Abstract Background: Detection of circulating tumor DNA (ctDNA) after neoadjuvant therapy for triple negative breast cancer (TNBC) is associated with increased risk of recurrence. Ongoing trials aim to determine whether knowledge of specific genomic mutations in ctDNA can inform targeted adjuvant therapy to improve prognosis. The impact of knowledge of ctDNA status on patient treatment decisions weighing benefit and toxicity is unknown. Methods: 401 women were recruited via the Research Advocacy Network from Young Survivors’ Coalition, Living Beyond Breast Cancer, and Pink-4-Ever Ending Disparities. Participants had to self-report a history of non-metastatic breast cancer and have received chemotherapy in the prior 6 months to 10 years to be eligible. Participants completed a 27 question Qualtrics survey detailing demographics and experience with prior chemotherapy. Based on estimations from prior data, participants were presented with scenarios mimicking residual TNBC and unknown, negative, or positive ctDNA status with corresponding risk of recurrence of 40%, 20%, or 55% respectively. Participants were then presented with 12 scenarios (in random order) combining various degrees of absolute risk reduction (5%, 15%, 35%) with established toxicity profiles of four possible post-neoadjuvant therapies (capecitabine, immunotherapy, PARP inhibitor, and PI3K inhibitor). Participants rated scenarios in terms of acceptability from 0-100. A general linear model with repeated measures (3 × 4) was used to determine the contributions of risk reduction and toxicity to acceptability. Models were also run with the addition of between subject factors: age group (< 40; >40), stage of cancer (Stage 1; Stage 2/3), and previous experience with toxicity (Yes; No), to examine whether any of these factors moderated the effects of risk reduction and toxicity. Effect sizes were determined by partial h2. Results: 286 eligible respondents completed the survey with evaluable responses. Average age was 41.2 (range 27-75). When the hypothetical risk of recurrence decreased from 40% (ctDNA-unknown) to 20% (ctDNA-negative), significantly less participants preferred adjuvant capecitabine vs. no therapy (95.1% versus 63.3%, p< 0.001). Across the 12 scenarios, both benefit (F=448.5, p< 0.001; preference for greater benefit) and toxicity (F=33.64, p< 0.001; preference for lower toxicity) significantly influenced acceptability, but benefit had a much larger effect size than toxicity (h2=0.76 and 0.26, respectively). There was no significant interaction effect, and the pattern of results was not moderated by age, stage of cancer, or prior experience with chemotherapy toxicity. The most preferred scenario (greatest benefit, lowest toxicity) had a mean rating of 87.8/100; however, even when presented with the scenario with the lowest benefit and highest toxicity, the mean rating was still 31.5/100, suggesting that this combination would be acceptable to some individuals. Conclusions: Knowledge of ctDNA-negative status significantly reduced the number of participants preferring adjuvant capecitabine over no further therapy. When faced with ctDNA-positive status, participants preferred maximum risk reduction regardless of toxicity profile. As genomic technology advances, it is imperative that researchers and treating physicians understand its impact on patient decision making. Citation Format: Tarah Ballinger, Gregory Zimet, Elda Railey, Mary Lou Smith, Bryan Schneider. Discerning the impact of ctDNA detection on patient decisions in early-stage breast cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-03-11.

The impact of knowledge of circulating tumor DNA (ctDNA) status on patient decisions in high-risk triple-negative breast cancer (TNBC) weighing benefit and toxicity is unknown. Here, 286 women with a history of non-metastatic breast cancer who had received chemotherapy completed a survey mimicking scenarios of residual TNBC after chemotherapy and unknown, negative, or positive ctDNA status to determine the shift in the decision to receive adjuvant therapy. Participants were then presented scenarios mimicking possible post-neoadjuvant therapies and rated acceptability. A general linear model with repeated measures determined contributions of risk reduction and toxicity. When the hypothetical risk of recurrence mimicked ctDNA negativity, significantly less participants were accepting of adjuvant capecitabine versus no therapy. When presented with ctDNA positivity and increased recurrence risk, the degree of benefit impacted acceptability more than the toxicity profile. As genomic technology advances and ctDNA assays become commercially available, it is imperative to understand the impact on patient decision-making.

