S138 I. J. Radiation Oncology d Biology d Physics Volume 72, Number 1, Supplement, 2008

1055 Does Medicare HMO Reimbursement Policy Hinder Clinical Trial Participation?

C. J. Lin1, D. E. Heron1, K. Connelly2

1University of Pittsburgh Cancer Institute, Pittsburgh, PA, 2UPMC McKeesport Hospital, Pittsburgh, PA

Purpose/Objective(s): Participation in clinical trials is associated with equivalent or better outcomes than that achieved with stan-dard treatment. Yet, it is estimated that\5% of adult patients with cancer participated in clinical trials in the U.S. Payer reimburse-ment policies are a frequently cited barrier to clinical trial participation. Nearly 60% of patients declined enrolling into clinical trialsdue to concern about lack of reimbursement for their routine cancer treatment costs by the third-party payer. Medicare reimburse-ment policies differ between fee-for-service (FFS) plans and health maintenance organizations (HMO). For all services included inthe clinical research protocol, Medicare FFS fully reimburses the costs whereas Medicare HMO requires patients to pay a deductibleamount and 20% of the allowable costs. University of Pittsburgh Medical Center (UPMC) Radiation Oncology Minorities Out-reach Program (ROCOG), an NCI-funded consortium of 5 hospitals, focuses on improving access and outcomes for underservedpopulations with cancer. One of the ROCOG’s aims is to increase minority patient enrollment in cancer clinical trials. The programhas implemented processes to assist patients in estimating their financial responsibility should they agree to participate in a giventrial. This study is to estimate monthly financial cost per treatment cycle for selected clinical trials and examine the proportion ofcancer patients with Medicare HMO coverage who have been treated in our facilities.

Materials/Methods: The study facilities include a small semi-urban, an inner-city, an urban, a rural, and a control hospital locatedin a semi-urban area. Using the UPMC EPIC billing system, new patients diagnosed with cancer who had consultations (CPT-4codes: 99201-5, 99241-5, 99251-5) during 2003-2007 were identified.

Results: The overall proportion of newly diagnosed cancer patients who had consultations and were insured by Medicare HMOsincreased from 20.9% in 2003 to 26.5% in 2007. The estimated monthly cost of a qualifying clinical trial for a patient was $112.80for trial #05-025, $326.60 for trial #03-091, $2,152.20 for trial #06-112, and $3082.8 for trial #05-044. In 2007, 103 subjects werescreened for clinical trials in the UPMC cancer centers and opted out of enrolling on a Medicare qualifying clinical trial due toincreased financial burden.

Conclusions: Since the passing of the Medicare Modernization Act and the establishment of Medicare Advantage in 2003, thenumber of Medicare beneficiaries enrolled in managed care has increased. Our results are consistent with the national trend thatthere is an increasing number of aging cancer patients enrolled in Medicare HMOs. Our findings suggest that Medicare HMO re-imbursement policy hinders cancer clinical trial participation in the ROCOG facilities.

Author Disclosure: C.J. Lin, None; D.E. Heron, None; K. Connelly, None.

1056 Employment and Insurance Status in Hodgkin Lymphoma Survivors

A. B. Chen1, Y. Feng1, D. Neuberg1, C. Recklitis1, L. Diller2, P. Mauch1, A. Ng1

1Dana-Farber Cancer Institute, Boston, MA, 2Children’s Hospital Boston, Boston, MA

Purpose/Objective(s): To compare employment and insurance status in survivors of Hodgkin lymphoma (HL) and their siblingsand to examine factors associated with employment and insurance status.

Materials/Methods: We conducted a questionnaire study on long-term HL survivors and their siblings, who served as a comparisongroup. The questionnaire included items on demographics, treatment, medical conditions, employment, and insurance. Fisher’s exacttests were used to compare the employment and insurance status of survivors versus siblings. Multivariable logistic regression withbackward stepwise selection was used to determine factors influencing employment and insurance variables among survivors.

