Background: Despite requirements for palliative care training during fellowship, there is a paucity of recent data regarding the attitudes, knowledge, and skills of hematology/ oncology fellows in palliative care. Objective: Our aim was to assess fellows' attitudes toward and quality of training in palliative care during fellowship and perceived preparedness to care for patients at the end of life (EOL). Methods: In May 2013 a cross-sectional survey of hematology/oncology fellows was conducted. Results: Fellows from 93 of 138 fellowship programs responded (67.4%). Of the 347 fellows e-mailed, 176 participated. Nearly all fellows (99%) indicated that physicians have a responsibility to help patients at EOL. Fellows felt their overall training in fellowship was superior to training in EOL care (4.24 -0.78 versus 3.53 -0.99 on a 5-5 scale where 1 = poor and 5 = excellent, p < 0.0001). Fellows who had a rotation in palliative care during fellowship (44.9%) reported better teaching on managing a patient at EOL than those who did not (3.91 -1.0 versus 3.21 -0.87, p < 0.0001). Fellows reporting better teaching in EOL care felt better prepared to care for patients at EOL (r = 0.52, p < 0.0001). More than 25% reported not being explicitly taught how to assess prognosis, when to refer a patient to hospice, or how to conduct a family meeting to discuss treatment options. Conclusion: Many recent oncology fellows are still inadequately prepared to provide palliative care to their patients. There is significant room for improvement with regards to the quality of palliative care training in U.S. hematology/oncology fellowship programs.

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Referral to outpatient clinics in a cancer center for benign hematologic diseases seems to increase psychological stress and anxiety among patients, who may perceive that they are being referred for evaluation of a cancer diagnosis.

Background Traditionally, benign blood disorders are being evaluated and managed by hematologists who are also trained in oncology. Many of these physicians have their clinics located in Cancer Centers. Based on our clinical observations, the term “Cancer Center” is misleading to many benign hematology patients and it may affect their perception of their disease and/or reason for referral. There are currently no studies investigating patient understanding of benign hematology, the impact of a referral to a cancer center on a patients' well being or their understanding of a referral- therefore we designed this survey to explore those issues. Methods At West Virginia University/Mary Babb Randolph Cancer Center we drafted a survey. This IRB approved, anonymous and voluntary survey included twenty-eight questions that abstracted patient data that included: age, gender, race, level of education, understanding of reason for referral, knowledge of basic training aspects of hematologists, and multiple questions on stress and the impact of emotional well-being of a referral to the cancer center. Multiple-choice questions were drafted with 4-6 answer choices with no option for unknown. Surveys were collected from exclusively new patient benign hematology visits from May 2013-July 2013. Patients were surveyed at outpatient appointments after a verbal consent was obtained prior to their first contact with a hematologist. Results A total of 55 patients consented and received the questionnaire. Of the 55 questionnaires, 4 were incomplete and thus were excluded. 41.2% (21) responders were males, 58.8% (30) were females, 76.4% (39) were >40 yrs, 98% (50) were Caucasian, and 56.8% (29) had at least some college education or above. 60.7% (31) of patients surveyed stated that they were surprised when they found that their appointment was at the Cancer Center and 39.2% (20) stated that they received no explanation as to why they were referred to the cancer center prior to the visit. 70.5% (36) of patients did not know what benign hematology was and only 54.9% (28) patients knew that cancer doctors are also frequently trained to see benign hematology patients. 49% (25) of patients stated that their primary care physician's office did not explain that their referral to the cancer center was for a benign hematologic problem. 45% (23) and 41.1% (21) of patients expressed an increase in their anxiety and stress levels, respectively, when they found out their referral was to a Cancer Center. 27.4% (14) of patients said they were afraid they might have cancer during the process of referral and 37.3% (19) actually thought that the reason for their referral to the Cancer Center was an evaluation for cancer. Only 11.7% (6) patients expressed that they would prefer to be referred at a benign hematology clinic that is not located in a Cancer Center. Conclusion Referral to Cancer Center for benign hematologic diseases appears to increase stress and anxiety of patients and patients may perceive that they are referred for evaluation of a cancer diagnosis. Careful explanation by the entire team including referring physicians, hematologists, and office staff as to the reason for evaluation of a benign hematologic disorder may decrease stress and increase understanding of this subset of patients. Disclosures: No relevant conflicts of interest to declare.

Appendicitis in leukemic patients is uncommon but associated with increased mortality. Additionally, leukemic cell infiltration of the appendix is extremely rare. While appendectomy is the treatment of choice for these patients, diagnosis and management of leukemia have a greater impact on remission and survival. A 59-year-old Caucasian female was admitted to the surgical service with acute right lower quadrant pain, nausea, and anorexia. She was noted to have leukocytosis, anemia, and thrombocytopenia. Abdominal imaging demonstrated appendicitis with retroperitoneal and mesenteric lymphadenopathy for which she underwent laparoscopic appendectomy. Peripheral smear, bone marrow biopsy, and surgical pathology of the appendix demonstrated acute myeloid leukemia (AML) with nonsuppurative appendicitis. In the setting of AML, prior cases described the development of appendicitis with active chemotherapy. Of these cases, less than ten patients had leukemic infiltration of the appendix, leading to leukostasis and nonsuppurative appendicitis. Acute appendicitis with leukemic infiltration as the initial manifestation of AML has only been described in two other cases in the literature with an average associated morbidity of 32.6 days. The prompt management in this case of appendicitis and AML resulted in an overall survival of 185 days.