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Prevention and early intervention can improve survival and quality of life across all cancers. Patient understanding of risk factors and associated actionable lifestyle changes and screening programs is not well understood by clinicians METHODS: An Internet-based tool, Reduce My Risk, was created in 2009 and made available on oncolink.org. Users voluntarily completed a survey regarding demographics and cancer risk factors, and received information about their cancer risk RESULTS: Twenty eight thousand and one surveys were completed from 2009 to 2019. Median age was 26 years (18-101); 60% were females, 87% lived in North America, and 37% had at least a bachelor's degree. Users reported on behavioral/ modifiable risk factors: 13% were current smokers, 52% were current consumers of alcohol, and 8% of those had ≥14 drinks/week. Body mass index (BMI) was ≥30 in 19%; 74% of all surveys reported dietary risks and 36% reported infrequent exercise. Excess UV exposure was reported by 19%. Among women, 36% reported performing breast self-examinations monthly, and 50% reported receiving clinician breast examinations at least once every 3 years. Sixty seven percent of men 55-75 years reported screening prostate specific antigen testing, with 50% receiving annual digital rectal examinations. Nonmodifiable risk factors included family cancer history (64%), genetic syndrome (3%), and cancer-predisposing health conditions (26%) CONCLUSIONS: Ninety-seven percent of users reported modifiable risk factors, and 60% reported ≥4 of these risk factors. Understanding detailed characteristics of a large number of respondents has the potential to improve educational interventions to reduce cancer risk through behavioral modification and cancer screening across the general public.

Objective: This study aimed to increase understanding of the effects of the pandemic on cancer patients, survivors and caregivers.Methods: An Internet-based survey was accessed over 2 months by individuals diagnosed with cancer or caregivers (N = 281), with descriptive statistics and chi square analysis used to compare subsets.Results: Most participants reported social isolation (76%) and mental health impact (70%) since the beginning of the COVID19 pandemic; isolation appeared to correlate with mental health impact (p < .00001). Food insecurity and financial hardship correlated significantly with mental health impact; food insecurity also correlated with social isolation.Conclusions: Our findings suggest that mental health during the pandemic in the cancer population may be impacted by social isolation, financial stress, and food insecurity, as well as stress regarding accessing cancer treatments. Awareness by psychosocial healthcare providers of need for resources to support these hardships, as well as framework to identify them, are essential elements of cancer-related care.

M Sean Peach,1 Daniel M Trifiletti,2 Carolyn Vachani,3 Karen Arnold-Korzeniowski,3 Christina Bach,3 Margaret Hampshire,3 James M Metz,3 Christine E Hill-Kayser3 1Department of Radiation Oncology, University of Virginia, Charlottesville, VA, USA; 2Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA; 3Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA Purpose: Head and neck cancer is occurring in an increasingly younger patient population, with treatment toxicity that can cause significant morbidity. Using a patient guided, Internet-based survivorship care plan program, we obtained and looked at patterns of patient-reported outcomes data from survivors seeking information after treatment for head and neck cancer. Methods: The Internet-based OncoLife and LIVESTRONG Care Plan programs were employed, which design unique survivorship care plans based on patient-reported data. Care plans created for survivors of head and neck cancer were used in this evaluation. Demographics, treatment modality, and toxicity were included in this evaluation. Toxicity was further analyzed, grouped into system-based subsets. Results: A total of 602 care plans were created from self-identified head and neck cancer survivors, from which patient-reported outcome data were attained. A majority of patients were Caucasian (96.2%) with median age at diagnosis of 55 years, living in suburban locations (39.9%), with ~50% receiving care within 20 miles of their residence. There was an equal distribution of education levels from high school only to graduate school. The majority of patients received care through cancer centers (96.7%), with a split between academic and non-academic centers. Ninety-three percent of patients had radiation therapy as part of their treatment modality, with 70.3% having chemotherapy and 60.1% having surgery. The most common system toxicities affected the oropharynx, followed by epithelium (skin/hair/nail), and then general global health. Specifically, the most common side effects were difficulty swallowing (61.5%) and changes in skin color/texture (49.7%). One third of patients experienced hearing/tinnitus/vertigo, xerostomia, loss of tissue flexibility, or fatigue. Conclusion: The current work demonstrates the ability to obtain patient-reported outcomes of head and neck cancer survivors through an Internet-based survivorship care plan program. For this group dysphagia and dermatitis were the most commonly reported toxicities, as was expected; however, global effects of therapy, such as fatigue, were also significant and should be addressed in future survivorship planning. Keywords: head and neck radiation, surgery, chemotherapy, patient reported outcomes, survivorship care plan, Internet, patient-reported outcomes