Supplementary Table 1 - Candidate SNPs genotyped in EA patients in E1199.

Supplementary Table 2 - Summary of evaluated candidate SNPs in patients with NE in E1199 or E5103.

Supplementary Table 4 - Summary of SNPs with p<0.0001 in EA patients with Grade 2-4 NE in E5103.

Supplementary Figure 1. Principal component analysis for patients in ECOG-5103 Supplementary Figure 2. Regional association (locuszoom) plots of rs3125923.

GWAS with E5103 samples and OpenArray Genotyping with E1199 samples.

e18741 Background: As the indications and complexity of precision medicine in oncology increase, we sought information about current provider needs and experiences. Methods: In early 2023, we conducted qualitative interviews with medical oncologists who reported treating patients with lung, breast, and/or colorectal cancer. Questions focused on use, concerns, patient communication, resources, and needs related to genomic testing and precision medicine. Results: A total of 24 oncologists were interviewed (50% in practice > 20 years, 71% at community sites, 88% general oncology). Three patterns of tumor genomic testing emerged: (1) Frequent use and an exploratory mindset; (2) measured use, often with a limited set of alterations tested initially, focused on actionable findings; and (3) infrequent use, requiring availability of effective and affordable treatment. Concerns included turnaround time (particularly for lung cancer), workflow and electronic medical record (EMR) non-integration, non-actionable results, cost, and tissue adequacy. Most respondents find test results easy to use, focusing on the first two pages; some use the entire report. Respondents identified problems securing patient access to indicated targeted therapies, particularly oral agents with costly copays requiring substantial staff administrative effort, with the greatest challenges faced by underinsured rather than uninsured patients. Recommendations included improving EMR integration, shortening time-to-result, reflex performance so results are available at initial oncology appointment, standardizing result presentation, and addressing cost issues. In addition, some suggested that centralized collection and analysis of patient outcome data would inform questions of actionability and access. Conclusions: This qualitative work identifies several major challenges practicing oncologists face in delivering precision medicine. Notably, downstream issues related to treatment access may influence decisions regarding tumor genomic profiling. Further investigation of barriers and potential solutions is needed.

Introduction: Risk of recurrence underlies virtually all decision-making in early-stage breast cancer (EBC). Yet, patients and physicians (HCPs) express challenges, limitations, and unmet needs related to HCP-patient communication about recurrence risk. Methods: This qualitative study included: (A) 16 individual interviews with patients diagnosed with EBC in the last 2 years, for their ability to draw on their experience and (B) 2 focus groups with consumers who have never had a cancer diagnosis, for their ability to provide the “cancer-naïve” perspective that may more closely match newly diagnosed patients. Prior to and after the qualitative research, several breast cancer HCP thought leaders were consulted regarding questions and takeaways. Patients were identified via Wellness House, a cancer support organization, whose staff provided counseling support in case the topic was distressing to interviewees. Consumers were identified via a nationwide market research panel. Research took place online in 02/2021. Within the domain of HCP-patient communication about risk of recurrence, questions differed a bit for patients vs consumers but focused on: Experience, Desires, Objectives, and Reactions to methods of explaining risk. Discussion guides, recruiting/screening materials, informed consent documents, and processes were submitted to Advarra IRB and received exempt status. Results: A total of 32 women (16 patients; 16 consumers) participated, with a mix of ages, educational attainment, and racial and ethnic social identities. Information needs were high with objectives centered on being part of treatment decision-making and being motivated to adhere to treatment, screening, and follow-up. Respondents noted that communication about hard topics is central to building a trusting HCP relationship. Many patients felt they had not heard much about their risk, with some admitting they did not want to hear about it. HCPs face a mix of attitudes, but no patients thought they were told too much. Communication timing was a central theme. Many described the information overload that occurs at/near diagnosis and felt they might need a general understanding of recurrence risk at that time, with intentional revisiting of recurrence risk at each decision or transition point (most often connected to changes in modalities or treatments). Within ER+/HER2- disease, patients discussed the transition to oral (endocrine) therapies and specifically noted that time with physicians was limited at that point. In such cases, recurrence risk was insufficiently linked to the recommendation to take a long course of oral therapy that often has significant side effects. Some interviewees were reticent to continue oral therapy, particularly without knowing why it mattered. Communication methods garnered a wide mix of reactions and revealed misinterpretations, underscoring the need to simplify and individually tailor tools. Some group-level tailoring is also possible with degree of risk over time differing by subtype and stage. From a “misunderstanding” standpoint, it seemed time horizons were even less likely to be recalled or understood by patients with ER+/HER2- disease. Respondents focused on wanting information on how they could reduce risk (e.g., diet, exercise, alcohol) and many felt they received inadequate information from HCPs. This led them to search elsewhere for such information. Conclusions: Improving HCP-patient communication about risk of recurrence appears very likely to contribute to shared decision-making and adherence. In particular, the timing of communication may offer a key opportunity to achieve these objectives. In addition, providing tips and tools to oncologists to enhance two-way communication may be helpful, particularly to simplify and tailor by subtype and patient need. Citation Format: Mary L Smith, Elda M Railey, Carol B White. Let's talk about it: Communicating about risk of recurrence in early-stage breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P5-15-07.

