Nonacademic Practices Research Articles

An international patient-centered outcome measurement set for colorectal cancer.

753 Background: While there are tools to measure outcomes relevant to patients with colorectal cancer, none is universally accepted and none incorporates components of long-term clinical outcomes, acute complications, and patient-reported outcomes (PROs). Methods: The International Consortium for Health Outcomes Measurement convened an international multidisciplinary working group to develop a comprehensive patient-centered outcome measurement set for patients with all stages of colorectal cancer. The working group utilized a literature review, patient focus group and their own clinical expertise to reach consensus on outcomes and case mix factors through a modified Delphi process. Measurement tools were selected by International Society of Quality of Life Research standards. The final list of PROs was validated through a patient survey. Results: The 29 members of the working group included patient representatives and palliative care, nursing, pathology, medical oncology, colorectal surgery and radiation oncology specialists from academic and nonacademic practices in Europe, Australia, Asia and the USA. The international focus group included 11 patients with colorectal cancer treated with palliative and curative intents. The working group defined four clinical outcomes applicable to all and eight specific to subgroups, such as presence of ostomy for patients with rectal cancer and hospital admission in the last 30 days of life for patients with advanced disease. An algorithm for documenting acute complications was developed. The working group defined 11 PROs applicable to all and eight specific to subgroups, such as erectile dysfunction for patients who received radiotherapy/surgery and neuropathy for those who received chemotherapy. 276 colorectal cancer patients completed the validation survey. Conclusions: Through use of extensive patient input, the international multidisciplinary group developed a patient-centered outcome measurement set incorporating clinical outcomes, acute complications and PROs for patients with colorectal cancer. This comprehensive measurement set allows for standardized international comparison on quality of care outcomes and will be revised annually.

Endocrine surgery fellowship graduates past, present, and future: 8 years of early job market experiences and what program directors and trainees can expect

Given the increasing number of endocrine surgery fellowship graduates, we investigated if expectations and job opportunities changed over time. American Association of Endocrine Surgeons (AAES) fellowship graduates, surgery department chairs, and physician recruiters were surveyed. Univariate analysis was performed with JMP Pro 12 software. We identified 141 graduates from 2008-2015; survey response rate was 72% (n=101). Compared to earlier graduates, fewer academic opportunities were available for the recent graduates who intended to join them (P=.001). Unlike earlier graduates, recent graduates expected to also perform elective general surgery, which ultimately represented a greater percentage of their practices (both P<.05). Interview offers increased for recent graduates, but job offers decreased. Overall, 84% of graduates matched their intended practice type and 98% reported being satisfied. Reponses from graduates, department chairs, and physician recruiters highlighted opportunities to improve mentor involvement, job search strategies, and online job board utilization. The endocrine surgery job market has diversified resulting in more graduates entering nonacademic practices and performing general surgery. This rapid evolution supports future analyses of the job market and opportunities for job creation. Almost every graduate reported job satisfaction, which encourages graduates to consider joining both academic and nonacademic practices equally.

Cryosurgery, an alternative treatment option for organ-confined prostate cancer: current beliefs and practice patterns of urologists.

We aim to evaluate the current beliefs and practice patterns of urologists in regard to use of cryosurgery for management of PCa. An anonymous 13-point survey was designed and sent out to members of the Society of Urologic Oncology (SUO), Endourological Society (ES) and American College of Cryosurgery (ACC). Descriptive statistics and univariate analyses were used to determine variables associated with the use of cryosurgery. Of the 206 responses received [81 (39.2%) SUO; 106 (51.5%) ES; 19 (9.2%) ACC], 83 (40.3%) performed cryosurgery. The majority of respondents who utilize cryosurgery do so in unilateral (80.3%) and bilateral (77.6%) intermediate-risk PCa. Also, users of this technology indicated significant use in primary treatment (>72%), salvage treatment (>83%), in patients who prefer cryosurgery (89.9%) have a life expectancy ≥10years (65.8%) and poor erections (74.7%). The main reason for not utilizing cryosurgery was the lack of technical expertise (56.7%). A urologist in a non-academic practice setting was 3.2 times more likely to perform cryosurgery compared to a urologist in an academic setting, p=0.0001. Cryosurgery is increasingly being accepted among urologists. However, the need for large-scale studies as well as randomized clinical trials to further delineate the benefits of cryosurgery and convince the non-users and institutions cannot be overemphasized.

