e18317 Background: The National Cancer Institute (NCI) Surveillance, Epidemiology, and End Results (SEER) Program curates population-based cancer data representing 34% of the US population. CancerLinQ is an ASCO initiative that collects and analyzes electronic health record (EHR) data to give oncologists opportunities to improve the quality of patient care. With the shared goal of understanding care delivery, NCI SEER and CancerLinQ launched a pilot linkage. Purpose: Establish data exchange between registries and oncology practices to a) provide clinicians with SEER data to more effectively evaluate care within their practices, and b) enhance ability of SEER registries to capture cancer-related data and facilitate compliance of legally mandated public health reporting requirements while supporting metrics for quality reporting to providers. Methods: The SEER Iowa Cancer Registry is developing bidirectional linkages with CancerLinQ practices. The initial pilot in Iowa establishes connectivity and a data pipeline to capture discrete data elements in EHRs. The linkage methods are securely conducted by IMS, an honest broker for the Registry and ASCO. Patterns of care will be evaluated in the matched patient population. Analysis of shared data elements will provide comparative validation of data captured electronically (EHR) and manually (abstraction). Enhancing the patient care quality through efficient utilization of shared data was paramount when selecting treatment-related Quality Oncology Practice Initiative (QOPI) measures for calculation focusing on breast (QPP 449, QPP 450) and prostate cancer (QPP 102, QPP 104). Results: Publicly available SEER data for cohort evaluation is available to providers via SEERLinQ. The two-way exchange data pipeline complies with reporting requirements. Validation of shared data elements, statistics for matched patients, improved data completeness measures, and automated calculation of QOPI measures will be demonstrated. Conclusions: This collaboration builds an initial foundation of curated Registry-EHR linked data to automate cancer reporting to lower the physician burden, improve SEER evaluation of clinical care patterns, and enhance patient care quality.

In the original version of the published article, line three of the third paragraph of the methods stated “Excluding patients with micrometastatic disease, the 5-year BCSM for patients with Recurrence Score results <18 and 1–3 positive nodes (n = 2,617) was 1.3% (95% CI, 0.6–2.9%).” To improve clarity this statement has been replaced with “Excluding patients with micrometastatic disease, there were 2,617 patients with 1–3 positive nodes. Of these, 1,487 also had Recurrence Score results <18 with 5-year BCSM of 1.3% (95% CI, 0.6–2.9%).” The original version of the published article also contained an error in the second sentence of the Figure 2 legend describing the mutation status of the patient population examined. The sentence in the original published version of the article stated “Patients with HR+, HER2-positive, node-negative…” this has been changed to “Patients with HR+, HER2-negative, node-negative…”. This has been corrected in the PDF and HTML versions of this paper.

