S496 I. J. Radiation Oncology d Biology d Physics Volume 75, Number 3, Supplement, 2009

Materials/Methods: Physicians completed an assessment survey evaluating patient charts for outcome measures. Areas of im-provement are selected and data re-assessed 3–18 months later using another cadre of patients.

Results: As of March 1, 2009, 353 physicians have registered and 168 have started a PAAROT PQI study. Of those eligible tocomplete their project (having waited the required time after initiating the project), 79% have done so. The metrics most frequentlyselected for monitoring were: 1) Was the patient screened for pain and counseled on options of pain management techniques; 2)Was the patient enrolled in a protocol; and 3) Was the patient screened for cancer related fatigue. Although success is not requiredfor PQI credit, 92% of the selected interventions were successfully completed. Pooled data from participating physician practicesreveals that history/physicals are present in the chart in 99% of cases, and AJCC stage in 85%. DVHs were signed 82% of the time.Films/EPIs were reviewed and weekly treatment checks performed in 95% of cases, and peer review conducted in 89%. Mostpatients treated with palliative intent received 6–15 fractions. Intensity modulation was used for no palliative cases and 23% ofcurative cases.

Conclusions: PAAROT has proven to be a viable mechanism for web-based PQI. Aggregate data provide a perspective on currentradiation oncology practice nationwide, and reveal that a focus on an area of improvement yields measurable improvement in thatarea.

Author Disclosure: M.A. Henderson, None; K. Thomas, None; W.R. Lee, None; P.A.S. Johnstone, None.

2699 Benefits of Aggressive Patient Management on Radiation Therapy in Socio-economically Disadvantaged

Populations

M. C. Baird, T. Shirley, S. Baird, L. Smithhart, N. Mayronne, D. Green, S. Vijayakumar

University of Mississippi, Jackson, MS

Purpose/Objective(s): Minority patients have poorer outcomes, despite the fact that race alone is not a factor in adverse results.Our socio-economically disadvantaged patients are often non-compliant both with initial consults and daily therapy. A study wasundertaken to see if aggressive patient management could reverse the negative effects of poverty, improve compliance and out-comes. A secondary endpoint was to see if this program was financially sustainable.

Materials/Methods: Aggressive patient management program consists of a coordinated multi-disciplinary assessment and planthat monitors and facilitates all aspects of the patient flow from initial consult to follow-up visits. Social services, nursing, dietitians,van drivers and volunteer managers are utilized.

Results: In the control period there were 180 no shows out of 1629 scheduled treatments (11%). In the program period there were121 no shows out of 1972 scheduled treatments (6%). Therefore, despite a 21 % increase in the number of scheduled treatments, theno show rate declined from 11% to 6%. This improvement equates to 99 cancellations being avoided during the program period. Inthe control period, there were 37 no shows out of 122 scheduled consults (30%). In the program period there were 21 no shows outof 137 scheduled consults (15%). Again, despite a 12 % increase in the number of scheduled consults, no shows decreased from30% to 15%. This reduction in consultation failures results in 21 additional consults being seen.

Financial Analysis:Expenses of the program:Housing and meals: $16,984Social Worker and Dietary consults: $ 2,924Travel costs (driver,gas,taxi) $ 3,535Total program costs 1Q 2009 $23,443Revenue and savings:The 5 % decrease in therapy no shows represent 98.6 units of service which were moved from a loss to gain in Q1 2009. This is

a revenue improvement of $ 44,000 (loss of $6,712 to gain of $37, 288). This increased revenue amount represents almost twice the$23,443 expended by the program. The financial contribution of the 21 additional consults will add additional revenue to the above.

Conclusions: This program has substantially grown volumes and decreased no show rates in initial consults and daily treatmentdelivery. The effect on health outcomes will be addressed with further follow-up. The positive effect on department finances wasunexpected. The dramatic improvement in financial performance generated almost twice as much revenue as the program costs.The improved capture of initial consults can be expected to generate even more revenue in the future.