RESEARCH RESULTS FOR QUALITY SCHOOLING: BRIDGING THE GAP BETWEEN RESEARCH AND PRACTICE

The quest for quality in education has been an avowed goal worldwide. The improvement of quality in school education depends largely on the research conducted in this field. The present study was conducted to know the extent of awareness of school teachers regarding researches conducted in school education and the problems faced by them in using the research results. The findings indicate that the teachers do not use research findings because they are not fully aware about the researches conducted, some of them do not understand the terminology used, while others find it difficult to access as these are printed in scattered form at different places. This study highlights some of the major factors accounting for the gaps that exist between the research and school practices and presents some strategic implementations to bridge this gap. The focus of the study is on getting research-based academic and non-academic practices into the hands of professionals for quality schooling.

Prostate Brachytherapy Case Volumes by Academic and Nonacademic Practices: Implications for Future Residency Training

The use of prostate brachytherapy has continued to decline in the United States. We examined the national practice patterns of both academic and nonacademic practices performing prostate brachytherapy by case volume per year to further characterize the decline and postulate the effect this trend might have on training the next generation of residents. Men diagnosed with prostate cancer who had undergone radiation therapy in 2004 to 2012 were identified. The annual brachytherapy case volume at each facility was determined and further categorized into ≤12 cases per year (ie, an average of ≤1 cases per month), 13 to 52 cases per year, and ≥53 cases per year (ie, an average of ≥1 cases per week) in academic practices versus nonacademic practices. In 2004 to 2012, academic practices performing an average of ≤1 brachytherapy cases per month increased from 56.4% to 73.7%. In nonacademic practices, this percentage increased from 60.2% to 77.4% (P<.0001 for both). Practices performing an average of ≥1 cases per week decreased among both academic practices (from 6.7% to 1.5%) and nonacademic practices (from 4.5% to 2.7%). Both academic and nonacademic radiation oncology practices have demonstrated a significant reduction in the use of prostate brachytherapy from 2004 to 2012. With the case volume continuing to decline, it is unclear whether we are prepared to train the next generation of residents in this critical modality.

Representativeness of patients and providers in the Canadian Primary Care Sentinel Surveillance Network: a cross-sectional study.

The Canadian Primary Care Sentinel Surveillance Network (CPCSSN) has established a national repository of primary care patient health data that is used for both surveillance and research. Our main objective was to determine how representative the data for patients and primary care practitioners in the CPCSSN are when compared with the Canadian population. In this cross-sectional study, we compared the 2013 CPCSSN patient sample with age and sex information from the 2011 census. The CPCSSN provider sample in 2013 was compared with the 2013 National Physician Survey. Results were stratified by 5 clinically relevant age categories and sex, and male-to-female ratios were calculated. Patients who were 65 years of age and older represented 20.4% of the CPCSSN sample but only represented 14.8% of the Canadian population (2011 census). Among young adults (20-39 yr), 39.3% fewer men than women visited their primary care practitioner within 2 years. CPCSSN sample practitioners were more likely to be under 45 years of age, more likely to be female and more likely to be in an academic practice. It is important to consider adjusting for age and sex when using CPCSSN data. CPCSSN practitioners are likely not representative of family physicians; therefore, CPCSSN needs to recruit more nonacademic practices, community clinics and practices that have a larger proportion of male providers.

