BOOK OF ABSTRACTS - camo-acom.ca€¦ · BOOK OF ABSTRACTS CAMO 2019 ANNUAL SCIENTIFIC MEETING Thursday, May 2, 2019 |MaRS Centre | Toronto, Ontario Co-chair: Dr. Samantha Gray Co-chair:

BOOKOFABSTRACTSCAMO2019ANNUALSCIENTIFICMEETINGThursday,May2,2019|MaRSCentre|Toronto,Ontario

Co-chair:Dr.SamanthaGrayCo-chair:Dr.LaceyPitre

2019CAMOAnnualScientificMeetingBookofAbstracts

TABLEOFCONTENT

ORALPRESENTATIONSAbstract# Title Author Page

23_CAMO_2019BARRIERSTOACCESSINGHEALTHCARESERVICES:AMULTIDISCIPLINARYAPPROACHTOWARDSIMPROVINGPANCREATICCANCERSURVIVALINACANADIANPROVINCE

ElizabethFaour 1

10_CAMO_2019

FIRST-LINE(1L)IMMUNO-ONCOLOGY(IO)COMBINATIONTHERAPIESINMETASTATICRENALCELLCARCINOMA(MRCC):PRELIMINARYRESULTSFROMTHEINTERNATIONALMETASTATICRENALCELLCARCINOMADATABASECONSORTIUM(IMDC)

ShaanDudani 2-3

27_CAMO_2019

RETROSPECTIVEOUTCOMESANALYSISOFPATIENTSWITHUNRESECTABLESTAGE3ANDSTAGE4CUTANEOUSMELANOMATREATEDWITHSYSTEMICIMMUNOTHERAPYINALBERTA

BohdariannaZorniak 4

15_CAMO_2019

THEIMPACTOFGEOGRAPHYANDCENTERVOLUMEONACCESSTOCAREANDOUTCOMESINADVANCEDHEPATOCELLULARCARCINOMA:ARETROSPECTIVEPOPULATIONBASEDSTUDY

IreneYu 5

26_CAMO_2019

PERIOPERATIVECHEMOTHERAPYALONEVERSUSPREOPERATIVECHEMORADIOTHERAPYFORLOCALLYADVANCEDDISTALESOPHAGEALANDGASTROESOPHAGEALJUNCTIONCANCER:A10-YEARREVIEWOFTHEBRITISHCOLUMBIA(BC)CANCERREGISTRY

ShiruLiu 6

22_CAMO_2019MINIMIZINGDRUGWASTAGE(DW)ANDCOSTOFCABAZITAXELUSEDTOTREATMETASTATICCASTRATE-RESISTANTPROSTATECANCER(MCRPC)

Di(Maria)Jiang 7

01_CAMO_2019DOALLPATIENTSWITHHER2POSITIVEBREASTCANCERREQUIREONEYEAROFADJUVANTTRASTUZUMAB?ASYSTEMATICREVIEWANDMETA-ANALYSIS

PaulStewart 8

24_CAMO_2019MEDICALONCOLOGYTRAINEES’PERCEPTIONSOFTHEIREDUCATIONANDPREPAREDNESSFORINDEPENDENTPRACTICE

GeordieLinford 9

ORALPRESENTATIONS

POSTERPRESENTATIONS(MINI-ORALS)Abstract# Title Author Page

04_CAMO_2019DELIVERYOFBLEOMYCINAMONGPATIENTSWITHTESTICULARCANCER:APOPULATION-BASEDSTUDYOFPULMONARYMONITORINGANDTOXICITY

MichaelRaphael 10

13_CAMO_2019

REAL-WORLDOUTCOMESAMONGPATIENTS(PTS)TREATEDWITHGEMCITABINE(GEM)-BASEDTHERAPYPOST-FOLFIRINOX(FFOX)FAILUREINADVANCEDPANCREATICCANCER(APC)

EricaTsang 11

02_CAMO_2019CENTRALNERVOUSSYSTEM-SPECIFICEFFICACYOFCDK4/6INHIBITORSINRANDOMIZEDCONTROLLEDTRIALSFORMETASTATICBREASTCANCER

LongNguyen 12

08_CAMO_2019TIMINGANDCOMPLETIONRATESOFADJUVANTCHEMOTHERAPYFOLLOWINGDEFINITIVESURGERYFORPANCREATICHEADADENOCARCINOMA

DanielBreadner 13

18_CAMO_2019THEINFLUENCEOFADJUVANTCHEMOTHERAPYDOSEINTENSITYONFIVEYEAROUTCOMESINRESECTEDCOLONCANCER

SuganijaLakkunarajah 14

17_CAMO_2019 BREASTCONSERVINGSURGERYFORLOCALLYADVANCEDBREASTCANCER RoochiArora 15


TABLEOFCONTENT

POSTERPRESENTATIONS(RESIDENTS/FELLOWS/MEDICALSTUDENTS)Abstract# Title Author Page

25_CAMO_2019

RELATIONSHIPBETWEENPETRESPONSEANDPATHOLOGICRESPONSEINDISTALESOPHAGEAL/GASTROESOPHAGEALJUNCTIONCANCERS:APROVINCIALPOPULATION-BASEDANALYSIS

IreneYu 16

16_CAMO_2019 MEDICALONCOLOGISTPERSPECTIVESONTHEOUTCOMESOFTHEIDEACOLLABORATION IreneYu 17

11_CAMO_2019 PERSISTENTIMMUNE-RELATEDADVERSEEVENTSAFTERIMMUNECHECKPOINTINHIBITORTHERAPY CamGiles 18

05_CAMO_2019

VOLUMEOFSYSTEMICCANCERTHERAPYDELIVERYANDOUTCOMESOFPATIENTSWITHSOLIDTUMORS:ASYSTEMATICREVIEWANDMETHODOLOGICEVALUATIONOFTHELITERATURE

MichaelRaphael 19

14_CAMO_2019UPTAKEANDIMPACTOFONLINERESOURCESINWOMENWITHBREASTCANCER:APILOTSURVEY-BASEDRESEARCHSTUDY

JaymieWalker 20

03_CAMO_2019DUCTALCARCINOMAINSITU(DCIS)ANDINVASIVEBREASTCANCER(IBC)INCIDENCESINNLASCOMPAREDTOTHERESTOFATLANTICCANADA

NicholasTompkins 21

POSTERPRESENTATIONS(OTHER)Abstract# Title Author Page

12_CAMO_2019THEEFFECTSOFIMMUNOTHERAPYANDNOVELTHERAPIESONMEDICALONCOLOGYWORKLOADINACANADIANPROVINCE

RaviRamjeesingh 22

06_CAMO_2019CLINICALPRACTICEPATTERNSONTHEUSEOFADJUVANTBISPHOSPHONATEFOREARLYBREASTCANCER:ACANADIANPERSPECTIVE

LaraZibdawi 23

09_CAMO_2019IMPLEMENTATIONOFCOMPETENCYBASEDMEDICALEDUCATIONINACANADIANMEDICALONCOLOGYTRAININGPROGRAM:LESSONSFROMOURFIRSTYEAR

AnnaTomiak 24

07_CAMO_2019

DEVELOPINGAFRAMEWORKFORTHEINCORPORATIONOFREAL-WORLDEVIDENCEINTOCANCERDRUGFUNDINGDECISIONSINCANADA:ANUPDATEFROMTHECANADIANREAL-WORLDEVIDENCEFORVALUEOFCANCERDRUGS(CANREVALUE)COLLABORATION

KelvinChan 25


1

ORALPRESENTATION

Abstract#23_CAMO_2019BARRIERSTOACCESSINGHEALTHCARESERVICES:AMULTIDISCIPLINARYAPPROACHTOWARDSIMPROVINGPANCREATICCANCERSURVIVALINACANADIANPROVINCEFaour,E1;ColwellB2,LamondN2,SnowS2,JeyakumarA2,PatilN2,CostaA3,WalshM4,Gala-LopezB4,LivingstoneS4,PeltekianK5,StueckA6,HuangW6,ArnasonT6,andRRamjeesingh2.1DepartmentofMedicine,DalhousieUniversity,Halifax,NovaScotia2NovaScotiaCancerCentre,DalhousieUniversityandQueenElizabethIIHealthSciencesCentre,Halifax,NS3DepartmentofDiagnosticRadiology,DalhousieUniversityandQueenElizabethIIHealthSciencesCentre,Halifax,NS4DivisionofGeneralSurgery,DalhousieUniversityandQueenElizabethIIHealthSciencesCentre,Halifax,NS5DivisionofDigestiveCareandEndoscopy,DalhousieUniversityandQueenElizabethIIHealthSciencesCentre,Halifax,NS6DepartmentofPathology,DalhousieUniversity,Halifax,NSBACKGROUNDPancreaticcancer(PC)isassociatedwiththehighestdeathrateamongcommonmalignanciesandisthefourthleadingcauseofcancer-relateddeathinNorthAmerica.DespitesimilaraccesstotreatmentoptionsacrossCanada,theprovinceofNovaScotia(NS)hasthelowest5-yearsurvivalrateforPC.ToinvestigatereasonsbehindthepoorPCoutcomesinNS,amultidisciplinaryteamwascreatedtoinvestigatebarrierstocareandstreamlinepatientflow.In2016,initialdatainformedthereorganizationofthehepatopancreaticobiliary(HPB)multidisciplinaryteamtowardsthegoalofidentifyingandreducingbarrierstocareand,ultimately,improvingsurvival.METHODSThisqualityimprovementprojectincludedaretrospectivechartreviewofPCpatientdatafromasingleinstitution(TheNSCancerCenter),whereover80%ofPCpatientsfromthisprovinceareseen.AreviewofPCdiagnosis,referralspatterns,andwaittimedatawasundertaken.RESULTSDatawasextractedon365patientswithadiagnosisofPCbetween2011and2014.Duringthatperiod,only40.4%ofpatientsdiagnosedwithPChadatissuediagnosisandjustover71%hadabaselineCA19-9.ReferralratetoMedicalOncology(MO)was53%,meanwaittimetoseeMOwas37.2daysandonly23%ofpatientsreceivedsystemictreatment.Initiativestoimproveaccesstocareincludedstandardizationofdiagnosticprocedures,earlytriagingofreferrals,transferofport-a-cath(PAC)insertionsfrominterventionalradiologytotheHPBsurgeons,andthecreationofprovincialguidelines,whichwereimplementedin2016.PositiveImprovementswereobservedinallidentifiedbarrierstocare.

