S490 I. J. Radiation Oncology d Biology d Physics Volume 75, Number 3, Supplement, 2009

difference in Gleason score or T-Stage among the race groups. Univariate analysis within white and AA race groups revealed forwhite men, risk group, PSA, Gleason and T-Stage were all predictive of 10-year FFbF; for AA men, risk group, PSA and Gleasonwere predictive of 10-year FFbF. Multivariate analysis of each group (white vs AA) using Gleason, PSA, use of hormones, T-Stagerevealed: use of hormones, Gleason, PSA (p\0.001, all 3 factors) and T-Stage (p = 0.017) were all significant predictors for 10-yearFFbF for white men and PSA (p = 0.007) and use of hormones (p = 0.039) were significant predictors in AA men. Multivariateanalysis of factors influencing 10-year FFbF in all patients (n = 1,947) revealed T-Stage (p = 0.004), PSA, Gleason, hormoneuse (p\0.001, all 3 factors) and AA race (p = 0.02) were significant predictors. There was no difference in overall survival or distantmetastatic disease.

Conclusions: AA men appear to present with more intermediate and high risk prostate cancer, mainly due to higher PSA at pre-sentation. In addition, AA race appears to be an independent negative predictor of FFbF. These factors portend a poorer outcome interms of FFbF following prostate brachytherapy and may highlight the need for more aggressive therapy.

Author Disclosure: H.A. Syed, None; R. Burri, None; N. Stone, Prologics LLC, E. Ownership Interest; Nihon MediPhysics, F.Consultant/Advisory Board; R.G. Stock, None.

2685 How Inflated is the Outcome of Patients Treated in a Tertiary Cancer Center Compared to the General

Population of Cancer Patients?

S. El-Sayed1, B. Esche2, T. Ramsay3

1Ottawa Regional Cancer Centre and University of Ottawa, Ottawa, ON, Canada, 2Ottawa Regional Cancer Centre, Ottawa,ON, Canada, 3Department of Epidemiology, University of Ottawa, Ottawa, ON, Canada

Purpose/Objective(s): Despite all the research, much of medical practice is based on center experiences and retrospective surveys.In addition to known and reported biases, the results of these surveys are also limited by the fact that reported experiences are a smallproportion of the total Patients population. Our study aims to quantify the difference in outcome between total population statisticsand the selected cohort of patients seen in a tertiary cancer center in patients with Head and Neck Cancer.

Materials/Methods: A Regional Cancer Centre (RCCDB) Computerized database was created in access inter-relational databasewith comprehensive data entry. This included all demographics, diagnostic, staging, treatment modalities and details, toxicity, out-come data including local control, survival and rate of second primaries. Patients’ charts registered in the period from 1960 to 2005were reviewed. All the Head and Neck data base listings were reviewed to ensure that all patients’ names were captured. Qualityassurance audits were carried out on the charts. Data were entered into the computer. A Sas Statistical package was used for anal-ysis. This was compared with a Provincial database (PDB) which included limited but sufficient information including: Demo-graphics, dates of various events, types of treatment, disease status and Survival statistics, and second primaries. Only patientsfrom the same catchment area were included.

Results: During the period of 1960 to 2005 a total of 6727 patients were registered in the PDB. 1137 arisen in the Oral Cavity(excluding Lips), 635 in the Lips, 256 Nasopharynx, 1272 in the Oropharynx, 379 in the Hypopharynx, 1890 in the Larynx (Supra-glottis - 581 , Glottis - 1279, Subglottis - 30). Reported incidence of second tumors were 6 primary tumors in 1 patient, 5 in 4 pa-tients, 4 in 15 patients, 3 in 68 patients, 2 in 523 patients(8%) and 1 in 6114 patients (91%). Only 1330 (19.6%) of the provinciallyregistered patients were eligible to be included in the Cancer Centre ‘‘comprehensive database’’RCCDB. Survival curves for the 2Data Bases were showing a difference of 15–20% In favour of the RCCDB. Detailed analysis will be presented.