Abstract P2-01-12: Impact of the ASOCOG Z0011 trial on a multi-institutional mixed practice setting

Abstract Background The ASOCOG Z0011 trial is widely considered to be practice changing, but reports to date on the adoption of Z0011 are largely confined to tertiary academic institutions with breast cancer surgical specialty services. The aim of this study was to assess the impact of Z0011 on the care of breast cancer patients in a mixed academic/ non-academic practice setting. Methods All patients who underwent surgical treatment for breast cancer in the Vidant Healthcare System, a multi-county network, between the years January 1, 2009 and September 20, 2013 were identified. Patients with Stage IV disease and ductal carcinoma in situ were excluded. Results One thousand six hundred four patients met initial inclusion criteria, 661 in the pre-Z0011 period and 973 in the post-Z0011 period. The majority of patients were female (99%) and Caucasian (65%). Infiltrating ductal cancer (67%) was the most common tumor type. Tumors on average were 23mm in size with the majority being ER (74%), PR (63%) positive and Her2 (82%) negative. Most patients had node negative disease (73%). Table 1 summarizes the characteristics of the pre- and post-Z0011 study populations. Patient and Tumor CharacteristicsVariablePre-Z0011Post-Z0011p valueFemale (%)656 (99.2)968 (99.4)0.86Race (%) 0.49White448 (67.8)642 (65.9) Black205 (31.0)314 (32.2) Mean size (mm)19.922.30.06Histology (%) 0.07Infiltrating ductal cancer434 (65.7)663 (68.1) Infiltrating lobular cancer30 (4.5)62 (6.4) ER Positive (%)484 (73.3)722 (74.2)0.92PR Positive (%)406 (61.5)622 (63.9)0.61Her2 Negative (%)304 (78.4)897 (83.5)0.01Triple Negative Subtype (%)83 (23.9)168 (18.9)0.07Node Positive Status175 (27.5)926 (26.7)0.71 A total of 142 patients met Z0011 criteria, with T1-2 disease, underwent partial mastectomy and had a positive SNB. There were a similar number of patients who met Z00111 criteria in the pre- (n=63) and post-Z0011 (n=79) periods, p&amp;gt;0.05. In the post-Z0011 period, patients were more likely to undergo SNB alone (56 vs. 19%, p&amp;lt;0.001). Post-Z0011 the decrease in ALND was in those who had immediate ALND (34% vs. 71%), with no substantive change in the delayed group (10.1 vs. 9.5%), p&amp;lt;0.001. Patient who underwent SNB alone had smaller tumors (22 vs. 32mm, p&amp;lt;0.001), but similar histologic subtypes (p=0.60) and receptor status (p≥0.15) as compared to patients who underwent SNB with ALND. Over the entire study period patients in an academic practice were less likely to undergo SNB alone (31 vs. 43%). In the post-Z0011 period, patients cared for in an academic practice had an increase in SNB alone from year 1 (2012) to year 2 (2013) (40% to 57%), while the non-academic practices had a decrease in SNB alone from year 1 to year 2, (63% to 56%). Conclusion In this mixed practice setting there was an overall decrease in ALND in T1/T2 patients with low metastatic axillary burden following publication of Z0011. Immediately post-Z0011 the non-academic practices more rapidly adopted SNB alone, however these differences were no longer apparent two years following Z0011. Continued longitudinal studies will further assess the variability in the incorporation of Z0011 among various surgical practices. Citation Format: Swapnil D Kachare, Nasreen A Vohra, Kathyrn M Verbanac, Timothy L Fitzgerald, Emmanuel E Zervos, Jan H Wong. Impact of the ASOCOG Z0011 trial on a multi-institutional mixed practice setting [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-01-12.