CONCLUSIONBarrierstoaccessingcareforPCpatientsinNSwereidentified,andamultidisciplinaryteamproposedprovincialguidelineswereimplementedtoexpeditecare.Preliminaryresultsshowimprovementinallaspectsofhealthcaredelivery.Survivaldatawillbeavailableinlate2019.

2011-2014(365patients) 2017-2018(134patients) %changeReferraltomedicalOncology 53.2% 61.9% +8.7%Ca19-9acquired 71.3% 89.9% +18.6%Tissue/CytologyDiagnosis 40.4% 82.9% +42.5%Receivedchemotherapy 23.3% 73.9% +50.6%TimetoSeeMO 37.18days(0-93days) 15.8days(0-81days) -57.5%TimetoseeHPBSurgery 19.1days(0-76days) 12.4days(0-33days) -35.1%TimeforPACinsertion NotavailableasFOLFIRINOX

wasnotusedexceptin10patients

10days n/a


2

ORALPRESENTATION

Abstract#10_CAMO_2019FIRST-LINE(1L)IMMUNO-ONCOLOGY(IO)COMBINATIONTHERAPIESINMETASTATICRENALCELLCARCINOMA(MRCC):PRELIMINARYRESULTSFROMTHEINTERNATIONALMETASTATICRENALCELLCARCINOMADATABASECONSORTIUM(IMDC)ShaanDudani1,JeffreyGraham1,J.ConnorWells1,SumantaKPal2,NazliDizman2,FredeDonskov3,GeorgABjarnason4,AaronHansen5,MarcoIafolla5,UlkaNVaishampayan6,CamilloPorta7,BenoitBeuselinck8,FloraYan9,LoriAWood10,ElizabethLiow11,ChristianKKollmannsberger12,TakeshiYuasa13,ChiyuanAZhang14,ToniK.Choueiri15,DanielYCHeng11TomBakerCancerCentre,UniversityofCalgary,Calgary,AB,Canada2CityofHopeComprehensiveCancerCenter,Duarte,CA3AarhusUniversityHospital,Aarhus,Denmark4SunnybrookResearchInstitute,Toronto,ON,Canada5PrincessMargaretCancerCentre,Toronto,ON,Canada6KarmanosCancerCenter,Detroit,MI7IRCCSSanMatteoUniversityHospitalFoundation,Pavia,Italy8UniversityHospitalsLeuven,LeuvenCancerInstitute,Leuven,Belgium9UniversityofTexasSouthwesternMedicalCenter,Dallas,TX10QueenElizabethIIHealthSciencesCentre,Halifax,NS,Canada11EasternHealth,BoxHill,Australia12BritishColumbiaCancerAgency,Vancouver,BC,Canada13CancerInstituteHospitalofJapaneseFoundationforCancerResearch,Tokyo,Japan14StanfordHospital,Stanford,CA15Dana-FarberCancerInstitute/BrighamandWomen’sHospital/HarvardMedicalSchool,Boston,MABACKGROUNDInmRCC,ipilimumabandnivolumab(ipi-nivo)isa1Ltreatmentoption.Recentdatahavealsoshownefficacyof1LPD(L)1-VEGFinhibitorcombinations.Theefficacyofthesetwostrategieshasnotbeencompared.METHODSUsingtheIMDCdataset,patients(pts)treatedwithany1LPD(L)1-VEGFcombinationwerecomparedtothosetreatedwithipi-nivo.MultivariableCoxregressionanalysiswasperformedtocontrolforimbalancesinIMDCriskfactors.RESULTS164ptsreceived1LIOcombinationtherapy:104treatedwithPD(L)1-VEGFcombinationsand60withipi-nivo.BaselinecharacteristicsandIMDCriskfactorswerecomparablebetweengroups(Table).WhencomparingPD(L)1-VEGFcombinationsvsipi-nivo,1Lresponserates(RR)were30%vs39%(p=0.29),timetotreatmentfailure(TTF)was13.2(95%CI8.3-16.1)vs8.5months(95%CI5.7-14.0,p=0.31),andmedianoverallsurvival(OS)wasnotreached(NR)(95%CI19.7-NR)vsNR(95%CI27.6-NR,p=0.39).WhenadjustedforIMDCriskfactors,thehazardratio(HR)forTTFwas0.77(95%CI0.44-1.35,p=0.36)andtheHRfordeathwas0.94(95%CI0.33-2.71,p=0.91).SimilarresultswereseenwhenrestrictingthecohorttoIMDCintermediate/poorriskptsonly.InptsreceivingsubsequentVEGF-TKImonotherapy,second-line(2L)RR(13%vs45%,p=0.07)andTTF(5.5vs5.4months,p=0.80)forPD(L)1-VEGFcombinations(n=15)vsipi-nivo(n=20)werenotsignificantlydifferent.


3

CONCLUSIONSTheredoesnotappeartobeasuperior1LIOcombinationstrategyinmRCC,asPD(L)1-VEGFcombinationsandipi-nivohavecomparableRR,TTFandOS.AlthoughthereisatrendtowardsdifferencesinRR,theredoesnotappeartobeasignificantdifferenceinTTFforpatientsreceiving2LVEGF-TKItherapy.

PD(L)1-VEGF(N=104) Ipi-Nivo(N=60)

IMDCRiskGroups

Favourable 25/61(41%) 10/42(24%)

Intermediate 27/61(44%) 25/42(60%)

Poor 9/61(15%) 7/42(17%)

IMDCRiskFactors

KPS<80 2/89(2%) 2/57(4%)

Diagnosistotherapy<1yr 58/104(56%) 30/60(50%)

Calcium>ULN 7/77(9%) 8/48(17%)

Hemoglobin<ULN 35/94(37%) 25/55(46%)

Neutrophils>ULN 11/87(13%) 7/49(14%)

Platelets>ULN 11/93(12%) 9/54(17%)

*Allnon-significant(p>0.05)


4

ORALPRESENTATION

Abstract#27_CAMO_2019RETROSPECTIVEOUTCOMESANALYSISOFPATIENTSWITHUNRESECTABLESTAGE3AND4CUTANEOUSMELANOMATREATEDWITHSYSTEMICIMMUNOTHERAPYINALBERTABohdariannaZorniak1,VincentHa1,DimasYusuf2,SunitaGhosh3,PeymanPakseresht3,DerekTilley4,MichaelSmylie1,JohnWalker11DepartmentofMedicalOncology,UniversityofAlberta,Edmonton,Alberta2JeffersonCaryCancerCenter,PinesHealthServices,Caribou,Maine(UnitedStates)3AlbertaHealthServices:CancerControlAlberta,Edmonton,Alberta4GuidelineResourceUnit:CancerControlAlberta,Calgary,AlbertaOBJECTIVERetrospectivelyanalyzethetrueoverallsurvivaldifferencebetweenupfrontcombinationCTLA-4/PD-1treatmentversussingleagentPD-1treatmentinunresectablestage3and4cutaneousmelanoma.RATIONALESinceCTLA-4checkpointinhibitionisonlyfundedinimmunotherapynaïvepatientsinAlberta,itisgenerallynotusedpost-failureofsingleagentPD-1toconfoundsurvivalanalysis.METHODSDatawaselectronicallyextractedDecember6,2018fromtheAlbertaCancerRegistry(ACR),ElectronicMedicalRecords(EMR),DischargeAbstractDatabase(DAD)andNationalAmbulatoryCareReportingSystem(NACRS).AllmelanomacancerpatientsinAlbertadiagnosedatage18oroldersince2008whoreceivedimmunotherapywereextracted(n=380patients).AdditionaldatawasmanuallyextractedFebruary8,2019fromEMRrecordsforpatientsreceivingcombinationimmunotherapythroughEdmonton’sSpecialAccessProgram(n=34).Individualimmunotherapytreatmentschemesweremanuallyreviewed.PatientswhoreceivedsingleagentCTLA-4(n=146)oralternateCTLA-4timing(n=4),hadnon-cutaneousmelanoma(n=37)orhadduplicateentries(n=8)wereremoved.Atotalof219patientsremainedforanalysis;n=80(36.5%)receivedcombinationCTLA-4/PD-1andn=139(63.5%)receivedsingleagentPD-1.Descriptivestatisticswereusedtodescribethestudyvariables.LogranktestswereusedtocompareKMcurves.SPSSversion23wasusedforstatisticalanalysisandtwo-sidedp-valueswerereported.RESULTSThe1and2yearsurvivalprobabilityforcombinationCTLA-4/PD-1was87.2%and75.9%.The1and2yearsurvivalprobabilityforsingleagentPD-1was56.1%and42.6%.P-value<0.0001.MediansurvivalforcombinationCTLA-4/PD-1wasnotreachedandforsingleagentPD-1was18.5months(95%CI:9.98-26.94).CONCLUSIONAmongimmunotherapynaïveunresectablestage3and4cutaneousmelanomapatients,realworlddatafromAlbertashowsupfrontcombinationCTLA-4/PD-1treatmentimprovessurvivalcomparedtosingleagentPD-1treatment.


