stepwise fashion, assess for improvement and revised our process over another 4 week period. We collect and analyze data for a total of 2 months. The objective of the study was to decrease wait-time to initiate chemotherapy treatment from the end of clinic visit to start of chemotherapy infusion by 20-30 minutes for 50% of patients in the oncology clinic over a three-month period.

Results: Pre-intervention data was collected on 245 patients. 55% (n=136) of these patients waited an average of 90 minutes and 45% (n=110) waited an average of 42 minutes from check-in to infusion clinic to start of chemotherapy. Identified barriers causing delayed chemotherapy administration included no consent, no prior authorization, unwritten/unsigned orders, pharmacy release delay, incomplete required labs, delay drug delivery from pharmacy, and difficulty with IV access. After the first cycle of PDSA, post-intervention data reveal a small improvement. 52% (n=199) patients waited an average of 87 minutes and 48% (n=183) average wait was 41 minutes.

Conclusions: By utilizing the PDSA cycle to test the modification of the revised workflow system and eliminate barriers to release of chemotherapy we could potentially reduce wait times for patient receiving chemotherapy at the Minneapolis VA. Updated data will be presented at the AVAHO Annual Meeting.

Background: Cancer diagnosis is a devastating and painful process for patients and their families, resulting in significant stress and uncertainty. Chemotherapy treatments may provide a cure, control or palliate symptoms caused by cancer. However, delivery of chemotherapy in outpatient clinics is challenging and timeconsuming. Long wait is a common patient complaint, affects work-flow and chair time usage, increases costs, and compromises safety. We sought to review our system and implement changes that may result in decrease wait time.

Methods: Utilizing the Institute for Healthcare Improvement (IHI) model, the plan-do-study-act (PDSA) method to test and implement changes, we established a preintervention Ishikawa diagram over a 4 weeks period to study the process and determine cause of delay. Changes were implemented in a stepwise fashion, assess for improvement and revised our process over another 4 week period. We collect and analyze data for a total of 2 months. The objective of the study was to decrease wait-time to initiate chemotherapy treatment from the end of clinic visit to start of chemotherapy infusion by 20-30 minutes for 50% of patients in the oncology clinic over a three-month period.

Results: Pre-intervention data was collected on 245 patients. 55% (n=136) of these patients waited an average of 90 minutes and 45% (n=110) waited an average of 42 minutes from check-in to infusion clinic to start of chemotherapy. Identified barriers causing delayed chemotherapy administration included no consent, no prior authorization, unwritten/unsigned orders, pharmacy release delay, incomplete required labs, delay drug delivery from pharmacy, and difficulty with IV access. After the first cycle of PDSA, post-intervention data reveal a small improvement. 52% (n=199) patients waited an average of 87 minutes and 48% (n=183) average wait was 41 minutes.

Conclusions: By utilizing the PDSA cycle to test the modification of the revised workflow system and eliminate barriers to release of chemotherapy we could potentially reduce wait times for patient receiving chemotherapy at the Minneapolis VA. Updated data will be presented at the AVAHO Annual Meeting.

Purpose: To establish a gold-standard methodology for accurately extracting progression-free survival (PFS) following Diffuse Large B-Cell Lymphoma (DLBCL) treatment using real-world electronic healthcare record (EHR) data.

Background: Randomized controlled trials using response evaluation criteria have long served as the gold standard for assessing response to therapy and PFS. However, characteristics of participants in clinical trials do not reflect the overall patient population, and formal response evaluation criteria are not used in realworld contexts. Furthermore, real-world data are often unstructured, preventing accurate comparison of PFS using structured clinical trial data versus real-world data, and existing approaches define PFS inconsistently. Despite the importance of assessing PFS in patients outside of controlled clinical trials, no goldstandard method for collecting and validating PFS from real-world evidence has been established.

Methods: Clinicians, programmers, and data scientists collaborated to develop an R Shiny10 application using Veterans Affairs Corporate Data Warehouse data from the EHR of 352 DLBCL patients. The application takes unstructured data such as clinical notes and facilitates the capture, annotation, and tagging of key words or phrases indicative of progression, thus allowing accurate determination of the date of first identification of progression by a treating clinician.

Data Analysis: In order to refine data-collection techniques and evaluate whether the application can enable calculation of real-world PFS, we conducted an adaptive and iterative process of reviewing EHR documents and capturing and annotating data until a consistent schema and methodology was established. In order to validate annotation schema and methodology, annotations of 50 patient records were performed by 2 annotators and assessed for concordance.

Results: We produced an R Shiny application that can capture, annotate, and transform unstructured EHR data into structured data—specifically, treatment lines, cycles, and response criteria with corresponding dates—ready for analysis of PFS. An annotation schema for capturing real-world data was also developed. Mapping of common phrases used by clinicians in real-world practice to response criteria resulted in a dictionary of these phrases.