Purpose/Objective(s) Common risk factors for head and neck cancer (HNC) include tobacco and alcohol use, HPV and EBV infection, and certain occupational exposures, including radiation. Genetics also play a role, though these effects are multifactorial and are likely not well appreciated in the lay population. We sought to understand the association between family history (FH) of HNC and other personal risk factors for cancer and hypothesized that those with a FH of HNC would be more likely to use tobacco and alcohol. Materials/Methods Reduce My Risk is an online tool available on OncoLink.org. Voluntary participants input information related to demographics, FH, risk-factors, and risk-associated behavior and then receive personalized information regarding their cancer risk. Use of collected data was IRB approved. Differences between respondents with vs without FH of HNC were analyzed using chi-square test and adjusted via logistic regression. Results 25179 responses were analyzed; 580 (2.3%) reported FH of HNC. Of these, median age was 30 (Range 18 - 72), 66.7% were female, 79.5% from North America, 83.1% White, 78.4% had at least some college, and 68.0% household income > $45,000. Comparing those with FH of HNC to those without, there were no significant differences in education, household income, or home setting. Those with FH of HNC were more likely to be “light” drinkers (1-7 per week), obese, and to have significant secondhand smoke exposure (Table). There were no significant differences in cigarette, marijuana, or “exotic” smoking, or use of smokeless tobacco products. (Table). There were also no differences in UV, radiation, or occupational exposures, except for hydrocarbons (OR 1.7, CI 0.99-2.74, P = 0.041). Conclusion Those with a FH of HNC were more likely to have secondhand smoke exposure but were not more likely to use tobacco products themselves, suggesting differences in inter-generational behavior. Those with FH also reported increased non-modifiable risks. Limitations of this work include a convenience sample frame that is disproportionately white and high income, and results may not be applicable to a more diverse population. Future work should explore targeted intervention for those with a FH of HNC to educate on risk of external exposures and promote preventive behaviors.

Pancreatic cancer survivors face a unique set of challenges in survivorship, yet structured survivorship care planning is lacking in practice. Survivorship care plans (SCPs) are an essential part of quality cancer care and can facilitate the transition following active treatment; the use of SCPs in pancreatic cancer survivors, however, has not been explored. With a convenience sample of 117 pancreatic cancer survivors and proxies who used an Internet-based SCP tool, we examined treatment details, patient-reported outcomes, and survivorship practices. Thirty-one percent of survivors were 2 years or greater from diagnosis with a median current age of 62 years. Most patients had received multimodality therapy (67%): 68%, 86%, and 43% reported surgical intervention, intravenous chemotherapy, and radiation therapy for their pancreatic cancer, respectively. Survivors commonly reported fatigue, cognitive change, neuropathy, pancreatic insufficiency, and chronic radiation dermatitis related to treatment. Most survivors are managed (47%) or co-managed (35%) by an oncology specialist; however, this percentage decreases over time with consequent increase in management by primary care providers alone. Only 5% had previously been offered an SCP. Of the 24 users who responded to a follow-up satisfaction survey, 83% indicated they would share the SCP with their healthcare team although half of respondents felt it should include more information. In all, our results demonstrate that there is a population of pancreatic cancer survivors who exist and seek survivorship support although structured survivorship care planning is lacking in practice. SCPs have a potentially valuable role for these survivors via communication of treatment-related effects and coordination across multidisciplinary healthcare teams. Further development and evaluation of SCPs is needed for this underserved survivor population.