PURPOSE: Advances in genomic techniques have led to increased use of next-generation sequencing (NGS). We evaluated the extent to which these tests guide treatment decisions. METHODS: We developed and distributed a survey assessing NGS use and outcomes to a survey pool of ASCO members. Comparisons between groups were performed with Wilcoxon two-sample, chi-square, and Fisher's exact tests. RESULTS: Among 178 respondents, 62% were male, 54% White, and 67% affiliated with academic centers. More than half (56%) indicated that NGS provided actionable information to a moderate or great extent. Use was highest (median ≥ 70% of cases) for lung and gastric cancer, and lowest (median < 25% of cases) in head and neck and genitourinary cancers. Approximately one third of respondents reported that, despite identification of an actionable molecular variant, patients were sometimes or often unable to access the relevant US Food and Drug Administration–approved therapy. When NGS did not provide actionable results, individuals reporting great or moderate guidance overall from NGS in treatment recommendations were more likely to request the compassionate use of an unapproved drug (P < .001), enroll on a clinical trial (P < .01), or treat off-label with a drug approved for another indication (P = .02). CONCLUSION: When NGS identifies an actionable result, a substantial proportion of clinicians reported encountering challenges obtaining approved therapies on the basis of these results. Perceived overall impact of NGS appears associated with clinical behavior unrelated to actionable NGS test results, including pursuing off-label or compassionate use of unapproved therapies or referring to a clinical trial.

Abstract Introduction: A growing trend in cancer research is the study of de-escalation of treatment, particularly chemotherapy. The hope is that eliminating or reducing drug(s) from treatment regimens will reduce toxicity burden and increase quality of life without increasing risk of recurrence and death. Large well-designed clinical trials are needed to ensure this hope is a reality. One such trial is EA1181 CompassHER2 pCR, which has an accrual goal of 1,250 patients. Methods: This qualitative study included: (A) 2 focus groups with patients diagnosed with HER2+ breast cancer 3-5 years ago, for their ability to draw on their experience and react to the trial and (B) 3 focus groups with consumers who have never had a cancer diagnosis, for their ability to provide the “cancer-naïve” perspective that may more closely match that of newly diagnosed patients (the EA1181 population). One of the consumer groups was composed of Black women and moderated by a Black facilitator to allow issues to surface that may be specific to this group. Patients were identified via Living Beyond Breast Cancer; consumers were identified via a nationwide market research panel. Groups took place online in April and May 2020, after the COVID pandemic had begun. After a brief introduction to the trial, questions focused on: Reactions and questions, motivations, concerns, and descriptive language. Results: A total of 30 women (11 patients and 19 consumers) participated, representing a mix of age groups, educational attainment, and racial and ethnic social identities. The trial description raised many questions in participants’ minds. Some of the more frequent responses from both patients and consumers related to the rationale for reducing treatment and the side effects and benefits of each drug. Consumers demonstrated confusion between what is to be tested in the trial versus what is part of the neoadjuvant process. Patients questioned the timeline and length of each step. Motivations for participation centered on avoiding some chemotherapy and the associated side effects, costs, and recovery time. Some discussed taking only what is needed. Concerns were significant and centered on: (A) Fear and the feeling that it is best to take everything, (B) Possible lengthened duration of treatment since chemotherapy may be needed after surgery (versus the certainly of having all chemo prior to surgery). The duration issue generated strongly negative reactions among patients who felt they would prefer chemo and its side effects all at once. Some motivations and barriers also seemed tied to the likelihood of not needing post-surgical chemo, with participants expecting thresholds (unaided) of 50% to 80% of the perceived desirable outcome. Language around the concept is a critical issue. Participants expressed many ideas related to possible milder treatment that is modified. The word, de-escalation, garnered very negative reactions including many comparisons to military action. Toxicity is also a term that was less familiar to consumers and disliked by many as it elicits additional fear; “side effects” seems more familiar and palatable. Conclusion: Communication about trials with reduced chemotherapy will need to be effective to lead to successful accrual. Providing tools to oncologists and patients to enhance two-way communication may be necessary to ensure concepts are understood. Since de-escalation is already becoming a term commonly used by researchers, replacing it with a more effective descriptor that is clear and connects to the benefits appears time-critical. Quantifying reactions to language options and other qualitative findings via a survey with a larger sample of consumers and patients is advised. Including patient voices in trial design, as well as consumers particularly for trials for the newly-diagnosed, sheds light on communication needs. Citation Format: Mary L Smith, Elda Railey, Carol B White, Janine Hill, Courtney J Andrews, Gabrielle B Rocque. Consumer and patient reactions to trials of chemotherapy reductions reveal an urgent need to name and explain the concept [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS9-01.

