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PURPOSE: To determine the association between patient-reported symptom burden and subsequent emergency department use and unplanned hospitalization (ED/Hosp) in a head and neck cancer (HNC) patient population. METHODS: This was a population-based study of patients diagnosed with HNC who had completed at least one outpatient Edmonton Symptom Assessment System (ESAS) assessment between January 2007 and March 2018 in Ontario, Canada. Logistic regression models were used to determine the relationship between outpatient ESAS scores and subsequent 14-day ED/Hosp use. A generalized estimating equation approach with an exchangeable correlation structure was incorporated to account for patient-level clustering RESULTS: There were 11,761 patients identified, completing a total of 73,282 ESAS assessments and experiencing 5,203 ED/Hosp events. Six of the nine ESAS symptom scores were positively associated with ED/Hosp use, with pain, appetite, shortness of breath, and tiredness demonstrating the strongest associations. A global ESAS score was calculated by selecting the highest individual symptom score (h-ESAS). Among patients reporting a maximum h-ESAS score of 10, 15.1% had an ED/Hosp event within 14 days compared with 1.5% for those with the lowest possible score of zero. In adjusted analysis, the odds of ED/Hosp use increased with h-ESAS (1.23 per one-unit increase [95% CI, 1.22 to 1.25]). When treated as a categorical variable, patients with the maximum h-ESAS score of 10 had 9.23 (95% CI, 7.22 to 11.33) higher odds of ED/Hosp use, relative to the minimum score of zero. CONCLUSION: ESAS scores are strongly associated with subsequent ED/Hosp events in patients with HNC. Clinician education around how ESAS data might inform patient care may enhance symptom detection and management.

330 Background: Lymph node metastases are associated with poor prognosis in oral cavity squamous cell carcinoma (OCSCC). In colorectal, lung, and gastric cancers, the number of lymph nodes removed during primary surgery, lymph node yield (LNY), is an established quality indicator that links with patient survival. As such, clinical guidelines have included a minimum (18) number of nodes to be resected, despite a lack of statistical evidence that supports such a LNY threshold. Currently, this kind of recommendation does not exist for OCSCC. Here, we used a novel single-centre dataset to evaluate the prognostic capacity of LNY on regional failure, locoregional recurrence and disease-free survival (DFS) in patients with OCSCC treated by primary neck surgery. Methods: This retrospective cohort study took place at Sunnybrook Hospital in Toronto, Canada and involved chart review data of all adult patients with treatment-naive OCSCC undergoing primary neck dissection. For each outcome, we first used the maximally selected rank statistics and a bias-corrected C-index to identify an optimal threshold of LNY, and then used a multivariable Cox proportional hazards model to assess the association between high LNY (> threshold) and each outcome. Results: Among the 579 OCSCC patients receiving primary neck dissection, 61.7% (n = 357) were male with mean age of 62.9 years (SD: 13.1) at cancer diagnosis. When adjusting for sociodemographic and clinical factors, LNY > 15 was significantly associated with improved DFS (adjusted HR [aHR]: 0.73, 95% CI: 0.54-0.98) and locoregional control (aHR: 0.68, 95% CI: 0.49-0.95), while LNY > 11 was associated with better regional control (aHR: 0.45, 95% CI: 0.26-0.76). Conclusions: Our study findings suggested high LNY to be a strong independent predictor of various patient-level quality of surgical care metrics. The optimal LNY we found (15 or 11) was lower than the conventionally recommended (18), which calls for further research to establish the validity in practice.

e18583 Background: Psychological distress is key in cancer care. Non-fatal self-injury (NFSI) represents a patient-centred, objectively measured manifestation of the greatest level of distress occurring in 3 out of 1,000 patients after a new cancer diagnosis. How to identify patients at high risk for NFSI remains unknown. We examined the relationships between routinely collected patient-reported outcomes measures and the risk of subsequent NFSI following a cancer diagnosis. Methods: We conducted a population-based case-control study of patients with a new cancer diagnosis (2007-2019) reporting a Edmonton Symptom Assessment (ESAS) score within 36 months of diagnosis. Cases were patients with NFSI within 36 months of diagnosis and controls those without NFSI (assigned a dummy index date corresponding to the case’s NFSI). Cases and controls were matched 1:4 on time from cancer diagnosis, ESAS record in 180 days prior index, age, sex, cancer site, and history of self-injury. Multivariable conditional logistic regression assessed the association between moderate-to-severe ESAS symptoms and total ESAS (t-ESAS) score with NFSI within 180 days. Results: Of 408,858 patients reporting >1 ESAS within 36 months of cancer diagnosis, 748 patients had a NFSI, including 425 patients with an ESAS score within 180 days preceding the NFSI event. Of those 406 cases were matched to 1,624 controls without NFSI. Cases reported a higher proportion of moderate-to-severe symptoms and higher t-ESAS than controls prior to the event (p < 0.01 for all). After adjusting for psychiatric illness history and cancer therapy received, reporting of moderate-to-severe anxiety (odds ratio – OR 1.61, 95%CI 1.14-2.27), depression (OR 1.66, 95%CI 1.2-2.31), and shortness of breath (OR 1.65, 955CI 1.18-2.31) were independently associated with higher risk of NFSI within 180 days. Each 10-point increase in t-ESAS (score 0-90) was independently associated with increased risk of NFSI within 180 days (OR 1.51; 95%CI 1.40-1.63). Conclusions: Reporting moderate-to-severe anxiety, depression, and shortness of breath, and increasing t-ESAS after cancer diagnosis are associated with higher odds of NFSI in the following 180 days. These data support the prospective identification of patients at high risk for NFSI via routine ESAS screening to improve supportive care. Patients with at-risk ESAS scores should receive tailored assessment, management, and longitudinal follow-up.

