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e18510 Background: It is well established that insurance coverage is strongly related to better health outcomes, however there has been little research comparing health care disparity between public vs privatehealth insurance. The aim of our research is to identify differences in treatment in patients with lobular carcinoma in situ (LCIS) based on insurance payer seen at our academic center in Southern New Jersey. Additional analysis included time from diagnosis to treatment and common reasons treatment was not obtained. Our goal is to provide further information on health care disparities between insurance payers and identify areas for improvement. Methods: We conducted a retrospective chart review of 292 patients with LCIS who were seen at the MD Anderson Cancer Center at Cooper in Camden, Voorhees and Willingboro, New Jersey from 2009 to 2019. We stratified the patient population by insurance payer; specifically Medicare, Medicaid and private insurance. We compared treatment outcomes between these three groups using chi square and Kruskall Wallis testing. Results: There was no significant difference in treatment outcome or time to treatment between insurance payers. The majority of patients in each insurance payer group did receive appropriate treatment with either chemoprevention or prophylactic mastectomy. Among those patients who did not receive risk reduction therapy, 22.2% of patients with Medicaid did not see a Medical Oncologist and therefore were not offered chemoprevention. In comparison, only 16.7% of patients with private insurers did not see a Medical Oncologist. Although not statistically significant, this supports prior studies suggesting a disparity in outpatient follow up for patients with Medicaid. Patients with Medicaid had the longest median time from diagnosis to initiation of chemoprevention as compared to patients with Medicare or private insurance. It was notable that among patients who underwent prophylactic bilateral mastectomy, those with Medicaid had the shortest observed time to surgery than patients with private insurance. The reasoning for more expedited times to prophylactic mastectomy than to chemoprevention in our study is unclear. Possible factors include patient perception of bilateral mastectomy being a “definitive” one time procedure eliminating the need for future screening and anxiety related to suspicious findings. Other causes may include the concern for adverse side effects of chemoprevention or patient decision to pursue surgery prior to Medical Oncology follow up. Conclusions: There was no significant difference in treatment outcomes for patients with LCIS based on insurance payer. This is a reassuring finding that provides evidence of appropriate care regardless of insurance payer. In the future, we hope to stratify this data by race and zip code to further assess health care disparities in our patient population in order to provide improvement in their care.

IgM multiple myeloma is a rare disease that shares many common features with Waldenström macroglobulinemia and lymphoplasmacytic lymphoma. It has been described in the literature as having unique diagnostic findings that separate it from the more common IgG and IgA myelomas. It is important for physicians to be able to differentiate between IgM multiple myeloma, Waldenström macroglobulinemia and lymphoplasmacytic lymphoma as their treatments vastly differ. This case report describes the clinical presentation of a patient with IgM lambda multiple myeloma and highlights the pathologic and clinical findings that are specific to this rare entity. We aim to provide further evidence for the previously reported diagnostic criteria for IgM multiple myeloma.

45 Background: Despite a 2016 ASCO recommendation that patients with advanced cancer receive dedicated palliative care (PC) services, many patients are not referred and continue to receive chemotherapy and utilize high-acuity services near the end of life (EOL). Studies suggest that early PC involvement is associated with lower spending, acute care utilization, and chemotherapy administration at the EOL. The Sidney Kimmel Cancer Center participates in the Oncology Care Model (OCM), a CMS episode-based alternative payment model promoting high-value care. Using OCM-generated data, we evaluated the effect of PC visits on EOL outcomes. Methods: We identified OCM patients with episodes starting April 1, 2016-July 1, 2018 with GI and head & neck malignancies who had died, and determined whether patients who saw a PC provider had greater documentation of a code status (CS) before death, as well as lower spending and utilization of chemotherapy or acute care in the last 30 days of life. CMS spending data and dates of death were derived from OCM quarterly feedback, while all other data was compiled via chart review. CS was recorded at the start of the episode and at the time of death. Results: The study included 126 patients (median age 66 years), of whom 38% had a PC visit. 24% had only an inpatient (IP) PC consult, 6% only an outpatient (OP) visit, and 9% both IP & OP visits. More patients who saw PC had an initial CS documented (85%, vs 46% for no PC), and had a greater proportional increase in CS documentation before death (96% vs 53%). Despite similar rates at baseline, the final CS was significantly more likely to be “Do Not Resuscitate/Intubate” (DNR/DNI) among PC patients (79%, vs 28% for no PC). An initial CS of DNR/DNI was associated with lower mean ICU and total non-hospice spending in the last 30 days of life. Conclusions: This retrospective study in OCM patients found that PC intervention is associated with improved documentation of a CS and higher rates of DNR/DNI documentation before death. There is an association between an initial DNR/DNI CS and lower acute care spending. This data suggests a beneficial effect of early PC on utilization at the EOL in advanced cancer patients.

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