5

ORALPRESENTATION

Abstract#15_CAMO_2019THEIMPACTOFGEOGRAPHYANDCENTERVOLUMEONACCESSTOCAREANDOUTCOMESINADVANCEDHEPATOCELLULARCARCINOMA:ARETROSPECTIVEPOPULATIONBASEDSTUDYIreneS.Yu1,LucyS.Liu1,ValeriyaZaborska2,TylerRaycraft2,SharleneGill1,2,JanineDavies1,21BCCancer,Vancouver,BC2UniversityofBritishColumbia,Vancouver,BCOBJECTIVEThetreatmentofadvancedHCCiscomplexandrequiresspecializedmultidisciplinarycare.WeaimedtocharacterizetheimpactofgeographyandcentervolumeonaccesstocareandoutcomesinHCCpatients(pts).METHODSPtsdiagnosedwithHCCwhoreceived≥1cycleofsorafenibatBCCancerfrom2008to2016wereincluded.Patientswerestratifiedbydistancefromnearestcancercenterasasurrogateforruralvsurbanstatus,andbytreatmentatahighvolumevslowervolumecenter.Chi-squaretestsandKaplanMeiercurveswereusedtotestfordifferencesbetweengroups.RESULTSAtotalof288ptswereidentified:medianage62(IQR56-72),81%male,40%Asian,82%ECOG0/1,and90%ChildPughA.Foretiology,hepatitisC(32%),hepatitisB(31%),andalcohol(25%)relatedliverdiseaseweremostcommon.Nearlyhalf(45%)hadbaselineAFP≥400.Mostptsresidedwithin100km(85%)and106(37%)livedwithinahighvolumecentercatchmentarea.Ethnicityandliverdiseaseetiologyvariedbystratificationgroup(table1).Accesstosubspecialistsweresimilarbetweengroupsstratifiedbydistance(allp>0.05)exceptthoseintheruralgroupweremorelikelytoseeaninternist(p=0.038).Thosewithinahighvolumeareaweremorelikelytoseeahepatologist(81%vs44%,p<0.001),hepatobiliarysurgeon(67%vs41%,p<0.001),and/orinterventionalradiologist(32%vs20%,p=0.03).MedianOSwassimilarbetweengroupsstratifiedbydistance(18.6vs19.4mo,p=0.437).MedianOSwashigherforthehighvolumecentergroup(30.2vs15.6mo,p=0.001).CONCLUSIONSHCCpatientsinproximityofahighvolumecenteraremorelikelytoseespecializedcliniciansandhaveimprovedsurvivaloutcomes.Furtherresearchisneededtobetterunderstandsocialandclinicalfactorsthatinfluencethesefindings.Table1:BaselineCharacteristics Urban(n=244) Rural

(n=44)Pvalue Highvolume

center(n=106)Lowervolumecenter(n=182)

Pvalue

Age≥65 110(45%) 17(39%) 0.428 52(49%) 75(41%) 0.196Male 200(82%) 34(77%) 0.463 89(84%) 145(80%) 0.368Asian 112(46%) 2(5%) <0.001* 68(64%) 46(25%) <0.001*ECOG0/1 199(82%) 36(84%) 0.688 94(90%) 141(78%) 0.006*ChildPughA 224(92%) 35(80%) 0.014* 99(93%) 160(88%) 0.172HepB+ 83(34%) 5(11%) 0.003* 54(51%) 34(19%) <0.001*HepC+ 72(30%) 20(46%) 0.037* 28(26%) 64(35%) 0.125Alcoholrelated 56(23%) 17(39%) 0.028* 15(14%) 58(32%) 0.001*


6

ORALPRESENTATION

Abstract#26_CAMO_2019PERIOPERATIVECHEMOTHERAPYALONEVERSUSPREOPERATIVECHEMORADIOTHERAPYFORLOCALLYADVANCEDDISTALESOPHAGEALANDGASTROESOPHAGEALJUNCTIONCANCER:A10-YEARREVIEWOFTHEBRITISHCOLUMBIA(BC)CANCERREGISTRYShiruL.Liu1,IreneS.Yu1,SallyLau2,YizhouZhao3,DevinSchellenberg3,SharleneGill1andHowardLim1.1DepartmentofMedicalOncology,BCCancer,Vancouver,BC2DivisionofHematologyandMedicalOncology,PrincessMargaretCancerCentre,Toronto,ON3DepartmentofRadiationOncology,BCCancer,Vancouver,BCOBJECTIVESTheoptimaltreatmentmodalityforcancerofthedistalesophagus(DE)andgastroesophagealjunction(GEJ)remainscontroversial.ThisstudyevaluatespatternsofpracticeinBC,ratesofsuccessfulsurgicalresection,andsurvivaloutcomesofpatientstreatedwithperioperativechemotherapyalone(CA),perMAGICorFLOT4protocol,versuspreoperativechemoradiotherapy(CRT),perCROSSprotocol.METHODSWeundertookaprovincialanalysisofinitiallyresectable,locallyadvanced,cancersoftheDEand/orGEJwhounderwentsurgeryinBC,from2008to2018.Baselinepatient,tumor,treatment,andclinicaloutcomedatawerecollectedfromtheBCCancerRegistry.Kaplan-Meiersurvivalandmultivariateregressionanalyseswereconducted.RESULTSAmong575patients,468underwentsurgery.107(18.6%)progressedduringpreoperativetherapyand24(5%)werefoundtobeunresectableatthetimeofsurgery(Table).MoresurgerieswereabortedintheCAcohort(N=18,12%)comparedtoCRT(N=6,2%)(p<0.001).WhileDEinvolvingGEJ(N=251,54%)istreatedmostlywithCRT(82%),GEJalone(N=217,46%)istreatedwithCRT(53%)andCA(47%)(p<0.001).CRT(59.3%)isapredictorofcompleteorpartialpathologicresponsecomparedtoCA(38.5%)(p=0.002).R0resectionratewas90%and94%intheCAandCRTcohort,respectively(p=0.383).Thereisnostatisticallysignificantdifferenceinoverallsurvival(OS),withmediansof29.6and26.0monthsforpatientstreatedwithCAandCRT,respectively(p=0.723),andthisissimilarinGEJonlypatients(p=0.767).Cancer-specificsurvivalisalsonotsignificantlydifferent(p=0.565).IntheCAcohort,37%ofpatientscompleteall8cyclesofFLOTand52%ofpatientscompleteall6cyclesofMAGIC(p=0.396).CONCLUSIONPatientstreatedwithCRThavehigherratesofsuccessfulsurgicalresectionandpathologicresponse,buttheirsurvivalisnotsignificantlydifferentcomparedtothosetreatedwithCA.Table Total Surgeryattempted Surgerycompleted Pathologic

responseCRT 420 322 316 156(59.3%)CA 155 146 128 47(38.5%)Total 575 468 444 203(52.7%)


7

ORALPRESENTATION

Abstract#22_CAMO_2019MINIMIZINGDRUGWASTAGE(DW)ANDCOSTOFCABAZITAXELUSEDTOTREATMETASTATICCASTRATE-RESISTANTPROSTATECANCER(MCRPC)Di(Maria)Jiang,NazaninFallah-Rad(co-firstauthor)RoyLee,PamelaNg,AlanD.Smith,AaronRichardHansen,AnthonyM.Joshua,SrikalaS.SridharPrincessMargaretCancerCenter,UniversityHealthNetwork,UniversityofToronto,Ontario,CanadaINTRODUCTIONCabazitaxelusedinmCRPCisonlyavailableinsingle-dose60mgvialsandhasshortreconstituteddrugstability,resultinginsubstantialDWandunnecessarycost.Weaimedtodeterminefeasibilityandcostsavingsofabatchingstrategytofacilitatevialsharing.METHODSCabazitaxel20mg/m2(withoutGCSFprophylaxis)wasadministered3-weeklyonMondayswheneverpossible.Drugwaspreparedafterpatientarrival.Left-overdrugwassavedforsubsequentpatientsonthesameday.Dosesadministered,discarded(DW)and#vialsusedwereobtainedfrompharmacyrecords.Allcostcalculationswerebasedonmarketprice($96.7CAD/mg)accountingforSanofi’sdiscountincentive(5vialsforthepriceof4).Weestimateddrugcostwithoutbatchingbyassigning1vial/treatment.Drugcostwithbatchingwascalculatedfromtheactual#vialsused.RESULTSBetween09/2015and09/2018,74patientsreceived404Cabazitaxeltreatmentson164daysusing322vials.Patientswerebatchedon68%treatmentdays.Batching3-5patientssaved1vial,andbatching6-7patientssaved2vials.Averagedose/treatmentwas37mg(20-45mg).Costssavingsareshownbelow.

#Patientsbatched

#days

NoBatching Batching

DrugCostSavedDrugCost DWCost DrugCost DWCost

1 53 $235,561 $119,229 $235,561 $119,229 0

2 36 $327,233 $158,685 $327,233 $158,685 0

3 39 $536,105 $257,609 $372,489 $31,331 $163,616 31%

4 24 $446,758 $211,193 $330,718 $71,945 $116,040 26%

5 6 $139,248 $70,881 $92,832 $12,861 $46,416 33%

6 5 $139,248 $67,883 $92,832 $9,863 $46,416 33%

7 1 $34,820 $15,665 $23,208 $4,061 $11,612 33%

Total $1,879,848 $721,285 $1,496,916 $326,846 $382,932 20%

CONCLUSIONBatchingCabazitaxeltreatmentsonedayperweekwasfeasibleandsignificantlylowereddrugcostsbyreducingwastage.Thisstrategycouldalsohelpmitigatecostsassociatedwithwastageforotheroncologydrugs.