Implications: These efforts show that it is possible to convert EHR context reliably into analyzable data such as PFS. Further attempts will be made to establish a gold-standard methodology.

Purpose: To establish a gold-standard methodology for accurately extracting progression-free survival (PFS) following Diffuse Large B-Cell Lymphoma (DLBCL) treatment using real-world electronic healthcare record (EHR) data.

Background: Randomized controlled trials using response evaluation criteria have long served as the gold standard for assessing response to therapy and PFS. However, characteristics of participants in clinical trials do not reflect the overall patient population, and formal response evaluation criteria are not used in realworld contexts. Furthermore, real-world data are often unstructured, preventing accurate comparison of PFS using structured clinical trial data versus real-world data, and existing approaches define PFS inconsistently. Despite the importance of assessing PFS in patients outside of controlled clinical trials, no goldstandard method for collecting and validating PFS from real-world evidence has been established.

Methods: Clinicians, programmers, and data scientists collaborated to develop an R Shiny10 application using Veterans Affairs Corporate Data Warehouse data from the EHR of 352 DLBCL patients. The application takes unstructured data such as clinical notes and facilitates the capture, annotation, and tagging of key words or phrases indicative of progression, thus allowing accurate determination of the date of first identification of progression by a treating clinician.

Data Analysis: In order to refine data-collection techniques and evaluate whether the application can enable calculation of real-world PFS, we conducted an adaptive and iterative process of reviewing EHR documents and capturing and annotating data until a consistent schema and methodology was established. In order to validate annotation schema and methodology, annotations of 50 patient records were performed by 2 annotators and assessed for concordance.

Results: We produced an R Shiny application that can capture, annotate, and transform unstructured EHR data into structured data—specifically, treatment lines, cycles, and response criteria with corresponding dates—ready for analysis of PFS. An annotation schema for capturing real-world data was also developed. Mapping of common phrases used by clinicians in real-world practice to response criteria resulted in a dictionary of these phrases.

Implications: These efforts show that it is possible to convert EHR context reliably into analyzable data such as PFS. Further attempts will be made to establish a gold-standard methodology.

Purpose: To establish a gold-standard methodology for accurately extracting progression-free survival (PFS) following Diffuse Large B-Cell Lymphoma (DLBCL) treatment using real-world electronic healthcare record (EHR) data.

Background: Randomized controlled trials using response evaluation criteria have long served as the gold standard for assessing response to therapy and PFS. However, characteristics of participants in clinical trials do not reflect the overall patient population, and formal response evaluation criteria are not used in realworld contexts. Furthermore, real-world data are often unstructured, preventing accurate comparison of PFS using structured clinical trial data versus real-world data, and existing approaches define PFS inconsistently. Despite the importance of assessing PFS in patients outside of controlled clinical trials, no goldstandard method for collecting and validating PFS from real-world evidence has been established.

Methods: Clinicians, programmers, and data scientists collaborated to develop an R Shiny10 application using Veterans Affairs Corporate Data Warehouse data from the EHR of 352 DLBCL patients. The application takes unstructured data such as clinical notes and facilitates the capture, annotation, and tagging of key words or phrases indicative of progression, thus allowing accurate determination of the date of first identification of progression by a treating clinician.

Data Analysis: In order to refine data-collection techniques and evaluate whether the application can enable calculation of real-world PFS, we conducted an adaptive and iterative process of reviewing EHR documents and capturing and annotating data until a consistent schema and methodology was established. In order to validate annotation schema and methodology, annotations of 50 patient records were performed by 2 annotators and assessed for concordance.

Results: We produced an R Shiny application that can capture, annotate, and transform unstructured EHR data into structured data—specifically, treatment lines, cycles, and response criteria with corresponding dates—ready for analysis of PFS. An annotation schema for capturing real-world data was also developed. Mapping of common phrases used by clinicians in real-world practice to response criteria resulted in a dictionary of these phrases.

Implications: These efforts show that it is possible to convert EHR context reliably into analyzable data such as PFS. Further attempts will be made to establish a gold-standard methodology.

Purpose: The primary objective of this study was to evaluate the total potential grams of intravenous immune globulin (IVIG) averted using ideal body weight (IBW) versus actual body weight (ABW) for dosing calculations. The secondary objectives assessed the indication for use of IVIG, change in serum immunoglobulin G (IgG) levels, and potential cost savings of using IBW to dose IVIG as an alternative to ABW.

Background: Dosing of IVIG in clinical studies is based on ABW. Increasing evidence suggests it is more appropriate to dose IVIG using IBW in all patients, given it primarily distributes throughout intravascular and extravascular fluid compartments. Recent studies have demonstrated benefit for the use of IBW for IVIG dosing in regard to outcomes such as grams of drug averted, guideline compliance, and changes in serum IgG levels. This study aimed to add to the body of literature supporting use of IBW for dosing of IVIG.