Conclusions: That study highlights the added deficiency in the published literature of reported centre experiences and retrospectiveevaluations. In our study a mere 19.6 % of the patients had well documented data to support reliable toxicity and outcome analysis.That is likely representative of what is reported in the literature. Reported tertiary centers experience likely overestimate survivaloutcome by 15–20%. A well-thought out and carefully designed prospective database of the total population of patients diagnosedwith cancer is a must for developing further reliable scientific evidence.

Author Disclosure: S. El-Sayed, None; B. Esche, None; T. Ramsay, None.

2686 The Future of Radiation Oncology in 2020: How will Changes in the US Population Influence Demand?

B. D. Smith, G. L. Smith, T. A. Buchholz

The University of Texas M. D. Anderson Cancer Center, Houston, TX

Purpose/Objective(s): Ongoing demographic changes due to aging and immigration are substantially changing the compositionof the US population. Between 2010 and 2020, projections from the US Census Bureau indicate that the number of older adults (age$ 65 years) will increase from 40 million to 54 million, and the number of minorities will increase from 104 million to 129 million.Although cancer incidence is known to vary by age and race, it is not known how demographic changes will impact the number ofcancers diagnosed in the US and subsequent demand for radiation therapy. We therefore sought to determine how changes in theUS population will influence demand for radiation therapy in 2020.

Materials/Methods: Using data from the Surveillance, Epidemiology, and End Results (SEER) registry for the years 2003–2005,we calculated overall cancer incidence rates and the percent of patients who received radiotherapy during their first cancer treatmentcourse. Population projections through 2020 were obtained from the Census Bureau. To calculate future demand for radiation ther-apy, we multiplied the age-, gender-, race-, and origin-specific population projections by the current age-, gender-, race-, and origin-specific cancer incidence rates and percent radiotherapy utilization rates. This method assumes that the percent of cancer patientsreceiving radiotherapy will remain constant over time.

Results: For the years 2003–2005, 28% of patients received radiotherapy during their first cancer treatment course. From 2010 to2020, the total number of patients treated with radiation therapy is expected to increase by 23% (from 440,000 patients treated in2010 to 539,000 patients treated in 2020). With respect to age, the number of older adults treated with radiotherapy will increase by36%, compared to an increase of only 2% for younger adults. With respect to race/origin, the number of minorities treated withradiotherapy will increase by 43%, compared to an increase of 17% for non-Hispanic whites. The most common cancers treated

Proceedings of the 51st Annual ASTRO Meeting S491

with radiation therapy in 2020 will include prostate, breast, and lung. Cancers with the greatest percent increase in demand forradiotherapy will include prostate (35% increase), gastric (27%), liver (26%), lung (25%), and pancreas (25%).

Conclusions: The major changes in the demographics of the US population expected over the next ten years are predicted to in-crease demand for radiation oncology services by approximately 23% between 2010 and 2020. Efforts to expand capacity and/ordecrease the length of radiotherapy treatment courses are needed to accommodate growth in demand. Further, a high priority shouldbe placed on clinical research specifically focused on the role of radiation therapy in older adults and minorities.

Author Disclosure: B.D. Smith, None; G.L. Smith, None; T.A. Buchholz, None.

2687 Systematic Review of the Cost-effectiveness of PET in Staging of Non–small Cell Lung Cancer and

Management of Solitary Pulmonary Nodules

J. Q. Cao G. Rodrigues

University of Western Ontario, London, ON, Canada

Purpose/Objective(s): The clinical effectiveness of positron emission tomography (PET) imaging in the assessment and manage-ment of lung cancer patients has been documented. However, due to its significant costs, some jurisdictions have been reluctant toimplement PET as a standard of care. Our objective was to perform a systematic review of the international literature describing thecost-effectiveness of PET imaging in the staging (ST) of non–small cell lung cancer and the management of solitary pulmonarynodules (SPN).

