Background Determine the effect of National Comprehensive Cancer Network Guideline- adherent initiation of postoperative radiation therapy (PORT), and different time to PORT intervals, on overall survival (OS) in patients with head and neck squamous cell carcinoma (HNSCC). Methods Reviewing the National Cancer Database (NCDB) from 2006–2014, patients with HNSCC undergoing surgery and PORT were identified. Kaplan-Meier survival estimates, Cox regression analysis, and propensity score matching were used to determine the effect of initiating PORT ≤ 6 weeks of surgery, and different time to PORT intervals, on survival. Results 41,291 patients were included in the study. After adjusting for covariates, starting PORT > 6 weeks postoperatively was associated with decreased OS (adjusted Hazard Ratio [aHR] 1.13; 99% confidence interval [CI] 1.08–1.19). This finding remained in the propensity score-matched subset (HR 1.21; 99% CI 1.15–1.28). Relative to starting PORT 5 to ≤ 6 weeks postoperatively, initiating PORT earlier was not associated with improved survival (≤ 4 weeks: aHR 0.93; 99% CI 0.85–1.02, 4 to ≤ 5 weeks: aHR 0.92; 99% CI 0.84–1.01). Increasing duration of delays beyond 7 weeks were associated with progressive small survival decrements (aHR 1.09, 1.10, and 1.12 for 7 to ≤ 8 weeks, 8 to ≤ 10 weeks, and > 10 weeks). Conclusions Non-adherence to NCCN Guidelines for initiating PORT within 6 weeks of surgery is associated with decreased survival. There is no survival benefit to initiating PORT earlier within the recommended 6-week timeframe. Increasing durations of delays beyond 7 weeks are associated with small progressive survival decrements.

The present study suggests that CRT patients with BMI greater than 25 have improved swallowing outcomes, longer time to disease recurrence, and improved survival when compared with similar patients with lower BMI. BMI at presentation may be an important clinical factor to consider when determining the optimal treatment modality for a head and neck cancer patient. Further investigation is required to determine whether primary surgery should be the preferred treatment in normal or low BMI patients.

Background: An ASCO taskforce comprised of representatives of oncology clinicians, the American Cancer Society National Lung Cancer Roundtable (NLCRT), LUNGevity, the GO 2 Foundation for Lung Cancer, and the ROS1ders sought to: characterize U.S. oncologists' biomarker ordering and treatment practices for advanced non-small-cell lung cancer (NSCLC); ascertain barriers to biomarker testing; and understand the impact of delays on treatment decisions. Methods:We deployed a survey to 2374 ASCO members, targeting U.S. thoracic and general oncologists. Results:We analyzed 170 eligible responses. For non-squamous NSCLC, 97% of respondents reported ordering tests for EGFR, ALK, ROS1, and BRAF. Testing for MET, RET, and NTRK was reported to be higher among academic versus community providers and higher among thoracic oncologists than generalists. Most respondents considered 1 (46%) or 2 weeks (52%) an acceptable turnaround time, yet 37% usually waited three or more weeks to receive results. Respondents who waited ≥3 weeks were more likely to defer treatment until results were reviewed (63%). Community and generalist respondents who waited ≥3 weeks were more likely to initiate non-targeted treatment while awaiting results. Respondents <5 years out of training were more likely to cite their concerns about waiting for results as a reason for not ordering biomarker testing (42%, vs. 19% with ≥6 years of experience).

Objective Head and neck squamous cell carcinoma (HNSCC) patients who smoke are at risk for poor treatment outcomes. This study evaluated symptom burden and clinical, sociodemographic and psychosocial factors associated with smoking in surgical patients to identify potential targets for supportive care services. Study Design Cross-sectional survey. Methods Individuals with HNSCC of the oral cavity, larynx or pharynx were recruited from two cancer centers and completed questionnaires assessing smoking status (never, former, current/recent), patient characteristics and symptoms before surgery. Results Of the 103 patients enrolled, 73% were male, 52% were stage IV, 41% reported current/recent smoking and 37% reported former smoking. Current/recent smokers were less likely than former smokers to have adequate finances (53% vs. 89%, p=.001) and be married/partnered (55% vs. 79%, p=.03). Current/recent smokers were also more likely than both former and never smokers to be unemployed (49% vs. 40% and 13%, respectively, p’s=0.02) and lack health insurance (17% vs. 5% and 13%, respectively, p’s≤.04). Fatalistic beliefs (p=.03) and lower religiosity (p=0.04) were more common in current/recent than never smokers. In models adjusted for sociodemographic/clinical factors, current/recent smokers reported more problems than former and never smokers with swallowing, speech, and cough (p≤.04). Current/recent smokers also reported more problems than never smokers with social contact, feeling ill and weight loss (p≤.02). Conclusions HNSCC patients reporting current/recent smoking before surgery have high-risk clinical and sociodemographic features that may predispose them to poor postoperative outcomes. Unique symptoms in HNSCC smokers may be useful targets for patient-centered clinical monitoring and intervention.