BACKGROUND Nearly 1 in 5 Americans will develop skin cancer, and as a result, survivors of skin cancer compose one of the largest groups of cancer survivors. Survivorship care plans (SCPs) are an important tool for improving patient outcomes and provide critical information to both survivors and health care professionals. Recent efforts have been made to expand SCP utilization; however, which patients currently receive SCPs is poorly understood. METHODS This study used 596 individuals with a diagnosis of melanoma (n = 391) or nonmelanoma skin cancer (n = 205) who had used an Internet-based SCP tool from May 2010 to December 2016 to model the patient and provider characteristics that determine SCP utilization. RESULTS Survivors were predominantly white (95.3%) and female (56.5%). Survivors who received a treatment summary were more likely to also receive an SCP. University and nonuniversity cancer centers used SCPs at a higher rate than other care settings. Survivors whose care was managed by a team rather than just an individual physician were also more likely to receive an SCP. Survivors older than 70 years at diagnosis were almost twice as likely to receive a plan as survivors who were diagnosed at a younger age. CONCLUSIONS With a convenience sample of skin cancer survivors, it is possible to model factors that predict the receipt of SCPs. Important variables include the diagnosis age, treatment setting, physician type, and treatment-summary utilization. A closer examination of these variables identified several disparities in care-plan use and, therefore, opportunities to improve the distribution of SCPs. Further validation in additional cohorts of survivors is necessary to confirm these conclusions. Cancer 2017. © 2017 American Cancer Society.

BACKGROUND The survivorship needs of patients living with chronic cancer (CC) and their use of survivorship care plans (SCPs) have been overlooked and underappreciated. METHODS A convenience sample of 39,088 SCPs completed for cancer survivors with an Internet-based SCP tool was examined; it included 5847 CC survivors (15%; CC was defined as chronic leukemia and/or recurrent/metastatic cancer of another nature). Patient-reported treatment effects and follow-up care patterns were compared between CC survivors and survivors treated with curative intent (CI). Responses from a follow-up survey regarding SCP satisfaction and use were reviewed. RESULTS CC survivors had greater odds of experiencing multiple treatment-related effects than survivors treated with CI; these effects included fatigue, cognitive changes, dyspnea, peripheral neuropathy, lymphedema, and erectile dysfunction. Nearly half of CC survivors were managed by an oncologist alone, and they were less likely than CI patients to be comanaged by a primary care provider and an oncologist. Fewer SCPs were generated by health care providers (HCPs) for CC survivors versus CI survivors. A smaller proportion of CC users versus CI users rated their experience and satisfaction with the SCP tool as very good or excellent, and CC users were less likely to share the HCP summary with their health care team. CONCLUSIONS A substantial number of CC survivors, often considered incurable but treatable, seek survivorship support. Tools to facilitate participation, communication, and coordination of care are valuable for these patients, and future iterations of SCPs should be designed to address the particular circumstances of living with CC. Cancer 2017;123:4268–4276. © 2017 American Cancer Society.

Nearly half of all Americans will develop cancer at least once in their lifetime. Through improved screening and treatments, the number of cancer survivors is reaching all-time highs. However, survivorship care plans (SCPs) are inconsistently used, denying many survivors access to critical information. This study used 46,408 SCPs generated from 2007 to 2016 and applied machine learning to identify predictors of SCP creation, including cancer type, type of physician, and healthcare center where they received care, as well as regional variations in care plan creation. Identifying these disparities in SCP use is a critical first step in efforts toward expanding access to survivorship care planning. Using a convenience sample of survivors, it is possible to model the factors that predict generation of SCPs either by the survivor or by a healthcare provider. This study identifies several important disparities both survivor intrinsic such as cancer type, as well as treatment associated and geographic differences in SCP generation. Identifying these disparities at the national level across cancer types will allow for more targeted recommendations to improve SCP creation and dissemination in underserved groups.

10546 Background: Risk factors for melanoma (ML) include UV exposure, sunburns, multiple nevi, and fair skin. Smoking and alcohol use may also play a role. Demographics associated with increased UV exposure include male gender, white race, age 18-29, and high-income. Those with family history (FH) of ML have increased risk of developing ML themselves yet are often unaware or do not engage in preventive behaviors. We sought to understand the association between FH of ML and other personal risk factors for cancer. Methods: Since 2009, voluntary participants could receive personalized information regarding their cancer risk via the OncoLink.org Reduce My Risk tool. Survey data was collected on demographics, FH, risk-factors, and risk-associated behaviors. Use of data was IRB approved. Differences between respondents with v. without FH of ML were analyzed using chi-square test and adjusted via logistic regression. Results: 25255 responses were analyzed; 1928 (7.6%) had FH of ML. Of these, median age was 26 (range 18-75), 73.1% were female, 88.6% from North America, 91.4% White, 78.2% had at least some college, and 62.0% household income > $45,000. Comparing those with FH of ML to those without, no significant differences were observed in education, income, or home setting. Those with a FH of ML were less likely to be “light” smokers ( < 1 pack per day) but were more likely to be both “light” drinkers and “heavy” drinkers (Table). There were no significant differences in BMI or exercise habits. Those with FH of ML were more likely to sunbathe, to have had “blistering” sunburns, have 50+ moles, show signs of sun damage on their skin, and have dysplastic nevi (Table). There were no differences in use of indoor tanning beds (Table). Conclusions: Those with a FH of ML were more likely to sunbathe and to report skin damage and history of blistering sunburns; they were more likely to use tanning beds, though not statistically significant. These behaviors are modifiable and may suggest parental influence on sun-protective behaviors. Those with FH also reported increased non-modifiable risks. Future work should continue to explore targeted intervention for those with a FH of ML to educate on risk and promote sun-protective behaviors.[Table: see text]