Methods: A retrospective chart review was conducted for patients administered IVIG therapy between May 1, 2018 and November 30, 2018. IBW was calculated per patient using the Devine equation.

Data Anaysis: Descriptive statistics were used to assess all primary and secondary objectives. This included examining medians and interquartile ranges for the primary objective as well as potential cost savings per dose.

Results: In regard to the primary objective, the total potential grams of IVIG averted was 965 grams. In terms per dose, a median of 45 grams of IVIG per patient could have been averted, with a range from 0 to 75 grams. In regard to secondary objectives, the total potential cost savings was $41,038.57. In terms per dose, a median of $252.43 per patient could have been avoided, with a range from 0 to $634.51. IVIG was most commonly being prescribed for primary humoral immunodeficiency states and chronic lymphocytic leukemia.

Implications: This data may help guide the decision to transition to utilization of IBW for IVIG dosing. In addition, it may give further insight regarding the need to create a pharmacy-to-dose protocol for IVIG.

Purpose: The primary objective of this study was to evaluate the total potential grams of intravenous immune globulin (IVIG) averted using ideal body weight (IBW) versus actual body weight (ABW) for dosing calculations. The secondary objectives assessed the indication for use of IVIG, change in serum immunoglobulin G (IgG) levels, and potential cost savings of using IBW to dose IVIG as an alternative to ABW.

Background: Dosing of IVIG in clinical studies is based on ABW. Increasing evidence suggests it is more appropriate to dose IVIG using IBW in all patients, given it primarily distributes throughout intravascular and extravascular fluid compartments. Recent studies have demonstrated benefit for the use of IBW for IVIG dosing in regard to outcomes such as grams of drug averted, guideline compliance, and changes in serum IgG levels. This study aimed to add to the body of literature supporting use of IBW for dosing of IVIG.

Methods: A retrospective chart review was conducted for patients administered IVIG therapy between May 1, 2018 and November 30, 2018. IBW was calculated per patient using the Devine equation.

Data Anaysis: Descriptive statistics were used to assess all primary and secondary objectives. This included examining medians and interquartile ranges for the primary objective as well as potential cost savings per dose.

Results: In regard to the primary objective, the total potential grams of IVIG averted was 965 grams. In terms per dose, a median of 45 grams of IVIG per patient could have been averted, with a range from 0 to 75 grams. In regard to secondary objectives, the total potential cost savings was $41,038.57. In terms per dose, a median of $252.43 per patient could have been avoided, with a range from 0 to $634.51. IVIG was most commonly being prescribed for primary humoral immunodeficiency states and chronic lymphocytic leukemia.

Implications: This data may help guide the decision to transition to utilization of IBW for IVIG dosing. In addition, it may give further insight regarding the need to create a pharmacy-to-dose protocol for IVIG.

Purpose: The primary objective of this study was to evaluate the total potential grams of intravenous immune globulin (IVIG) averted using ideal body weight (IBW) versus actual body weight (ABW) for dosing calculations. The secondary objectives assessed the indication for use of IVIG, change in serum immunoglobulin G (IgG) levels, and potential cost savings of using IBW to dose IVIG as an alternative to ABW.

Background: Dosing of IVIG in clinical studies is based on ABW. Increasing evidence suggests it is more appropriate to dose IVIG using IBW in all patients, given it primarily distributes throughout intravascular and extravascular fluid compartments. Recent studies have demonstrated benefit for the use of IBW for IVIG dosing in regard to outcomes such as grams of drug averted, guideline compliance, and changes in serum IgG levels. This study aimed to add to the body of literature supporting use of IBW for dosing of IVIG.

Methods: A retrospective chart review was conducted for patients administered IVIG therapy between May 1, 2018 and November 30, 2018. IBW was calculated per patient using the Devine equation.

Data Anaysis: Descriptive statistics were used to assess all primary and secondary objectives. This included examining medians and interquartile ranges for the primary objective as well as potential cost savings per dose.

Results: In regard to the primary objective, the total potential grams of IVIG averted was 965 grams. In terms per dose, a median of 45 grams of IVIG per patient could have been averted, with a range from 0 to 75 grams. In regard to secondary objectives, the total potential cost savings was $41,038.57. In terms per dose, a median of $252.43 per patient could have been avoided, with a range from 0 to $634.51. IVIG was most commonly being prescribed for primary humoral immunodeficiency states and chronic lymphocytic leukemia.

Implications: This data may help guide the decision to transition to utilization of IBW for IVIG dosing. In addition, it may give further insight regarding the need to create a pharmacy-to-dose protocol for IVIG.