Author Disclosure: M.C. Baird, None; T. Shirley, None; S. Baird, None; L. Smithhart, None; N. Mayronne, None; D. Green, None;S. Vijayakumar, None.

2700 Significant Increased Survival in Mesothelioma Patients Treated with Radiation and Surgery: An Analysis

of the SEER Registry

L. Li1, B. Lally2, B. L. Egleston1, A. Lebethal1, W. J. Scott1, G. R. Simon1, H. Borghaei1, R. Mehra1, N. Kuritzky1,S. J. Feigenberg1

1Fox Chase Cancer Center, Philadelphia, PA, 2University of Miami, Sylvester Comprehensive Cancer Center, Miami, FL

Purpose/Objective(s): Mesothelioma is a rare aggresive disease and the role of radiation in the treatment of patients with meso-thelioma remains controversial. Multiple single center trials point to a survival advantage of multimodality therapy. We seek tocharacterize favorable tumor, patient, and treatment factors by examining mesothelioma patients in a prospectively maintained pop-ulation-based registry.

Materials/Methods: Using the Surveillance, Epidemiology, and End Results (SEER) database, patients with histologically con-firmed malignant mesothelioma of the thorax with active follow-up were selected. SEER Stat 6.4.4 was used for survival statisticalanalysis.

Results: Between 1998 and 2004, 4441 patients met the inclusion criteria. The median age was 74 years (range 22–81), with 80.3%male, 92.2% white, 4.6% black, 56.5% involving the right thorax, and 36.7% the left thorax. Histologies include 5.1% biphasic,

Proceedings of the 51st Annual ASTRO Meeting S497

26.5% epithelioid, 8.8% fibrous, and 59.6% mesothelioma not otherwise specified (NOS). Treatment with surgery was provided in23% of patients (5.4% pneumonectomy, 16.5% wedge resection/lobectomy, 1% surgery NOS), no surgery in 76.7%, external beamradiotherapy in 11.5%, and no radiation therapy in 86.5%. Combination therapy with pneumonectomy and external beam radio-therapy was given to 2.5% of patients. Overall Kaplan-Meier median survival was 8 months (95% CI: 7.6 – 8.4). Median survivalsin months by histology were: epithelioid 11 (95% CI: 10.1 – 11.9), biphasic 7 (95% CI: 6.0 – 8.0), fibrous 6 (95% CI: 4.8 – 7.2), andmesothelioma NOS 8 (95% CI: 7.6 – 8.4), p\0.001; by surgical treatments were: pneumonectomy 16 (95% CI: 13.2 – 18.8), wedgeresection/lobectomy 11 (95% CI: 9.8 – 12.2), no surgery 7 (95% CI: 6.6 – 7.4), p\0.001; by radiation treatments were: externalbeam radiotherapy 11 (95% CI: 9.8 – 12.2), and no radiation therapy 7 (95% CI: 6.6 – 7.4), p\0.001. For patients treated withpneumonectomy, median survival with external beam radiotherapy (n=110) versus without (n=119), was 19 (95% CI: 15.8 –22.1) versus 12 (95% CI: 9.1 – 14.9), respectively, p=0.001. After accounting for perioperative mortality in pneumonectomy pa-tients by excluding patients with survival of less than 3 months, the median survival without external beam radiotherapy was 13(95% CI: 10.0 – 16.0) and remained statistically significant when compared the median survival with external beam radiotherapy,p = 0.01.

Conclusions: Epithelioid histology, pneumonectomy, and external beam radiotherapy were correlated with increased survival inmesothelioma patients. Analysis of the SEER database supported established series on life expectancy and median survival, as wellas published reports on improved survival after multimodality therapy with pneumonectomy and radiation.

Author Disclosure: L. Li, None; B. Lally, None; B.L. Egleston, None; A. Lebethal, None; W.J. Scott, None; G.R. Simon, None; H.Borghaei, None; R. Mehra, None; N. Kuritzky, None; S.J. Feigenberg, None.

