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QOLP-35. PEDIATRIC POST-MORTEM TISSUE DONATION DURING A PANDEMIC: A MODEL OF COLLABORATION

Abstract BACKGROUND Obtaining post-mortem tissue from pediatric oncology patients is not only critical to research, but studies show that participating in the process can also help grieving families heal. Since 2019, the national Gift from a Child program — a multi-institutional effort to increase the rate of rapid autopsies for pediatric CNS tumor patients — has made significant progress. Collecting high-quality post-mortem tissue has advanced research through cell line generation and genomic analyses. Unfortunately, some autopsy programs temporarily shut down during the COVID-19 pandemic. METHODS We retrospectively reviewed autopsies of four patients treated at Memorial Sloan Kettering (MSK) who underwent limited brain post-mortem examination at Weill Cornell Medicine College (WCMC) from June 2020 to June 2021. We collected patient demographics; DNR status; time of death and procedure; restrictions due to the COVID-19 pandemic; and results of the tissue analysis. Each case presented unique challenges and the timing of securing parental consent varied. RESULTS Three of four specimens were processed within 12 hours of the time of death. Two Spanish-speaking families required interpreters services to obtain consent. In all cases tumor aliquots were flash frozen for further study. All specimens contained viable tumor and cell line generation was successful in one case. All families/caregivers expressed gratitude for the opportunity to participate and for the handling of the procedures. DISCUSSION Despite the sensitive nature of these cases, clinicians should offer the option of a rapid autopsy to caregivers of pediatric patients based on the scientific need and the positive effect it has on grieving families. This paper outlines the logistical efforts required for these donations to take place and provides a framework for providers to offer rapid autopsy as an option for families through this program.

BACKGROUND: Gliomas are devastating primary tumors of the central nervous system that often present with difficult to manage symptoms in addition to the antineoplastic tumor itself. Due to recent increase in popularity and societal acceptance of cannabis products, their use by glioma patients has increased. METHODS: We conducted a single center, prospective study: patients with glioma answered a locally validated survey to inquire about their cannabis use at baseline and every three months. Quality of Life was measured using the EORTC QLQ-C30, its complementary module BN-20 and the EQ-5D-5L instrument. Eligible participants were classified as cannabis users or non-users. We performed linear regression clustered by subjects to see differences by user group and trends overtime. RESULTS: To date, 89 patients agreed to participate, enrolled, and answered the baseline questionnaires, and 64 have answered the 3 month follow up survey. The mean age was 49.7(SD 13.74), 55 were male, 55 were cannabis users at baseline (61.8%) and 34 at 3 months (53.13%). Patients who were cannabis users scored 11.73 lower points at baseline when compared to  vs 67.92 [SD 19.22]) in the QLQ-C30 instrument. Similarly, cannabis users recorded 9.624 lower points at 3 months compared to ). The difference-indifference estimator was 2.108 (p< 0.7). CONCLUSION: Although we observed cannabis users scoring lower QoL measurements (p< 0.05) at baseline and 3 months, we observed a slight improvement in QoL of cannabis users while observing no change or decline (in some measures) among non-users. Our findings provide insight to the impact that cannabis has in QoL over time. While not conclusive, these preliminary results need to be studied on a longer-term basis with a larger sample size in order to detect trends on quality of life among patients with different tumor types. SIGNIFICANCE AND AIMS: Financial toxicity (FT) after a cancer diagnosis is the consequence of decreased earnings and increased spending. In patients with primary central nervous system (PCNS) tumors, the correlation between FT and factors such as symptom burden, psychological distress, and health-related quality of life has not been extensively studied. We assessed employment status and several patient illness factors in a PCNS tumor cohort. METHODS: Patient and disease characteristics and patientreported outcomes (PROs) were collected from adults diagnosed with PCNS tumors between 9/2016-12/2019. Descriptive statistics and regression analyses were used to describe PROs. RESULTS: Of 277 patients, 77 (28%) reported being unemployed due to tumor diagnosis. They reported difficulty walking (64%) and performing usual activities (64%). This group had lower general health status (p< 0.001) and higher tumor-related symptom severity (p=0.004) than employed patients. Unemployed patients reported high symptom burden with an average of 6 moderate-severe symptoms for those with brain tumors and 10 for those with spine tumors. Both brain and spine tumor patients who were unemployed reported increased moodrelated interference (p=0.020), as well as moderate-severe anxiety (30%) and depression (25%) compared to employed patients (15% vs 8%, respectively). Unemployed brain tumor patients reported worse scores in cognitive and neurologic symptom subscales (p< 0.001). CONCLUSIONS AND IM-PLICATIONS: These data provide indirect evidence that financial toxicity that correlates with high symptom burden across several domains and lower health-related quality of life. Future research work will include the COST questionnaire to further evaluate the implications of FT in the PCNS tumor patient population.