PURPOSETo identify factors that may influence physician participation in tumor profiling studies and to assess the routine use of tumor profiling in clinical practice.METHODSPhysicians in the National Cancer Institute-Molecular Analysis for Therapy Choice (NCI-MATCH) were invited to participate in an electronic survey consisting of 73 questions related to participation in genomic profiling studies, tumor profiling practices and education during usual patient care, and physician background and practice characteristics.RESULTSThe survey response rate was 8.9% (171 surveys returned of 1,931 sent). A majority of respondents practiced in academic medical centers (AMCs). Participation in NCI-MATCH increased workload and cost but resulted in increased professional satisfaction, confidence in treatment recommendation, and subsequent use of tumor profiling. Barriers to patient participation included length of wait time for results and lack of a therapeutic option from the testing. Physicians who worked in AMCs reported a higher use of tumor profiling than did those who worked in non-AMC settings (43% v 18%; P = .0009). Access to a molecular tumor board was perceived as valuable by 56%. The study identified a need for educational materials to guide both physicians and patients in the field of genomic profiling.CONCLUSIONPhysicians who participate in NCI-MATCH perceive value to patient treatment that outweighs the additional effort required; survey results help identify barriers that may limit participation. The current findings have implications for the design of future genomic and other profiling studies.

e19145 Background: Scientific advances in genomics have ushered in new cancer tests and therapies. Many researchers, clinicians and advocates wonder how breakthroughs are implemented in practice. Methods: We examined Next Generation Sequencing (NGS) use, results, actions and outcomes among US oncologists (oncs) in treatment of their patients (pts) with advanced cancer (AC). 178 physician members of ASCO who used NGS for AC pts in past 3 months completed an online survey (response rate=30%). Results: Table shows NGS use, outcomes, and perceptions of treatment response among oncs who treat AC pts. Results from questions that were NOT asked by cancer type: 19% of respondents reported that NGS results guided treatment recommendations to a great extent, and 37% to a moderate extent, 65% reported tests often provided no actionable information; among oncs reporting NGS results provided actionable information, 31% reported they sometimes/often tried but couldn’t obtain the FDA-approved drug; respondents used many approaches to “decide what to do” with results. 83% explored trials, 68% reviewed scientific literature, 64% explored feasibility of FDA-indicated drug, 52% used NGS report recommendations, 47% talked with colleague, and 23% accessed molecular tumor board most (>60%) of the time. Conclusions: Oncologists reported high use of NGS results to guide treatment decisions for pts with select ACs and an associated benefit in some pts. Two-thirds of oncs often experienced lack of actionable information across a broad range of tumor types. Even when NGS yielded actionable information, it was common for oncs to experience problems obtaining FDA-approved drugs. The large number of approaches oncs used to make treatment decisions may suggest an important opportunity to improve decision-making efficiency in healthcare delivery. [Table: see text]