Purpose: An Innovation Network Spark award was received to develop “My Chemo Calendar,” a tool aimed at providing veterans with easy to understand critical information (eg drug name, schedule, side effects), to optimize the benefits of their oral anticancer drugs (OADs). Using a human-centered design approach, we are first obtaining insight from patients and providers on tools (including “my Chemo Calendar”) and strategies that may improve experiences with OADs.

Background: OADs often have complex dosing schedules, toxicity risk, and special handling precautions. Best tools and practices for ensuring safe and effective care for veterans who are prescribed OADs are not yet well established.

Methods: Surveys, focus groups, and semi-structured interviews are being conducted with patients and providers. Topics included: OAD education and knowledge, medication handling and adherence, and symptom management.

Data Analysis: Descriptive statistics will be used to summarize the survey data. Audio files from focus groups and semi-structured interviews will be transcribed and analyzed using NVivo.

Results: To date, data has been collected from two patients and eighteen oncology care providers. Both patients were ‘very satisfied’ with the information they received to successfully and safely take their OADs. They preferred to receive information from multiple sources (eg physician, internet, hand-outs). The majority of providers reported that they never/rarely/sometimes spoke about digesting an OAD with/without food, necessary diet modifications (e.g. no grapefruit), missed doses, medication storage temperatures, and refills. Most usually spoke about side effects, timing (eg morning), adverse effects, phone number to report side effects, and reporting concerning symptoms. Most were not/slightly/moderately confident that the patients were receiving all the necessary instructions to use the OAD properly. The oncology pharmacist was identified as the most appropriate oncology team member to provide patient education. Although, it was noted that it would be best for patients to receive information at various touch points from different team members. The concept of “My Chemo Calendar” was well received but how best to integrate it into care was unclear.

Implications: Data collection and analysis is still ongoing. This information will be used create and pilot new strategies and tools to improve experiences with OADs.

Purpose: An Innovation Network Spark award was received to develop “My Chemo Calendar,” a tool aimed at providing veterans with easy to understand critical information (eg drug name, schedule, side effects), to optimize the benefits of their oral anticancer drugs (OADs). Using a human-centered design approach, we are first obtaining insight from patients and providers on tools (including “my Chemo Calendar”) and strategies that may improve experiences with OADs.

Background: OADs often have complex dosing schedules, toxicity risk, and special handling precautions. Best tools and practices for ensuring safe and effective care for veterans who are prescribed OADs are not yet well established.

Methods: Surveys, focus groups, and semi-structured interviews are being conducted with patients and providers. Topics included: OAD education and knowledge, medication handling and adherence, and symptom management.

Data Analysis: Descriptive statistics will be used to summarize the survey data. Audio files from focus groups and semi-structured interviews will be transcribed and analyzed using NVivo.

Results: To date, data has been collected from two patients and eighteen oncology care providers. Both patients were ‘very satisfied’ with the information they received to successfully and safely take their OADs. They preferred to receive information from multiple sources (eg physician, internet, hand-outs). The majority of providers reported that they never/rarely/sometimes spoke about digesting an OAD with/without food, necessary diet modifications (e.g. no grapefruit), missed doses, medication storage temperatures, and refills. Most usually spoke about side effects, timing (eg morning), adverse effects, phone number to report side effects, and reporting concerning symptoms. Most were not/slightly/moderately confident that the patients were receiving all the necessary instructions to use the OAD properly. The oncology pharmacist was identified as the most appropriate oncology team member to provide patient education. Although, it was noted that it would be best for patients to receive information at various touch points from different team members. The concept of “My Chemo Calendar” was well received but how best to integrate it into care was unclear.

Implications: Data collection and analysis is still ongoing. This information will be used create and pilot new strategies and tools to improve experiences with OADs.

Purpose: An Innovation Network Spark award was received to develop “My Chemo Calendar,” a tool aimed at providing veterans with easy to understand critical information (eg drug name, schedule, side effects), to optimize the benefits of their oral anticancer drugs (OADs). Using a human-centered design approach, we are first obtaining insight from patients and providers on tools (including “my Chemo Calendar”) and strategies that may improve experiences with OADs.

Background: OADs often have complex dosing schedules, toxicity risk, and special handling precautions. Best tools and practices for ensuring safe and effective care for veterans who are prescribed OADs are not yet well established.

Methods: Surveys, focus groups, and semi-structured interviews are being conducted with patients and providers. Topics included: OAD education and knowledge, medication handling and adherence, and symptom management.

Data Analysis: Descriptive statistics will be used to summarize the survey data. Audio files from focus groups and semi-structured interviews will be transcribed and analyzed using NVivo.