BACKGROUND There is significant need for quality follow-up care to optimize long-term outcomes for the growing population of lower gastrointestinal (GI) cancer survivors. Patient-reported outcomes (PROs) provide valuable information regarding late and long-term effects (LLTEs). METHODS A convenience sample from 1129 colon, rectal, and anal cancer survivors (n = 792; 218, and 119, respectively) who participated in an Internet-based survivorship care plan (SCP) tool between May 2010 and October 2014 was used to examine patient-reported demographics, treatment, and toxicity data. Responses from a follow-up survey were reviewed. RESULTS The median age of diagnosis was 51 years, and 81% of survivors were Caucasian. The most commonly reported LLTEs for all survivors were neuropathy, fatigue, cognitive changes, changes in GI function, urogenital and sexual dysfunction, and dermatologic effects. The prevalence of these effects varied with time since diagnosis, treatment modality, and treatment center. Individuals who had survived anal cancer reported a high prevalence of sexual dysfunction and radiation-induced dermatologic effects. Over 87% of users reported satisfaction levels of good to excellent using the SCP tool, and 69% reported that they intend to share the SCP with their health care team. CONCLUSIONS For lower GI cancer survivors, it is feasible to obtain PROs from an Internet-based survivorship tool. Survivors report a wide spectrum of LLTEs, and these can be used to inform counseling at the time of diagnosis and to help anticipate and respond to disease-related and treatment-related sequelae during follow-up. The authors are among the first to report on PROs in anal cancer survivors. Further investigation on the impact of SCPs on health care communication and use is needed. Cancer 2017;123:1860–1868. © 2017 American Cancer Society.

e13605 Background: Well-established risk-factors exist for gynecologic cancers (GC): estrogen exposure increases risk of endometrial cancer (EC); HPV infection and smoking are associated with cervical cancer (CC); oral contraceptive (OCP) use may be associated with an increased risk of CC but a reduced risk of EC and ovarian cancer (OC). Women with a family history (FH) of cancer are more likely to receive regular CC screening, but the association between FH of GC and other risk factors has not been investigated. Methods: Reduce My Risk is an Internet tool created in 2009 to provide personalized information regarding cancer risk, available at OncoLink.org. Voluntary participants were asked about risk factors and risk-associated behaviors. Differences between female respondents with v. without FH of GC were analyzed using chi-square test. Results: Among 16,878 female respondents, 841 (5.0%) had FH of CC, 345 (2.0%) EC, 1,117 (6.6%) OC, and 92 (0.5%) vulvar/vaginal (VC) cancer. Those with FH of any GC showed no difference in alcohol consumption compared to those without FH. Those with FH of CC, EC, OC, and VC were more likely to be obese (34.1% v. 24.7%; 37.2% v. 24.9%; 31.4% v. 24.7%, 43.7% v. 25%, p < 0.001 for all). Those with FH of CC were more likely to have first sexual intercourse before age 18 (69.2% v. 57.8%, p < 0.001) and to have > 10 sexual partners (24.0% v. 16.7%, p < 0.001). This group was also more likely to be current smokers (19.3% v. 11.7%, p < 0.001), and to smoke > 1 pack/day (6.5% v. 2.8%, p < 0.001). They were more likely to receive regular CC screening (91.2% v. 86.8%, p = 0.09), though the difference was not statistically significant. Women < 35 y with a FH of CC showed no differences in HPV vaccination rate (37.0% v. 39.3%, p = 0.29). Those with FH of EC were more likely to have menarche before age 12 (39.3% v. 32.0%, p = 0.005), and to have taken post-menopausal HRT for ≥2 y (77.6% vs. 66.8%, p < 0.001). Those with FH of EC, and OC were more likely to have taken OCPs (77.6% v. 66.8%; 71.9% v. 66.7%, p < 0.001 for both). Conclusions: Many with a FH of GC have increased likelihood of both modifiable and non-modifiable risk factors that are associated with the development of cancer. FH of CC did not increase likelihood of regular screening or HPV vaccination, but was associated with smoking, early intercourse, and multiple sexual partners. Future work should explore targeted intervention for those with FH of GC as a teachable opportunity for the benefits of weight reduction, smoking cessation, pap screening, and HPV vaccination.