BackgroundAlthough there is increased attention to designing and explaining clinical trials in ways that are clinically meaningful for patients, there is limited information on patient preferences, understanding, and perceptions of this content.MethodsMaximum difference scaling (MaxDiff) methodology was used to develop a survey for assessing patients' understanding of 19 clinical terms and perceived importance of 9 endpoint surrogate phrases used in clinical trials and consent forms. The survey was administered electronically to individuals with metastatic breast cancer affiliated with the Metastatic Breast Cancer Alliance. Analyses were performed using Bayesian P values with statistical software.ResultsAmong 503 respondents, 77% had a college degree, 70% were diagnosed with metastatic disease ≥2 years before survey completion, and 77% had received ≥2 lines of systemic therapy. Less than 35% of respondents reported understanding “fairly well” the terms symptomatic progression, duration of disease control, time to treatment cessation, and endpoints. Income level and time since onset of metastatic disease correlated with comprehension. Patients who had received ≥6 lines of therapy perceived that time until serious side effects (P < .001) and time on therapy (P < .001) were more important compared with those who had received only 1 line of therapy. Positively phrased parameters were associated with increased perceived importance.ConclusionsEven among educated, heavily pretreated patients, many commonly used clinical research terms are poorly understood. Comprehension and the perceived importance of trial endpoints vary over the course of disease. These observations may inform the design, discussion, and reporting of clinical trials.

6531 Background: This survey of Targeted Agent and Profiling Utilization Registry (TAPUR) Study physicians examined use, attitudes, and perception of tumor genomic testing (TGT), defined as any DNA test performed on tumor specimen/plasma. TAPUR is a multibasket study of marketed agents targeting tumor genomics. Methods: 333 physicians at 54 TAPUR sites were surveyed (2016-2017). Survey domains included use of TGT, barriers to ordering TGT, and genomic confidence. Surveys included 3 scenarios for TGT ordering 1) pretreated advanced cancer patients (pts) without options, 2) newly diagnosed, untreated, metastatic pts and 3) early stage/potentially curable pts with standard options. Data were analyzed with descriptive statistics. Results: 112 physicians responded (33%). The table displays demographics and genomic confidence. Respondents reported a median of 25% of their pts had TGT in past 12 months for trials/routine care (range 0-85%). Barriers to testing included access to tumor specimen (86%), insurance coverage (67%), concerns that results will not be actionable (55%), and test issues (wait time, unsure which test/lab to use, test accuracy) (54%). TGT was ordered most often for scenario 1 (96%) and 2 pts (70%). Few respondents (32%) would order testing in scenario 3. Of those who reported testing for scenarios 1 & 2, most told pts that results could inform treatment/prognosis/trials (97%) or may be uninformative (84%). In all scenarios, pt expectations of TGT results were discussed prior to testing. A minority reported frequently telling pts in advance that results could inform heritable cancer susceptibility (37%). Conclusions: Confidence in using TGT was high. TGT was performed most for pts with advanced cancer and few options. Availability of specimens was largest barrier reported, indicating the importance of blood-based tests. Few respondents discussed implications of germline findings in advance, despite growing evidence of germline findings in somatic testing. [Table: see text]

223 Background: We have engaged 10 patient partners in the development and implementation of S1415CD, a five-year pragmatic clinical trial currently in year 3 assessing the effectiveness of a guideline-based colony stimulating factor standing order intervention (NCT02728596). Patient partners serve as part of a 21-person External Stakeholder Advisory Group (ESAG), which also includes providers, payers and guidelines experts. This abstract explores the influence of patient partners on the design, tools and implementation of S1415CD Methods: Patient partners advise the study team on protocol development, patient-facing materials and implementation challenges over four teleconferences each year, annual in-person meetings and targeted email communication. All patient partner input from 2014-2017 was tracked, collected and reviewed for impact on the trial. Results: Input from patient partners led to the refinement of the study’s patient-reported outcome (PRO) survey questions, the creation of a highly utilized patient brochure, and the formation of talking points for clinic staff to help explain the study. Patient partners in conjunction with high performing sites helped develop strategies for sites with lower patient accrual to optimize the approach and consent of study participants. Conclusions: The sustained engagement of patient partners in S1415CD ensured patient-centeredness in trial design and guided the development of PRO surveys and relevant, high quality patient-facing materials. Drawing on experiential knowledge and insights from their roles as caregivers and advocates, patient partners provided valuable feedback that influenced patient approach and engagement in the study. Embedding patient partners in the research continuum has catalyzed critical discussions and problem solving among the patient partners and study team, which has led to patient-centered solutions to study challenges. Clinical trial information: NCT02728596.