Adapting relationships with place: Investigating the evolving place attachment and ‘sense of place’ of UK higher education students during a period of intense transition

In recent years interest has emerged regarding the geographies of higher education students, particularly in patterns of mobility and dispersion. While anecdotal rhetoric suggests a ‘typical student’ exists within UK institutions, what resonates is the notion that students are inherently heterogeneous, experiencing University in differing ways and times according to their circumstances and year of study. This paper uses ‘walking interviews’ conducted with University of Portsmouth students as a method to unpack how ‘non-local’ students might go about interpreting their sense of place within their term-time location. This methodology was designed specifically to ensure discussions of ‘sense of place’ remain directly in the context of the city and recognises the adaptive relationships students have with their term-time locations. This is important as there is a tendency within the literature to focus solely on the transition into University, ignoring that students often experience pressures throughout their degree pathway. These pressures can be linked to various social and spatial changes, such as insecurities regarding fitting in amongst unfamiliar peer groups or a lack of confidence concerning engagement with academic and non-academic practices, and draws attention to the non-linearity of students’ associations with their term-time location.

What I need to start my job: a wish list (positioning yourself for success in an academic or nonacademic environment).

Beginning practice as an orthopaedic traumatologist is an important event, when the groundwork is set up for the next few years of hard work. Plans must be made, resources allocated, staff hired, etc. to optimally support the newly practicing surgeon. Academic and nonacademic practice settings are possible, where the facets of practice (i.e., clinic, operating room, floor work, education, and research) may be quite different. The goal of this article is to discuss these differences between relatively academic and nonacademic practices, ultimately to allow the young orthopaedic traumatologist to form a "wish list" with which to start planning the logistics of his or her career.

Surgeon-specific factors affecting treatment decisions among Canadian urologists in the management of pT1a renal tumours

The ubiquitous use of diagnostic imaging has resulted in an increased incidental detection of small renal masses (SRM). Patient- and tumour-related factors affect treatment decisions greatly; however, with multiple treatment options available, surgeon-specific characteristics and biases may also influence treatment recommendations. We determine the impact of surgeon-specific factors on treatment decisions in the management of SRM in Canada. An online survey study was conducted among Canadian urologists currently registered with the Canadian Urological Association. The questionnaire collected demographic information and recommended treatments for 6 SRM index cases involving theoretical patients of various ages (51-80 years) and comorbidities. A total of 110 urologists responded (17% response rate) to the survey. Of these, 18% were over 65 years old and 45% were from academic centres. With increasing patient age and comorbidity, active surveillance and thermal ablative therapies were more the recommended treatment. Laparoscopic/robotic surgery was more commonly recommended by academic urologists and those under 65. Recommending surgery (radical nephrectomy or partial nephrectomy) for both elderly (about 80 years old) index patients correlated with surgeon age (surgeons over 65, p < 0.001), surgeons with no oncologic fellowship training (p = 0.021), surgeons with a non-academic practice (p = 0.003), surgeons with a personal history of cancer (p = 0.038) and surgeons with a family history of cancer death in the last 10 years (p = 0.022). There are various factors that influence the management options offered to patients with SRMs. Our results suggest that surgeon age, personal history of cancer, practice-type and other surgeon-specific variables may affect treatments offered among urologists across Canada.

“How They Really Talk”

This article responds to the need for more student voices in digital literacies research by discussing the results of interviews with two college students concerning the roles that their non-academic digital literacy practices can play in first-year college writing courses. The author reviews recent literature that has indicated that value of students’ non-academic literacy practices. The author then discusses students’ ideas for utilizing their non-academic digital literacies to provide a social context for situated writing practice and to give students the opportunity to exercise and critically recognize their abilities to code switch for different communicative purposes. The article concludes with a discussion of the need for gaining knowledge about students’ individual positions as users of technology and for facilitating students’ critical engagement with the digital technologies they use.

Prostate MRI: Access to and Current Practice of Prostate MRI in the United States