Results: Questionnaires were completed by 511 survivors and 224 siblings (response rates 61% and 58%, respectively). Amongsurvivors, 86.5% had stage I-II disease. 60.1% received radiation alone, 4.1% received chemotherapy alone, and 33.1% received both.Median time from HL treatment was 15 years and median age at questionnaire completion was 44. Survivors and siblings were similarin age, sex, marital status, education, and income. Regarding employment, survivors were more likely than siblings to report ever beingdenied civilian or non-civilian jobs due to medical history (6.1% vs 1.8%, p = 0.01). However, there were not significant differences inemployment in the past year, demotions, or promotions. Regarding insurance, survivors were more likely than siblings to report dif-ficulty in obtaining health insurance because of health history (16.8% vs 4%, p\0.01), inability to change jobs due to fear of losinghealth insurance (26.8% vs 10.3%, p\0.01), difficulty obtaining life insurance due to health history (36.8% vs 2.2%, p\0.01), andextra premiums charged for life insurance (12.1% vs 0.9%, p\0.01). Multivariable analysis among survivors found that male gender(OR = 12.2, p \ 0.01), income\$60K/yr (OR = 3.6, p = 0.01), and treatment-related scarring of the head and neck (OR = 5.0, p\0.01) were associated with denial of civilian or non-civilian jobs. Survivors with income $$60K/yr (OR = 2.4, p = 0.03) were morelikely to report difficulty obtaining health insurance due to health history, and those who made .4 physician visits/yr (OR = 2.0, p\0.01), were #10 years from treatment (OR = 1.9, p = 0.02), or had permanent hair loss in the radiation treatment field (OR = 1.9, p =0.02) were more likely to report feeling as if they could not change jobs for fear of losing health insurance.

Conclusions: Compared to their siblings, HL survivors may face greater challenges in obtaining employment, health insurance,and life insurance. Late effects from treatment, including permanent cosmetic changes, may contribute to some of these differences.

Author Disclosure: A.B. Chen, None; Y. Feng, None; D. Neuberg, None; C. Recklitis, None; L. Diller, None; P. Mauch, None; A.Ng, None.

1057 Survivorship Care among Cancer Patients having Undergone Radiotherapy: The Utilization of Internet-

based Survivorship Care Plans

C. E. Hill-Kayser, C. Vachani, M. K. Hampshire, L. A. Jacobs, J. M. Metz

University of Pennsylvania Medical Center, Philadelphia, PA

Purpose/Objectives: Medical care for cancer survivors may be complex, and has been demonstrated to often be inadequate. Sur-vivors treated with radiotherapy (RT) are at particular risk for treatment-related late effects. The Institute of Medicine has identified

Proceedings of the 50th Annual ASTRO Meeting S139

survivorship care plans (SCP) as essential to care of cancer survivors. Here, we present patterns of use of the world’s first Internet-based SCP by cancer survivors, focusing on those treated with RT.

Materials/Methods: A program for creation of SCP, OncoLife, has been made publicly accessible through OncoLink (www.oncolink.org), a website serving over 3.9 million pages/month to 385,000 unique IP addresses (Aug 2007) and based at the Uni-versity of Pennsylvania. OncoLife allows users to respond to queries regarding demographics, diagnosis, and treatment, and pro-duces individualized guidelines for future care addressing issues such as late toxicity, second malignancy, fertility, and tumorrecurrence. User information was recorded anonymously with IRB-approved methodology from the period of 5/07-3/08.

Results: OncoLife was utilized by 2054 individuals during the study period. Median age at cancer diagnosis was 48 yrs (range,\18to .100), and median current age was 51 yrs (range,\18 to .100). Users were most often Caucasian (87%), and college educated(52%), and identified themselves as patients (69%), friends/family (13%), and healthcare providers (17%). The most common over-all primary cancer diagnoses were breast (45%), hematologic (12%), gastrointestinal (11%), and gynecologic (8%). The majority ofusers (60%) reported having been treated with RT. Of survivors who received RT, primary diagnoses were most commonly breast(74%), gastrointestinal (9%), lymphoid (7%), prostate (6%), and gynecologic (6%) malignancy. Radiotherapy was utilized in thetreatment of the majority of survivors of sarcomas (92%) and cancers of the head/neck (87%), brain (86%), breast (75%), prostate(59%), and lung (58%). The vast majority of survivors treated with RT stated that an oncologist was involved in their healthcare(83%), but only 12% reported ever having been offered information on survivorship care in the past.

Conclusions: The majority of cancer survivors utilizing this tool have undergone RT, placing them at increased risk for treatment-related late effects. Despite most users reporting being cared for by oncologists, few have been offered information on survivorshipcare. Survivors appear to be willing to utilize the Internet to create SCP, and OncoLife fills an important niche in the care of thispopulation. Future iterations will focus on further individualization of late-effect recommendations, and will improve understand-ing of both RT use patterns and the medical needs of modern cancer survivors.