BC diagnoses in older patients (pts) are rising as population demographics change and life expectancy increases. The multinational TEAM study (N = 9,766) reported worse outcomes for older pts with HR+ BC (JAMA. 2012;307:590). To confirm this finding and to examine the role of tumor biology, SEER and Genomic Health collaborated to electronically supplement SEER registries with RS results and evaluate BC-specific mortality (BCSM). 21-gene RS results were provided to the NCI-sponsored SEER registries and linked to SEER BC cases. Eligible pts were diagnosed (Jan 2004 – Dec 2011) with N0 HR+ BC, and had no prior malignancy or multiple tumors. BCSM, defined previously (JNCI. 2010;102:1584), was analyzed separately for pts <70 y and ≥70 y. Mortality estimates were compared using a log-rank test. Updated results with longer follow-up will be presented. Of 184,190 eligible pts, 70%/30% were <70 y/ ≥ 70 y. 35,487 of 128,712 pts <70 y (28%) had RS results (median age 55 y; 29%/54% grade 1/2; 26%/54% ≤1 cm/ > 1-2 cm). 4,647 of 55,478 pts ≥70 y (8%) had RS results (median age 73 y; 25%/55% grade 1/2; 20%/48% ≤1 cm/ > 1-2 cm). Reported chemotherapy (CT) use and 5-y BCSM are shown in Table. CT use was lower for pts ≥70 y (p < 0.001). Continuous RS result was associated with BCSM for pts both <70 y and ≥70 y (p < 0.001). As expected, 5-y other-cause mortality was higher in pts ≥70 y (11%) than in pts <70 y (4%) but was not associated with RS results (p = 0.92). 5-y BCSM was worse for pts ≥70 y, particularly for those with RS ≥18 (p < 0.001). For pts ≥70 y with no RS assay (n = 50,422; 4% CT use), 5-y BCSM was 5.4% (95%CI, 5.2%-5.6%).Tabled 1RS <18RS 18-30RS ≥31NCT (%N)5-y BCSM (95% CI)NCT (%N)5-y BCSM (95% CI)NCT (%N)5-y BCSM (95% CI)All pts217607%0.4 (0.3,0.5)1515235%1.4 (1.1,1.7)322270%4.5 (3.5,5.8)<70191378%0.3 (0.2,0.4)1354937%1.2 (0.9,1.5)280172%4.5 (3.5,5.8)≥7026232%1.2 (0.6,2.2)160315%2.8 (1.9,4.2)42153%11.7 (7.1,18.9) Open table in a new tab This large population-based observational study of N0 HR+ BC shows that unacceptably high BCSM persists in US clinical practice for pts ≥70 y with either no 21-gene assay done or an RS ≥18 (but not RS <18). Further research and actions are urgently needed worldwide to understand and address the factors behind this outcome disparity.

6553 Background: The 21-gene assay has been used in clinical practice since 2004 to predict the recurrence and chemotherapy benefit of breast cancer in patients with hormone receptor positive (HR+) disease. This analysis evaluates how the test disseminated in the patient population over time. Methods: Genomic Health data on tests ordered was linked to SEER Registries for women diagnosed with invasive breast cancer between Jan 2004 and Dec 2012. The percent of women for whom Oncotype DX was ordered was calculated for SEER areas covering 30% of the US population. Results: The percent of women for whom the Oncotype DX test was ordered increased from 1.1% in 2004 to 23.1% in 2012. Percent ordering was higher among women with N0 disease, isolated tumor cells and micrometastases (28.8, 37.1, and 34.5 in 2012, respectively). The percent ordering for women with N+ disease (excluding micrometastasic disease) began increasing in 2008 and reached 12.2% by 2012. After restricting the analysis to women with HR+ and N0 disease, a pattern of more rapid dissemination was evident and reached higher levels in younger women with continued low usage in older women. Although there was little difference by race/ethnicity or SES measures overall, differences became apparent when data was stratified by age with non-Hispanic whites and high SES groups showing earlier dissemination and higher usage for women < 65 years of age. For women ≥ 65, there was no difference. Conclusions: In N0, HR+ breast cancer, age is the strongest predictor of whether a woman will receive an Oncotype DX test. This strong dependence on age masks differences among important subgroups of women with earlier age of onset when not controlling for age. This difference may have implication in treatment received and health disparities associated with race/ethnicity and SES.

BACKGROUND : Little empirical evidence exists about the effectiveness of performance management systems in government. This study assessed the effectiveness of the performance management system of the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) and explored why it works. METHODS: Generalized estimating equation models were used to assess change in program performance after the implementation of a performance management system. In addition, qualitative case study data including observations, interviews, and document review were analyzed using inductive methods. RESULTS: Five of the 7 indicators tested had statistically significant increases in performance postimplementation. Case study results suggest that the system is characterized by high‐quality data, measures viewed by grantees as meaningful and fair, and institutionalized data use. CONCLUSIONS: Several factors help to explain the system's effectiveness including characteristics of the NBCCEDP program (eg, service delivery program), qualities of the indicators (eg, process level), financial investment in the system, and a culture of data use. Cancer 2014;120(16 suppl):2566‐74. © 2014 American Cancer Society .