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High out-of-pocket (OOP) spending on cancer drugs is a known contributor to "financial toxicity" among cancer patients. Many predict that this problem will only worsen as patients continue to bear more responsibility for the cost of their medical care and as the use of oral chemotherapeutic agents increases. Although foundations and pharmaceutical companies offer patient assistance programs (PAPs) to improve drug affordability, the degree to which these programs are used is poorly understood. There are several barriers to the use of PAPs that not only affect access to patients who may benefit but also create limitations on the research and study of these programs.

Background Commonly used adjuvant systemic therapies harbor high rates of severe short-term and long-term side effects but are often justified to patients because of curative intent in early-stage breast cancer. One of the oldest and least toxic adjuvant regimens, CMF (oral cyclophosphamide given with intravenous methotrexate and 5-fluourouracil), has been largely abandoned because of the perception that it underperforms for survival outcomes compared with modern regimens containing anthracycline and/or taxanes. Materials and Methods To address this misperception, we performed a review of all consecutive breast cancer patients at the Seattle Cancer Care Alliance over the past decade who received 6 months of adjuvant CMF as their sole chemotherapy regimen and determined rates for relapse-free survival (RFS), overall survival (OS), and major organ toxicity. From January 2003 to August 2013, 248 patients (median age of 52 years at the start of chemotherapy) met criteria for inclusion in this series and had a median follow-up of 67 months. Results RFS and OS at 5 years was 94.5% (91.3%-97.9%) and 98% (96%-100%), respectively. The only major organ toxicity that occurred in > 5% of patients was Grade 3 neutropenia (18.1%, 24 patients). One patient died during therapy from pneumocystis pneumonia attributed to previously undiagnosed AIDS. Conclusion In a modern cohort of patients thoroughly characterized for Grade and hormone receptor status, CMF was a well-tolerated and effective adjuvant regimen for early-stage breast cancer and should be considered for appropriately selected patients.

e17530 Background: High out-of-pocket (OOP) costs for prescription cancer drugs has been implicated as a major cause of cancer patients’ increasing financial burden. While many foundations and phar...

Excess phosphorus can lead to eutrophication of aquatic ecosystems, which can indirectly cause many species to suffer due to lower oxygen levels. The intent of this project was to determine if wetlands draining agricultural soil in the Cedar River watershed are removing phosphorus prior to empting into a tributary of the Cedar River. To determine the fate and transport of phosphorus in the wetlands, the total phosphorus (TP) of both the water and sediments was measured, and the ability for sediments to remove phosphate was also determined. The TP in the water column in the wetlands varied temporally from 700 to 1700 μg/L. Dissolved inorganic phosphate (SRP) totals were usually less than 10% of the total P, with a modest spike observed after a rainfall event. The low levels of SRP in the water led to testing of the TP levels in sediments and TP sorption capabilities. The TP of the sediment varied spatially from 500-700 μg/gdw. Sediments from the tributary (Beaver Creek) had total phosphorus levels of about 500 μg/gdw and the inlet to the wetlands varied from 300-400 μg/gdw. Depending on sampling locations, maximum sorption for sediments from the main body of the wetland ranged from 2-9 mg/gdw. Sediments from both the tributary (Beaver Creek) and the inlet to the wetlands sorbed about 7 mg/gdw. The results suggest that sediments in the wetlands are not yet saturated with phosphorus and therefore, when aerobic, can prevent phosphorus transport to rivers and streams.