Purpose Multimodal treatment of Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) yields excellent outcomes; however, survivors are at risk of developing myriad late and long-term effects. Methods From a convenience sample of 964 survivors of HL (37%) and NHL (63%) using a publicly available Internet-based survivorship care plan (SCP) tool between 2011 and 2016, we examined patient-reported cancer care, toxicities, and survivorship care data. Results Of all survivors, 67% were female and 84% were white and 88% were free of cancer. Median age of diagnosis was 28 years for survivors of HL and 49 years for NHL. Many survivors reported treatment with chemotherapy (92%), surgery (52%), and/or radiation (41%), with most radiation delivered to chest/mantle fields (81%). Survivors reported a diversity of radiation- and chemotherapy-related sequelae, including thyroid dysfunction, speaking and/or swallowing changes, pulmonary fibrosis/pneumonitis, heart disease, chronic fatigue, neurocognitive decline, neuropathy, sexual changes, and secondary breast cancers. Few reported receipt of previous survivorship information. Most reported management/comanagement by an oncology specialist after active treatment; however, a shift to management by primary care provider alone was observed as a trend over time in follow-up. Sixty-six percent of users who responded to a follow-up survey reported that they intend to share the SCP with their health care team. Conclusion Survivors of lymphoma, many of whom are free of disease, report a substantial burden of late and long-term adverse effects, suboptimal delivery of survivorship information, and transitions of care in follow-up in which fragmented systems and/or poor communication may contribute to unmet survivor needs. Multiple opportunities thus exist for which SCPs may be used to improve awareness regarding survivorship and associated adverse effects in addition to communicating follow-up care plans between survivors and treatment teams.

814 Background: American Indian and Alaska Native (AI/AN) survivors are at significant risk for GI cancers, and also represent an underserved medical population. Gastrointestinal cancers represent the third most commonly diagnosed cancers in the AI/AN population and are a leading cause of death. Survivorship resources tailored for the AI/AN population are sparse and patterns of survivorship care poorly understood. Methods: The OncoLife survivorship care plan has been through the OncoLink website since 2007. The tool is free and publically available. It asks survivors to enter data regarding diagnosis, demographics, and treatments, and provides customized guidelines for future care. All research is IRB approved. Results: Over the past 12 years, the OncoLife tool has been utilized by >85,000 persons, with survivors of GI cancer representing 10-12% of users each year. Most users are women (75%) and Caucasian (80%). American Indian and Alaska Native survivors represent

