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e24181 Background: The number of cancer survivors is rapidly climbing due to increased screening and improved treatment. Survivorship Care Plans (SCPS) summarize the patients’ treatment and is a communication tool between oncologists and primary care physicians (PCP)s. Creation and delivery of the SCPs has been labor intensive and costly for many healthcare systems and a previous paper based system at our institution was ineffective. The University of New Mexico Comprehensive Cancer Center (UNMCCC) treats a unique population of lower socioeconomic status (SES) (poverty rate 19.7%), rural (22.6%) and minority (Native Americans and Hispanics constitute 10.4% and 48% of the population respectively) patients in a large rural state. Methods: Beginning March 2019, UNMCCC initiated a process for creation and delivery of SCPs through the Electronic Medical Record (EMR). EMRs are not designed to delivery SCPs to patients and PCPs, so EMR functions were creatively repurposed. Upon identification of eligible patients, providers would place an electronic SCP order through the EMR. Designated staff then partially completes the SCPs based on medical record review while the EMR imports demographics, PCP, cancer and stage. Then the EMR flags SCPs ready for delivery and the provider edits, approves and prints the SCP for the patient at the next encounter. Once printed, the EMR alerts medical records to send the SCP to the PCP via mail or EMR routing. Results: 282 SCPs were ordered, 222 (78.7%) were created and 86 (38.7%) given to patients after definitive therapy of Breast (77.9%), Colorectal (7.0%), Gynecological (9.3%) and Prostate Cancer (5.8%). Of 72 SCPs eligible to be sent to PCPs, 48 (66.7%) were successfully mailed or sent via EMR, 13 (18.1%) had PCP discrepancies, 6 (8.3%) had no PCP and 5 (6.9%) had PCPs in systems which do not accept unsolicited records. Conclusions: The UNMCCC cares for low SES, rural and minority patients and was able to create and deliver SCPs to a significant number of patients and PCPs. Future process steps will involve creating tailored SCPs for other diagnoses, resolving PCP discrepancy issues and creating an EMR alert for PCPs when they receive an SCP. Additionally, assessment of both patient and PCP perceptions is ongoing.

69 Background: The Institute of Medicine endorses delivery of survivorship care plans (SCPs) to the growing number of cancer survivors in order to improve the coordination of care between oncologists and primary care providers (PCPs). In response, the Commission on Cancer (COC) has increased the SCP delivery requirement to >50% of eligible patients, a goal that is difficult to meet given limited resources. Here we outline the initiatives taken to achieve this goal at the University of New Mexico Comprehensive Cancer Center (UNMCCC). Methods: Prior to 2017, SCPs were not routinely delivered. Beginning 2017, providers were tasked to complete and deliver printed SCPs , resulting in a 17% rate of SCP completion. However, there was general lack of provider support and enthusiasm as the process was time consuming with no method for identifying eligible patients and tracking SCP delivery. In 2018, designated staff was assigned to partially complete the SCPs to assist providers, resulting in an increase in SCP delivery rate to 41%. However, the same barriers existed. SCP softwares, although available, were expensive. A cost effective process therefore was needed. A committee was then formed to create a system-wide process utilizing the existing electronic health record (EHR) MOSAIQ. ASCO based SCPs were created. Once providers identify eligible patients, an SCP electronic order was initiated. Designated staff then partially completes the SCPs based on review of medical records. The EHR extracts data items including demographics, PCP information, cancer type and stage. The EHR is programmed to flag SCPs ready for delivery which the provider then edits and approves. This system tracks multiple time points including referral, completion and delivery of SCPs. This new process was implemented in April 2019. Quarterly reviews are set to assess metrics. Results: Utilizing existing EHR (MOSAIQ), a new SCP delivery process was created that allows tracking of assembly, completion and timing of delivery. Conclusions: To overcome existing barriers to SCP completion and delivery, a new cost effective process was created utilizing existing staff and EHR resources. Institutional support is key to the success of this initiative.

