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Population changes, legislative changes, time and cost constraints, and practitioner and family perceptions each affect the delivery of early intervention services. This pilot project examined current evaluation practices used with the birth to 3 population. The role of norm-referenced and authentic assessment tools in the eligibility determination process was examined through a convenience sample of child–caregiver dyads and interdisciplinary practitioners. A majority of the children in the project were given a norm-referenced assessment along with authentic assessment measures. For more than half of those children, interpretation of the norm-referenced scores was questioned as standardized procedures could not be followed due to home language differences. Practitioners reported using authentic assessment information rather than norm-referenced data to derive developmental needs in nearly 80% of the children evaluated. The results of the pilot project provide a foundation for future study of evidence-based practices for norm-referenced and authentic assessment tool use with infants and toddlers.

Background The impact of treatment delays on survival in oropharyngeal cancer and whether the effect varies by human papillomavirus (HPV) status have yet to be defined. Methods Retrospective analysis of the survival impact of time from diagnosis to surgery (DTS), surgery to radiation (SRT), and duration of radiation (RTD) for patients in the National Cancer Database with resected oropharyngeal cancer who underwent adjuvant radiation from 2010 to 2014. Results We identified optimal thresholds of 30, 40, and 51 days for DTS, SRT, and RTD, respectively, with treatment times exceeding these thresholds associated with significantly worse overall survival. Prolonged SRT and RTD were associated with mortality regardless of HPV status, although rising DTS was only predictive among patients with HPV‐negative tumors. Conclusions Treatment delays significantly impact survival in oropharyngeal cancer. The consequences of prolonged DTS may be stronger in HPV‐negative than HPV‐positive disease. These data serve as a foundation for future research and clinical management.

Objectives/Hypothesis: Psychosocial distress is common among patients with head and neck cancer (HNC) and is associated with poorer quality of life and clinical outcomes. Despite these risks, distress screening is not widely implemented in HNC care. In this study, we investigated the prevalence of psychosocial distress and its related factors in routine care of patients with HNC.Methods: Data from medical records between September 2017 and March 2020 were analyzed. Psychosocial distress was measured by the National Comprehensive Cancer Network's Distress Thermometer (DT), and a modified HNC-specific problem list; depression and anxiety were assessed using the Patient Health Questionnaire-4. Descriptive statistics and logistic regression were conducted to report prevalence of distress, depression and anxiety, and factors associated with clinical distress. Implementation outcomes, including rates of referrals and follow-up for distressed patients, are also reported.Results: Two hundred and eighty seven HNC patients completed the questionnaire (age 64.3 AE 14.9 years), with a mean distress score of 4.51 AE 3.35. Of those, 57% (n = 163) reported clinical distress (DT ≥ 4). Pain (odds ratio [OR] = 3.31, 95% CI = 1.75-6.26), fatigue (OR = 2.43, 95% CI = 1.1.7-5.05), anxiety (OR = 1.63, 95% CI = 1.30-2.05), and depression (OR = 1.51, 95% CI = 1.04-2.18) were significantly associated with clinical distress (P < .05). Of patients identified as distressed, 79% received same-day psychosocial evaluation.Conclusions: Clinical distress was identified in 57% of patients who completed the questionnaire, suggesting that an ultra-brief psychosocial screening protocol can be implemented in routine ambulatory oncology care, and identifies patients whose distress might otherwise go unrecognized.

43 (47%) patients were still alive. The median prior irradiation dose to the skull base region was 6360 cGy for those without TLN and 6760 cGy for those with TLN (PZ.055). Median re-irradiation proton dose was 60 CGE without TLN and 7 0CGE with TLN (PZ.419). Twelve patients (13%) were found to have temporal lobe necrosis with median time to development of 8 months. Of these patients, 6 patients had right-sided TLN, 5 had left-sided, and 1 patient had bilateral TLN. The median total mean dose to 2 cc to the right temporal lobe was 51.87 CGE for those without TLN and 75.10 CGE for those with TLN (PZ.057); median max pixel dose to the right was 68.80 CGE without TLN and 110.13 CGE with TLN (PZ.040). On the left side, median total mean dose to 2 cc was 32.29 CGE with no TLN and 59 CGE with TLN (PZ.211) and median max pixel dose was 55.19 CGE without TLN and 71.34 CGE with TLN (PZ.560). All patients were determined to have grade 1 TLN per CTCAE 4.0 with only radiographic evidence and were clinically asymptomatic except for one patient with grade 2 toxicity requiring medical management with steroids. Conclusion: Among patients treated in the re-irradiation setting with proton therapy, 13% of patients developed TLN that was only apparent radiographically except for one who was treated medically. Analysis of more detailed dosimetric data with longer follow-up data are underway to better ascertain the significance of these findings.