8

ORALPRESENTATION

Abstract#01_CAMO_2019DOALLPATIENTSWITHHER2POSITIVEBREASTCANCERREQUIREONEYEAROFADJUVANTTRASTUZUMAB?ASYSTEMATICREVIEWANDMETA-ANALYSISPaulStewart1,PhillipBlanchette1,PrakeshS.Shah2,3,XiangY.Ye3,R.GabrielBoldt4,RicardoFernandes1,TedVandenberg1,JacquesRaphael1

1DepartmentofOncology,DivisionofMedicalOncology,TheUniversityofWesternOntario,London,Ontario2InstituteofHealthPolicy,ManagementandEvaluation,UniversityofToronto,Toronto,Ontario3DepartmentofPediatrics,MountSinaiHospital,Toronto,Ontario4LondonRegionalCancerProgram,LondonHealthSciencesCentre,London,OntarioOBJECTIVEOurobjectivewastoconductasystematicreviewandmeta-analysisofrandomizedtrialsinpatientswithHER2positivebreastcancertoassesswhetherashorterdurationofadjuvanttrastuzumabwasnon-inferiortooneyearoftreatment.METHODSPubMed,EMBASEandTheCochraneLibraryweresearchedforeligiblerandomizedtrials.Hazardratios(HR)fordiseasefreeandoverallsurvival(DFS,OS)wereweightedusinggenericinversevarianceandpooledinameta-analysisusingrandom-effectsmodels.Themedianofnon-inferioritymarginsderivedfromeachtrialwascalculatedtosetanon-inferioritymarginof1.29forthepooledanalysis.Subgroupanalysescomparedsurvivaloutcomesbyhormonereceptorstatus,nodalstatus,lengthandtimingoftrastuzumabtreatment.RESULTSDataof11,376patientsfrom5trialswereanalyzed.Ashorterdurationoftrastuzumabwasnon-inferiortooneyearoftherapyforDFS(HR1.13,95%CI1.03-1.24)butworseforOS(HR1.16,95%CI1.02-1.32).Inaddition,non-inferiorityforDFSwasmetforpatientswithestrogenreceptor(ER)positivedisease(HR1.1,95%CI0.95-1.28)andpatientstreatedwith6months(HR1.09,95%CI0.98-1.22)orsequentialtrastuzumab(HR0.97,95%CI0.75-1.27).Conversely,non-inferiorityforDFSwasnotmetforpatientswithERnegativedisease,nodenegativedisease,andpatientstreatedwith9weeksorconcomitanttrastuzumab.CONCLUSIONWithinthelimitationsoftheavailabledataandthedifferentnon-inferioritymarginsusedinrandomizedtrials,ashorterdurationofadjuvanttrastuzumabisnon-inferiortooneyearoftherapyinpatientswithHER2positivebreastcancerforDFS,particularlyinpatientswithERpositivedisease.Furthertrialswithappropriatelychosennon-inferioritymarginsareneededtoconfirmtheoptimaldurationoftrastuzumabinpatientswithlow-riskdisease.


9

ORALPRESENTATION

Abstract#24_CAMO_2019MEDICALONCOLOGYTRAINEES’PERCEPTIONSOFTHEIREDUCATIONANDPREPAREDNESSFORINDEPENDENTPRACTICEGeordieLinford1,NazikHammad1,NancyDalgarno2,NicholasCofie2,RaviRamjeesingh3,AnnaTomiak11DepartmentofOncology,CancerCenterofSoutheasternOntario,Kingston,Ontario,Canada2OfficeofProfessionalDevelopmentandEducationalScholarship,FacultyofHealthSciences,Queen’sUniversity,Kingston,Ontario,Canada3DivisionofMedicalOncologyandDepartmentofCommunityHealthandEpidemiology,NovaScotiaCancerCenter,NovaScotia,CanadaOBJECTIVEToexamineCanadianMedicalOncology(MO)residents’perceptionsandsatisfactionwiththeireducationalexperienceandtheirpreparednessforpracticepriortoinitiationofCompetencyBasedMedicalEducation(CBME).METHODSDigitalsurveysweresenttoMOresidentsinCanadiantraininginstitutionsyearlyfrom2014–2017.Becauseoflowerthanexpectedresponserates,invitationsweresubsequentlyextendedtorecentgraduatescompletingtrainingbetween2009–2014.EthicswasgrantedbyQueen’sUniversity.RESULTSAtotalof71surveyswerecompleted(26residents,26recentgraduates,19unspecified)withrepresentationfrom11trainingprograms.Usefulnessofteachingmodalities:Participantsrankedlearninginaclinicalsettingasmostuseful(6.53/8,1=leastuseful,8=mostuseful)andeducationalsessionsbyresidents(4.24/8)andJournalClub(3.74/8)asleastuseful.Mostparticipantsfelttheirtrainingwasasharedlearner-teacherresponsibility(56.1%)orwaslearner-centered(22.5%).QualityofteachingbyCanMEDsdomain:ParticipantsreportedsimilarlevelsofsatisfactionwithteachingacrossdomainsexceptforManagerwhichscoredlowest(3.46/5,1=poor,5=excellent).Self-assessmentofskills:Participantsweremostsatisfiedbytheirabilitytoassesstheirownperformanceandcompetenceattheendoftraining(7.16/10,1=notsatisfied,10=verysatisfied).Thedegreetowhichtheirprogramssetexpectationsaboutrequiredknowledge,skills,orattitudesatvariouspointsintraining(6.63/10)andparticipantsabilitiestoself-assesstheseskillsduringtheirtraining(6.64/10)scoredslightlylower.PerceivedcompetencebyCanMEDsdomain:ParticipantsreportedhighestperceivedcompetenceintheProfessionaldomain(4.63/5,1=notprepared,5=wellprepared).ThelowestrankeddomainwasManager(3.72/5)followedbyMedicalExpert(3.91/5).CONCLUSIONThissurveyprovidesanoverviewofMOtrainees’perceptionsoftheireducationandpreparednessforpractice.Aplannedfollow-upstudywillassesspotentialimpactsofthetransitiontoCBMEtraining.


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POSTERPRESENTATION(MINI-ORALS)

Abstract#04_CAMO_2019DELIVERYOFBLEOMYCINAMONGPATIENTSWITHTESTICULARCANCER:APOPULATION-BASEDSTUDYOFPULMONARYMONITORINGANDTOXICITYMichaelJ.Raphael1,2,M.DianeLougheed3,4,5,XuejiaoWei1,5,SafiyaKarim6,AndrewG.Robinson1,2,PhilippeL.Bedard7,ChristopherM.Booth1,2,3,51DivisionofCancerCareandEpidemiology,Queen’sCancerResearchInstitute,Kingston,CanadaDepartmentsofOncology2andPublicHealthSciences3,Queen’sUniversity,Kingston,Canada4DivisionofRespirology,DepartmentofMedicine,Queen’sUniversity,Kingston,Canada5InstituteofClinicalEvaluativeSciences,Toronto,Canada6DepartmentofOncology,TomBakerCancerCentre,UniversityofCalgary,Calgary,Canada7DivisionofMedicalOncology&Hematology,DepartmentofMedicine,PrincessMargaretCancerCentre,UniversityofToronto,Toronto,CanadaINTRODUCTIONBleomyciniscommonlyusedtotreattesticularcancerandcanbeassociatedwithseverepulmonarytoxicity.Thereislimitedinformationabouthowcliniciansmonitorpatientsduringtreatmentandtheincidenceofpulmonarytoxicityinroutinepractice.METHODSTheOntarioCancerRegistrywaslinkedtoelectronicrecordsoftreatmenttoidentifyallincidentcasesoftesticularcancertreatedwithorchiectomyandbleomycin,etoposide,andcisplatin(BEP)chemotherapyintheprovinceofOntarioduring2005-2010.Health-administrativedatabaseswereusedtodescribeuseofpulmonaryfunctiontests(PFTs),chestimagingandphysicianvisits.RESULTS475patientsweretreatedwithorchiectomyandchemotherapy.Completechemotherapyrecordswereavailablefor93%(368/394)ofmentreatedwithBEP.Bleomycinwasomittedamong32%(116/368)ofpatients.PFTswereperformedin17%(63/368),17%(61/368)and29%(106/368)ofpatientsbeforeBEP,duringBEP,andwithin2yearsoffinishingBEP,respectively.Duringchemotherapy,62%ofpatients(227/368)hadchestimaging.InthetwoyearsfollowingBEP,23%(85/368)hadaphysicianvisitforrespiratorysymptoms;thisratewassubstantiallyhigheramongmenwithgreaterexposuretobleomycin;40%(24/60)for10-12dosesbleomycinvs21%(53/250)for7-9dosesvs14%(8/58)for1-6doses(p=0.002).Twopercentofmen(8/368)hadvisitcodesforpulmonaryfibrosis.CONCLUSIONSAsubstantialproportionofmentreatedwithBEPwillseekmedicalattentionafterchemotherapyforrespiratorysymptomsandthisisassociatedwithcumulativedoseofbleomycin.UseofPFTsandchestimagingduringtreatmentiscommon.WhetherPFTtestresultsorclinicalsymptomsareleadingtobleomycindoseomissionisuncertain.


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Abstract#13_CAMO_2019REAL-WORLDOUTCOMESAMONGPATIENTS(PTS)TREATEDWITHGEMCITABINE(GEM)-BASEDTHERAPYPOST-FOLFIRINOX(FFOX)FAILUREINADVANCEDPANCREATICCANCER(APC)EricaS.Tsang1,JenniferSpratlin2,WinsonCheung3,ChristinaA.Kim4,ShiyingKong2,ShawnXu2,SharleneGill11BCCancer,Vancouver,BritishColumbia2CrossCancerInstitute,Edmonton,Alberta3TomBakerCancerCentre,Calgary,Alberta4CancerCareManitoba,Winnipeg,ManitobaOBJECTIVESLimitedevidenceexistsfortheselectionofchemotherapyinAPCafterfirst-line(1stL)FFOX.Gemcitabine/nab-paclitaxel(GEMNAB)ispubliclyfundedforsecond-line(2ndL)useintheprovincesofAlberta(AB)andManitoba(MB),butisnotcoveredinBritishColumbia(BC).Wecomparedpopulation-basedoutcomesbyregiontoexaminetheutilityof2ndLGEMNABvs.GEMalone.METHODSWeidentifiedptstreatedwith1stLFFOXbetween2013-2015acrossBC,AB,andMB.BaselinecharacteristicsandtreatmentregimenswerecomparedbetweenAB/MBandBC.SurvivaloutcomeswereassessedbytheKaplan-Meier,andcomparedwithlog-ranktest.RESULTS370ptstreatedwith1stLFFOXwereidentified(145AB/MB,225BC),withamedianageof61y,42%female,and68%withmetastaticdisease(similarinbothgroups).Receiptof2ndLtherapywas49%AB/MBvs44%BC(p=0.35),andtimefromdiagnosisto2ndLtherapymeasured7.6mosAB/MBvs9.4mosBC(p=0.1).Thedistributionof2ndLgemcitabineusewas:72%GEMNAB,23%GEMinAB/MBvs.27%GEMNAB,66%GEMinBC(p<0.001).Medianoverallsurvival(OS)fromdiagnosiswassimilar:12.4mosinAB/MBvs.10.9mosinBC(p=0.75).OnCoxregressionanalysis,regionwasnotsignificant.Asecondarysurvivalanalysisby2ndLregimendemonstratedamedianOSof18.0moswithGEMNABvs14.3mosGEM(p<0.01).CONCLUSIONInourpopulation-basedcomparisonofAPCptstreatedwith1stLFFOX,survivaloutcomeswerecomparableregardlessofpubliclyfundedaccessto2ndLGEMNABvs.GEM.OSbyregimenfavored2ndLGEMNAB,butpatientselectionmaybelargelyresponsibleforthisdifference.RandomizedtrialsareneededtodemonstratethebenefitofGEMNABpost-FFOXinAPC.