601 Background: Anal cancer comprises only 2.5% of all digestive system malignancies in the United States; only 8200 new cases are diagnosed annually, nevertheless, an increasing incidence rate has been noted. The goal of this study is to describe the incidence rates of anal cancer in New Mexico. New Mexico is a unique, mainly rural state, with unique demographics consisting of a large mix of patients being primarily Non-Hispanic White, Hispanics or Native Americans. Methods: All incident cases of anal cancer diagnosed among New Mexico residents during the twenty-year period 1995-2014 were identified from the population-based New Mexico Tumor Registry. Average annual age-adjusted incidence rates (US 2000 standard) were calculated by the direct method for non-Hispanic whites, Hispanics and American Indians. Incidence rates for non-Hispanic whites in nine core areas of the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program served as the comparison. Results: A total of 556 anal cancers were diagnosed among New Mexico residents during the study period, an average of approximate 28 cancers annually. Anal cancer incidence rates per 100,000 were highest for non-Hispanic whites (1.80, 95% Confidence Interval (CI) 1.62-1.98) in New Mexico, which were similar to rates for non-Hispanic whites (1.70, 95% CI 1.66-1.74) in nine core areas of the SEER Program. Statistically significant lower rates were observed in New Mexico Hispanics (0.92, 95% CI 0.76-1.11) and American Indians (0.75, 95% CI 0.45-1.16). Females had higher rates than males in each of these three racial/ethnic groups. Incidence rates increased from 1995-2004 to 2005-2014 for all race/ethnic groups, with the largest increase observed in Hispanic females. Conclusions: Anal cancer incidence rates vary by race/ethnicity and sex in New Mexico. Further research is needed to characterize time trends in incidence and to identify factors that may account for observed differences in incidence rates by race/ethnicity and sex in New Mexico.

Purpose Familial melanoma patients are reported to present with thinner melanomas, to be younger at the time of diagnosis, and to have a greater likelihood of developing multiple primary tumors. We sought to determine whether melanomas that occur in a familial setting demonstrate different prognostic and survival statistics relative to sporadic melanoma. Patients and Methods This population-based study used the Utah Cancer Registry and Utah Population Database to objectively evaluate prognostic and survival statistics of the familial melanoma population. From 1973 to 1999, there were 7,785 cases of invasive melanoma identified through the Utah Cancer Registry. These were linked to the Utah Population Database, resulting in 2,659 subjects with family-history information from which a familiality score could be calculated. Cases scored in the top ninth percentile were assigned as high familial risk, and the remaining 91% were considered low familial risk. Results Multivariate logistic-regression analysis found no association between sex, Breslow depth, Clark level, or survival and the familial status. Age at first diagnosis of invasive melanoma was slightly lower in the high-familial-risk group (57 v 60 years; P = .03). High-familial-risk subjects had more melanomas diagnosed at age 30 or younger (12% v 6%; P < .001). A significant difference in the overall number of individuals with two or more primary malignant melanomas was not detected among the groups (P = .2). Conclusion These data suggest that melanomas occurring in the context of an underlying inherited susceptibility do not have a significantly different biologic behavior.

Purpose: To evaluate the role of breast tumor location on survival in patients with breast cancer. Patients and Methods: We evaluated tumor location within the breast on breast cancer–specific survival (BCSS) and overall survival (OS) in patients with invasive breast cancer using the Surveillance, Epidemiology, and End-Results (SEER) registries in the United States. Effects on survival were evaluated according to age, stage, tumor site, tumor size, grade, axillary lymph node status, extent of surgery, and radiotherapy (RT). A multivariate model was used with complete data on 45,880 patients. The median follow-up was 59 months. Results: Patients with outer tumor location demonstrated superior BCSS on Kaplan-Meier analysis for both local stage (node-negative, P < .001) and regional stage disease (node-positive, P = .0002). For BCSS, the hazard ratio (HR) for inner quadrant location compared with outer quadrant was 1.31 (95% confidence interval [CI], 1.19 to 1.37; P < .001); and for OS, the HR was 1.12 (95% CI, 1.05 to 1.17; P < .001). When ER and PR status were included in the model, the HR for inner quadrant location compared with outer quadrant was 1.27 for BCSS (95% CI, 1.16 to 1.40; P < .001) and 1.11 for OS (95% CI, 1.03 to 1.19; P = .004). Patients treated by lumpectomy that received RT had a superior OS compared with patients that did not receive RT in both local (HR, 0.52; 95% CI, 0.48 to 0.61; P < .001) and regional (HR, 0.63; 95% CI, 0.56 to 0.72; P < .001) stage disease. Mastectomy patients with local stage disease that received RT had a diminished OS (HR, 1.24; 95% CI, 1.02 to 1.50; P = .033). Conclusion: On multivariate analysis, incorporating data on age, stage, tumor site, tumor size, grade, ER and PR status, axillary lymph node status, extent of surgery, and RT, this SEER registry–based study demonstrates that medial tumor location adversely impacts BCSS and OS.