Results: To date, data has been collected from two patients and eighteen oncology care providers. Both patients were ‘very satisfied’ with the information they received to successfully and safely take their OADs. They preferred to receive information from multiple sources (eg physician, internet, hand-outs). The majority of providers reported that they never/rarely/sometimes spoke about digesting an OAD with/without food, necessary diet modifications (e.g. no grapefruit), missed doses, medication storage temperatures, and refills. Most usually spoke about side effects, timing (eg morning), adverse effects, phone number to report side effects, and reporting concerning symptoms. Most were not/slightly/moderately confident that the patients were receiving all the necessary instructions to use the OAD properly. The oncology pharmacist was identified as the most appropriate oncology team member to provide patient education. Although, it was noted that it would be best for patients to receive information at various touch points from different team members. The concept of “My Chemo Calendar” was well received but how best to integrate it into care was unclear.

Implications: Data collection and analysis is still ongoing. This information will be used create and pilot new strategies and tools to improve experiences with OADs.

Background: Chronic Myelomonocytic leukemia (CMML) is a clonal hematopoietic malignancy and remains the most common overlapping myelodysplastic/ myeloproliferative neoplasm. Complications of CMML to acute monocytic leukemia transformation may include leukostasis, tumor lysis syndrome, and disseminated intravascular coagulation. We report a case that illustrates the disease characteristics and complications of CMML.

Case Report: A 76-year-old man, who was diagnosed 3 months prior to presentation with CMML, presented to the emergency department with dyspnea, altered mental status and right upper quadrant abdominal pain. His white count on admission was 314.5 × 109/L, which included 50 × 109/L blasts. His liver enzymes were elevated, and initial lactic acid was 12.5. No source of infection was found on imaging with Computed Tomography. Flow cytometry of peripheral blood revealed Acute Monocytic Leukemia. The diagnosis was consistent with CMML transformation to acute monocytic leukemia with hyperleukocytosis and leukostasis. He was started on cytoreduction therapy with hydroxyurea, leukapheresis, and decitabine chemotherapy. His symptoms improved with normalization of his white cell counts and he was discharged to concurrent hospice.

Discussion: Blast transformation (BT) to acute monocytic leukemia occurs in about 14% of patients diagnosed with CMML. 10-20% of newly diagnosed acute myeloid leukemia patients develop hyperleukocytosis (white cell counts greater than 100 x 109/L), a laboratory abnormality which may manifest clinically as leukostasis. Leukostasis, diagnosed empirically in a patient with BT who presents with respiratory and neurological symptoms, has 1-week mortality of 20%-40% if left untreated. Treatment of leukostasis includes leukapheresis, hydroxyurea, and induction chemotherapy. Recent studies have shown that leukapheresis reduces four-week mortality but does not affect long term mortality rate. More research is needed in understanding the pathophysiology of leukostasis, thus paving the way for novel therapeutic agents.

Background: Chronic Myelomonocytic leukemia (CMML) is a clonal hematopoietic malignancy and remains the most common overlapping myelodysplastic/ myeloproliferative neoplasm. Complications of CMML to acute monocytic leukemia transformation may include leukostasis, tumor lysis syndrome, and disseminated intravascular coagulation. We report a case that illustrates the disease characteristics and complications of CMML.

Case Report: A 76-year-old man, who was diagnosed 3 months prior to presentation with CMML, presented to the emergency department with dyspnea, altered mental status and right upper quadrant abdominal pain. His white count on admission was 314.5 × 109/L, which included 50 × 109/L blasts. His liver enzymes were elevated, and initial lactic acid was 12.5. No source of infection was found on imaging with Computed Tomography. Flow cytometry of peripheral blood revealed Acute Monocytic Leukemia. The diagnosis was consistent with CMML transformation to acute monocytic leukemia with hyperleukocytosis and leukostasis. He was started on cytoreduction therapy with hydroxyurea, leukapheresis, and decitabine chemotherapy. His symptoms improved with normalization of his white cell counts and he was discharged to concurrent hospice.

Discussion: Blast transformation (BT) to acute monocytic leukemia occurs in about 14% of patients diagnosed with CMML. 10-20% of newly diagnosed acute myeloid leukemia patients develop hyperleukocytosis (white cell counts greater than 100 x 109/L), a laboratory abnormality which may manifest clinically as leukostasis. Leukostasis, diagnosed empirically in a patient with BT who presents with respiratory and neurological symptoms, has 1-week mortality of 20%-40% if left untreated. Treatment of leukostasis includes leukapheresis, hydroxyurea, and induction chemotherapy. Recent studies have shown that leukapheresis reduces four-week mortality but does not affect long term mortality rate. More research is needed in understanding the pathophysiology of leukostasis, thus paving the way for novel therapeutic agents.

Background: Chronic Myelomonocytic leukemia (CMML) is a clonal hematopoietic malignancy and remains the most common overlapping myelodysplastic/ myeloproliferative neoplasm. Complications of CMML to acute monocytic leukemia transformation may include leukostasis, tumor lysis syndrome, and disseminated intravascular coagulation. We report a case that illustrates the disease characteristics and complications of CMML.