Background: Oral chemotherapy performance measures were first introduced into ASCO’s Quality Oncology Practice Initiative (QOPI) in 2013. This study examined performance on these measures among QOPI-participating practices and evaluated whether it differed among practices based on meeting QOPI Certification Program standards. Methods: A total of 192 QOPI-participating practices (certified, n=50 [26%]; not certified, n=142 [74%]) reported performance on oral chemotherapy measures in 2017 and 2018. Inclusion was limited to practices reporting on ≥3 charts for ≥1 oral chemotherapy measure. Performance was defined as the percentage of charts examined that adhered to the measure. Descriptive analyses were used to characterize performance within and across practices, and mixed-effects logistic regression models were conducted to compare performance based on certification status. Results: Median performance across practices for the 9 oral chemotherapy measures examined ranged from 44% (education before the start of treatment addressing missed doses, toxicities, and clinical contact instructions [composite measure]) to 100% (documented dose, documented plan, and education about toxicities). Certified practices were more likely to provide education about clinic contact instructions than noncertified practices (odds ratio, 4.87; 95% CI, 1.00–24.0). Performance on all other measures was not significantly associated with certification status. Conclusions: There is wide variability in quality related to performance on oral chemotherapy measures across all QOPI-participating practices, and several areas were identified in which administration of oral chemotherapy could be improved. Our findings highlight the need for the development and implementation of appropriate standards that apply to oral chemotherapy and address the complexities that set it apart from parenteral treatment.

Cyclosporine (CsA) and MTX are commonly used for GVHD prophylaxis in pediatric allo-SCT. Mucositis and hepatic toxicity frequently restrict the delivery of the fourth dose of MTX. Folinic acid (FA) may ameliorate MTX toxicity. We conducted a retrospective chart review of all pediatric patients who received CsA and MTX for GVHD prophylaxis from January 2000 to July 2010. Patients treated before July 2007 (N ¼ 29) did not receive FA and those treated from July 2007 onward did receive FA (N ¼ 18). Patients who received FA were significantly more likely to receive day þ11 MTX (odds ratio (OR) 10.42, 95% confidence interval (CI): 1.21-262.27) but there was no significant difference in Grade III-IV GVHD between the two groups (OR 1.15, 95% CI: 0.08-18.14). FA did not impact relapse-free survival (RFS) (P ¼ 0.82). Increased likelihood of receiving day þ11 MTX suggests that FA ameliorates MTX toxicity, such as severe mucositis. FA administration for MTX GVHD prophylaxis should be studied in a prospective, randomized fashion. Keywords: MTX; folinic acid; GVHD INTRODUCTIONAs the annual number of transplants continues to increase worldwide, GVHD remains a leading cause of non-relapse mortality after allo-SCT. 1 Earliest efforts at utilizing immunosuppressive agents to reduce GVHD used single-agent therapy, with no notable decreases in acute GVHD when Cyclosporine (CsA) was compared with MTX. 2-4 After the successful combination of CsA and MTX in canine BM transplantation models, seminal trials in humans demonstrated the superiority of the combined regimen over CsA alone in reducing acute GVHD. [5][6][7][8] From this first report, however, it was noted that there was a significantly increased incidence of severe oral mucositis and hyperbilirubinemia in patients receiving CsA and MTX. In addition, only 58% (25/43) of the patients received full-dose MTX due to renal impairment. 7 Administration of folinic acid (FA) after MTX decreased toxicity without increasing GVHD in canine transplantation models, and later the administration of FA with MTX appeared to reduce toxicities compared with CsA alone in humans as well. 8,9 Consequently, several adult BMT studies have supported the reduction of regimen-related toxicity by the administration of FA rescue with CsA and MTX combination therapy. 10,11 Despite this, FA administration after MTX has not been widely adopted in practice. An European Group for Blood and Marrow Transplantation (EBMT) survey regarding GVHD prophylaxis and treatment in 1995 revealed that 46% (37/81) gave FA after MTX. There was considerable variation, however, in the administration schedule. 12 Similarly, a survey of allo-SCT centers in Australia and New Zealand reported that 44% (8/18) of responding centers routinely administered FA after MTX. 13 Although there are no published studies examining the effects of FA rescue with CsA and MTX combination therapy in pediatric patients, the EBMT

6530 Background: Only a small fraction of patients with cancer participate in treatment trials. Patients identifying as members of racial and ethnic minority groups are consistently underrepresented in these trials. A recent systematic review reported that patients, regardless of race and ethnicity, are willing to enroll in trials if asked to participate by their treating clinician. Prospective and longitudinal data and metrics at the site- and clinician-level are necessary to understand whether patients are equitably considered for clinical trials. Methods: ASCO and Association of Community Cancer Centers (ACCC) developed a self-assessment for trial sites to record and gauge the number of patients across races and ethnicities screened, offered, and enrolled into clinical trials. Research sites, from across the US, were recruited through an open call to apply to participate in the ASCO-ACCC Pilot Project. There were 65 sites assigned to this pilot study, which tested the feasibility and utility of the site assessment. Sites were asked to enter 2019 and 2020 aggregate data for each step along the clinical trial enrollment continuum by select races and ethnicities (Black, Hispanic/Latinx, White) and overall. Results: 62 of 65 sites completed the study and represented a range of settings and practice types (61% academic, 26% hospital/health system, 13% independent). Only 2 sites (3%) were able to provide the data requested at each enrollment step in the assessment (table). Sites that collected the data did not do so routinely (table) and most had to compile data through multiple sources and/or manual extraction (40-100% across enrollment steps). Sites with missing data reported they did not collect data at all (36-64% across enrollment steps), did not collect data in a systematic way (0-29% across enrollment steps), or stated it would be too burdensome to manually review charts to extract data (12-29% across enrollment steps). Conclusions: Data collection and routine evaluation of participation metrics, by race and ethnicity, are necessary to assess and monitor equity and diversity in clinical trials. Most sites in this study did not collect, or routinely collect, data for screening, offering, and consenting patients to clinical trials. Without these data, sites are unable to evaluate and monitor whether their patients have equitable access to clinical trials or establish strategies to address any inequities. ASCO and ACCC will continue to partner with sites to better understand their processes and the feasibility of collecting such data in a systematic and automated way, such as through electronic health record systems. [Table: see text]

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