PURPOSE:Prior data suggest that breast cancer patients accept significant toxicity for small benefit. It is unclear whether personalized estimations of risk or benefit likelihood that could be provided by biomarkers alter treatment decisions in the curative setting.METHODS:A choice-based conjoint (CBC) survey was conducted in 417 HER2-negative breast cancer patients who received chemotherapy in the curative setting. The survey presented pairs of treatment choices derived from common taxane- and anthracycline-based regimens, varying in degree of benefit by risk of recurrence and in toxicity profile, including peripheral neuropathy (PN) and congestive heart failure (CHF). Hypothetical biomarkers shifting benefit and toxicity risk were modeled to determine whether this knowledge alters choice. Previously identified biomarkers were evaluated using this model.RESULTS:Based on CBC analysis, a non-anthracycline regimen was the most preferred. Patients with prior PN had a similar preference for a taxane regimen as those who were PN naïve, but more dramatically shifted preference away from taxanes when PN was described as severe/irreversible. When modeled after hypothetical biomarkers, as the likelihood of PN increased, the preference for taxane-containing regimens decreased; similarly, as the likelihood of CHF increased, the preference for anthracycline regimens decreased. When evaluating validated biomarkers for PN and CHF, this knowledge did alter regimen preference.CONCLUSIONS:Patients faced with multi-faceted decisions consider personal experience and perceived risk of recurrent disease. Biomarkers providing information on likelihood of toxicity risk do influence treatment choices, and patients may accept reduced benefit when faced with higher risk of toxicity in the curative setting.

60 Background: Chemotherapy-induced peripheral neuropathy (CIPN) is common in cancer patients (pts). CIPN impacts quality of life (QoL) and causes emotional distress and treatment (Tx) delays. No agents are recommended for prevention and one agent is recommended for Tx of CIPN (ASCO Guidelines, 2014). Limited data exist about pt experiences with CIPN. The study goal was to understand pt experiences related to CIPN. Methods: An online, 67-question survey was completed by pts with breast or lung cancer. All had chemotherapy and self-reported moderate (mod) or severe CIPN within the past 2 years (mild CIPN excluded). Pts rated CIPN symptom frequency, socioemotional wellness, and impact on a 6- or 7-point scale (depending on item) and bothersomeness on a 5-point scale. Results were not analyzed by chemotherapy type. Results: Respondents had early breast cancer (EBC; n = 114), metastatic breast cancer (MBC; n = 96), or lung cancer (LC, all stages; n = 65). All EBC and MBC and 72% of LC pts were women; > 80% were White. Moderate CIPN existed in 63%, 67%, and 82% of EBC, MBC, and LC pts; severe CIPN occurred in 37%, 33%, and 18%, respectively. CIPN severity was associated with reduced QoL. Very/extremely bothersome effects on QoL occurred in 63% severe CIPN (n = 86) and 15% mod CIPN (n = 189) pts. Almost all EBC (94%) and two-thirds of MBC and LC pts had persistent CIPN. Symptoms included foot (97%)/hand (88%) numbness/tingling, foot (92%)/hand (81%) discomfort, foot/leg pain (85%), and joint pain (83%). Pts reported reduced physical function, productivity, and socioemotional wellness. Receiving information before Tx was linked with greater chance of mod vs severe CIPN. More pts with mod vs severe CIPN (37% vs 21%) received information about CIPN before chemotherapy. Having healthcare providers (HCPs) ask about symptoms was linked with a greater chance of mod vs severe CIPN. More pts with mod vs severe CIPN (28% vs 17%) had HCPs ask about CIPN symptoms. Conclusions: Learning about CIPN before chemotherapy was associated with a lower chance of severe CIPN. Early and ongoing communication with pts about risks, manifestations, and importance of reporting CIPN may limit severe CIPN and preserve QoL specifically with regards to socioemotional wellness.

