6609 Background: ASCO and ESMO have developed frameworks to evaluate the benefit of cancer therapies. Here, we apply the frameworks to a cohort of contemporary randomized controlled trials (RCTs) to explore agreement and to evaluate the relationship between treatment benefit and cost. Methods: Characteristic and outcome data from RCTs evaluating systemic therapies in non-small cell lung cancer (NSCLC), breast cancer, colorectal cancer (CRC), and pancreatic cancer published and cited in PubMed between 2011-2015 were abstracted. Trial endpoints were evaluated using ASCO and ESMO frameworks. Cohen’s kappa statistic was calculated to determine agreement between the two frameworks, using the median ASCO score as a benefit threshold. Differences in monthly drug cost between RCT experimental and control arms were derived from 2016 average wholesale prices. Analyses included Pearson chi-square tests, Fisher’s Exact tests, independent samples t-tests, and Pearson correlation to assess the association between continuous variables. Results: Fifty percent (136/271) of published RCTs favoured the experimental arm; scoring rubrics were applicable to 109 RCTs (39% NSCLC, 33% breast, 23% CRC, 5% pancreas). ASCO scores ranged from 2 to 72; median score was 25. Thirty seven percent (40/109) of RCTs met benefit thresholds using the ESMO framework. Agreement between frameworks was fair at best (κ = 0.28, p = 0.002). When stratified by treatment intent (19 curative, 90 palliative RCTs), agreement remained poor (κ = 0.23, p = 0.115; κ = 0.34, p < 0.001). Major differences leading to limited agreement includes the relative weights each framework places on HR, endpoints, and toxicity/QOL analysis. Smaller RCT sample size was the only trial characteristic associated with higher ASCO scores (p = 0.015). Among the 100 RCTs for whom drug costing data were available, there was no association between ASCO benefit score and monthly drug costs (r = -0.12, p = 0.22); those meeting ESMO thresholds had a lower mean drug cost than those who did not (p = 0.046). Conclusions: There is only fair correlation between ASCO and ESMO clinical benefit frameworks. Drug costs are not associated with ESMO/ASCO measures of magnitude of clinical benefit.

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148 Background: Smoking cessation is integral to cancer care. Active smoking is associated with increased toxicity of treatment, poorer response to therapy and is associated with worse overall survival. Patients who quit smoking at diagnosis have better survival outcomes. Cancer Care Ontario has aimed to improve rates of smoking screening and referral to smoking cessation programs based on the validated Ottawa model. Methods: We aimed to implement an “opt-out” referral process for recent or current smokers to a smoking cessation program at the Credit Valley Hospital. We aimed to achieve a referral rate of 20%, based on an institutional baseline of 8.5% and a provincially defined target of 20%. Key stakeholders targeted included nursing, administration, physicians, smoking cessation counsellors and patients. Sequential education interventions were delivered to address gaps in patient and provider knowledge; these included grand rounds, an informal lecture and an educational pamphlet. Results: After the initiative was launched, the referral rate increased from 8.5% to 14.3%. The impact of each intervention is summarized in Table 1. Conclusions: Smoking cessation referrals increased with new process but not to target. Patient refusals lead to a low rate of referral, warranting efforts aimed at addressing patient barriers. Future outcome measures may include smoking cessation rates. [Table: see text]