2701 Use of Complementary and Alternative Medicine Therapies among Rural Minnesota Radiation Therapy

Patients

M. F. Winegardner1, S. Rausch1, A. Vincent1, D. Wahner-Roedler1, B. Bauer1, V. Phatak2

1Mayo Clinic, Rochester, MN, 2University of Washington, Seattle, WA

Purpose/Objective(s): To identify the prevalence of CAM (Complementary and Alternative Medicine) use among radiation on-cology patients and the disclosure of use to radiation oncologists.

Materials/Methods: Patients undergoing radiation therapy at two rural Minnesota treatment facilities were invited to participate inthe survey from January 2007 through December 2008. A validated CAM survey that inquired about use of CAM therapies in thepreceding six months was used. The information provided by patients in this survey was compared to the information the samepatients provided to their radiation oncology providers at the time of their consultations. The number of consultations per patientranged from one to three. Consultations were audited for (1) vitamins/minerals use, (2) dietary/herbal supplements use, or (3) both.The data obtained from the survey was correlated with the data obtained from the report of vitamin/minerals use, dietary/herbalsupplement use, or both at the time of consultation.

Results: One hundred fifty-three patients completed the CAM survey. Of these, 95.4% reported that they had used some form ofCAM therapy. Analysis of the data demonstrated 62% participated in spiritual healing (prayer), 49.6% had taken multiple vitaminsupplements, 37.9% had taken herbal and/or dietary supplements and 5% had taken megavitamins supplements. Comparison of thesurvey with two hundred eighteen consultation notes from twenty-nine clinicians indicated 34.6% of respondents did not disclosetaking minerals, vitamins and/or supplements.

Conclusions: CAM usage is common among patients undergoing radiation therapy in rural Minnesota. This study demonstratesthat there is a discrepancy in CAM usage between what patients report to their physicians versus what they are actually using andthat patient’ patterns of self administered vitamins, minerals and supplements are not being recognized by radiation oncologistsapproximately one third of the time.

Author Disclosure: M.F. Winegardner, None; S. Rausch, None; A. Vincent, None; D. Wahner-Roedler, None; B. Bauer, None; V.Phatak, None.

2702 Results of Patterns of Care Survey of Patients Treated with Radiotherapy for Prostate Cancer in

Wisconsin: Comparison to a National Survey

D. Wang1, A. Ho2, A. Trentham-Dietz3, J. Owen2, C. Lawton1, J. Wilson1

1Medical College of Wisconsin, Milwaukee, WI, 2American College of Radiology, Philadelphia, PA, 3University of Wisconsin,Madison, WI

Purpose/Objective(s): To report results of a 2004 patterns of care survey that expanded data routinely collected by the state cancerregistry for patients treated with radiotherapy (RT) for prostate cancer in Wisconsin (WI) and to compare the results to the 1999national patterns of care survey.

Materials/Methods: A sample of records was abstracted from 983 prostate cancer patients newly diagnosed in 2004 from 46institutions of WI. Clinical practice trends were analyzed according to prognostic risk groups and compared with results of the1999 national patterns of care survey including use of androgen deprivation therapy (ADT) in combination with EBRT. Param-eters used to characterize the prognostic risk groups include pretreatment PSA #10 ng/mL, Stage T1–T2 and Gleason score#6.When all three indicators are present, the patient is included in the favorable prognosis group. An increase in the value of oneof the indicators classifies the patient in the intermediate group and two or more indicators in the unfavorable prognosisgroup.

Results: Of the 282 patients who had RT, 44% were treated with brachytherapy with or without external beam radiotherapy(EBRT) and 56% were treated with EBRT only. Compared with the national survey, the number of patients in the WI surveytreated with brachytherapy was significantly higher (44% vs. 36%, p = 0.0073). The EBRT only group, which included nofavorable risk patients, is the subject of the remaining findings. The incidence of ADT use for intermediate and unfavorablerisk groups was 38% and 79%, respectively (p\0.0001). A multivariate logistic regression analysis revealed a statistically