Case Report: A 76-year-old man, who was diagnosed 3 months prior to presentation with CMML, presented to the emergency department with dyspnea, altered mental status and right upper quadrant abdominal pain. His white count on admission was 314.5 × 109/L, which included 50 × 109/L blasts. His liver enzymes were elevated, and initial lactic acid was 12.5. No source of infection was found on imaging with Computed Tomography. Flow cytometry of peripheral blood revealed Acute Monocytic Leukemia. The diagnosis was consistent with CMML transformation to acute monocytic leukemia with hyperleukocytosis and leukostasis. He was started on cytoreduction therapy with hydroxyurea, leukapheresis, and decitabine chemotherapy. His symptoms improved with normalization of his white cell counts and he was discharged to concurrent hospice.

Discussion: Blast transformation (BT) to acute monocytic leukemia occurs in about 14% of patients diagnosed with CMML. 10-20% of newly diagnosed acute myeloid leukemia patients develop hyperleukocytosis (white cell counts greater than 100 x 109/L), a laboratory abnormality which may manifest clinically as leukostasis. Leukostasis, diagnosed empirically in a patient with BT who presents with respiratory and neurological symptoms, has 1-week mortality of 20%-40% if left untreated. Treatment of leukostasis includes leukapheresis, hydroxyurea, and induction chemotherapy. Recent studies have shown that leukapheresis reduces four-week mortality but does not affect long term mortality rate. More research is needed in understanding the pathophysiology of leukostasis, thus paving the way for novel therapeutic agents.

Background: Myxoid liposarcomas (MLS) are intermediate to high grade liposarcomas, which are the most common type of soft tissue sarcoma. Although MLS most frequently develops in the legs, it can arise in any of the body’s soft tissue adipose. Previous studies of MLS survival have been limited in terms of geography, cohort size, variety of treatment settings, and assessment of primary site role. We retrospectively studied survival data for a nationwide cohort of MLS patients to identify prognostic factors and assess their effects on survival.

Methods: Using the National Cancer Database, we obtained data on 4636 patients diagnosed with MLS (ICD-O-3 8852) between 2004 and 2016. 5- and 10-year survival curves were estimated with Kaplan-Meier analysis and compared with log-rank analysis. Cox hazard regression was also used to compare multiple variables’ effects on survival.

Results: Approximately 59.2% of the cohort was male with a median age of presentation of 49 years. The most common site of metastasis was the bone followed by lung, liver, and brain. The majority (46.8%) of patients were stage I at time of diagnosis, followed by stage II with 18.1%, stage III with 13.1%, and stage IV at 5.3%. Overall 5- and 10-year survival probabilities for the cohort were 76.1% and 62.0%. Female patients (5-year: 79.6% and 10-year: 65.5%) had better survivals than male patients (5-year: 73.8% and 10-years: 59.6%). As stage increased, overall survival decreased with stage IV patients having 5- and 10-year survival probabilities of 21.2% and 9.4%, respectively. Patients with tumors localized to the extremities (5-year: 81.2%) had the best overall survival followed by tumors in the head or neck (5-year: 79.9%), pelvis (5-year: 77.3%), pelvis (5-year: 78.0%), thorax or trunk (5-year: 66.5%), and the retroperitoneum or abdomen (5-year: 53.1%). Finally, adjuvant radiation treatment correlated with decreased mortality to surgical resection of primary tumor alone (HR: 0.847; 95% CI: 0.726-0.989), whereas adjuvant chemotherapy correlated with increased mortality (HR: 2.769; 95% CI: 1.995-3.841).

Conclusion: Primary anatomical site was determined to be a major prognostic factor along with treatment facility type, sex, stage, and surgical margins for patients with myxoid liposarcoma.

Background: Myxoid liposarcomas (MLS) are intermediate to high grade liposarcomas, which are the most common type of soft tissue sarcoma. Although MLS most frequently develops in the legs, it can arise in any of the body’s soft tissue adipose. Previous studies of MLS survival have been limited in terms of geography, cohort size, variety of treatment settings, and assessment of primary site role. We retrospectively studied survival data for a nationwide cohort of MLS patients to identify prognostic factors and assess their effects on survival.

Methods: Using the National Cancer Database, we obtained data on 4636 patients diagnosed with MLS (ICD-O-3 8852) between 2004 and 2016. 5- and 10-year survival curves were estimated with Kaplan-Meier analysis and compared with log-rank analysis. Cox hazard regression was also used to compare multiple variables’ effects on survival.