807 Background: Certain behaviors are known modifiable risk factors for development of GI cancers. The relationship between family history (FH) of GI cancers and individuals’ behaviors is not well understood, but is important for risk assessment/ counseling. Methods: The OncoLink “Reduce My Risk” tool is a publicly available online survey created in 2009 to provide customized information regarding cancer risk. Details of this survey have been reported; research is IRB-approved. Differences between those with v. without FH of GI cancers were analyzed using chi-square test. Results: 28,001 surveys were submitted. Median age was 26y (18-101), 60% female, 87% lived in North America, 76% White/Non-Hispanic, 64% reported FH of cancer. Individuals with FH of CRC reported eating less red meat (31% v. 34%, p = 0.007), processed grains (55% v. 59%, p < 0.001), or charred meats (14% v. 19%, p < 0.001), but were equally likely to be vegetarian (9% v. 10%, p = 0.059). Those with FH of esophageal cancer were more likely to have GERD (16% v. 9%), smoke > = 1 pack per day (7% vs. 4%) and drink alcohol (63% v. 55%) (p < 0.001 for all). Those with FH of gastric cancer were more likely to have H. Pylori or gastric ulcers (5% v. 3%, p < 0.001), but no difference in the consumption of smoked/salted foods (27% v. 25%, p = 0.20). Those with FH of HCC reported no differences in alcohol consumption (56% v. 55%, p = 0.41) or hepatitis B virus (HBV) vaccination (62% v. 62%, p = 0.66). Those with FH of anal cancer were more likely to have receptive anal intercourse (26% v. 16%, p < 0.001) but showed no differences in human papillomavirus (HPV) vaccination (21% v. 22%, p = 0.91). Those with FH of HCC (15% v. 13%, p = 0.035), gastric (16% v. 13%, p = 0.001), esophageal (17% v. 13%, p < 0.001), and anal (21% vs. 13%, p < 0.001) cancers were more likely to be smokers; those with a FH of CRC were less likely (11% v. 13%, p = 0.006), and those with FH of pancreatic (12% vs. 13%, p = 0.71) or cholangiocarcinoma (15% vs. 13%, p = 0.59) showed no difference. Conclusions: Many individuals with a FH of GI cancers engage in behavioral and other modifiable risk factors that increase risk for GI and other cancers. Future work should explore utility of targeted intervention and screening.

To understand what factors influence whether a cancer survivor will share their survivorship care plan (SCP) with their healthcare provider (HCP). We used data from 3231 cancer survivors who utilized the OncoLink SCP resource between 2009 and 2016. Random forest and stepwise regression were used to identify predictors of SCP satisfaction and barriers to survivors sharing their care plans with their HCPs. Eighty-seven percent of users rated their satisfaction with their SCP as good or better; however, only 70% of survivors planned to share their SCP with their HCP. The most commonly reported reason for not sharing was a feeling that their HCP would not care. Self-reported satisfaction with their SCP was strongest predictor of whether a survivor would share their SCP. Gender, cancer status, number of chemotherapies received, and who was managing their healthcare were all associated with self-reported survivor satisfaction with their SCP. Survivor satisfaction with SCPs was high, but there was a disconnect in the number of satisfied survivors and the number of survivors planning to share their SCP with their HCP. To bridge this gap, additional prompts that HCPs are expecting this information should be added to the care plans. One of the primary functions of survivorship care plans is to improve communication between survivor and healthcare provider. While survivors are overwhelmingly satisfied with their SCP, additional steps are necessary to get survivors to share their SCP with their HCP.

Nearly 1 in 5 Americans will develop skin cancer, and as a result, survivors of skin cancer compose one of the largest groups of cancer survivors. Survivorship care plans (SCPs) are an important tool for improving patient outcomes and provide critical information to both survivors and health care professionals. Recent efforts have been made to expand SCP utilization; however, which patients currently receive SCPs is poorly understood.This study used 596 individuals with a diagnosis of melanoma (n = 391) or nonmelanoma skin cancer (n = 205) who had used an Internet-based SCP tool from May 2010 to December 2016 to model the patient and provider characteristics that determine SCP utilization.Survivors were predominantly white (95.3%) and female (56.5%). Survivors who received a treatment summary were more likely to also receive an SCP. University and nonuniversity cancer centers used SCPs at a higher rate than other care settings. Survivors whose care was managed by a team rather than just an individual physician were also more likely to receive an SCP. Survivors older than 70 years at diagnosis were almost twice as likely to receive a plan as survivors who were diagnosed at a younger age.With a convenience sample of skin cancer survivors, it is possible to model factors that predict the receipt of SCPs. Important variables include the diagnosis age, treatment setting, physician type, and treatment-summary utilization. A closer examination of these variables identified several disparities in care-plan use and, therefore, opportunities to improve the distribution of SCPs. Further validation in additional cohorts of survivors is necessary to confirm these conclusions. Cancer 2018;124:183-91. © 2017 American Cancer Society.

