Toxicity Of Cancer Treatment Research Articles

The value of immunotherapy: Comparison of annual cost per patient receiving immunotherapy versus chemotherapy in patients with non-small cell lung cancer.

e19364 Background: Checkpoint Inhibitors (CPI) has revolutionized cancer treatment but financial toxicity can be incurred due to high cost. We performed a population-based analysis examining the cost of CPI vs. conventional chemotherapy (CT) in patients with NSCLC to capture the real-world value of CPI on an individual and community level. Methods: Population based claims database of privately insured individuals, MarketScan was interrogated. Pts in years 2015 and 2016 with ICD 9 or 10 diagnosis of lung cancer who were continuously enrolled in insurance plan for at least 12 months were included. CPT codes for CPIs and CT were used. Outcome Measure was Health Service Use ( surrogate for treatment related toxicity) such as Inpatient Admissions and Emergency Department Use. Cost Categories (US Dollars) noted were Total Costs,Total Out-of-Pocket Costs,Total Outpatient Infusion Costs, Outpatient Infusion Out-of-Pocket Costs, Inpatient Admissions Costs and Emergency Department Use Costs.Statistical tests “paired t tests” and “unpaired t tests” were used to compare the above variables using SAS software. Results: In 2015 of 22,193 with lung cancer 554 received CPI vs CT in 21,639. In 2016 of 22,810 pts 2478 received CPI vs CT in 20,332. Data for CPI vs. CT in years 2015 (a) and 2016 ( b) respectively. p value for each pair was <0.0001 unless as noted below 1. Mean Total Cost: a) 228504 vs. 140,970 b) 202202 vs. 147801 2. Mean Total Out of Pocket Cost: a) 3381 vs. 3308 p=0.4829 b) 3500 vs. 3343 p=0.0021 3. Mean Total Outpatient Infusion Cost: a) 51158 vs. 18634 b) 60087 vs. 18999 4. Mean Total Out of Pocket Outpatient Infusion Cost: a)159 vs. 282 b) 359 vs. 263 5. Inpatient Admission rate: a) 33.75% vs. 59.40% b) 43% vs. 58% 6. Mean Inpatient Admission Cost: a) 53045 vs 69810 p =0.0025 b) 54124 vs 73903 7. ED Visit rate: a) 38.2% vs. 61.4% b) 50% vs. 61% 8. Mean ED Cost: a) 4117 vs. 5265 p=0.0379 b) 4947 vs. 6025 p=0.0001. Conclusions: Despite the higher individual total cost in pts receiving CPI vs CT; the cost of CPI could potentially be offset at healthcare level by lesser expenditure through lower ED visits and inpatient hospitalization. Though the out of pocket costs/patient was statistically different, the mean numerical difference was small between CPI vs CT. Future prospective trials of CPI should also incorporate costs to individual and healthcare systems in addition to evaluating the impact of CPI on Quality of life vs CT to understand the real “value” of CPI. This novel study can serve as a benchmark for future population based studies.

Predictors of and longitudinal assessment of health utility scores in patients with small cell lung cancer using real-world data.