MRI of the prostate has increasingly become more important in clinical medicine because of the risk of over-detection of low-grade, low-volume prostate cancer, as well as because of the poor sampling of transrectal ultrasound-guided prostate biopsy in high-risk patients. We sought to determine the access, imaging protocols, and indications for MRI imaging of the prostate in the United States. A brief survey was sent through mailing lists to members of the Society of Abdominal Radiology and Texas Radiological Society. Thirty-six academic centers responded to the survey, 88.9% of which routinely perform prostate MRI. Nine centers routinely performed imaging at 1.5T with an endorectal coil (25%), 11 performed at 3.0T without an endorectal coil (31%), and 10 performed at 3.0T with an endorectal coil (28%). All institutions used T1-weighted axial and orthogonal T2-weighted sequences. Most groups used diffusion-weighted imaging (94.7%) and dynamic contrast enhancement (81.6%). Only 21.1% of groups performing prostate MRI routinely performed MR spectroscopy as part of their protocol. Prostate MRI is becoming a commonly performed examination at academic institutions, with most locations performing prostate MRI at minimum standards. There is a need to educate nonacademic practices regarding the addition of functional MRI techniques to anatomic techniques, increase the number of institutions that regularly perform prostate MRI, and increase access to direct MRI-guided biopsy in institutions that perform prostate MRI on a regular basis.

The Diaspora of Otolaryngologists after Residency Training

Objectives: 1) Describe the transition of otolaryngologists from residency to clinical practice. 2) Provide data to state and local communities who could be sources of supplementary funding for graduate medical education. Methods: Cross sectional data from the 2009-2010 Member Directory of the American Academy of Otolaryngology-Head and Neck Surgery were analyzed. The sample included fellows of the AAO-HNS practicing within the US and graduating from residency programs accredited by the ACGME. First year fellows, fellows of greater than thirty-five years, and military fellows were excluded. Data from 5,870 otolaryngologists were analyzed. To evaluate trends within generations and career paths, subsets were divided by academic or non-academic practice and by decade of completion of residency. Results: Relative to their residency program, 1/3 of otolaryngologists practice within 100 miles, 1/3 practice within 100-500 miles, and 1/3 practice greater than 500 miles away. This was relatively constant for those in academic and non-academic practice. This was also relatively constant across decades of graduation. Approximately 1/3 of otolaryngologists practice in the same state as their residency program whether in academic or non-academic practice. Conclusions: Proposed reductions in federal funding of graduate medical education could result in the closure of approximately 18.4% of all ACGME training programs. This should stimulate otolaryngology leaders to explore alternative sources of funds from their state and local community, ie, those who most benefit from retaining valuable practitioners. Our data demonstrate a substantial portion of otolaryngologists practice within the area and state surrounding their residency program.

SU-E-E-01: A 20-Year History of the First Accredited Physics Residency Program: Lessons Learned

Purpose: When the AAPM released Report Number 36 (superseded by Report 90), Guidelines for Physics Residency Programs, our institution created one in Radiation Oncology. This report summarizes our 20 year history. Methods: In 1993, our institution formalized our training approach and established Radiation Oncology Physics Residencies. In 1997, the program became the first accredited by CAMPEP. The program was re-accredited in 2003, 2008, and 2013 (pending). Over time we have tried to improve our program and modernize as technologies advance. We have tracked administrative aspects, particularly, the success of our graduates in terms of employment and board certification, and backgrounds of our applicants. Results: For the 43 individuals that have entered our program, 14 had been post-doctoral fellows, 14 had graduated non-CAMPEP programs, 11 graduated from CAMPEP accredited programs, and 4 had established careers. Thirty-three physicists have graduated (26 PhD, 7 MS), 3 failed to complete the program, and one departed due to medical issues. Of the graduates, 25 are at academic facilities and 8 are in non-academic practice. All but one graduate that has taken the ABR/ABMP exam, written and oral, have passed at every stage on their 1st attempt. Over the past 5 years, there have been 777 applicants for the position(s) that were available. Of these, 58% have been newly graduating physicists with a minority (18% of total applicants) graduating from CAMPEP-accredited programs. Some changes we have made over the years have been to establish more customized and advanced rotations (i.e. IMRT, IGRT, protons, ViewRay), and to increase testing frequency. Conclusions: The majority of applicants have come from non-CAMPEP accredited graduate programs, while we have primarily accepted and graduated applicants with post doctoral backgrounds. Our program is sufficiently dynamic to adapt to technological advancements and undergo continuous improvement.

