Although the Internet may help to increase cancer patients' awareness of clinical trials, little is known about the accessibility and quality of online clinical trial information. We simulated the experience of a na€ ve cancer patient without clinical trial knowledge by searching three popular search engines for treatment information for breast, lung, and prostate cancer, and myelodysplastic syndromes (MDS). Two coders independently evaluated website content for accessibility and quality. We screened 120 websites and identified 40 unique sites for analysis. Overall, 85% [95% confidence interval (CI), 70%-94%] of sites mentioned clinical trials on the landing page and 68% (51%-81%) included links to specific trials. Overall readability was poor. Approximately half of websites (36%-68%) included information on the potential benefits and risks of clinical trials and 40% provided information about when the site had been updated (25%-57%). Among sites with links to specific clinical trials, only 44% (25%-65%) provided an interactive interface that would allow patients to customize search results; breast (100%) and prostate (50%) sites were more interactive than lung (25%) and MDS (14%; P ¼ 0.007). Although cancer clinical trial information is widely available on the Internet, its quality is highly variable. Given the fact that many emerging cancer therapeutics are personalized based on disease or genomic characteristics, interactive web-based interfaces could serve as powerful vehicles to help patients locate appropriate clinical trials. Without enhanced efforts to ensure greater interactivity of cancer treatment websites, patient awareness of relevant clinical trials may remain low. Cancer Epidemiol Biomarkers Prev; 24(10); 1629-31. Ó2015 AACR.

BACKGROUND: Successful bone marrow assessment is essential to the diagnosis and staging of hematologic malignancies. The objective of this study was to determine whether specific operator techniques and/or use of a specimen preparation checklist could impact the quality of bone marrow assessment by reducing the frequency of nonspicular aspirates, small cores, and nondiagnostic samples. METHODS: All bone marrow biopsies performed at the Dana-Farber Cancer Institute from April, 2012 to September, 2012 were eligible for inclusion. Six operator techniques were linked with specimen quality in a preintervention cohort. Next, a specimen preparation checklist was implemented, and outcomes were compared from the preintervention and postintervention cohorts. RESULTS: In total, 830 procedures performed by 41 operators were prospectively observed and analyzed. In the preintervention cohort (n 5 413), no operator technique was associated with specimen quality in multivariable models accounting for patient characteristics and operator. Compared with the preintervention cohort, in multivariable analyses, the postintervention cohort (n 5 417) had decreased odds of nondiagnostic specimens (odds ratio, 0.49; 95% confidence interval, 0.28-0.87; P 5.01) and core lengths 1 cm (odds ratio, 0.67; 95% confidence interval, 0.50-0.90; P 5.009), but there was no significant difference in spicularity. CONCLUSIONS: Variation in the operator techniques studied did not have an impact on specimen quality, but implementation of a specimen preparation checklist significantly improved core length and frequency of diagnostic samples. Cancer 2013;119:3472-8.

2055 Background: Although bone marrow aspiration and biopsy have been utilized in the diagnosis and staging of hematologic malignancies for almost a century, little is known about the potential impact of operator techniques on the quality of specimens obtained. We aimed to characterize the impact of operator techniques used for bone marrow biopsies, and to determine if any of these techniques are associated with specimen quality. Methods: From April to July 2012, we recorded operator data corresponding to all consecutive bone marrow biopsy procedures resulting in a specimen performed as part of routine care at the Dana-Farber Cancer Institute (Boston, MA). These data included type of needle used, whether or not the operator redirected the needle between aspirate and biopsy, patient position (prone or lateral decubitus), use of a drill, use of a measuring stylet, and volume of aspirate obtained in the first pull. We then reviewed the resulting pathology reports, focusing on specific indicators of quality such as presence of a diagnosis, spicularity, and core length. For the purposes of this study, we allowed credit for a diagnostic specimen if the pathology reports mentioned normal trilineage hematopoiesis or a pathologic process on either the aspirate or core biopsy. Univariate associations between operator techniques and bone marrow biopsy quality were determined using chi-square and Fisher's exact tests; multivariable logistic regression taking patient characteristics (age, gender and body mass index) and individual operator into account were also fit to characterize operator techniques that were independently predictive of quality. Finally, we assessed the association between spicularity and core length with diagnosticity. Results: 413 procedures performed by a total of 23 operators were analyzed. 91.5% of the bone marrow evaluations were diagnostic, 66.6% were spicular, and 52.8% had a core length greater than 1cm. The univariate analysis of operator techniques is detailed below: In multivariable models, no operator technique was significantly associated with obtaining diagnostic specimens; however, lateral decubitus position was associated with lower likelihood of obtaining spicular specimens (odds ratio (OR) 0.15 [95% confidence interval (CI) 0.04, 0.59], p=0.007), and redirecting was associated with lower likelihood of core length >1cm (OR 0.41 [95% CI 0.20, 0.82], p=0.01). Spicular specimens had significantly higher rates of diagnosticity compared to aspicular specimens (96.3% vs. 71%, p <0.001). Finally, among the thirty-five patients who had non-diagnostic biopsies, nine underwent repeat biopsy within thirty days of initial procedure. Conclusion: In our large cohort of observed bone marrow procedures, we found a high diagnostic rate of 91.5%. Moreover, although there were several univariate associations, in multivariable models, specific operator techniques did not predict higher likelihood of obtaining a diagnostic specimen. Although redirecting was associated with shorter cores, core length was not significantly associated with diagnosticity. Overall, our data suggest that several different operator techniques ultimately result in bone marrow specimens of similar quality. Disclosures: No relevant conflicts of interest to declare.