e18067 Background: The high cost of cancer care creates adverse financial consequences for cancer patients, impacting adherence to treatment, clinical outcomes, and quality of life. Prior studies estimate that 40% of colorectal cancer (CRC) patients experience treatment-related financial burden. This study aims to identify factors associated with financial burden and evaluate its relationship with cancer recurrence. Methods: This cross-sectional study identified individuals diagnosed with stages I-III CRC between 2001 and 2012 through the statewide New Mexico Tumor Registry. A comprehensive survey was administered in 2014. Participants were considered to have experienced financial burden if they reported any treatment-related debt accumulation, bankruptcy filing, other financial sacrifices, or inability to pay medical bills. Multivariable logistic regression was used to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI). Results: Among the 277 CRC survivors who participated in this study, 40% identified as Hispanic and 39% lived in a rural area. Financial burden was reported by 43% of CRC survivors. In a model adjusted for age at diagnosis, sex, race, ethnicity, education, and years since diagnosis, participants who spoke a mixture of English and Spanish (OR: 3.5, 95% CI: 1.3-9.5), those with low health literacy (OR: 2.4, 95% CI: 1.2-4.7), and those with public insurance (OR: 2.2, 95% CI: 1.2-4.4) were more likely to report financial burden. Ethnicity and rural status were not independently associated with financial burden. Six percent (n = 16) of participants experienced a CRC recurrence. Survivors who reported financial burden were 4-times as likely to experience a recurrence (OR: 4.3, 95% CI 1.1-17.7) as those who did not report financial burden. Conclusions: Language, low health literacy, and public insurance may increase the likelihood that CRC survivors experience financial burden. These disparities are alarming given the observed association between financial burden and CRC recurrence. Larger, prospective studies are needed to confirm the association between financial burden and recurrence and to identify potential intervention targets.

551 Background: ASCO guidelines published in 2009 recommend all patients with metastatic colorectal cancer (CRC) receive KRAS testing to guide anti-EGFR monoclonal antibody treatment. Recent literature examining nation-wide trends via the Surveillance, Epidemiology, and End Results (SEER) database showed New Mexico to exhibit the highest KRAS rates of testing out of 18 registries. We aim to explore disparities in KRAS testing in the state of New Mexico. Methods: The New Mexico Tumor Registry (NMTR), a population-based cancer registry participating in the SEER Program, was queried to identify all incident cases of CRC among New Mexico residents from 2010 to 2013. Chi-square tests were used to identify disparity in KRAS testing with a p-value ≤ 0.05 considered significant. Results: A total of 637 patients were diagnosed with metastatic CRC from 2010-2013. As expected, KRAS testing in Stage 4 patients presented the highest frequency (38.4%), though testing in stage 3 (8.5%), stage 2 (3.4%) and stage 1 (1.2%) was also seen. In those with metastatic disease, younger patients (ages 22-39 and 40-64 years) were more likely to receive testing than patients 65 years and older (p < 0.0001). Patients living in or near a metropolitan center received KRAS testing more often than patients living in non-metro and rural areas (p = 0.016). There were no disparities in testing between male and female patients (39.1 v. 37.7%; p = 0.71) or amongst the predominant ethnic groups (p = 0.66). A small increase in the occurrence of KRAS testing was noted from 2010 to 2013 (34.2 to 42.2%); this trend approached though did not obtain significance (p = 0.07). In stage 4 patients, there were no significant differences in rates of wild-type versus mutant status when examined by age (p = 0.95), sex (p = 0.41), ethnicity (p = 0.41), by progressive years (p = 0.42) or geography (p = 0.35). Conclusions: New Mexico exhibits high rates of KRAS biomarker testing in patients with metastatic CRC. Age and geographic disparities exist in the rates of testing, while sex, ethnicity and the year tested showed no differences. Further study is required to explore the reasons for this disparity in KRAS testing, as well as to determine the motivation for testing in stage 1 through 3 CRC which is contrary to current treatment guidelines.

516 Background: Clear cell RCC (ccRCC) accounts for 70-75% of all kidney and renal pelvis cancers with approximately 16% of patients presenting with distant (metastatic) disease. Five year overall survival (OS) remains dismal at 11.2% for patients with distant disease. Several tyrosine kinase inhibitors (TKI) were approved by US Food and Drug Administration for use in metastatic RCC between 2005 and 2012. While these therapies have been shown to improve outcomes in metastatic ccRCC, the long term impact remains unknown. Methods: The Surveillance, Epidemiology and End-Results (SEER) database was queried for patients aged 18 years and older diagnosed with distant stage (metastatic) ccRCC between 2001 and 2012 in the nine core SEER registries. Analyses were restricted to histologically confirmed cases. Study period was divided into 3-year intervals: 2001-03 (pre-TKI era); 2004-06 (TKI trials era); 2007-09 (early TKI era); and 2010-12 (sequential TKI era). Patients were stratified by age at diagnosis: 18-60 years, 60-69 years, and 70+ years. One, two, and three year, and median cause-specific survival were calculated by Kaplan-Meier method. Differences in cause-specific survival by time period were assessed with the Log-Rank test. Results: A total of 3,747 eligible patients were included in the analysis. For all ages combined, cause-specific survival at three years post-diagnosis was 18.8% for those diagnosed during the period 2001-03 (median 8 months), 22.7% in 2004-06 (median 10 months), 23.2% in 2007-09 (median 9 months), and 28.9% in 2010-12 (median 11.0 months) (p= 0.0004). No statistically significant improvement in survival was observed in patients aged 70 years and above (p= 0.1302). Conclusions: Our analysis quantifies the improvement in survival outcomes in metastatic ccRCC that correlate with TKI use in this setting. While there is evidence that all age groups may have benefitted from these therapies, the impact is least pronounced in patients aged 70 years and above. A SEER-Medicare analysis is planned to evaluate disparities in TKI use in this age group.