A Review of Trends in Attrition Rates for Surgical Faculty: A Case for a Sustainable Retention Strategy to Cope with Demographic and Economic Realities

Our aim was to compare trends in retention of academic surgeons by reviewing surgical faculty attrition rates (leaving academic surgery for any reason) of 3 cohorts at 5-year intervals between 1996 and2011. The Association of American Medical Colleges' Faculty Administrative Management On-Line User System database was queried for a retention report of all tenure/clinical track full-time MD faculty within our academic medical center on July 1, 1996 (group 1), July 1, 2001 (group 2), and July 1, 2006 (group 3). Retention was tracked for 5 years post snapshot. The individual 5-year cohort attrition rates (observed frequencies) were compared with combined attrition rates for all 3 groups (expected frequencies). Overall, attrition trends for groups 2 (lower) and 3 (higher) were significantly different than the trends for all groups combined. Minorities and professors at the full or associate rank in group 3 contributed to this difference. Faculty in group 3 leaving our academic medical center were significantly more likely to transition into nonacademic practice compared with the other 2 groups. Greater attrition in the last 5-year cohort, despite the increase in faculty positions, is worrisome. A continuous retention life cycle is critical if academic medical centers hope to compete for talent. Retention planning should include on-boarding programs for enculturation, monitoring of professional satisfaction, formalized mentoring of younger surgeons, retaining academic couples and a part-time workforce, leadership and talent management, exit interviews, and competitive financial packages.

Transfusion Practices in the Management of Sickle Cell Disease: A Survey of Florida Hematologists/Oncologists

The purpose of this study was to characterize transfusion practices in the management of sickle cell disease and to identify factors attributing to differences in prescribing practices among Florida hematologists/oncologists. A cross-sectional study was performed in 2005-2006 utilizing a mail survey. The survey instrument addressed practice characteristics, sickle cell patient populations, transfusion settings, indications and techniques, red blood cell phenotype specifications/modifications, use of practice guidelines, and educational resource utilization. One hundred fifty two physicians (75% adult-oriented, 25% pediatric) completed the survey. Non-academic practice settings (78 %) were the primary location. Pediatric practices had a larger percentage of patients with overt strokes, and receiving hydroxyurea therapy than adult-oriented practices. The majority of survey respondents did not request limited phenotypically matched red blood cells on a routine basis. The majority of pediatric practices (60%) had individually defined transfusion practice guidelines in contrast to 8% of adult-oriented practices. There were statistically significant differences for pediatric and adult-oriented practices in managing certain acute and chronic transfusion indications. Analysis of clinical vignette data revealed variation among hematologists/oncologists in the transfusion management of common clinical scenarios. The study underscores the need for the development and dissemination of comprehensive sickle cell transfusion guidelines and protocols.

Lead aprons: how protected are you?

Lead aprons: how protected are you?

Maternal-Fetal Medicine Subspecialists' Provision of Second-Trimester Termination Services

Most abortions for pregnancy complications occur in the second trimester. Little is known about whether maternal-fetal medicine subspecialists (MFMs) perform terminations for these women. We surveyed all members of Society of Maternal Fetal Medicine by e-mail or mail regarding second-trimester abortion provision. We conducted analyses of whether MFMs perform abortions, by what method, and how frequently. Our response rate was 32.4% (689/2,125). Over two-thirds of respondents perform either dilation and evacuation (D&E) or induction; 31% perform D&Es. Male gender, frequent chorionic villus sampling provision, and being trained in D&E during fellowship are associated with performing D&Es. Nonprovision of any second-trimester abortion is significantly associated with age over 50, nonacademic practice setting, and less supportive abortion attitudes (p < 0.001). A nonsignificant trend toward association between south/southeast region and nonprovision of any second-trimester abortion is seen (p = 0.09). Many MFMs include D&E and induction termination services in their practice. Supporting current D&E providers and expanding training options for MFMs may optimize care for women diagnosed with serious pregnancy complications.