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Abstract#02_CAMO_2019CENTRALNERVOUSSYSTEM-SPECIFICEFFICACYOFCDK4/6INHIBITORSINRANDOMIZEDCONTROLLEDTRIALSFORMETASTATICBREASTCANCERLongV.Nguyen1,KatarzynaJ.Jerzak1.1DivisionofMedicalOncologyandHematology,OdetteCancerCentre,SunnybrookHealthSciencesCentre,Toronto,ON,Canada.BACKGROUNDBreastcancerwithcentralnervoussystem(CNS)metastasescarriesapoorprognosisasmostsystemicagentspoorlypenetratetheblood-brainbarrier(BBB).CDK4/6inhibitorshavebeenshowntocrosstheBBBinpre-clinicalandphaseItrials.InphaseII/IIItrialsforhormonereceptor(HR)+/HER2-metastaticbreastcancer,theadditionofaCDK4/6inhibitortoendocrinetherapyhasnearlydoubledtheprogression-freesurvivalbutCNS-specificefficacyispoorlyunderstood.METHODSHere,wereviewunpublisheddatafromphaseII/IIItrialstoevaluatetheCNS-specificefficacyofCDK4/6inhibitorsinHR+/HER2-metastaticbreastcancer.RESULTSRelevantstudiesinclude1ongoingphaseIItrial(NCT02308020)and9publishedphaseII/IIItrials(MONARCH-1,2,and3,MONALEESA-2,3and7,andPALOMA1,2,and3).Thoughpreliminary,resultsfromNCT02308020demonstratedadurablepartialresponsein2/23(8.7%)patientstreatedwithAbemaciclib(5.74monthsandbeyond11.47months,respectively),whereasanother15(65.2%)patientshadstablebrainmetastasesforatleast6months;thistranslatesintoaclinicalbenefitrateof74%.InPALOMA-2,2/666patients(0.3%)hadbrainmetastasesthatwerepreviouslytreatedandstable(1patientineacharm);neitherhadCNSprogression.Newbrainmetastasesdevelopedin5/444patients(1.1%)inthePalbociclibarmand4/222(1.8%)intheplaceboarm.InPALOMA-3,5/521patients(1.0%)hadbrainmetastases;1/1patientintheplaceboarmand1/4patientsinthePalbociclibarmdemonstratedCNSprogression.Othertrialsexcludedpatientswithbrainmetastasesand/ordidnotassesstheCNSasasiteofprogression.CONCLUSIONSLimitedavailabledatasuggestssomeCNS-specificefficacyofCDK4/6inhibitors.Broadeningtrialeligibilitytoincludepatientswithbrainmetastaseswillhelpguideclinicalpracticeandthedesignoffuturestudies.


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Abstract#08_CAMO_2019TIMINGANDCOMPLETIONRATESOFADJUVANTCHEMOTHERAPYFOLLOWINGDEFINITIVESURGERYFORPANCREATICHEADADENOCARCINOMARachelLiu1,DanielBreadner2,SanjayVBPatel1,CarlosGarcia-Ochoa1,AntonSkaro1,KennethLeslie1,StephenWelch21. DivisionofGeneralSurgery,DepartmentofSurgery,LondonHealthSciencesCentre,VictoriaHospital,London,Ontario,Canada2. DepartmentofMedicalOncology,LondonRegionalCancerProgram,London,Ontario,CanadaBACKGROUNDPrognosisofresectablepancreaticadenocarcinomaimproveswiththeuseofadjuvantchemotherapy,howevertheimportanceoftimingandchemotherapycompletionisnotwellunderstood.METHODSAcohortanalysiswasperformedonpatientswhounderwentpancreaticresectionforductaladenocarcinomafromasingletertiaryhospitalbetween2007and2016.Patientswhocompletedadjuvantchemotherapywerecomparedtothosewhodidnot.Overallsurvival(OS)anddisease-freesurvival(DFS)wereassessedusingaCoxproportionalhazardsmodeladjustingforconfoundingvariables.Alogisticregressionanalysiswasperformedtoevaluatewhatfactorsmayinfluenceadjuvantchemotherapycompletionratesfollowingresection.RESULTSThecohortincludedatotalof150patientseligibleforchemotherapy,98receivedadjuvantchemotherapywith54completingtreatment.DFSat1-yearwassignificantlyimprovedwithcompletingchemotherapy(HR0.225,p<0.01).However,thiseffectwasnotseenforoverallDFS(HR0.901,p=0.76).Therewerenodifferencesin1-yearsurvival(HR0.997,p=0.99)orOS(HR0.993,p=0.98)betweenthesegroups.Chemotherapycompletionratesdecreasedwithincreasingage(p<0.01)andimprovedinpatientsreceivingadjuvantradiation(p<0.01).Peri-operativecomplications,pancreaticfistulaandlengthofstaydidnothaveasignificantimpactonchemotherapycompletionrates.Themediantimefromsurgerytochemotherapywas64days,andthisdidnotimpactDFSorOS.Sub-groupanalysisshowedchemotherapycompletionimprovedwithadjuvantradiation(OR4.31,p=0.001),however,thesepatientshadareduced1-yearDFS(p<0.01).CONCLUSIONCompletionadjuvantchemotherapyfollowingpancreaticoduodenectomyforductaladenocarcinomaappearstohaveanearlyandnon-sustainedDFSbenefit.Despiteincompletetreatment,survivaldidnotappeartobeadverselyaffected.Ourcurrentsamplesizesuggestthatcompleteandpartialadjuvantchemotherapyhavesimilarlong-termbenefits.Ourfindingsthatadjuvantradiationincreaseschemotherapycompletionbutalsotheriskofdeathat1yearislikelyrelatedtoaselectionbiasofR1/R2diseaseandpatientsathighriskforearlylocalrecurrence.


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Abstract#18_CAMO_2019THEINFLUENCEOFADJUVANTCHEMOTHERAPYDOSEINTENSITYONFIVEYEAROUTCOMESINRESECTEDCOLONCANCERSuganijaLakkunarajah1,DanielBreadner2,FrancesWhiston3,LarryStitt3,StephenWelch2,3

1DepartmentofMedicine,SchulichSchoolofMedicineandDentistry,London,Ontario2DepartmentofOncology,SchulichSchoolofMedicineandDentistry,London,Ontario3ClinicalResearchUnitattheLondonRegionalCancerProgram,London,OntarioBACKGROUNDANDMETHODSThereisevidencethatachievingadoseintensity>70-80%inadjuvantcoloncancertreatmentimprovessurvival.192consecutivepatientswithresectedstageIIIcoloncancerthatreceivedadjuvantchemotherapyatatertiaryreferralcenterwereretrospectivelyanalysed.Patientswhoreceivedatleast6weeksofadjuvanttherapywereincluded.Theprimaryobjectivewastoassesstheinfluenceofdoseindex(DI)andrelativedoseintensity(RDI)onDFSandOSat3and5yearsinpatientsreceivingfluorouracil-baseddoublettherapywithoxaliplatin(FU-OX),orcapecitabinemonotherapy.FU-OXregimens,CAPOXandFOLFOX,werenotcomparedasavastmajorityofpatientsreceivedFOLFOX.RESULTS66%ofpatientsreceivedFU-OX,while34%receivedcapecitabinealone.Inthecapecitabinegroup,DFSratesfor3and5yearswere69.3%and64.2%respectivelywhileOSrateswere93.4%and87.3%respectively.Similarly,thoseintheFU-OXgroupshowedDFSratesof78.2%and72.4%in3and5years,respectively.OverallsurvivalrateswithFU-OXwere98.4%and95.5%at3and5years,respectively.MedianRDIwas74%forcapecitabineand77%and86%fortheoxaliplatinandFUcomponentswithinFU-OX,respectively.TherewasnosignificantdifferenceinDFSorOSwhencomparingpatientswhoachievedanRDIofaboveversusbelowthemedianorcut-offsat70or80%.TherewasalsonodifferenceinDFSorOSbasedonDI.CONCLUSIONTherewasnosignificantdifferenceinoutcomesbasedonRDIorDIinaretrospectiveanalysisof192patientsthatreceivedchemotherapyforstageIIIresectedcoloncancer.ConsideringtheevidenceoftheIDEAcollaboration,poolingdatafrommultipleinstitutionstoexaminetheinfluenceofRDIandDIonoutcomeswouldbewarranted,specificallywithCAPOXandFOLFOXregimens.