e19306 Background: Recent advances in small cell lung cancer (SCLC) treatments necessitate a better understanding of health utility scores (HUS) of patients treated under standard regimens to facilitate robust pharmaco-economic assessments. HUS collected in clinical trials may be inherently skewed due to restrictive eligibility criteria, highlighting the need for real-world data. Methods: In this cohort observational study, HUS were evaluated in SCLC patients through EQ-5D surveys. We also evaluated patient reported (pr) ECOG performance status (PS)), treatment toxicities (modified patient reported (mpr) CTCAE) and symptoms (Edmonton Symptom Assessment System, ESAS). Clinical data were abstracted from electronic medical records. The impact of these variables on HUS was explored using regression. Results: Of 282 clinical encounters (12% newly diagnosed; 37% stable on treatment; 22% progressing; 29% stable off therapy/other) in 111 SCLC patients (58% male; 64% extensive stage), 29% had pr-ECOG PS ≥ 2 at the first encounter. Mean HUS in treatment naïve patients with limited disease was 0.848 (SEM = 0.028); for extensive stage, mean HUS = 0.715 (SEM = 0.046). Extensive stage (β = -0.12; p = 0.03), bone metastases (β = -0.10; p = 0.04), females (β = -0.07; p = 0.006), and pr-ECOG PS ≥ 2 (β = -0.21; p < 0.001) were each associated with decreased HUS in multivariable analyses. When excluding pr-ECOG PS from the model (highly correlated with HUS), progressive disease (β = -0.07; p = 0.02) was also associated with decreased HUS. Longitudinally, in patients with disease stability, HUS were unchanged in limited disease, but slowly decreased for extensive stage over time. HUS were inversely associated with increasing severity of most measured toxicities (mpr-CTCAE rho values ranged from -0.34 to -0.47) and symptoms (rho values -0.27 to -0.54). Conclusions: HUS in SCLC is impacted by the presence of extensive stage and bone metastases, in addition to cancer symptoms and treatment toxicities. The values reported from this real-world sample provides a basis in which to compare with new SCLC therapies in health technology assessments. [Table: see text]

Supportive care in cancer-a MASCC perspective.

The term 'supportive care' arose from the medical oncology literature predominantly in the context of managing the toxicities of cancer treatment but embraces all symptom management through treatment and survivorship. Supportive care should be patient-centred with good communication which includes family and carers and applies across the cancer experience from diagnosis, treatment, survivorship to end of life care. Supportive care encompasses physical and functional, psychological, social and spiritual well-being to improve the quality of life. Supportive care must be evidence-based and thus further research is essential. Supportive care requires screening for some symptoms and tools for patients to report their outcomes. Supportive care has to accommodate new physical toxicities, emotional distress as well as financial toxicity. Supportive care is often delivered by medical oncologists but any organ-related specialist, geriatrician, palliative care clinician, pain specialist, nutritionist, psycho-oncologist, social worker, physiotherapist, nurse or allied health worker who is required to relieve a patient's symptoms or side effects may be involved in a multidisciplinary way. The field is evolving to embrace technology such as eHealth and mHealth capabilities which will enhance integrated care.

‘Measuring up’: A comparison of two response expectancy assessment formats completed by men treated with radiotherapy for prostate cancer

ObjectiveResponse expectancies of cancer treatment toxicities are often, but not always, associated with subsequent experiences. A recent meta-analysis indicated that response expectancies, measured using different assessment formats, reveal different effect sizes, potentially explaining mixed outcomes. Utilizing a clinical sample, we compared 5-point assessments and visual analogue scales, as measures of response expectancies for the incidence and severity of subsequent toxicities. MethodsFour weeks pre-radiotherapy, 45 men with prostate cancer rated their response expectancies of the same 18 toxicities on 5-point assessments and visual analogue scales, presented in random order. Descriptors anchored each end of visual analogue scales and every point of 5-point assessments was labelled, including an ‘unsure’ midpoint. Toxicities were subsequently assessed 2-weeks into radiotherapy on 100-point visual analogue scales. ResultsAcross all toxicities, 17.5–62.8% of patients selected ‘unsure’ on 5-point assessments. No response expectancies were reported on 5-point assessments for ‘blood in stools’ or ‘rectal urgency’ yet 54.8%–64.3% of patients indicated response expectancies for these toxicities on visual analogue scales. Visual analogue scales and 5-point scales demonstrated small-to-moderate associations (r = 0.30–0.58) as measures of response expectancy incidence, but mostly large associations when visual analogue scales captured severity (r = 0.43–0.76). Response expectancies measured with visual analogue scales predicted more toxicities to a moderate degree or greater (68.8%) than 5-point assessments (37.5%). ConclusionThis novel investigation demonstrated an ‘unsure’ midpoint is often selected, potentially reducing the sensitivity of 5-point assessments. Based on their associations, and outcomes, these assessment formats should be considered independent in response expectancy research of cancer treatment toxicities.

Human Amnion Membrane Proteins Prevent Doxorubicin-Induced Oxidative Stress Injury and Apoptosis in Rat H9c2 Cardiomyocytes.

