303 Background: Aggressive medical interventions and associated high costs of care for cancer pts near the EOL are common. Addressing this issue at the local level requires an accurate, automated process to merge real-time clinical EHR data with cost data for performance reporting. Methods: This was a single-center, observational cohort study of decedents treated with anticancer therapy (antiCT) in the last 6 months of life from January 2016 to October 2017. Pts were stratified by antiCT use in the last 30 days of life. The primary outcome measure was total cost of care. Secondary outcome measures (hospitalizations, ER and ICU utilization, antiCT use, and hospice referral) were obtained through Flatiron Health EHR-based automated data processing. Cost data were merged from the Value-Driven Outcomes analytics framework. Results: 650 pts were included. 228 (35.1%) received antiCT in the 30 days before death. Non-drug costs for pts who received antiCT in the last 30 days of life were higher than those who did not (p < 0.01, median 38X higher). A higher proportion of pts who received antiCT in the last 30 days of life had ≥1 ER visit (29.4% vs 9.5%, p < 0.01) and hospital admission (58.8% vs 27.3%, p < 0.01) during the last 30 days. In addition, more of these pts received ICU care (35.5% vs 11.4%, p < 0.01). AntiCT in the last 30 days was associated with shorter median time from first hospice referral to death (1.4 vs 4.7 weeks; IQR 0.7-2.0 vs 3.14-7.7 weeks, p < 0.01). Distribution of antiCT types administered to pts in the last 30 days versus those given antiCT > 30 days from the EOL was significantly different, with the most substantial difference seen in the proportion of pts receiving immunotherapy (20.2% vs 12.6%, p = 0.04). Conclusions: Real-time assessment of EOL outcomes shows antiCT in the last 30 days of life is associated with aggressive medical interventions and increased total cost of care. Future research should identify pts who are unlikely to benefit from aggressive care, and whether performance reporting to oncologists will reduce futile interventions near the EOL.

The potential relation between body condition of gilts in late-pregnancy and litter BW gain as well as mammary development was studied using 2 sets of data. Gilts either from a commercial herd (Part 1, n = 182) or from a series of trials looking at mammary development (Part 2, n = 172) were separated in 3 groups according to backfat thickness (BF) on d 110 of gestation. Group categorization was similar for Parts 1 and 2 of the study and was: low (LOW), 13.6 ± 1.6 mm (mean ± SD); medium (MED), 17.6 ± 1.0 mm (mean ± SD); and high BF (HIGH), 21.8 ± 1.8 mm (mean ± SD) for Part 1, and LOW, 14.2 ± 1.3 mm (mean ± SD); MED, 18.1 ± 1.0 mm (mean ± SD), and HIGH 23.4 ± 2.6 mm (mean ± SD) for Part 2. The effects of BF group on piglet BW gain (Part 1) or on various mammary gland characteristics (Part 2) were determined using ANOVA. Litters from HIGH sows tended to have a greater lactation BW gain than those from LOW sows (P &lt; 0.10). Sows with HIGH BF had more mammary parenchymal tissue and more total protein and total DNA than MED and LOW sows (P &lt; 0.05), which led to greater total protein and total DNA contents (P &lt; 0.05). There were strong positive correlations (P &lt; 0.0001) between parenchymal weight and total protein, total DNA, and total RNA. Results suggest that it is beneficial for primiparous sows to have greater BF (i.e., 20 to 26 mm) at the end of gestation to achieve optimal mammary development and greater litter BW gain in the subsequent lactation.

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8 Background: Performance status, which is prognostic of survival, is a physician’s interpretation of PROs. This retrospective study evaluated prognosis of PROs, independent of physician assessment, with overall survival (OS) and hospitalization-free survival (HFS). Methods: Patients (pts) at HCI were assessed using the NCI PROMIS-Ca bank from May 2016. Physical function (PF), fatigue, depression, anxiety, and pain scores were collected via iPad in pts with metastatic cancers. A single PRO score collected within 6 months of metastatic diagnosis for each pt was merged with outcome data using the Flatiron Health database. Associations between PROs, gender, cancer type, OS and HFS were assessed. Results: 287 complete sets of pt data were available. The PRO domains were interrelated with moderate-strong correlations (0.40-0.79). Cancer types differed by OS and HFS (p’s < 0.001). PF scores were worse for NSCLC than other cancers (p < 0.001). Individual PRO scores were worse for women than men, HFS was better for women and survival was not different. All individual PRO domains were strongly associated with HFS and OS. After correction for gender, cancer type, and individual PROs, only PF remained significant among individual PROs. Conclusions: PROs, especially PF, are prognostic of OS and HFS without physician interpretation. Gender difference may influence PROs. [Table: see text]

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