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Abstract#17_CAMO_2019BREASTCONSERVINGSURGERYFORLOCALLYADVANCEDBREASTCANCERRoochiArora,ErikaLee,GhazalehKazemiJuravinskiCancerCentreDepartmentofOncologyMcMasterUniversityTraditionalmanagementoflocallyadvancedbreastcancer(LABC)includesneoadjuvantchemotherapyfollowedbymastectomyandradiation.OvertimethedefinitionofLABChasevolvedandresponsestosystemictreatmenthaveimprovedtothepointwherebreastconservingsurgery(BCS)maybeconsidered.Atthe2016LHIN4DayinBreastCancerconference,regionalconsensusguidelineswereestablishedforidentifyingpatientswhocouldbeofferedBCS.Improvedcosmeticoutcomes,reducedpostoperativecomplicationsandreducedhealthcarecostsaremajoradvantagesofBCSovermastectomy.ThepurposeofthisstudywastodetermineiftheestablishedconsensusguidelinesonBCSforLABCchangedpractice.AretrospectivechartreviewwasperformedofallpatientswithLABCtreatedattheJuravinskiCancerCentrewithneoadjuvantchemotherapyfollowedbysurgerybetweenJune2015-June2017.Atwo-sidedchi-squaretestwasusedtodetermineifthedifferencebetweenproportionsofthosewhounderwentBCSbeforeandaftertheLHIN4Daywasstatisticallysignificant.210patientswereincludedinthisstudy,withamedianageof52.8.Anon-significanttrendofincreasedratesofBCSaftertheLHIN4Daywasobserved(5.4%vs1.6%,p=0.29).AlthoughpreoperativeclipinsertionwasarecommendationforofferingBCS,nopatientsinourreviewreceivedthis.ThisdeficiencyinourcurrentsystemwillbeofgrowingconcernasemergingevidenceisincreasinglysuggestingthatneoadjuvanttherapyalsobeofferedtoearlystageHer2positiveandtriplenegativebreastcancerpatients.Pathologiccompleteresponsewasachievedin16.7%ofallpatients,and88%ofpatientsreceivedneoadjuvantdosedenseACTchemotherapy.Overall,nosignificantchangewasobservedintheratesofBCSbeforeandaftertheestablishmentoflocalconsensusguidelines.However,thelackofpreoperativeclipinsertionmustbeaddressedgiventheexpectedincreaseintheuseofneoadjuvanttherapyforbreastcancer.


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POSTERPRESENTATION(RESIDENTS/FELLOWS/MEDICALSTUDENTS)

Abstract#25_CAMO_2019RELATIONSHIPBETWEENPETRESPONSEANDPATHOLOGICRESPONSEINDISTALESOPHAGEAL/GASTROESOPHAGEALJUNCTIONCANCERS:APROVINCIALPOPULATION-BASEDANALYSISIreneS.Yu1,ShiruL.Liu1,YizhouZhao1,SallyLau2,DevinSchellenberg1,HowardLim1

1BCCancer,Vancouver,Canada2PrincessMargaretHospital,Toronto,CanadaOBJECTIVESTheutilityofPETscans(PETs)topredictoutcomesafterneoadjuvanttreatmentofDE/GEJcancersisunclear.WeaimedtoexploretherelationshipbetweenPETresponseandpathologic/clinicaloutcomesinareal-worldsetting.METHODSPatients(pts)diagnosedwithDE/GEJcancertreatedwithperioperativechemotherapyorneoadjuvantchemoradiationinBritishColumbiawereincluded.Retrospectivechartreviewwasconducted;ptswerestratifiedintoPETresponders(PET-R,>/=35%decreaseinmaxSUV)orPETnon-responders(PET-NR,<35%)groups.Chi-squareandKaplanMeierwereusedtotestforassociationsbetweenvariablesandoutcomes.RESULTSOf576ptsidentified,299(52%)underwentPETsbeforeneoadjuvanttreatmentandsurgery;232(78%)proceededtosurgeryandwereincludedforanalysis.TreatmentregimenscomprisedofCROSS(72%),MAGIC(24%)andFLOT(4%).Medianagewas66(IQR57-72),85%male,91%ECOG0/1,62%GEJinvolvement,and81%adenocarcinomahistology.CharacteristicswerebalancedbetweenthePET-RandPET-NRgroups(allp>0.05).MediantimefromendoftreatmenttoPETswas30days(IQR22-36);67%werePET-R.Pathologiccompleteresponserate(14%vs13%,p=0.079)andypT0-1(31%vs37%,p=0.172)rateweresimilarforPET-RvsPET-NR,respectively.Discordanceratewas34%betweenPETvspathologicresponse(table1).AbortedsurgeryratewashigherinthePET-NRgroup(8%vs3%,p=0.03);70%ofabortedcaseswereduetoperitonealinvolvement.Medianoverallsurvivalwassimilarbetweenthegroups(PET-R31.5movsPET-NR36.1mo,p=0.616).CONCLUSIONSInourpopulation-basedcohort,PETresponsedidnotpredictforpathologiccompleteresponserateoroverallsurvival,butnon-respondersweremorelikelytohavetheirsurgeriesaborted.FurtherstudieslookingattheprognosticandpredictiveuseofPETsarewarranted.Table1:DiscordanceRates Definition N %PrimaryTumourDiscordance

PET-R(decreaseinSUV>/=35%)PathologicstageypT3orhigher

64/232 27.6%

NodalDiscordance NodenegativeonPETPathologicstageypN2orhigher

33/232 14.2%

PrimaryTumourand/orNodalDiscordance

Asabove 79/232 34.1%


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Abstract#16_CAMO_2019MEDICALONCOLOGISTPERSPECTIVESONTHEOUTCOMESOFTHEIDEACOLLABORATIONIreneS.Yu1,AllanA.A.L.Pereira2,MichaelLee1,KrittiKorphaisarn2,DanielRenouf1,SharleneGill1,HowardLim1,ScottKopetz2,JonathanLoree11BCCancer,Vancouver,BritishColumbia2TheUniversityofTexasMDAndersonCancerCentre,Houston,TexasOBJECTIVEWeaimedtocharacterizethereal-worlduptakeoftheIDEACollaborationdataandprescribingpatternsofadjuvantFOLFOX/CAPOXinstageIIIcolorectalcancer.METHODSAlistofquestionsdevelopedby4medicaloncologistsregardingtheviewsofphysicianswhotreatGIcancerstowardtheIDEAcollaborationresultswereformulatedanddistributedusinganonlinesurvey.Descriptivestatisticsandchi-squaretestswereutilizedtosummarizeinformation.RESULTSOf165responses,138werecompleteandincludedforanalysis.ResponsesoriginatedfromSouthAmerica(55%),Canada(25%),Asia(7%),Australia/Oceania(7%)andUnitedStates(4%);59%havebeeninpracticefor≥10years,andpracticesettingswerebalanced(academic34%vs.community30%vs.both36%).PriortoIDEA,FOLFOXwaspreferredoverCAPOX(83vs.17%)exceptinAsia(40vs.60%,p<0.05).SubsequenttoIDEA,ratesofpreferenceforCAPOXincreased(52vs.48%forFOLFOX),whichwasconsistentacrossprescriberlocation,gender,practicesetting,andpracticeduration(allp>0.05).Thepreferredapproachis3moforT1-3N1disease(67%);however30%ofprescriberscontinuetoconsiderthestandardofcareas6mo,and3%consider3moasstandardstageIIItx.ThosefromAustraliaandCanadaaremorelikelytotailordurationbasedondiseaserisk(89%and78%,p<0.05vs.otherlocations).FollowingIDEA,moreoncologists(77%)arewillingtodiscontinueoxaliplatinearlyiftoxicitiesdevelop.Halfofresponders(49%)foundtheIDEAtrialincreasedtheirconfidenceindecisionmakingforadjuvanttx;36%wereunchangedand15%indicateddecreasedconfidence.CONCLUSIONSPriortoIDEA,mostoncologistspreferredFOLFOXbutrealworldsurveydatashowsashiftinpreferencefavoringCAPOX.Themajorityofcliniciansarenowprescribing3monthsofadjuvanttxforlowriskstageIIIcancersandaremorewillingtodiscontinueoxaliplatinearly.


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Abstract#11_CAMO_2019PERSISTENTIMMUNE-RELATEDADVERSEEVENTSAFTERIMMUNECHECKPOINTINHIBITORTHERAPYCameronRGiles1,CarlyCBarron2,ElaineMcWhirter31FacultyofMedicine,McMasterUniversity,Hamilton,Ontario,L8S4L82DepartmentofMedicine,McMasterUniversity,Hamilton,Ontario,L8S4L83DepartmentofOncology,McMasterUniversity,Hamilton,Ontario,L8S4L8Treatmentwithimmunecheckpointinhibitorsleadstoimprovedprogression-freeandoverall-survivalinanumberofcancers.Unfortunately,thenon-specificimmuneresponseinducedbytheseagentsalsoleadstoimmune-relatedadverseevents(irAEs),whichmaypersistdespitewithholdingimmunotherapyand/ortreatmentwithimmunosuppressiveandimmunomodulatingmedications.Thereislittledataintheliteratureontheseprolongednon-endocrineirAEs.WeperformedaretrospectivechartreviewtoidentifypatientswhoexperiencedpersistentirAEs(>6months).Wedescribepreliminaryresultsofsixpatientsmeetingourinclusioncriteria.Onepatientwithmetastaticpancreaticadenocarcinomawastreatedwithtremelimumab+durvalumabanddevelopedgrade3hepatitisrefractorytotreatmentwithoral/intravenoussteroidsandmycophenolate.Twopatientswithmetastaticmelanomaweretreatedwithnivolumabandnivolumab+ipilimumab,respectively.Thefirstdevelopedgrade3dermatitis,thengrade3-4arthritisthatpersistedaftertreatmentwithoral/intra-articularsteroidsandsulfasalazine.Theseconddevelopedgrade3colitisthatwastreatedwithintermittentoral/intravenoussteroidsoverathree-yearperiod,whicheventuallyresolved.OnepatientwithunresectablestageIIICmelanomatreatedwithpembrolizumabdevelopedgrade3peripheralneuropathythatpersisteddespiteoralsteroidtreatment.Twopatientswithmetastaticlungadenocarcinomaweretreatedwithnivolumabandpembrolizumab,respectively.Thefirstdevelopedgrade2arthritisthatpersisteddespiteoral/intra-articularsteroidsandhydroxychloroquine.Theseconddevelopedgrade2mucositisandgrade4dermatitis,withmultipleunsuccessfuloralsteroidtapersduetorepeatedsymptomflares.FouroutofthesesixpatientsexperiencedmorbidityrelatedtotheimmunosuppressivemedicationsusedtotreattheirirAEs.OurinitialexperiencesuggeststhereareasubsetofpatientsreceivingimmunotherapywhoexperienceprolongedirAEs.Theseeventsarechallengingtoclinicallymanageandmayleadtopatientmorbidity.Furtherresearchisrequiredtocharacterizethispopulationandlearntobestmanagetheirtoxicities.