Doxorubicin (DOX) is widely used as an effective chemotherapy agent in cancer treatment. Cardiac toxicity in cancer treatment with DOX demand urgent attention and no effective treatment has been established for DOX-induced cardiomyopathy. It has been well documented that human amniotic membrane proteins (AMPs), extracted from amnion membrane (AM), have antioxidant, anti-apoptotic, and cytoprotective properties. Therefore, in this study, we aimed to investigate the protective effects of AMPs against cardiotoxicity induced by DOX in cultured rat cardiomyocyte cells (H9c2). DOX-induced cell injury was evaluated using multi-parametric assay including thiazolyl blue tetrazolium bromide (MTT), the release of lactic dehydrogenase (LDH), intracellular Ca2+ , reactive oxygen species (ROS) levels, cellular antioxidant status, mitochondrial membrane potential (ΔΨm), malondialdehyde (MDA), and NF-κB p65 DNA-binding activity. Moreover, expression profiling of apoptosis-related genes (P53, Bcl-2, and Bax) and Annexin V by flow cytometry were used for cell apoptosis detection. It was shown that AMPs pretreatment inhibited the cell toxicity induced by DOX. AMPs effectively attenuated the increased levels of LDH, Ca2+ , ROS, and MDA and also simultaneously elevated the ΔΨm and antioxidant status such as superoxide dismutase (SOD) and Catalase (CAT) in pretreated H9c2 cardiomyocytes. Besides, the activity of NF-kB p65 was reduced and the p53 and Bax protein levels were inhibited in these myocardial cells subjected to DOX. These findings provide the first evidence that AMPs potently suppressed DOX-induced toxicity in cardiomyocytes through inhibition of oxidative stress and apoptosis. Thus, AMPs can be a potential therapeutic agent against DOX cardiotoxicity.

Financial toxicity of cancer treatment: Moving the discussion from acknowledgement of the problem to identifying solutions

Although there is no formal definition, financial toxicity (FT) refers to the detrimental effects of the excess financial strain caused by the diagnosis of cancer on the well-being of patients, their families and society. With continued escalation in the costs of cancer treatment, FT has become an important consideration in recent cancer care.

Young head and neck cancer patients are at increased risk of developing oral mucositis and trismus.

To evaluate cancer treatment-related toxicities in young head and neck cancer (HNC) patients. A total of 44 patients were included in the present retrospective cohort study, which was designed to access oral toxicities of cancer treatment in young (< 45years of age, Group I, n = 22) and old (> 58years of age, Group II, n = 22) HNC patients with similar tumor stage and treatment protocols. Oral mucositis (OM), xerostomia, dysphagia, dysgeusia, trismus, and radiodermatitis were assessed during days 7th, 21st, and 35th of head and neck radiotherapy (HNRT) according to previously validated scales (World Health Organization criteria and the National Cancer Institute and Common Terminology Criteria for Adverse Events version 4.0). Patients from both groups showed high incidence and severity of oral toxicities by the end of the HNRT with OM (81.9% (Group I); 63.6% (Group II)) and xerostomia (72.6% (Group I); 77.2% (Group II)) being the most prevalent toxicities. No differences regarding xerostomia, dysphagia, dysgeusia, and radiodermatitis incidences or severity could be observed between groups. However, higher incidences and severity of OM at 21st and 35th fractions (odds ratio = 2.22 and 5.71, respectively) and trismus at 21st and 35th fractions (odds ratio = 6.17 and 14.5, respectively) were observed throughout the treatment in young patients when compared to older patients (p < 0.01 and p < 0.05, respectively). Young HNC patients are more affected by cancer treatment-related OM and trismus despite the similarities in clinical staging and treatment protocols with elderly patients.