Readability of websites containing information about prostate cancer treatment options.

e16544 Background: 90 million adults have literacy skills that test below a high school reading level. Websites written above this level can pose a challenge for those seeking more information about prostate cancer treatment options. In this study, we determine the readability of selected websites, using a systematic search process and validated readability formulas. Methods: We identified the three most popular keywords (“prostate cancer,” “prostatectomy,” and “prostate cancer treatment”) from 513 terms related to prostate cancer treatment options. Three physician searchers (CE, AP, AK) systematically collected 270 websites from the top three search engines, representing 95 % of all internet searches (Google, Yahoo, and Bing). We excluded sites that were non-English, not primarily text, irrelevant and/or duplicated, and then categorized the remaining sites by source (government, academic practice, nonacademic practice, commercial, nonprofit, news, health website, other) and treatment type. We used validated readability instruments, the Flesch-Kincaid (FK) grade level and Flesch reading ease, to calculate scores for each site. We also calculated an intraclass correlation coefficient, in order to assess inter-rater agreement among our three searchers. Results: Sixty-two unique websites were available for analysis. The mean FK grade level of all sites was 11.4 (SD +/- 0.95, range 8.0-12.0), indicating that on average, passages were written at an eleventh grade reading level. The mean Flesch reading ease score on all sites was 35.6 (SD +/- 15.7, range 0.0-65.5), indicating that on average, passages were slightly easier to read than passages more suited for university graduates (0-30). Only three sites (4.8%) were written below a high school reading level (&lt; 9.0). The intraclass correlation coefficient between the three searchers was 0.96 for grade level and 0.97 for reading ease. Conclusions: Few websites with discussions on prostate cancer treatment options are written below a high school reading level. This is problematic for patients with a low literacy level who search online for more information. Clinicans should be aware of this finding and guide patients to websites written at their patient's reading level.

Clinical characteristics and natural history of patients with squamous cell lung carcinoma with FGFR1 amplification.

1533 Background: FGFR1 amplifications have been described as a promising oncogenic target in squamous cell lung cancer. Here we aimed at describing the clinical characteristics and natural history of FGFR1amplified squamous cell lung cancer patients. Methods: From 01/2011 to 01/2012 we screened 553 squamous cell lung cancer patients in our Network for Molecular Screening of Lung Cancer for the presence of FGFR1 amplifications by FISH analysis in accordance with the local ethics committee. FGFR1 was defined as amplified if the ratio of FGFR1 copies to centromeric copies was above 2 or if more than 50% of tumor cells showed 5 copies or if more than 15% of tumor cells demonstrated clusters of FGFR1. Clinical data were collected by extracting information from medical records, the local cancer registry and by questioning treating physicians and patients. Results: FGFR1FISH analysis could be performed in 95% of the cases and was amplified in 16%. Of the amplified cases 75 % were male and 25% female without significant enrichment for male or female. The median age of the patients at diagnosis was 67 yrs (range 46 - 82). Stage at presentation was: 16% I; 17.3% II; 26.7% IIIa, 40% IIIb/IV. 97,3% of the patients were former or active smokers with a median of 40 pack years. The median progression free survival of patients with stage IIIb/IV disease was 11 months (95% CI 8-14; n=14). The median overall survival was not yet reached after a median follow-up time of 14 months (95% CI 11 - 17; n=24). We further screened for co-existing genetic lesions such as mutations in EGFR, BRAF, KRAS, PIK3CA as well as translocations of ALK and amplifications of ERBB2. Two patients demonstrated co-occurring PIK3CA mutations and one a BRAFmutation. Conclusions: Screening for FGFR1 is feasible under routine clinical conditions. By implementation of a regional molecular screening network the ability to screen for FGFR1 amplification was successfully expanded to non-academic centers and private practices. FGFR1 amplifications in squamous cell cancer of the lung are frequent (16%) and associated with smoking history. Screening for FGFR1 might pave the way for the application of new FGFR1 directed targeted drugs in squamous cell lung cancer.