The survivorship needs of patients living with chronic cancer (CC) and their use of survivorship care plans (SCPs) have been overlooked and underappreciated.A convenience sample of 39,088 SCPs completed for cancer survivors with an Internet-based SCP tool was examined; it included 5847 CC survivors (15%; CC was defined as chronic leukemia and/or recurrent/metastatic cancer of another nature). Patient-reported treatment effects and follow-up care patterns were compared between CC survivors and survivors treated with curative intent (CI). Responses from a follow-up survey regarding SCP satisfaction and use were reviewed.CC survivors had greater odds of experiencing multiple treatment-related effects than survivors treated with CI; these effects included fatigue, cognitive changes, dyspnea, peripheral neuropathy, lymphedema, and erectile dysfunction. Nearly half of CC survivors were managed by an oncologist alone, and they were less likely than CI patients to be comanaged by a primary care provider and an oncologist. Fewer SCPs were generated by health care providers (HCPs) for CC survivors versus CI survivors. A smaller proportion of CC users versus CI users rated their experience and satisfaction with the SCP tool as very good or excellent, and CC users were less likely to share the HCP summary with their health care team.A substantial number of CC survivors, often considered incurable but treatable, seek survivorship support. Tools to facilitate participation, communication, and coordination of care are valuable for these patients, and future iterations of SCPs should be designed to address the particular circumstances of living with CC. Cancer 2017;123:4268-4276. © 2017 American Cancer Society.

e13075 Background: Prevention and early intervention can improve survival and quality of life across all cancers. Patient understanding of risk factors, and associated actionable lifestyle changes and screening programs, is not well understood by clinicians. Methods: The Internet-based OncoLink “Reduce My Risk” tool was created in 2009 to provide information about cancer risk after individuals responded to a comprehensive survey regarding demographics and cancer risk factors. Research related to these data has been IRB-approved. Results: 28,001 surveys were submitted. Median age among respondents ≥18y was 26y (18-101). 60% were female, 87% lived in North America, and 76% were White/Non-Hispanic. 37% had at least a bachelor’s degree, and 22% had household income > $100,000/y; most lived in a city/suburb (81%). 13% were current smokers, 23% previous smokers, 10% used cigars or pipe tobacco (10%), 6% used oral snuff/chew/quid, and 29% reported secondhand smoke exposure. Other substance use included marijuana (22% former users, 10% current users), alcohol (52% current users, 8% of those ≥14 drinks/w), and areca nut, betel leaf, or exotic smoking (1%). BMI was ≥30 in 19%. 74% reported dietary risks and 36% infrequent exercise. Early intercourse and > 10 sexual partners were reported by 43% and 10%, respectively. Excess UV exposure was reported by 19%, and exposure to known carcinogens 14%; 1% were exposed to DES in utero, and < 1% took DES while pregnant. Nonmodifiable risk factors included family cancer history (64%) or genetic syndrome (3%), and cancer-predisposing health condition (26%). 31% of women began menstruating < 12y and 33% gave birth to a first child > 30y. Conclusions: This free, publicly accessible cancer risk assessment tool has a large user population with higher educational status, higher income, and smaller household than the general population. 97% of users report behaviors associated with cancer risk. Another 72% report non-modifiable risks. By understanding detailed characteristics of a large number of respondents, these data have the potential to answer many hypothesis-generating questions, with the ultimate goal of improving educational interventions to reduce cancer risk across the general public.

119 Background: Multimodal treatment of HL and NHL yields excellent outcomes, however, survivors are at risk for developing myriad late- and long-term effects (LLTEs). We describe survivorship care practices and LLTEs reported by HL/ NHL survivors. Methods: From a convenience sample of 964 HL (37%) and NHL (63%) cancer survivors using a publicly available Internet-based survivorship care plan (SCP) tool between 2011-2016, we examined cancer care and toxicity profile data. Results: Of all survivors, 67% were female and 84% were Caucasian; median age of diagnosis was 28y for HL and 49y for NHL survivors with median fu of 5y and 2y, respectively. 88% were free of cancer, 9% with recurrent or secondary malignancy, and 3% with metastatic disease. Chemotherapy was delivered to 89% of HL and 94% of NHL survivors, and radiation (RT) to 64% and 28%, respectively. Of those receiving RT, 96% (n = 217) HL and 61% (n = 106) NHL survivors received chest/mantle RT. Few reported receipt of previous SCP (13%) or treatment summary (4%). Most reported continued care from an oncologist (49%) or in combination with a PCP (19%). A shift to PCP management alone was observed, increasing from 2% of survivors if < 2y fu to 30% once ≥2y fu. Survivors who received chest RT reported: hyper- or hypothyroidism (35%), thyroid nodules (8%), speaking/swallowing changes (20%), heart disease (14%), pulmonary fibrosis/pneumonitis (12%), and skin cancers within the RT field (9%). 6 of 321 (2%) who received chest RT reported secondary breast cancers, compared to zero in the group not receiving chest RT with median time to breast cancer 20.5y (R 6-32 years). Receipt of chemotherapy was associated with: chronic fatigue (56%), cognitive change (56%), peripheral neuropathy (35%), sexual changes (15% of males, 35% of females), and heart disease (10%). Conclusions: While this population achieves excellent disease outcomes, survivors report a substantial burden of LLTEs, suboptimal delivery of survivorship information, and transitions of care in follow-up. Multiple opportunities thus exist through which SCPs may be used to improve awareness regarding survivorship/ LLTEs and communicate follow-up care plans between survivors and treatment teams.