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Abstract#05_CAMO_2019VOLUMEOFSYSTEMICCANCERTHERAPYDELIVERYANDOUTCOMESOFPATIENTSWITHSOLIDTUMORS:ASYSTEMATICREVIEWANDMETHODOLOGICEVALUATIONOFTHELITERATUREMichaelJ.Raphael1,2,RobertSiemens1,3,YingweiPeng1,4,6,FranciscoE.Vera-Badillo2,5,ChristopherM.Booth1,2,61DivisionofCancerCareandEpidemiology,Queen’sUniversityCancerResearchInstitute,Kingston,Canada2DepartmentofOncology,Queen’sUniversity,Kingston,Canada3DepartmentofUrology,Queen’sUniversity,Kingston,Canada4DepartmentofMathematicsandStatistics,Queen’sUniversity,Kingston,Canada5CanadianCancerTrialsGroup,Queen'sUniversityCancerResearchInstitute,Canada.6DepartmentofPublicHealthSciences,Queen’sUniversity,Kingston,CanadaBACKGROUNDPatientsundergoingcomplexcancersurgeryhavebetteroutcomeswhencareisprovidedbyhigh-volumesurgeonsandhospitals.Itisnotknownwhetherthisvolume-outcomerelationshipextendstothesystemictreatmentofsolidtumors.METHODSTwoauthorsindependentlyreviewedallstudiesthatwerepotentiallyeligibleforinclusion.Wherenecessary,studyauthorswerecontactedtoobtainadditionalinformation.Studieswerenotassignedaqualityscore.ElementsofthescoringsystemproposedbyInstituteofMedicinetoevaluatesurgicalvolume-outcomestudiesandtherecommendationsbyLivingstonandCaotoevaluatethestatisticalrigorofvolume-outcomestudieswereusedtoevaluatethemethodologicrigoroftheavailableevidence.RESULTSSixteenstudiesincluding441,890patientswereincluded.Cancersitesevaluatedweretesticular(N=7),lung(N=2),melanoma(N=2),renalcell(N=2),pancreas(n=1),esophagogastric(N=1),andcholangiocarcinoma(N=1).Moststudiesadjustedforage(N=14)andstageofdisease(N=14),butfewdidsoforpatientcomorbidities(N=7)orperformancestatus(N=1).Moststudiesevaluatedvolumeasacategoricalvariable(N=13)andusedsingle-levelregression(N=11).Nostudyprovidedanestimateoftherelativecontributionofvolumetothevarianceinsurvivalobserved.Patientstreatedathigh-volumecenterswereyounger,moreaffluent,moreeducated,fromurbanareas,andweremorelikelytohaveprivateinsurance.Fourteenof16studiesconcludedthatincreasingvolumewasassociatedwithbettersurvival.Theunadjusted,absoluteimprovementcomparingthelowesttohighestvolumecategoriesrangedfrom1%to24%.CONCLUSIONSANDRELEVANCETheavailableevidencesuggeststhatvolumeofsystemictherapyprovisionforsolidtumorsmaybeassociatedwithimprovedsurvival.However,eachstudyidentifiedinthisreviewcontainssuchconsiderablemethodologicshortcomingsand/orunresolvedconfoundingthatestimationofanunbiasedtreatmenteffectisnotpossible.Priortoimplementationofregionalizationpoliciesfurtherhighqualityresearchisneeded.


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Abstract#14_CAMO_2019UPTAKEANDIMPACTOFONLINERESOURCESINWOMENWITHBREASTCANCER:APILOTSURVEY-BASEDRESEARCHSTUDYJaymieWalker1,CraigHHarlos1,2,Josee-LyneEthier3,4,DanielleNDesautels1,21CollegeofMedicine,UniversityofManitoba,Winnipeg,Manitoba2DepartmentofMedicalOncologyandHaematology,CancerCareManitoba,Winnipeg,Manitoba3DepartmentofMedicalOncology,Queen'sUniversity,Kingston,Ontario4DepartmentofMedicalOncology,KingstonHealthSciencesCentre,Kingston,OntarioOBJECTIVEThispilotstudysoughttocharacterizeonlineresourceuseamongwomennewlydiagnosedwithbreastcancer.METHODSWesurveyed27womenreferredtomedicaloncologyatCancerCareManitobaforanewbreastcancerdiagnosis.Participantscompletedabriefsurveybeforetheirinitialconsultation,wheretheywereaskedabouttheirInternetusageandtheirreason(s)forconsultingonlineresources.Theywerealsoaskediftheyanticipatedspecifictreatmentrecommendations.Afterthevisit,weaskedparticipantstocompleteabrieffollow-upquestionnairetodeterminewhatinformationsourcebestpreparedthemforthetreatmentrecommendations.RESULTSParticipantagerangedfrom33to79(meanage56).Twothirds(63%)werefromurbanlocations.Twentyparticipants(74%)consultedtheInternetaboutbreastcancerpriortotheirmedicaloncologyconsultation.TherewasnoassociationbetweenageorruralityandconsultingtheInternet.Nineteen(70%)patientsthoughttheyknewwhichtreatment(s)wouldberecommended;therewasnoassociationbetweenthisandInternetuse.Ofthese19patients,15(79%)expectedtoberecommendedchemotherapy,whileonly11(58%)wereactuallyrecommendedchemotherapy.Nopatientwhowasnotexpectingchemotherapywasrecommendedchemotherapy.Only21%ofparticipantsindicatedthattheInternetwasthemosthelpfulresource.Amongthosewhofoundonlineinformationatallhelpful,themajority(62%)ratedofficialcancer/medicalsocietywebsitesasmostvaluable.Onlyonepatientrefusedtreatment.Shecitedawebsitethatpromotesalternativecancertreatmentsandstronglyopposesconventionalcancertherapiesasthemostvaluableresource.CONCLUSIONThemajorityofwomennewlydiagnosedwithbreastcancerwillconsultonlineresourcesregardingtheirdiagnosis,withofficialcancer/medicalsocietywebsitesratedmosthighly.However,onlinemisinformationremainsaconcern.


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Abstract#03_CAMO_2019DUCTALCARCINOMAINSITU(DCIS)ANDINVASIVEBREASTCANCER(IBC)INCIDENCESINNLASCOMPAREDTOTHERESTOFATLANTICCANADATompkinsN.MSc1,McCarthyJ.,MD1MemorialUniversity,St.John’s,NLInNewfoundlandandLabrador,thereislimiteddataontheincidenceofDCIS,providingtherationaleforthisstudy.CurrentdiagnosisderivesfromhighriskgroupsthataredetectedbymammographyorbyscreeningbreastMRI.TheobjectiveofthisstudywastodeterminewhetherthereisanydifferenceintheproportionofDCIStoinvasivebreastcancerintheNLpopulationvstherestofAtlanticCanadafromtheyearsof2003to2013.AretrospectivecohortstudywasperformedusingpatientswithhistologicallyconfirmedDCISorIBCusingtheprovincialandterritorialcancerregistries(PTCRs),aswellastheCanadianCancerRegistry(CCR).ForincidenceoftotalIBC,theCCRwasassessedusingCANSIMsoftware.FordeterminationofincidenceofDCIS,individualPTCRswerecontactedfornewpureDCIScasesfrom2003to2013.AccordingtotheNewfoundlandandLabrador(NL)cancerregistry,therehasbeenanexponentialincreaseinthenumberofnewlydiagnosedcasesofDCISsince1969.Iftrendscontinue,therecouldbeasmanyas100newcasesofDCISdiagnosedby2020.AfterusingregressionanalysisforeachAtlanticprovince,itisshownthatNShasthelowestincidenceofDCISthatisreportedinAtlanticCanada(averageof6.5%ofnewbreastcancerdiagnosis),howeverinterestinglytheyalsohavethehighestincidenceofIBC.NewfoundlandandLabrador(NL)hasthefastestgrowingincidenceofDCISinAtlanticCanadaaccordingtoregressionanalysis(y=7E-87e0.0995x,R²=0.3417).NLalsohastheonlyincreasingincidencerateofIBCintheAtlanticprovinces.AllotherAtlanticprovinceshaveadecreaseintheincidenceofIBCovertheperiodof2003-2013.ThisstudyshowsthatDCISincidenceisquicklyontheriseinAtlanticCanada.