Quality of Life in Ovarian-Cancer Patients Receiving Chemotherapy

Background: Ovarian cancer accounts for 4% of cancers occurring in women and ranks first in gynecological cancer mortality. Maintaining and improving quality of life is an important goal of cancer treatment. The toxicities of cancer treatment particularly chemotherapy can impact an individual’s wellbeing. Objective: Assessment of quality of life among ovarian cancer patients receiving chemotherapy. Method: A descriptive study was conducted among 202 patients with ovarian cancer treated at the National Institute of Cancer Research and Hospital in Bangladesh. Ethical approval was received from the ethics committee of NICRH. Data was collected using the EORTC QLQC30 questionnaire and the ovarian cancer specific EORTC QOL OV-28 module. Functional, symptomatic and global variables were scored and analyzed by SPSS. Multiple linear regressions determined the effects of predictor variables and correlation of the global health status with other variables. Results: 48.6% of patients were ages 41 to 50 years. The mean score of global health status was 55.77. Deteriorating emotional function, distressing physical and psychological symptoms, sexual dysfunction and financial difficulties adversely affect the quality of life. Their correlation with global health status was strongly significant (P value -0.604; p -0.442; p -0.339; p -0.377; p -0.369; p -0.262; p Conclusion: The overall quality of life among the ovarian cancer patients receiving chemotherapy is low. Increasing knowledge in this area will help clinicians to optimize patient management. Interventions should focus on both physical and psychological and sexual health issues that adversely affect the quality of life.

B7-H3, a checkpoint molecule, as a target for cancer immunotherapy

B7-H3 (also known as CD276) is a newly found molecule of B7 family, which may be a promising target for cancer treatment. B7-H3 protein was demonstrated to be expressed in several kinds of tumor tissues including non-small-cell lung cancer (NSCLC) and prostate cancer. Its expression is highly associated with undesirable treatment outcomes and survival time, due to function of the immune checkpoint molecule. It was classified as either a co-stimulatory molecule for T cell activation or the nonimmunological role of regulating signaling pathways. Although there is still no agreed conclusion on the function of B7-H3, it may be a valuable target for cancer therapy. This review aims to provide a comprehensive, up-to-date summary of the advances in B7-H3 targeting approaches in cancer therapy. Although several challenges remain, B7-H3 offers a new therapeutic target with increased efficacy and less toxicity in future cancer treatment.

Future of Cancer Treatment and Genomic Toxicity

Future of Cancer Treatment and Genomic Toxicity

Cancer cachexia and treatment toxicity.

Cancer cachexia is a metabolic disturbance resulting in a loss of skeletal muscle mass that is generally not reversed through traditional nutritional interventions. We review on both the impact of nutritional status on cancer treatment side effects, as well as cancer- specific outcomes. Cancer-specific cachexia and sarcopenia are associated with increased treatment-associated toxicity, and overall worse cancer-specific outcomes across all cancer types in surgical, chemotherapeutic, and radiotherapeutic populations. Despite the fact that cancer cachexia is generally thought to be irreversible, there is some evidence that nutritional intervention can be helpful. Nutritional status is an important factor to consider in determining cancer therapy. Patients with poor nutritional status should be identified prior to the initiation of therapy and be monitored judiciously.

Co-Encapsulation of Chlorin e6 and Chemotherapeutic Drugs in a PEGylated Liposome Enhance the Efficacy of Tumor Treatment: Pharmacokinetics and Therapeutic Efficacy.

Long-circulating PEG-modified liposome has been shown to improve pharmacokinetic properties and reduce systemic toxicity in cancer treatment. However, drug bioavailability from liposome remains a major challenge to the improvement of its therapeutic efficacy. Previously, we designed a PEGylated dual-effect liposome (named as PL-Dox-Ce6) with chlorin e6 incorporated in the lipid bilayer and Doxorubicin encapsulated in the interior. In this study, another dual-effect liposome with cisplatin encapsulated in the interior was further developed. The pharmacokinetics of these two dual-effect liposomes were studied in tumor-bearing mice. Based on the kinetic data of tumor and plasma, light irradiation was applied onto the tumors at different time points after drug administration to compare the therapeutic efficacy. We demonstrated that a single dose of the dual-effect liposomes combined with two doses of light irradiation can completely eradicate over 90% of the tumor in mice alone with significant survival rate and no toxicity. Thus, this study established a platform that utilizes the dual-effect liposome which combines photodynamic therapy and chemotherapy to improve the therapeutic outcomes of tumors.