695 Background: There is significant need for quality follow-up care to optimize long-term outcomes for the growing population of lower gastrointestinal (GI) cancer survivors. Patient-reported outcomes (PROs) provide valuable information regarding late- and long-term effects. Methods: Using a convenience sample from 1,129 colon, rectal and anal cancer survivors (n=792, 218, and 119, respectively) who utilized an Internet-based survivorship care plan (SCP) tool, we examined patient-reported demographics, treatment, and toxicity data. Responses from a follow-up survey were reviewed. Results: Median age of diagnosis was 51 years and median current age was 54 years. 81% of respondents were Caucasian and 58% were female. The most commonly reported late- and long-term effects for all survivors were neuropathy (65%), fatigue (56%), cognitive changes (49%), changes in GI function (43%), sexual dysfunction (22% in males, 43% in females), and radiation-induced dermatologic effects including changes in color/texture of skin (39%) and loss of flexibility in radiated areas (31%). The prevalence of these effects varied with length of time since treatment and treatment modality. Anal cancer patients reported a high prevalence of sexual dysfunction and radiation-induced dermatologic effects. Over 87% of users reported satisfaction levels of "good" to "excellent" using this tool, and 69% reported they intend to share SCP with their healthcare team. Conclusions: For lower GI cancer survivors, it is feasible to obtain PROs from an Internet-based survivorship tool. Survivors report a wide spectrum of late- and long-term side effects, which can be used to inform counseling at time of diagnosis, as well as help anticipate and respond to disease- and treatment-related sequelae during follow-up. We are among the first to report on PROs in anal cancer survivors. Further investigation on the impact of SCPs on healthcare communication and use is needed.

58 Background: A cornerstone to cancer survivorship care is the education provided to patients regarding late and long-term effects, follow up care, and healthy living after a cancer diagnosis and treatment. Nurses have long provided patient education in oncology care. The provision of survivorship care is a natural extension of this role. An online survivorship care plan (SCP) builder can facilitate this and reduce the resources required for implementation of a survivorship program. Methods: We examined nurse and nurse practitioner (NP) use and satisfaction of two free online SCP builders, OncoLife on http://www.oncolink.org , and the LIVESTRONG Care Plan, between May 2010 and July 2015. Users of the program were queried about their satisfaction with the information provided, if their practice had an established survivorship program and if they would use the program for other patients. Time to complete a SCP was measured. Results: Healthcare providers completed 16,302 SCPs during the timeframe examined. The majority of plans were completed by nurses (n = 7393, 45%) and nurse practitioners (NPs) (n = 6296, 39%), while the remaining were completed by physicians (n = 754, 5%) and unknown users (n = 1859, 11%). When compared to University-based cancer centers (UCC), SCPs completed in community settings were more often delivered by nurses, as opposed to NPs (UCC: Nurses 22%, NPs 53%; community setting: Nurses 57%, NPs 31%; p < 0.001). A satisfaction survey was completed by 415 Nurse and NP users. They reported high satisfaction with the information provided (31% excellent, 33% very good, 26% good); 75% reported that the plan provided “just enough information”, whereas 11% felt it “could use more information”, and 6% felt there was “too much information”. Sixty-four percent had an established survivorship program and 100% would use it for other patients. The median time to complete an SCP was 4 min 17 sec (IQR 2:38-7:19). Conclusions: Nurse and NP users report high satisfaction using an online SCP builder. In community settings, nurses were completing the plan significantly more often than NPs. The short time required to create the SCPs may allow practices to efficiently meet regulatory requirements with minimal resources.