Results: Approximately 59.2% of the cohort was male with a median age of presentation of 49 years. The most common site of metastasis was the bone followed by lung, liver, and brain. The majority (46.8%) of patients were stage I at time of diagnosis, followed by stage II with 18.1%, stage III with 13.1%, and stage IV at 5.3%. Overall 5- and 10-year survival probabilities for the cohort were 76.1% and 62.0%. Female patients (5-year: 79.6% and 10-year: 65.5%) had better survivals than male patients (5-year: 73.8% and 10-years: 59.6%). As stage increased, overall survival decreased with stage IV patients having 5- and 10-year survival probabilities of 21.2% and 9.4%, respectively. Patients with tumors localized to the extremities (5-year: 81.2%) had the best overall survival followed by tumors in the head or neck (5-year: 79.9%), pelvis (5-year: 77.3%), pelvis (5-year: 78.0%), thorax or trunk (5-year: 66.5%), and the retroperitoneum or abdomen (5-year: 53.1%). Finally, adjuvant radiation treatment correlated with decreased mortality to surgical resection of primary tumor alone (HR: 0.847; 95% CI: 0.726-0.989), whereas adjuvant chemotherapy correlated with increased mortality (HR: 2.769; 95% CI: 1.995-3.841).

Conclusion: Primary anatomical site was determined to be a major prognostic factor along with treatment facility type, sex, stage, and surgical margins for patients with myxoid liposarcoma.

Background: Myxoid liposarcomas (MLS) are intermediate to high grade liposarcomas, which are the most common type of soft tissue sarcoma. Although MLS most frequently develops in the legs, it can arise in any of the body’s soft tissue adipose. Previous studies of MLS survival have been limited in terms of geography, cohort size, variety of treatment settings, and assessment of primary site role. We retrospectively studied survival data for a nationwide cohort of MLS patients to identify prognostic factors and assess their effects on survival.

Methods: Using the National Cancer Database, we obtained data on 4636 patients diagnosed with MLS (ICD-O-3 8852) between 2004 and 2016. 5- and 10-year survival curves were estimated with Kaplan-Meier analysis and compared with log-rank analysis. Cox hazard regression was also used to compare multiple variables’ effects on survival.

Results: Approximately 59.2% of the cohort was male with a median age of presentation of 49 years. The most common site of metastasis was the bone followed by lung, liver, and brain. The majority (46.8%) of patients were stage I at time of diagnosis, followed by stage II with 18.1%, stage III with 13.1%, and stage IV at 5.3%. Overall 5- and 10-year survival probabilities for the cohort were 76.1% and 62.0%. Female patients (5-year: 79.6% and 10-year: 65.5%) had better survivals than male patients (5-year: 73.8% and 10-years: 59.6%). As stage increased, overall survival decreased with stage IV patients having 5- and 10-year survival probabilities of 21.2% and 9.4%, respectively. Patients with tumors localized to the extremities (5-year: 81.2%) had the best overall survival followed by tumors in the head or neck (5-year: 79.9%), pelvis (5-year: 77.3%), pelvis (5-year: 78.0%), thorax or trunk (5-year: 66.5%), and the retroperitoneum or abdomen (5-year: 53.1%). Finally, adjuvant radiation treatment correlated with decreased mortality to surgical resection of primary tumor alone (HR: 0.847; 95% CI: 0.726-0.989), whereas adjuvant chemotherapy correlated with increased mortality (HR: 2.769; 95% CI: 1.995-3.841).

Conclusion: Primary anatomical site was determined to be a major prognostic factor along with treatment facility type, sex, stage, and surgical margins for patients with myxoid liposarcoma.

Background: Pleomorphic liposarcomas is an aggressive, high grade subtype of soft tissue sarcoma representing < 15% of liposarcomas. It most commonly arises in the retroperitoneum and proximal upper extremities. Current prognostic factors are centered around staging, which accounts for the grade, size, and location of the tumor in relation to the superficial fascia.

Methods: A total of 1778 patients diagnosed with pleomorphic liposarcoma were identified in the National Cancer Database and stratified by primary anatomical site: head/neck, upper limb, lower limb/hip, thorax/lung, pelvis, and retroperitoneum/abdomen. Kaplan-Meier survival tables were produced to estimate 1-, 5-, and 10-year overall survival. Log-rank tests with a Bonferroni correction for multiple comparisons and a multivariable Cox proportional hazards analysis were utilized to compare the primary site groups; P < 0.05 was considered significant.

Results: The most common primary anatomical site was the lower limb/hip. The head/neck primary anatomical site demonstrated the highest 10-year overall survival probability, while retroperitoneum/abdomen had the lowest (50% and 18.4%, respectively). Median survival was 9.19 years for the head/neck group, and 3.08 years for the retroperitoneum/abdomen group. Significant overall survival differences were found between the retroperitoneum/abdomen group and each of the following groups: head/neck (P=0.001), upper limb (P<0.001), lower limb/hip (P<0.001), and pelvis (P=0.001). After adjusting for age, biological sex, race and ethnicity, Charlson-Deyo comorbidity index, and AJCC pathologic stage, a 48.4% increased risk of death was found for retroperitoneum/abdomen vs. lower limb/hip primary site (95% CI: 14.6% to 92.1%; P=0.003). Thorax/lung vs. lower limb/hip was also associated with a 55.1% increased risk of death (95% CI: 8.4% to 121.9%; P=0.016).