Huganpian, a traditional chinese medicine, inhibits liver cancer growth in vitro and in vivo by inducing autophagy and cell cycle arrest

Huganpian (HGP), a traditional chinese medicine composed of 6 herbs, possesses excellent therapeutic effects in clinical application. In this study, we aimed to elucidate the anti-tumor activity and the underlying mechanisms of HGP in liver cancer. The results of this study indicated that HGP effectively inhibited liver cancer growth in vitro and in vivo in a dose-dependent manner. Mechanistically, HGP exerted its anti-tumor effects by triggering autophagy with increased LC3Ⅱ and beclin1 levels and arrested the cell cycle on G0-G1 phase by downregulating the expressions of cyclin-dependent kinase 2 (CDK2), cyclin-dependent kinase 4 (CDK4) and cyclinE1 in vitro and in vivo. Meanwhile, HGP did not induce apoptosis significantly. Importantly, we also confirmed that there were fewer side effects of HGP on immune system. Taken together, our findings suggest for the first time that HGP may become a promising drug or adjuvant drug with a lower toxicity for liver cancer treatment in the future.

Study of the intracellular delivery mechanism of a pH-sensitive peptide modified with enhanced green fluorescent protein

The targeted delivery of therapeutic agents is a promising approach to enhance the efficacy and reduce the toxicity of cancer treatments. Understanding the intracellular endocytic mechanisms of a cell penetrating peptide (CPP) in an acidic environment is important for targeted delivery of macromolecules to tumours. In this study, we constructed a pH-sensitive CPP-based delivery system for the intracellular delivery of macromolecules. A pH-sensitive CPP, HBHAc, was fused with a model protein, enhanced green fluorescent protein (EGFP), through recombinant DNA technology. We found that is essential that negatively charged proteoglycans on the cell surface interact with HBHAc-EGFP prior to the cellular uptake of HBHAc-EGFP. The uptake was significantly restricted at 4 °C under pH conditions of both 6.5 and 7.5. The increased positive charge of HBHAc-EGFP under the acidic condition leads to a pH-dependent cellular uptake, and we observed that the internalisation of HBHAc-EGFP was significantly higher at pH 6.5 than at pH 7.5 (p < .05). Thus, with pH-sensitive activity, HBHAc is expected to improve tumour-targeted intracellular protein delivery. Moreover, our findings provide a new insight that the endocytic pathway may change under different pH conditions and suggest that this unique phenomenon benefits pH-sensitive drug delivery for tumour therapy.

Overview and critical revision of clinical assessment tools in chemotherapy-induced peripheral neurotoxicity.

Chemotherapy-induced peripheral neurotoxicity (CIPN) is a major toxicity of cancer treatment, leading to dose reduction and premature treatment cessation, potentially affecting patient function, and quality of life. The development of accurate and sensitive assessment tools for CIPN is essential to enable clinical monitoring during treatment, follow-up of long-term outcomes and measurement of toxicity in clinical trials. This review examines CIPN clinical assessment scales incorporating clinician-based, composite, and patient-reported outcomes (PROs), providing a systematic review of their properties and an updated critical analysis of recommendations on current evidence for their use. This systematic review of CIPN assessment tools identified 50 papers containing 41 assessment tools, across 4 categories (common toxicity criteria; composite neurological scale; PROs; pain scale). The majority of these tools were PROs, underscoring the importance of patient-based assessment of symptoms. While there has been considerable work in the field over the past 10 years, this review highlights significant gaps, including a lack of evaluation of responsiveness and problematic neuropathic pain evaluation. There remains a need for consensus on the best available tool and the need to modify existing instruments to improve utility.

