Background and purpose: The COVID-19 pandemic warrants operational initiatives to minimize transmission, particularly among cancer patients who are thought to be at high-risk. Within our department, a multidisciplinary tracer team prospectively monitored all patients under investigation, tracking their test status, treatment delays, clinical outcomes, employee exposures, and quarantines. Materials and methods: Prospective cohort tested for SARS-COV-2 infection over 35 consecutive days of the early pandemic (03/19/2020-04/22/2020). Results: A total of 121 Radiation Oncology patients underwent RT-PCR testing during this timeframe. Of the 7 (6%) confirmed-positive cases, 6 patients were admitted (4 warranting intensive care), and 2 died from acute respiratory distress syndrome. Radiotherapy was deferred or interrupted for 40 patients awaiting testing. As the median turnaround time for RT-PCR testing decreased from 1.5 (IQR: 1-4) to 1-day (P < 0.001), the median treatment delay also decreased from 3.5 (IQR: 1.75-5) to 1 business day (IQR: 1-2) [P < 0.001]. Each patient was an exposure risk to a median of 5 employees (IQR: 3-6.5) through prolonged close contact. During this timeframe, 39 care-team members were quarantined for a median of 3 days (IQR: 2-11), with a peak of 17 employees simultaneously quarantined. Following implementation of a ''dual PPE policy," newly quarantined employees decreased from 2.9 to 0.5 per day. Conclusion:The severe adverse events noted among these confirmed-positive cases support the notion that cancer patients are vulnerable to COVID-19. Active tracking, rapid diagnosis, and aggressive source control can mitigate the adverse effects on treatment delays, workforce incapacitation, and ideally outcomes.

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To investigate practice patterns of use of IC amongst oncologists in treatment of head and neck cancer (HNC) patients. Materials/Methods: An IRB approved survey was sent using Red Cap software to oncologists registered on the American Society of Radiation Oncology (ASTRO) website. Variables were subjected to analysis with Fisher's exact test. Data analysis was considered significant at Bonferroni adjusted pZ0.05 threshold if the p-value was 0.001 and suggestive if p<0.05.The survey was sent to 6818 unique email addresses. Results: The response rate was 14.9% of US and 4.6% of international practitioners. 371 (98.4%) of participants were radiation oncologists. Participants identified as their practice type as Private Practice (23.9%), Academic (44.6%), Hospital Based (30.8%). Level of experience was "still in training" (15.4%), <1 year after completion of training (3.4%), 1-5 years (17.5%), 6-10 years (13.5%), 11-20 years (17.8%), 20-30 years (19.6%), and >30 years (12.7%). 56.8% participants treated >20 HNC patients yearly. 52.5% felt that there are some scenarios where IC improves cancer control and 57.8% felt that there were some scenarios where IC improves quality of life (QOL) outcomes for patients with locally advanced HNC. There was no difference between type of practice or level of training and feelings regarding IC in improving outcomes. Non US practitioners were more likely to feel that IC improved QOL (pZ0.03) and were more likely to use IC (pZ0.005). Increased volume of HNC patients treated was correlated with an increased use of IC (pZ0.001). HNC patient volume was correlated with use of IC in a borderline laryngeal preservation (pZ 0.006), bulky cervical lymph node (pZ0.0005), and optic structure impinging tumor (pZ0.007) case. Variability in use of IC was high. In a patient with a bulky lymph node, 30.5% of respondents rated their willingness to use IC at 0 of a 5 on a 5 point scale, 10.6% at 1, 8% at 2, 11.9% at 3, 15.1% at 4 and 19.9% at 5. In a case with tumor impinging on the optic structures, 25.2% of respondents rated their willingness to use IC at 0 of 5, 9.5% at 1, 12.7% at 2, 14.6% at 3, 17.5% at 4 and 16.7% at 5. After a complete response to IC, doses recommended were 70 Gy (54.6%), >60 but <70 Gy (34.1%), and 60 Gy (8.9%). For a patient with a partial response to IC with a decreased size of a lymph node mass, participants were divided on the dose to treat the areas that were previously involved with tumor, treating with <60 Gy (1.4%), 60 Gy (18%), >60 but <70 Gy (36.3%), 70 Gy (41.1%) and >70 Gy (3.5%). Conclusion: Practice patterns regarding the use of IC were highly varied. IC was most often recommended in patients with bulky cervical lymph node burden or a tumor impinging on the optic structures. Use of IC correlated with patient volume and country of practice.