160 Background: Gallbladder cancer (GBCA) is a rare malignancy; however, within the U.S. incidence varies geographically. GBCA has a higher occurrence in the American Indian (AI) population versus non-Hispanic whites (NHW) and Hispanics (H). The goal of the study is to determine if clinicopathologic features correlate with ethnicity. Methods: Incident GBCA diagnosed in New Mexico from 1980-2009 were identified from the population-based New Mexico Tumor Registry. Average age-adjusted incidence rates were calculated by direct method using the United States 2000 standard population. Chi-squared statistic was used to assess ethnicity differences in case distribution at diagnosis by sex, age, stage and grade. Cause-specific survival was calculated by the Kaplan-Meier method and assessed with log-rank statistic. Results: GBCA incidence rates in New Mexico are highest for AI (7.6 per 100,000–95% confidence interval (CI)=6.5-8.9), followed by H (2.8 per 100,000 – 95% CI=2.5-3.2) and NHW (1.0 per 100,000 – 95% CI=0.9-1.1). Females are predominantly affected (Table). Median ages varied among NHW (74 years), H (71 years) and AI (69 years). There are no appreciable differences with respect to stage and tumor grade. Cause-specific survival at 60 months is also similar among NHW (20.25%), H (17.94%), and AI (22.43%) (log-rank p-value=0.7388). Conclusions: GBCA has a higher prevalence in AI. Regardless it shares similar characteristics in all evaluated ethnicities as it is predominantly a disease of older females, with similar tumor grade and stage and with equally poor survival. [Table: see text]

357 Background: Anal squamous cell carcinoma (SCC) is rare, but results in significant morbidity and mortality. The aim of this study was to characterize the trends of anal SCC in the U.S. between 1980-2009. Methods: Subjects were identified from records in the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) Program. The study included incident malignant squamous cell cancer of the anus, anal canal, and anorectum diagnosed among nine core areas of the SEER program from 1980-2009. Average annual age-adjusted incidence rates were calculated by the direct method with the U.S. 2000 standard population. 95% confidence intervals were calculated using the Tiwari adjustment. Temporal trends were assessed by joinpoint regression. Results: Incidence rates of anal cancer in the U.S. more than doubled during this period. A linear increase in anal cancer incidence rates was observed with an Annual Percent Change (APC) of 4.6 (p

421 Background: CRC is a leading cause of morbidity and mortality among NM’s American Indians, Hispanics, and non-Hispanic whites. Previous studies have shown that rural residents are more likely than urban dwellers to be diagnosed with late stage disease. Geographically New Mexico is the 5th largest state with a population of 2 million, many of whom reside in rural regions. This study was designed to characterize the association between distance-to-care and stage of disease at diagnosis in NM. Methods: The population-based NM Tumor Registry was used to identify records for all incident cases of CRC between 2001-2008. Latitude and longitude were determined for the place of residence for cancer cases and for the facility where each case was diagnosed. The “Great Circles” algorithm was used to estimate the distance from place of residence to the diagnosing facility. The percentage of cases diagnosed with early stage vs. other stages (i.e., regional, distant, and unknown stages-combined) was assessed by quartile of distance-to-care with the use of the chi-squared test for trend. Multiple logistic regression was used to characterize the association between stage and quartile of distance-to-care while controlling for other factors know to be associated with stage at diagnosis. Results: Analysis was based on 6,291 incident cases of CRC that were diagnosed among NM residents. Latitude and longitude for both place of residence at diagnosis and location of diagnosing facility were available for 4,385 (69.7%) of all incident cases. The percentage of cases diagnosed at early stage was inversely related to the distance between the place of residence at diagnosis and the facility where the cancer was diagnosed, as follows: 41.4% of cases in Quartile 1 (shortest distance-to-care); 39.9% in Quartile 2; 37.8% in Quartile 3; and 35.3% in Quartile 4 (p=0.002).By multiple logistic regression, distance-to-care was a significant predictor of stage at diagnosis after adjustment of sex, age and race/ethnicity. Conclusions: Rural residents of NM who must travel relatively long distances to receive medical care are at increased risk of being diagnosed at late stage colorectal cancer.