e18577 Background: Psychological distress is a key construct of patient-centred cancer care. While an increased risk of suicide for cancer patients has been reported, more frequent consequences of distress after a cancer diagnosis, such as non-fatal self-injury (NFSI), remain largely unknown. We examined the risk for NFSI after a cancer diagnosis. Methods: Using linked administrative databases we identified adults diagnosed with cancer between 2007-2019. Cumulative incidence of NFSI, defined as emergency department presentation of self-injury, was computed accounting for the competing-risk of death from all causes. Factors associated with NFSI were assessed using multivariable Fine and Gray models. Results: Of 806,910 included patients, 2,482 had NFSI and 182 died by suicide. 5-year cumulative incidence of NFSI was 0.27% [95%CI 0.25-0.28%]. After adjusting for key confounders, prior severe psychiatric illness whether requiring inpatient care (sub-distribution hazard ratio (sHR) 12.6, [95% CI 10.5-15.2]) or outpatient care (sHR 7.5, 95% CI 6.48-8.84), and prior self-injury (sHR 6.6 [95% CI 5.5-8.0]) were associated with increased risk of NFSI. Young adults (age 18-39) had the highest NFSI rates, relative to individuals >70 (sHR 5.4, [95% CI 4.5-6.5]). The magnitude of association between prior severe psychiatric illness and NFSI was greatest for young adults (interaction term p < 0.01). Certain cancer subsites were also at increased risk, including head and neck (sHR1.52, [95%CI 1.19-1.93]). Conclusions: Patients with cancer have higher incidence of NFSI than suicide after diagnosis. Younger age, prior severe psychiatric illness, and prior self-injury were independently associated with NFSI. These exposures act synergistically, placing young adults with a prior mental health history at greatest risk for NFSI events. Those factors should be used to identify at-risk patients for psycho-social assessment and intervention.

12084 Background: Symptoms are common in oncology patients, though they remain undetected and untreated by clinicians in up to 50% of cases. Integrating patient reported outcomes (PRO) within routine clinical practice has been suggested as a way to improve detection. In order to inform an effective and efficient PRO symptom screening program, we sought to determine whether outpatient symptom scores could predict emergency room use and unplanned hospitalization (ER/Hosp) in a cancer patient population. Methods: This was a population-based study of patients diagnosed with head and neck cancer who had completed at least one outpatient Edmonton Symptom Assessment System (ESAS) assessment between January 2007 and March 2018 in Ontario. Logistic regression models were used to determine the relationship between reported outpatient ESAS scores and ER/Hosp use in the 14-day period following ESAS completion. A generalized estimating equations approach was incorporated to account for possible patient-level clustering. Results: There were 11,761 unique patients identified with a total of 73,282 ESAS assessments. There were 5,203 ER/Hosp outcome events. In adjusted analysis, the odds of ER/Hosp use increased log linearly with ESAS score (1.23 per 1 unit increase in index ESAS score, [95% confidence interval (CI) 1.22 – 1.25]). This corresponds to a 9.23 (95%CI 7.22-11.33) higher odds of ER/Hosp use for the maximum index ESAS score of 10. Seven of the nine ESAS symptom scores were significantly associated with ER/Hosp use with pain, appetite and shortness of breath demonstrating the strongest association. Conclusions: ESAS scores are independently associated with 14-day ER/Hosp in head and neck cancer patients. Appropriate and timely management of symptom burden may reduce rates of ER/Hosp. [Table: see text]

6044Background: Mucosal head and neck squamous cell cancers are often managed with multimodality treatment which can be associated with significant toxicity. The objective of this study was to asse...