Introduction of a Modified Scleroderma Patient-Reported Outcome Questionnaire to Identify and Categorize Patients with Radiation-Induced Fibrosis of the Head and Neck

Skin and soft tissue fibrosis of the neck is a common late toxicity of head and neck cancer treatment. To date, no comprehensive patient-reported outcome survey specifically addresses this toxicity. This study documents a patient-reported outcome metric adapted from research in scleroderma that identifies and categorizes patients with symptomatic fibrosis that may be missed on other quality of life (QOL) surveys. As part of an ongoing IRB-approved prospective clinical trial currently accruing at a single-institution, we enrolled patients previously treated with head and neck radiation (RT). Participants completed the EORTC Core QOL Questionnaire (QLQ-C30), QOL Questionnaire Head and Neck Module (QLQ-H&N43), in addition to a modified pre-existing survey initially validated to assess symptom severity in patients with fibrotic disease states (Scleroderma Skin Patient-Reported Outcome, SSPRO). The SSPRO survey was minimally modified from its validated version to be more applicable to our intended cohort and is composed of 22 questions divided into four subdomains including physical effect (PE), emotional effect (E), physical limitation (PL), and social limitation (SL). A correlation between the QLQ-C30 and QLQ-H&N43 scoring against SSPRO was performed using Pearson’s correlation coefficient statistical analysis against the SSPRO survey scores for patients with RT-induced fibrosis. A total of 35 patients have enrolled in the clinical trial and are included in this analysis. Seven patients received surgery followed by concurrent chemoRT, 7 patients underwent surgery and adjuvant RT, 20 patients had concurrent chemoRT, and 1 patient was treated with RT alone. Using SSPRO raw scores, patients were placed into mild, moderate and severe categories: mild 0-25, n=24 (68.6%); moderate 26-49, n=8 (22.8%); severe 50-100, n=3 (8.6%). Using Pearson’s correlation coefficient, correlations were significant between the SSPRO survey scores and QLQ-C30 (r=0.443, p=0.0076) and QLQ-H&N43 (r=0.601, p=0.0001). In these preliminary results, we identified the modified SSPRO as a new QOL tool that improves the ability to identify symptomatic fibrosis in head and neck patients. Comparison of this survey to the QLQ-C30 and QLQ-H&N43 indicates significant positive correlations in scoring although of only mild and moderate strength. Relatively few skin-focused questions in the EORTC surveys may account for lack of a stronger correlation with the SSPRO. We propose that the SSPRO more adequately captures QOL detriment after head and neck RT because it provides more detailed fibrosis information. Likewise, since such few skin-directed questions are included in the EORTC surveys, the SSPRO also allows for more precise categorization of patients based on symptom severity. More studies are needed to determine how this tool can be used to follow patients with fibrosis as well as quantify improvements after treatment.

Combination of Sodium Selenite and Doxorubicin Prodrug Ac-Phe-Lys-PABC-ADM Affects Gastric Cancer Cell Apoptosis in Xenografted Mice.

The incidence of gastric cancer is extremely high in China, prompting the development of effective therapeutic strategies. Sodium selenite (SS) affects the proliferation and redifferentiation of gastric cancer cells and the Adriamycin prodrug Ac-Phe-Lys-PABC-ADM (PADM) reduces toxicity in gastric cancer treatment. However, the mechanisms involved therein remain unclear. In this study, nude mice were transplanted with SGC-7901 gastric cancer cells to construct a tumor xenograft model. After administration of SS and PADM, tumor weight and size were reduced. In addition, the levels of alanine aminotransferase, aspartate transaminase, creatinine, and lactate dehydrogenase were decreased, indicating improved hepatic and renal function and inhibited cancer cell metabolism. Furthermore, combined treatment of SS and PADM downregulated the expression of cell cycle-related proteins (cyclin-dependent kinase 4, Ki67, cyclin E, and cyclin D1), elevated that of proapoptosis proteins (Bax, cleaved caspase-3, cleaved caspase-9, and P53), and upregulated that of mitochondrial apoptosis-associated proteins (apoptotic protease activating factor 1 and second mitochondria-derived activator of caspases). In conclusion, combined treatment of SS and PADM effectively promoted apoptosis in gastric cancer xenografts via the mitochondrial apoptosis pathway.

Breast Cancer Treatment in Resource Constrained Countries: a Zimbabwean Perspective

Purpose of Review Breast cancer is becoming a significant burden to the healthcare system in Zimbabwe. The financial toxicity of breast cancer treatment is a significant problem for patients even in the developed world. This review looks at the management of breast cancer patients in Zimbabwe relating it to the other developed nations.