e18118 Background: A greater proportion of women diagnosed with MBC are working at the time of diagnosis and through their treatment. We surveyed women with MBC to understand the impact of treatments on symptom burden, ability to perform activities of daily living (ADL), and productivity. Methods: We invited members of three advocacy groups currently living with MBC to participate in a cross-sectional, web-based survey. Respondents completed the MD Anderson Symptom Inventory (MDASI), Rotterdam Symptom Checklist-ADL (R-ADL) and the Work Productivity and Activity Impairment (WPAI) questionnaires. Adjusting for age, race, education, US region, health insurance, and work status, we evaluated outcomes for respondents if they received one of the following agent classes at any time since the diagnosis of MBC: Biologics+Hormonals(BH), Chemo+Biologics(CB), Chemo+Hormonal agents(CH). We also evaluated relationships between symptom burden, ability to perform ADLs, and level of impairment at work. Results: We received 1,169 responses from US residents with complete covariate information. 545 respondents received all 3 agent classes and 116 received only one agent class. Adjusted means for agent classes are reported in the table. Patients receiving BH reported significant differences compared to CB and CH across all measures evaluated. Ability to perform ADLs and symptom burden score were negatively correlated (Pearson r=-0.58, p<0.001). In adjusted analyses, as symptom burden increased, respondents also reported a greater degree of impairment at work (p<0.0001), and level of impairment at work decreased with an increase in the respondent’s ability to perform their ADLs (p<0.0001). Conclusions: These results show that treatments received can affect a number of outcomes including the severity/intensity of symptom burden, the ability to perform ADLs and productivity at work. Agent Class received N MDASI SS MDASI SI R-ADL % impairment WPAI BH 121 3.64* 3.95* 26.2* 36.1* CB 275 4.8 5.1 20.6 60.7 CH 109 4.7 5.0 21.6 56.5 * statistically significant vs. CB, CH (p<0.001). For the MDASI and the WPAI, lower is better. For R-ADL, higher is better.

70 Background: Metastatic breast cancer (MBC) and its treatments can have a significant impact on patients’ health-related quality of life (HRQoL) and daily functioning. To better assess the impact of MBC on HRQoL, we conducted an online survey among women with MBC. Methods: We developed and administered a cross-sectional, web-based survey, and invited registered members of three advocacy groups currently living with MBC to participate. Respondents completed an informed consent and completed assessments on symptom burden using an overall QOL question (1 item), the MD Anderson Symptom Inventory Survey (MDASI), activities of daily living (ADLs, Rotterdam Scale), and impacts on work productivity. Results: We received 1285 complete responses to the survey. Over half the respondents were between 40-49yrs (37%) or 30-39 yrs (26%). The majority were white (87.7%), well-educated (70.7% had a bachelor’s degree or higher), and working at the time of the survey (55%), with private health insurance (63%). After diagnosis with MBC, most patients had received endocrine therapy (44.2% aromatase inhibitors, 27.3% fulvestrant). The most common chemotherapy agents received after diagnosis with MBC were capecitabine (30.1%) and docetaxel (26.9%). The overall mean HRQoL score was 74 (0-100, higher is better). Mean respondent-reported MDASI scores for symptom severity (SS) and symptom interference (SI) were 4.2 and 4.5 (0-10, higher is worse). Mean Rotterdam scale scores to assess ADLs were 23.7 (0-32, higher better). On average, working women with MBC missed 9.3 hours of work in the past 7 days due to their MBC. As symptom burden increased, respondents reported a lower ability to perform ADLs (p < 0.0001) and lower overall HRQoL (p < 0.0001). The ability to perform ADLs decreased with increase in the total number of agents received (p < 0.0001) and time since diagnosis (p < 0.0001). Conclusions: This survey provides valuable insights into health status, ability to perform ADLs, and lost productivity among patients with MBC. Future analyses will present results by tumor subtypes and drug treatments received.