Materials/Methods: The systematic literature searches were conducted in the MEDLINE/PreMEDLINE, EMBASE, and the NHSEconomic Evaluation databases.Our inclusion criteria also included a measurement of study quality as assessed by the previouslyvalidated Quality of Health Economic Studies (QHES) instrument. Studies which did not receive a QHES score greater than 75were excluded. Various characteristics including study methodology/assumptions as well as cost-effectiveness metrics such as in-cremental cost-effectiveness ratio (ICER) based on life years saved and average cost savings per patient (ACSP) were abstractedfrom the literature. Descriptive statistics were generated with all cost amounts converted to a common inflation-adjusted 2007 USDcurrency.

Results: We screened a total of 629 citations, retrieved full texts of 57 potentially eligible articles and included 20 studies thatmet our inclusion criteria. All 20 studies received QHES scores greater than 75 independently by two reviewers (average score87.8). The studies were primarily based on the national health care system perspectives of 8 different countries: Australia (n = 3),Canada (n = 2), France (n = 2), Germany (n = 2), Italy (n = 2), Japan (n = 4), the Netherlands (n = 1), and the United States (n =4). Investigations assessed the SPN scenario (n = 8), the ST scenario (n = 11) and both the SPN and ST scenarios (n = 1). Meanassumed cost of PET scanning was $1267 (range, $769–$2580) in these studies. Median ICER for SPN and ST was $2039($181–$3927) and $4037 ($527–$32618), respectively. Median ACSP for SPN and ST was $518 ($66–$1480) and $1390($143–1633), respectively.

Conclusions: The cost-effectiveness metrics reported in these studies are highly variable and can depend on input variables/as-sumptions including: cost and disease prevalence, diagnostic operating characteristics, the diagnostic strategies assessed, and sta-tistical methodologies utilized. Despite this observed variation within this systematic review, these studies consistently haveconcluded that PET imaging in the context of SPN and S has favorable cost effectiveness characteristics compared to non-PETstrategies.

Author Disclosure: J.Q. Cao, None; G. Rodrigues, None.

2688 Development of a Web-based Radiation Oncology Quality Improvement Initiation (ROQII)

M. Gabel, S. Goyal, N. Patel, D. Pierce, S. Patel, G. Rajagopal, B. Haffty

CINJ/Robert Wood Johnson University Hospital, New Brunswick, NJ

Purpose/Objective(s): Given the global measures of care quality determined by the Joint Commission, National ComprehensiveCancer Network (NCCN), and American College of Surgeons Commission on Cancer (CoC) we developed a detailed web-basedpractice quality improvement tool, ROQII, that measures both patient-specific and department process-specific variables. ROQIIwas developed collaboratively with the American College of Radiology (ACR).

Materials/Methods: The 2008 RWJUH PI plan was used to develop the prototype for ROQII. The prototype was tested againstmanual assessment of 20 patient records, until correlation with detailed review of the record was obtained. The 2009 P.I. measureswere then written into ROQII and the 2009 first quarter P.I. results were obtained. A total of 55 patient records were reviewed indetail for patients having received at least one week of external beam treatments or brachytherapy treatment during a given week.The performance goal for each of the measures was set at 100% compliance, or for treatment variances, less than 0.2% error rate. Ittook an average of three minutes to enter each patient’s data onto the server.

Results: 100% of charts were reviewed at weekly chart rounds, 73% of chart rounds recommendations were acted upon within 48hours, documentation of pain, performance status and risk of fall at the time of consultation were documented in 94.6%, 98% and98% of cases, respectively. Documentation of active pain management for those patients with a score of 3/10 or greater was only31.6 %. Written instructions upon completion of radiation course included complete information on medications (medication, doseand frequency) in 93.5%, follow-up care was consistent with NCCN guidelines in 98.5% patients (breast, prostate, H&N, GI, GYNand lung cancer patients), allergies and dose and agent of chemotherapy were flagged on the chart in 78% and 36% of cases, re-spectively, and patients seen in follow-up were counseled regarding evidence-based cancer screening (for colorectal, breast andcervical cancer) in 71% of cases.

Conclusions: ROQII promotes efficient and accurate PI data collection. Improved efficiency allows for data collection ona wider range of variables, and results direct process improvements. The web-based program encouraged all Radiation Oncol-ogy staff to utilize and review the data, and can easily be made available to other centers planning PI improvements. ROQII