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POSTERPRESENTATION(OTHER)

Abstract#12_CAMO_2019THEEFFECTSOFIMMUNOTHERAPYANDNOVELTHERAPIESONMEDICALONCOLOGYWORKLOADINACANADIANPROVINCERaviRamjeesingh1,BruceColwell1andDanielRayson11DivisionofMedicalOncology,DalhousieUniversity.BACKGROUNDBothnoveltargetedtherapiesandimmunotherapieshavedramaticallychangedthelandscapeinanumberofdiseasesiteswithpreviouslylimitedtreatmentoptions.Thishasresultedinanimpactonclinicalworkloadforoncologistswithsubspecialtypracticesintheareasofnon-smallcelllung,(NSCLC),melanoma(M),andgenitourinary(GU)cancer.OuraimwastoinvestigatetheshiftinworkloadamongstthesepracticesascomparedtootherdiseasesiteswithinasingleacademiccancercenterinNovaScotia(NS),Canada.METHODSTheNSCancerCenteristheacademiccancercenterfortheprovinceofNSprovidingconsultativeandongoingcareforapproximately72%ofprovincialpatients.Wemanuallyquantifiedappointmentvisits(newconsultation,treatmentandfollowupvisits)aswellastelephonetoxicityandchartchecksbookedfromFebruary1toApril30acrossa3-yearinterval(2016,2017,and2018)andthenextrapolatedthisdatatoderivefullyearestimates.Diseasesitesmostimpactedbytherapiesthathavechangedtreatmentlandscape(NSCLC,MandGU)werecomparedwiththeBreastandGastrointestinaldiseasesites.RESULTSClinicalworkloadincreasedacrossalldomainsoverthe3yearperiodbutthemajorityoftheincreaseisattributedtothe3diseasesites(Table1). 3months

2016201720181yearEstimates

201620172018%increase2016-2018

Combinedcohort: Teletoxicity 150 145 228 600 580 912 52%ChartReview 1409 1495 1737 5636 5980 6948 23.3%Consultations 514 560 554 2056 2240 2216 7.8%Followupvisits 2175 2216 2505 8700 8864 10020 15.1%NSCLC/M/GU: Teletoxicity 93 85 181 372 340 724 94.6%ChartReview 924 948 1225 3696 3792 4900 32.6%Consultations 219 251 287 876 1004 1148 31.1%Followupvisits 1104 1149 1524 4416 4596 6096 38.0%GI/Breast: Teletoxicity 57 60 47 228 240 188 -17.5%ChartReview 485 547 512 1940 2188 2048 5.6%Consultations 295 309 267 1180 1236 1068 -9.5%Followupvisits 1071 1067 981 4284 4268 3924 -8.4%CONCLUSIONSMedicaloncologyworkloadsareincreasingovertimeandnoveltreatments(includingimmunotherapy)indiseasesiteswithpreviouslylimitedoptionslikelyaccountforasignificantportionofthatincrease.Newpatientconsultationmetrics,takeninisolation,donotreflectcurrenttrendsinmedicaloncologyworkload.Hiringpractices,spaceallocationanduseofphysicianextendersmusttakeintoaccounttheseshiftingworkloaddynamicstomitigatephysicianburnoutandpotentialimpactsonqualityandtimelinessofcare.


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Abstract#06_CAMO_2019CLINICALPRACTICEPATTERNSONTHEUSEOFADJUVANTBISPHOSPHONATEFOREARLYBREASTCANCER:ACANADIANPERSPECTIVELaraZibdawi1,DemetriosSimos2,ShaqilKassam2,AmiraRana2,FarrahKassam2,YasminRahim2

1AppliedHealthSciencesDepartment-Kinesiology,UniversityofWaterloo,Waterloo,Ontario,Canada2DivisionofMedicalOncology/Hematology,StronachRegionalCancerCentre,Newmarket,Ontario,Canada

OBJECTIVESTobettercharacterizehowCanadianmedicaloncologists(MOs)useABPsandwhetherpracticepatternsareconcordantwiththeCCO/ASCOguideline.METHODSAbriefsurveywascirculatedbye-mailto618CanadianMOsbetweenNov2017-May2018.Questionsweredesignedtogatherdataondemographics,patientselection,choiceofbisphosphonate,schedule/durationoftreatmentandbarrierstouse.Noincentivewasprovided.RESULTSSixty-eightMOsfrom8Canadianprovincescompletedthesurvey(responserate11.0%).MostpracticedinOntario(65.7%)andjustoverhalf(51.5%)werecommunityoncologists.MOsofferedABPsto52.2%ofmenopausalwomenwithEBC.Usewashigherinthecommunitycomparedtotheacademicsetting(p=0.049).Mostusedzoledronicacid(85.3%)every6months(95.6%)for3years(69.1%)andstartedtreatmentwithin3monthsofcompletingadjuvantchemotherapy/radiation(67.7%).FactorsassociatedwithuseofABPswere:highOncotypeDxscore(89.1%),hightumorgrade(72.1%),triplenegativedisease(63.6%),osteoporosis(87.7%)/osteopenia(83.9%)anduseofaromataseInhibitor(75.0%).ThemostcommonfactorprecludinguseofABPswaspresenceofcomorbidities(89.7%).About1/3rdindicatedtheywouldofferABPstowomenwithstageIHRpositive/Her2negativeEBC.CONCLUSIONCanadianMOshaveaddedintravenousABPstotheirarmamentariumoftherapiesinkeepingwiththespiritoftherecentguideline.High-riskdiseasefeaturesandlowbonedensityappeartobeinfluencingthedecision-makingprocess.Furtherworkaimedatidentifyingthosepatientswhoareunlikelytobenefitfromtreatmentisneeded.


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Abstract#09_CAMO_2019IMPLEMENTATIONOFCOMPETENCYBASEDMEDICALEDUCATIONINACANADIANMEDICALONCOLOGYTRAININGPROGRAM:LESSONSFROMOURFIRSTYEARAnnaTomiak,GeordieLinford,MichelineMcDonald,JaneWillms,NazikHammad.DepartmentofOncology,Queen’sUniversity,Kingston,OntarioOBJECTIVEToshareobservationsandexperiencesfromthefirstyearofCompetencyBasedMedicalEducation(CBME)implementationatQueen’sUniversity.METHODSAssessmentmetricswereobtainedthroughMEdTech,theelectronicplatformforassessmentcaptureatQueen’sUniversity.EthicswasgrantedbyQueensUniversityaspartofanongoingresearchstudyonfeedback.LessonslearnedwerecompiledfromdiscussionsbetweentheProgramDirector,Residents,ProgramAdministrator,CBMEEducationConsultantandCBMElead.RESULTSAtotalof179assessmentswerecompletedbetweenJuly2017andDecember2018.89%wereEntrustableProfessionalActivityassessmentsandtheremainderwerebasedonmultisourcefeedback,rubricsandfieldnotes.Themediannumberofassessmentsperfacultywas16(1-42).52%ofassessmentsincludedwritten“Comments”or“Nextsteps”.Amedianof6assessmentsperfacultymemberincludedspecificoractionablefeedback.Lessonslearnedcenteredon:1)FacultyandResidentdevelopmentandengagement(criticalinvestmentsbefore,duringandafterimplementation);2)ValueofsharingworkofCBME(CBMEEducationConsultant,CBMELead,AcademicAdvisors,CompetenceCommittee);3)Importanceofcollaborationandcommunication(Division,institutional,nationallevels);4)Evolvingculturechangeinmedicaleducation;5)Residentconcernsregardinglackofglobalassessment;6)Assessmentplanchallenges(Howmanyobservationsrequired?);7)BurdenofCBME(Residentdrivenassessmentsorabetterbalance?)8)Limitationsofe-portfolio(Howtolivetrackandbywhom?);9)Costs.CONCLUSIONSOurfirstyearofimplementationwassuccessfulinintroducingCBMEconcepts,workbasedassessmentsande-portfolios.Ongoingworkisneeded,includingincreasingthenumberofassessmentsandqualityoffeedback.


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Abstract#07_CAMO_2019DEVELOPINGAFRAMEWORKFORTHEINCORPORATIONOFREAL-WORLDEVIDENCEINTOCANCERDRUGFUNDINGDECISIONSINCANADA:ANUPDATEFROMTHECANADIANREAL-WORLDEVIDENCEFORVALUEOFCANCERDRUGS(CANREVALUE)COLLABORATIONKelvinKar-WingChan1,WilliamK(Bill)Evans2,AlexChambers3,ClairedeOliveira4,JeffHoch5,ScottGavuraS6.1SunnybrookOdetteCancerCentre,Toronto,Ontario;CanadianCentreforAppliedResearchinCancerControl,Toronto,Canada,2DepartmentofOncology,McMasterUniversity,Hamilton,Ontario,3Pan-CanadianOncologyDrugReview,Toronto,Ontario4CentreforAddictionandMentalHealth,Toronto,Ontario,5DepartmentofPublicHealthServices,UCDavis,CaliforniaUSA,6CancerCareOntario,Toronto,OntarioOBJECTIVETheCanREValuecollaborationisamulti-year,multi-stakeholderinitiativefundedbytheCanadianInstitutesofHealthResearchtodevelopaframeworkforthegenerationanduseofreal-worldevidence(RWE)forcancerdrugstoenable:(i)reassessmentofcancerdrugsbyrecommendation-makers;and(ii)refinementoffundingdecisionsorrenegotiations/reinvestmentbyCanadiandecision-makers/payers.METHODSThecollaborationhasestablished5workinggroups(WG)tofocusondifferentaspectsoftheCanREValueframework.TheRWEplanninganddrugselectionWGwillrecommendcriteriatoidentifypotentialcandidatesforrealworldevaluationandadviseonthenecessaryprovincialinfrastructureneededforRWE.TheRWEDataWGwillrecommendstrategiesfordataaccessandharmonizationofdataelementsrelevantforRWEstudiesacrossprovinces.TheRWEMethodsWGwillrecommendmethodstoanalyzerealworlddatawithmethodologicalrigor.TheRWEUptakeandReassessmentWGwilladviseonstrategiestouseRWEresultsforHTAreassessment.TheRWEEngagementWGwillestablishmechanismstoinformkeystakeholdersonthedraftrecommendationsfromtheWGsandobtainstakeholderfeedbackforconsiderationbytheWGsasrecommendationsaredevelopedinaniterativeprocess.EachWGwillemployarangeoftools,includingteleconferences,face-to-facemeetings,webinarsandsurveystoengagestakeholders,includingclinicians,patientgroups,pharmaceuticalcompaniesandpayers.Toreachmedicaloncologists,theRWEEngagementWGwillprovideCAMOmemberswithupdatesthroughtheAssociation’snewsletter,seekinputtoWGrecommendationsthroughsurveys,andengageacoregroupofoncologistsactiveinthepCODRdrugreviewprocess.CONCLUSIONCanREValueisamulti-stakeholderinitiativetoproviderecommendation-anddecision-makerswithadviceonaframeworkfortheconductanduseofRWEforoncologydrugs.Astheprescribersofoncologyproducts,medicaloncologistsshouldbeawareofCanREValueandavailthemselvesofopportunitiestoshapetherecommendations.

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BOOK OF ABSTRACTS - camo-acom.ca€¦ · BOOK OF ABSTRACTS CAMO 2019 ANNUAL SCIENTIFIC MEETING Thursday, May 2, 2019 |MaRS Centre | Toronto, Ontario Co-chair: Dr. Samantha Gray Co-chair: