In this modern, multi-institutional cohort of SRS patients, melanoma BM patients had worse FFICP compared to non-melanoma BM patients, and BRAFmut patients had worse FFICP than BRAFwt patients. RN was associated with mutational status and receipt of TT pre-SRS. OS did not vary significantly across groups. This analysis may help inform systemic therapy decisions and future genomic studies for patients with BMs from melanoma.

PurposeInterprofessional education (IPE) is gaining recognition as a means of improving health care delivery and patient outcomes. A primary goal of IPE is improved interprofessional collaboration (IPC). The multidisciplinary team in the radiation oncology clinic requires effective IPC for optimal delivery of radiation therapy. However, there are limited data on IPE and IPC in radiation oncology. This qualitative study aims to characterize IPC in radiation oncology.Methods and MaterialsSemistructured phone interviews were performed from June to August 2019 with radiation oncologists, nurses, dosimetrists, radiation therapists, medical physicists, and medical students across a single academic medical center and affiliated network sites. Interviews were recorded, de-identified, and transcribed verbatim. Resulting transcripts were analyzed using thematic analysis.ResultsSeventeen interviews were performed with 4 radiation oncologists, 2 nurses, 2 dosimetrists, 4 radiation therapists, 2 medical physicists, and 3 medical students. Thematic analysis identified 4 themes: (1) management of the radiation oncology clinic, (2) potential impact of interprofessional training in radiation oncology, (3) current climate of interprofessional education in radiation oncology, and (4) creating an interprofessional training program in radiation oncology. Each theme elicited between 2 and 7 subthemes.ConclusionsFrom the analytical themes that emerged, it is hypothesized that misunderstanding professionals’ roles can lead to communication breakdown, which creates less efficient clinic management and disorganized patient care. Although other medical professionals shadow physicians during their training, physicians are not learning about other professions in the same way. Interviewees from each professional category recommend a formal shadowing program for radiation oncology trainees at the medical student or resident level. Having structured opportunities for IPE is important given competing demands of learners during medical student rotations and residency. This study suggests an unmet need for exposure of radiation oncology medical trainees to IPE with the ultimate goal of improving IPC in the radiation oncology clinic.

The impact of electronic health record (EHR) use on physicians has been studied in specialties other than radiation oncology. However, there are limited data regarding the impact of EHR use on the radiation oncologist. This qualitative study examined the impact of the EHR on radiation oncologists to determine how radiation oncologists perceive the impact of the EHR on their practice and their relationship with patients. Using constructivist grounded theory with voluntary sampling, individual telephone interviews were conducted with United States radiation oncologists from June to August 2019. Each of the interviews lasted around one hour for each interviewee, and a standardized interview transcript was used with an additional question which allowed interviewees to make comments that were not covered in the standardized interview transcript. These interviews were recorded, directly transcribed, and de-identified. Qualitative analysis was used to create consensus codes and themes based on these interviews, and these codes were applied to each of the interviews in order to generate the results. Fifteen radiation oncologists were interviewed (six at academic medical centers, nine in private practice). Radiation oncologists expressed similar views regarding the EHR's impact on their practice and the radiation oncology physician-patient relationship. Seven major themes were elucidated from these interviews: 1) the physician experience as a whole, 2) fatigue/burnout, 3) efficiency, 4) administrative tasks, 5) overall attitude to the EHR, 6) work/life balance, and 7) note writing. The radiation oncologists interviewed stated that they enjoyed their career as a physician, which was made easier by using the EHR, but they were frustrated with the additional work that was required to use the EHR. This additional work primarily involved having to write unnecessarily detailed patient notes for billing purposes which they determined was inefficient and time consuming. Solutions proposed by the interviewees included a more user friendly and efficient EHR with less emphasis on note writing that did not improve patient care. Solutions proposed from the interview subjects include creating a more user friendly EHR for radiation oncologists and making documentation of patient care more efficient. Further exploration of the EHR's impact on radiation oncologists work satisfaction and their interaction with patients is warranted.

Hypofractionated (HF) radiotherapy (RT) is now recommended for the majority of women undergoing breast conserving surgery (BCS). Oncoplastic reconstruction (OR) combines BCS with plastic surgery techniques to allow for oncologic resection while preserving cosmesis. Cosmesis and toxicity for OR with conventionally fractionated (CF) RT is well established. While HFRT is now standard of care, there are limited data reporting cosmesis for women undergoing HFRT after OR. Given OR is a cosmetic procedure, this study aimed to demonstrate acceptable late toxicity and post-treatment cosmesis with HFRT after BCS and OP. Women with > 3 months of follow-up after treatment with BCS, OR and HFRT between 2010 and 2018 were identified. Surgery was performed either as a single or staged procedure with immediate or delayed reconstruction. All women received 42.56 Gy to the whole breast using field-in-field technique. A lumpectomy cavity boost was performed at the discretion of the treating physician. Demographic, disease and treatment characteristics, and toxicity outcomes were recorded. For a subset of patients, pre and post-operative photos were maintained. Cosmesis at the time of most recent follow-up was independently rated by two plastic surgeons and two radiation oncologists (excellent, good, fair, poor). Chi-squared, Mann-Whitney U, and logistic regression were used to assess association between patient/treatment related factors and toxicity. 38 women were identified with a median follow-up of 12 months from completion of HFRT. Median age was 61.5 (61% white, 30% black, and 9% mixed /other). 55% underwent a single procedure with immediate reconstruction. 61% had local tissue rearrangement alone, 20% had mastopexy and reduction, and 24% had flap rearrangement. 16% of women received a lumpectomy cavity boost. Due to inability to accurately delineate the post-surgical tumor bed, the lumpectomy cavity was only contoured in 66% of women. Surgical toxicities were reported in 12% women prior to HFRT. Late cosmesis related toxicities were found in 52% women (table 1) of which the majority (58%) were skin toxicity (all RTOG grade 1). There was no significant association between age, race, BMI, comorbidities, receptor status, chemotherapy status, HFRT treatment position, boost, V105, or max point dose and late cosmesis. Of the cohort with longitudinal photos, cosmesis was rated as excellent in 42%, good in 46%, and fair in 12%. There were no locoregional failures. OR with HFRT has good toxicity profiles and favorable physician rated cosmetic outcomes. It offers an acceptable alternative to CFRT. Further investigation of patient reported cosmesis and prospective evaluation of OR and HFRT is warranted.Abstract 2113; Table 1Late Toxicityn (%)Pain3 (7)Edema4 (12)Fibrosis2 (5)Dimpling0 (0)Nipple retraction2 (5)Volume loss1 (2)Skin changes11 (29) Open table in a new tab