Key Clinical MessageDrug‐induced aHUS is rare; however, early diagnosis is vital to reduce morbidity and mortality. With confirmation of the diagnosis, eculizumab appears to be a viable treatment option to suppress the pro‐inflammatory surge. Furthermore, adverse side effects of medications such as carfilzomib and gemcitabine should be considered in the appropriate settings.

Extending the maintenance flushes of implanted ports in adult oncologic patients to once every 3 months is safe, effective, and likely to increase patient adherence and satisfaction while decreasing the associated cost.

BackgroundClinical trials are critical to scientifically evaluate promising new therapies in oncology, but patient accrual to these studies is persistently low. Patient preference plays an important role in enrollment in these trials. We performed this survey to evaluate the perceptions of newly diagnosed oncology patients about clinical trials and the reasons why they wish to or not to participate in these trials.MethodsPatients were given a ten question survey reflective of their attitudes regarding clinical trials as a treatment option at their initial visit. The self-directed questionnaire was scored on an ordinate scale from strongly agree [1] to strongly disagree [5].ResultsNinety three patients were surveyed in the cancer specific multispecialty clinics in an academic center. Our patients expected their providers to discuss all information relating to clinical trials and eligibility at the first visit (65.4% agree and 15.4% neutral, p < 0.0001). Patients felt their privacy and safety would be safeguarded in the University sponsored trials (56.8% agree, and 25.7% neutral, p < 0.0001). Over 80% patients showed their unwillingness to participate in randomized clinical trials (disagree 61%, neutral 19.5%, p < 0.001). Patients also showed less likelihood to participate in clinical trials as a first treatment option (48.7% disagree and 28.9% neutral, p0.0161), but were willing to consider participating in a clinical trial if the conventional treatment failed. Industry sponsored trials, phase 1 trials, investigator initiated trials with the involved tests and time commitment and altruistic reasons did not significantly deviate from the mean preference analyzed using Fisher's exact test analysis.ConclusionsPatients consider the option of clinical trials as important in their treatment, and expect to be informed by their oncologist about such trials. Newly diagnosed cancer patients perceive randomization and first line trials negatively. Since randomization data provides new standards of care and hope for improved treatment, patients and their families must be educated of their importance.

Background As with other complex therapies, treatment of AML varies among centers (ctrs) due to differences in patients (pts), infrastructure and care delivery models. Variation in ctrs practices, experience and resources may influence pt outcomes. Few studies have examined the association of ctr characteristics and survival in AML. Previous research offers conflicting results regarding outcomes of AML pts treated in National Cancer Institute Comprehensive Cancer Centers (NCICCC) versus community settings; neither study investigated ctr-level differences other than volume. We sought to compare AML outcomes in any of the HCA Healthcare (HCA) network of 131 community hospitals from 2011-18 with those reported in the Surveillance, Epidemiology, and End Results (SEER) database. We then examined pt, disease and center-related characteristics influencing outcomes in HCA hospitals. Methods We identified pts with AML (excluding APL) > 18 yrs treated between 10/31/11 and 10/31/18 in an HCA hospital (N = 4,882) and obtained pt level data from electronic medical records. A comparative population treated was developed from the most recent SEER database (2011-15; N = 19,349). We used coarsened exact matching to control for as many potential biases as possible. We compared mortality at 30, 90 and 120-days and overall survival curves between HCA and SEER . A Cox regression model was used to investigate differences in hazard rates among HCA facilities while simultaneously assessing the impact of patient characteristics and facility characteristics. Of the HCA patients, 1339 were treated in 6 hospitals that meet defined metrics of infrastructure, staffing, processes and volume as part of certification to participate in the Sarah Cannon Blood Cancer Network (SCBCN). Results Matching for age, gender and race, HCA pts were found to have significantly lower mortality than SEER at 30, 90 and 120 days (p<.001) as well as significantly better survival (p<0.001; fig.1). We next investigated how pt and facility characteristics interact to predict outcomes for HCA patients (table 1). Elevated White Count at diagnosis (HR=1.3), Charlson index (HR=1.1), older age (HR= 1.04), and receiving treatment at a hospital with larger bed count (HR=1.26) were associated with significantly worse survival. Commission on Cancer (COC) accreditation status, Socio-economic status (SES), distance to facility, and gender did not significantly impact risk. Being treated in the SCBCN (HR=0.68) and African American race (HR= 0.66) were associated with improved survival Conclusions Previous research utilizing registry data demonstrated better survival for pts with AML treated in higher volume centers but provides conflicting information about survival for pts treated in a NCICCC versus a community setting. Neither study examined center characteristics beyond NCI designation. This report examines a large pt cohort treated in community hospitals across the US. Pts treated in these hospitals had significantly better survival than a matched cohort from the SEER database. We validate the importance of age, acuity and Charlson index as adverse factors. Analysis of facility characteristics demonstrated that qualification as a member of SCBCN was associated with improved survival underscoring the importance of infrastructure, quality systems and volume in achieving improved outcomes. Disclosures Lemaistre: HCA: Employment. Chao:HCA: Employment. Cruz:1. Daiichi Sankyo advisory board: Membership on an entity's Board of Directors or advisory committees; Takeda: Consultancy, Speakers Bureau. Eghtedar:Verastem Oncology: Consultancy; Novartis: Consultancy, Honoraria, Speakers Bureau; Jazz: Consultancy, Honoraria, Speakers Bureau; Celgene: Honoraria, Speakers Bureau; Takeda: Honoraria, Speakers Bureau. Holder:Sarah Cannon: Employment. Malik:Kite Pharma: Honoraria. Rotta:Kadmon Corporation, LLC: Consultancy; Jazz: Speakers Bureau.