Incidence of severe late toxicities of head and neck squamous cell cancer (HNSCC) treatment in the era of intensity modulated radiotherapy (IMRT).

e17570 Background: IMRT for HNSCC limits exposure to critical nearby structures thereby reducing toxicities. Real world data on toxicities after long term follow-up post IMRT for HNSCC are lacking. This study assessed the incidence of late toxicities in patients with HNSCC within 5 years post-treatment with definitive IMRT (d-IMRT). Methods: This is a retrospective, IRB approved, single-institution review of patients (pts) with stage I-IVB HNSCC treated with d-IMRT +/- chemotherapy between 2009 and 2013. The primary outcomes were incidence of severe late toxicities (dysphagia requiring esophageal stricture dilation, physician-reported grade 2 or worse neck fibrosis and xerostomia) occurring 3 months or more after completion of IMRT; feeding tube (FT) dependence within 1st year of IMRT completion, and FT dependence beyond 1st year post IMRT. Toxicities were deemed acute if they occurred during IMRT and up to 90 days post IMRT. Results: 274 pts, median age 59 years (38 – 82.9), were identified. 67.6% were HPV positive, 10.5% HPV negative and HPV status was unknown in 21.9%. Site of disease was oropharynx in 70%, larynx in 25% and hypopharynx in 4%. 206 pts (75.2%) received d-IMRT alone, 37 (13.5%) had definitive concurrent chemoradiation – mostly with cisplatin (58%), and 31 (11.3%) received adjuvant IMRT. Of the 243 pts treated with d-IMRT +/- chemotherapy, 80 (32.9%) required FT during RT due to grade 2 or worse acute dysphagia. Excluding 11 pts with disease recurrence or new HNSCC diagnosis, FT dependence at any time from 3 months to one year post IMRT occurred in 22 of 232 pts (9.48%), while FT dependence beyond 1st year post IMRT occurred in 8 pts (3.4%). 11 pts (4.7%) required stricture dilation for late dysphagia. Late grade 2 or worse fibrosis and xerostomia occurred in 7 (3.0%) and 89 (38.4%) pts, respectively. Conclusions: Our study suggests that except for xerostomia, severe late toxicities after definitive IMRT for HNSCC is likely uncommon. Prospective studies with late IMRT toxicities and their impact on quality of life (QoL) as endpoints are warranted.

Abstract OT2-10-01: Treatment burden and capacity to manage care among patients with breast cancer

Abstract Patients with breast cancer spend significant time1, effort, and financial resources2 to combat the disease for years after their diagnosis. The large volume of healthcare tasks can cause patients to become overburdened, leading to reduced adherence with care plans and worse outcomes3. On the other hand, certain patient characteristics such as physical resilience, financial well-being, and supportive family environments increase patients' capacity to manage care4. Assessing treatment burden and capacity when prescribing care has been applied to populations such as diabetes patients5. We are investigating this paradigm in treatment of patients with breast cancer. The goal of this preliminary study is to identify significant factors that contribute to treatment burden, capacity to manage care, and outcomes of overburden for patients with breast cancer. Examples of treatment burden, capacity to manage care, and outcomes of overburden in patients with breast cancerTreatment burdenCapacity to manage careOutcomes of overburdenTraveling long distances for careAccess to reliable transportationReduced spending on food, utilities, or other necessitiesPaying for child care during chemotherapyFlexibility in informal caregivers' schedulesMissed appointment with medical oncologistRemembering to take medications with mealsMedical understanding or knowledgeWorse than expected side effectsReporting adverse eventsProficiency with mobile deviceTrip to emergency room Through literature review, interviews with survivors, and expert panels of navigators and providers, we will develop a survey instrument given to patients at the time of diagnosis. The survey will assess patient capacity and help providers give treatment options based on attributes of the patient. Additionally, we will attempt to correlate survey results with treatment burden measures derived from electronic health record data at a population level1. With treatment personalized for patient capacity, patients should be better able to adhere to care plans leading to improved quality of life during treatment and beyond. Acknowledgements: The authors would like to thank Cheryl Jernigan, our patient advocate mentor, for her guidance in this project. We would also like to thank the Susan G. Komen Foundation for their support of this research.