Conclusion: The current prognostic modality for pleomorphic liposarcoma is limited. There are statistically significant differences in survival based on primary anatomical sites, which may serve as a useful prognostic indicator. Tumors manifesting in the retroperitoneum/abdomen demonstrated the lowest survival.

Background: Pleomorphic liposarcomas is an aggressive, high grade subtype of soft tissue sarcoma representing < 15% of liposarcomas. It most commonly arises in the retroperitoneum and proximal upper extremities. Current prognostic factors are centered around staging, which accounts for the grade, size, and location of the tumor in relation to the superficial fascia.

Methods: A total of 1778 patients diagnosed with pleomorphic liposarcoma were identified in the National Cancer Database and stratified by primary anatomical site: head/neck, upper limb, lower limb/hip, thorax/lung, pelvis, and retroperitoneum/abdomen. Kaplan-Meier survival tables were produced to estimate 1-, 5-, and 10-year overall survival. Log-rank tests with a Bonferroni correction for multiple comparisons and a multivariable Cox proportional hazards analysis were utilized to compare the primary site groups; P < 0.05 was considered significant.

Results: The most common primary anatomical site was the lower limb/hip. The head/neck primary anatomical site demonstrated the highest 10-year overall survival probability, while retroperitoneum/abdomen had the lowest (50% and 18.4%, respectively). Median survival was 9.19 years for the head/neck group, and 3.08 years for the retroperitoneum/abdomen group. Significant overall survival differences were found between the retroperitoneum/abdomen group and each of the following groups: head/neck (P=0.001), upper limb (P<0.001), lower limb/hip (P<0.001), and pelvis (P=0.001). After adjusting for age, biological sex, race and ethnicity, Charlson-Deyo comorbidity index, and AJCC pathologic stage, a 48.4% increased risk of death was found for retroperitoneum/abdomen vs. lower limb/hip primary site (95% CI: 14.6% to 92.1%; P=0.003). Thorax/lung vs. lower limb/hip was also associated with a 55.1% increased risk of death (95% CI: 8.4% to 121.9%; P=0.016).

Conclusion: The current prognostic modality for pleomorphic liposarcoma is limited. There are statistically significant differences in survival based on primary anatomical sites, which may serve as a useful prognostic indicator. Tumors manifesting in the retroperitoneum/abdomen demonstrated the lowest survival.

Background: Pleomorphic liposarcomas is an aggressive, high grade subtype of soft tissue sarcoma representing < 15% of liposarcomas. It most commonly arises in the retroperitoneum and proximal upper extremities. Current prognostic factors are centered around staging, which accounts for the grade, size, and location of the tumor in relation to the superficial fascia.

Methods: A total of 1778 patients diagnosed with pleomorphic liposarcoma were identified in the National Cancer Database and stratified by primary anatomical site: head/neck, upper limb, lower limb/hip, thorax/lung, pelvis, and retroperitoneum/abdomen. Kaplan-Meier survival tables were produced to estimate 1-, 5-, and 10-year overall survival. Log-rank tests with a Bonferroni correction for multiple comparisons and a multivariable Cox proportional hazards analysis were utilized to compare the primary site groups; P < 0.05 was considered significant.

Results: The most common primary anatomical site was the lower limb/hip. The head/neck primary anatomical site demonstrated the highest 10-year overall survival probability, while retroperitoneum/abdomen had the lowest (50% and 18.4%, respectively). Median survival was 9.19 years for the head/neck group, and 3.08 years for the retroperitoneum/abdomen group. Significant overall survival differences were found between the retroperitoneum/abdomen group and each of the following groups: head/neck (P=0.001), upper limb (P<0.001), lower limb/hip (P<0.001), and pelvis (P=0.001). After adjusting for age, biological sex, race and ethnicity, Charlson-Deyo comorbidity index, and AJCC pathologic stage, a 48.4% increased risk of death was found for retroperitoneum/abdomen vs. lower limb/hip primary site (95% CI: 14.6% to 92.1%; P=0.003). Thorax/lung vs. lower limb/hip was also associated with a 55.1% increased risk of death (95% CI: 8.4% to 121.9%; P=0.016).

Conclusion: The current prognostic modality for pleomorphic liposarcoma is limited. There are statistically significant differences in survival based on primary anatomical sites, which may serve as a useful prognostic indicator. Tumors manifesting in the retroperitoneum/abdomen demonstrated the lowest survival.