6547 Background: The Internet is a communication tool that may be used to improve awareness of and access to cancer-related clinical trials; however, few data characterize how the Internet may encourage clinical trial education and accrual. Methods: In January of 2013, we simulated the experience of a user without knowledge of clinical trials by simply searching “breast cancer treatment”; “lung cancer treatment”; “MDS treatment”; and “prostate cancer treatment” in three popular search engines (Google, Bing, and Yahoo). The top ten unsponsored websites for each were recorded, after eliminating news articles and duplications. Sites were independently evaluated for quality and accessibility by two coders, and discordant data were resolved by consensus. Differences in content by disease type were evaluated using Fisher’s exact tests. Results: The searches yielded 40 unique websites. Before consensus, inter-observer agreement ranged from 75% to 100% (average kappa .67). Overall, 85% of the sites (95% CI: 70% to 94%) mentioned clinical trials on the landing page. Selected measures of quality and accessibility are detailed in the table. Lung cancer and MDS sites were less likely to have interactive features as compared to breast and prostate cancer sites (20% vs. 82%, p=0.004). Conclusions: These data suggest that basic clinical trial information is widely available for naive users searching for cancer treatment information. The quality of that information is highly variable, with only about three-quarters of sites defining clinical trials, one-half providing information about the benefits and risks of enrollment, and only one third of sites Health on Net certified. Moreover, for certain cancers, few sites offer interactive features to facilitate access to information about relevant clinical trials. [Table: see text]

Background The factors that influence utilization of reduced-intensity conditioning hematopoietic stem cell transplantation (RIC HSCT) for “fit” elderly patients with advanced myelodysplastic syndromes (MDS) remain unclear. Methods The “MDS Transplant-Associated Outcomes Study,” or “MDS-TAO,” is a prospective longitudinal observational study which began at the Dana-Farber/Harvard Cancer Center in May of 2011. It is designed to examine survival, quality of life (QoL), and other outcomes for RIC HSCT versus non-HSCT approaches for HSCT-appropriate MDS patients ages 60 to 75. Inclusion criteria include: histologically-confirmed diagnosis of MDS or CMML, and at least one of the following: (1) therapy-related disease, or (2) intermediate-2/high risk IPSS (Greenberg, 1997), or (3) intermediate/poor-prognosis risk cytogenetics (Haase, 2007), or (4) severe and sustained anemia or thrombocytopenia, or (5) platelet or red cell transfusion dependence. Exclusions include: (1) comorbidities that in the judgment of the enrolling clinician preclude HSCT eligibility (2) prior donor search, and (3) patient unwillingness to consider HSCT. For this analysis, time to HSCT was estimated using Kaplan-Meier methods, and log rank tests were used to assess time to HSCT by age, gender, ECOG performance status, IPSS, IPSS cytogenetic risk group, and baseline EORTC QLQ-C30 global QoL and fatigue scores. Results As of April 30, 2013, 87 patients had been enrolled. The median age was 69 years, 66% were male, and 88% had an ECOG performance status of 0 or 1. As of July 15, 2013, 22 had received HSCT within a median of 4.0 months (range 2-10 months) from study enrollment, and 17 had died without receiving HSCT. The 9-month probability of having had a transplant was 31% (95% CI [21% to 44%]). The median global QoL score was 66.7 and the median fatigue score was 33.3 (published medians are 66.7 and 33.3 for other cancers; higher global QoL scores indicate superior QoL whereas higher fatigue scores indicate worse fatigue). MDS-TAO patients with poorer cytogenetics (p<.001) and worse IPSS at enrollment (p<.001) were more likely to undergo HSCT. Age showed a complex relationship (p=.03), with those aged 65-70 most likely to undergo HSCT (34%), followed by those aged 60-65 (33%), and those aged >70 (11%). Female gender (p=.10), performance status (p=.14), global QoL (p=.56; see figure), and fatigue score (p=.58; see figure) all showed no significant association with the likelihood of undergoing HSCT. Conclusion Our data suggest that while older transplant-appropriate MDS patients suffer from similar QoL impairment as compared to other cancer patients, cytogenetics and IPSS likely have more influence than patient-reported QoL in influencing which patients ultimately receive HSCT. Disclosures: No relevant conflicts of interest to declare.