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baseline for future comparisons. These results have been shared with the dosimetry staff and additional guidance has been given to improve the detection rate of the dosimetry peer review. We will report updated results at the annual meeting.

3.80; p Z 0.0007); there was no significant difference for assistant professorship (p Z 0.067) nor associate professorship (p Z 0.348). The overall mean h-index for all faculty was 17.64 +-16.89. For junior faculty (n Z 532), mean h-index was 8.21 +-6.57. For associate professors (n Z 244), mean h-index was 18.46 +-11.45, and for full professors (n Z 215) the mean h-index was 40.05 +-18.37. Citation-based activity differences between junior faculty and associate professor and between associate professor and full professor were statistically significant (p<0.0001). The overall mean h-index was 19.35 +-17.86 for men (n Z 668) and 14.11 +-14.05 for women (n Z 323); this difference was statistically significant (p<0.0001). Conclusion: The majority of academic radiation oncologists are assistant professors; fewer than 5% are underrepresented minorities. Men comprise more than two-thirds of the workforce. While there is no gender difference in achieving assistant professorship and associate professorship, men are significantly overrepresented at the full professor (by 78%) and departmental chair (by 280%) levels in academic radiation oncology. The average radiation oncologist at a comprehensive cancer center has published more than 17 manuscripts cited at least 17 times; the average full professor has published 40 manuscripts cited at least 40 times each, compared to the average junior faculty member who has published 8 manuscripts cited at least 8 times each. Contrary to previous findings comparing male and female residents, the difference in academic productivity by gender among faculty was statistically significant. These findings provide objective data to assess the radiation oncology academic workforce and provide a useful benchmark to measure change going forward.

e18305 Background: The cost of a full cycle of radiation therapy at MD Anderson Cancer Center has not been determined using a bottom-up measurement approach. Due to the complexity and variation in clinical processes, typical costing strategies do not provide the level of detail necessary to evaluate the value equation, defined as outcomes over cost. To address this limitation, we designed and implemented a practice-wide Time-Driven Activity-Based Costing (TDABC) strategy to capture our total direct cost of care for all treatment modalities within each of 9 disease site-specific services. Methods: Process maps were created for each of the 9 disease site-specific services. Care delivery times were captured by treatment modality for each service as determined by multidisciplinary teams routinely performing each step of the process. The data were entered into a standardized tool, which calculated step costs based upon capacity cost rates for each human resource. The costing tool also calculated total direct labor costs for specific treatment plans based on modality, complexity, and fractionation. Results: The analysis took six months to complete and required the use of approximately 1,000 administrative hours, 250 physician hours, 250 clinical staff hours and 100 medical physics hours. Approximately 17 process maps were created for each of the 9 services with each process map receiving further analysis based upon radiation treatment modality. As a result of observed variation in costs between disease-site services, best practices were identified and 15 standardization opportunities were discovered. Additionally, the cost-benefit analysis between high profile modalities within each disease-site service, such as Proton Therapy and Intensity Modulated Radiation Therapy (IMRT) on the Head and Neck service, were easier to complete. Conclusions: Time-Driven Activity-Based Costing is a valid method for calculating direct costs in a large academic radiation oncology practice. Standardized clinical outcome data can be used to complete the value equation and ultimately provide insight for better clinical and administrative decision making.

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