Author Disclosure: C.E. Hill-Kayser, None; C. Vachani, None; M.K. Hampshire, None; L.A. Jacobs, None; J.M. Metz, None.

1058 Collaborative Web-based Radiation Oncology Textbook: A Paradigm Shift in the Writing, Editing, and

Publishing of Textbooks

B. C. Cook1, T. Dvorak2, M. D. Chan2, D. E. Wazer2

1Sampson Radiation Oncology, Clinton, NC, 2Tufts-New England Medical Center, Boston, MA

Purpose/Objective(s): The wiki collaborative concept has an emerging role in medicine, where it is currently being used to de-velop shared online and protein databases, owing to the unique way in which information can rapidly and easily be created andshared among multiple users. Our goal was to develop a free-access web-based radiation oncology reference textbook usingthis concept, which allows anyone to access and update content at any time from any Internet connection.

Materials/Methods: The textbook (http://en.wikibooks.org/wiki/Radiation_Oncology) was created in 9/2004. User-friendly soft-ware facilitates collaborative online editing, such that a large work can be built up and maintained by multiple users. It can be up-dated as quickly as new data emerge, allowing it to stay current compared to traditional textbooks. As it is hosted online, there is norestriction on the amount of text or number of images that can be included. Hyperlinking allows for the reader to navigate easilyamong connected topics. The book has no official editors, since anyone can edit any page, but the software keeps a history of allchanges, and unwanted changes can easily be reversed.

Results: The textbook has grown to 387 web pages/chapters, containing more than 356,000 words (�460 full-text pages of theIJROBP). There are .3,000 papers summarized and linked directly to PubMed. Breast cancer is the largest topic (12%), containing24 web pages and 42,000 words. Contributions have been made by 35 registered users and from 116 unique anonymous IP ad-dresses in the U.S.A. and internationally. Registered users were responsible for 95% of the edits. Less than 0.5% of the editswere inappropriate and were corrected by other users, usually within hours.

Conclusions: An Internet-based open-access radiation oncology textbook has been successfully established. It offers multiple ad-vantages over print textbooks in terms of potential breadth and depth of topic coverage, timeliness, collaborative power, organi-zation and navigation, searchability, open accessibility, and open authoring process. However, issues related to control of content,level of peer review, comprehensiveness, coherence, and ultimately its validity as a teaching and reference resource remain to beevaluated, and will form a second part of our study.

Author Disclosure: B.C. Cook, None; T. Dvorak, None; M.D. Chan, None; D.E. Wazer, None.

1059 Validation of the Common Terminology Criteria for Adverse Events v3.0 (CTCAE) for Dysphagia after

Chemo-Radiotherapy (RT) for Head and Neck (HN) Cancer

I. Gluck, K. Agbulos, D. B. Chepeha, T. Lyden, M. Haxer, A. Popovtzer, O. Gutfeld, A. Eisbruch

University of Michigan, Ann Arbor, MI

Purpose/Objective(s): Dysphagia is a major sequel of chemo-RT of HN cancer. Most studies report the maximal observer rateddysphagia score according to CTCAE. This scoring has never been correlated with objective measurements or with patient-reportedmeasures of swallowing. The aim of this study was to investigate alternative parameters, which incorporate the duration of dys-phagia for both acute and late phases.

Materials/Methods: 46 patients with HN cancer who enrolled in a prospective study of dysphagia underwent videofluoroscopy(VF) before and 3 m and 12 m after chemo-IMRT, filled QOL questionnaires before RT and 1, 3, 6, and 12 m after RT, and wereassessed for CTCAE rated dysphagia weekly during RT and 1 m, 3 m, 4 m, and every 2 m thereafter. The QOL questionnairesincluded three dysphagia specific questions inquiring about the relative difficulty in swallowing solid foods and liquids. The pa-tients were followed for 1 y after RT. The cut-off point between the acute and chronic phases was defined as 1 m after RT. For eachpatient the area under the dysphagia score-versus-time curve (AUC) was calculated. Spearman’s correlation tests were used to cor-relate the maximal and cumulative observer rated toxicity during the acute phase (O-Ac-Max and O-Ac-AUC respectively) and to