QOLP-34. EVALUATING ADJUSTMENT DISORDER AND POST-TRAUMATIC STRESS DISORDER IN BRAIN TUMOR PATIENTS
Alec Gibson 1 , and Jerome Graber 2 ; 1 University of Washington, Seattle, WA, USA, 2 University of Washington Medical Center, Seattle, WA, USA Patients with primary and metastatic brain tumors are particularly susceptible to psychiatric comorbidities. Adjustment disorder (AD) and post-traumatic stress disorder (PTSD) are particularly prevalent in cancer patients and benefit from focused treatment; however, few studies have assessed these conditions in both brain tumor patients and their caregivers. This study aims to evaluate the prevalence of cancer-related AD and PTSD in both brain tumor patients and caregivers, including patients with gliomas, meningiomas, metastases and other brain tumor types. Patients and caregivers at the University of Washington's Alvord Brain Tumor Center completed modified ADNM-20 and PCL-5 questionnaires to screen for cancer-related AD and PTSD, respectively. Cutoff scores for a positive screen were set at 47.5 for the ADNM-20 and 33 for the PCL-5. A total of 11 patients and 5 caregivers completed both surveys between December 2019 and May 2021. Two caregivers (40%) screened positive for AD, while none of the brain tumor patients met the cutoff score. One brain tumor patient (9%) screened positive for PTSD, while no caregivers had a positive score. Mean ADNM-20 scores were 34.9 (± 8.8) for brain tumor patients and 34.2 (± 14.8) for caregivers (p = 0.890, Mann-Whitney test). Mean PCL-5 scores were 15.3 (± 10.5) for brain tumor patients and 16.6 (± 11.2) for caregivers (p = 0.681, Mann-Whitney test). Mean scores for ADNM-20 and PCL-5 did not differ between groups, confirming that both caregivers and patients are psychologically affected, and 2 out of 5 caregivers screened positive for AD while 1 out of 11 brain tumor patients screened positive for PTSD. These results demonstrate that cancer-related AD and PTSD can be identified in these populations and suggest a difference in these psychiatric conditions between patients and caregivers. Identifying patients and their caregivers with AD and PTSD could improve their quality of life.

QOLP-35. PEDIATRIC POST-MORTEM TISSUE DONATION DURING A PANDEMIC: A MODEL OF COLLABORATION
Esteban Uceda 1 , Cindy Campbell 1 , Sheila McThenia 2 , Melanie Degliuomini 2 , Yasmin Khakoo 2 , David J. Pisapia 1 , and Jeffrey Greenfield 1 ; 1 Weill Cornell Medicine, New York, NY, USA, 2 Memorial Sloan Kettering Cancer Center, New York, USA BACKGROUND: Obtaining post-mortem tissue from pediatric oncology patients is not only critical to research, but studies show that participating in the process can also help grieving families heal. Since 2019, the national Gift from a Child program -a multi-institutional effort to increase the rate of rapid autopsies for pediatric CNS tumor patients -has made significant progress. Collecting high-quality post-mortem tissue has advanced research through cell line generation and genomic analyses. Unfortunately, some autopsy programs temporarily shut down during the COVID-19 pandemic. METHODS: We retrospectively reviewed autopsies of four patients treated at Memorial Sloan Kettering (MSK) who underwent limited brain post-mortem examination at Weill Cornell Medicine College (WCMC) from June 2020 to June 2021. We collected patient demographics; DNR status; time of death and procedure; restrictions due to the COVID-19 pandemic; and results of the tissue analysis. Each case presented unique challenges and the timing of securing parental consent varied. RESULTS: Three of four specimens were processed within 12 hours of the time of death. Two Spanish-speaking families required interpreters services to obtain consent. In all cases tumor aliquots were flash frozen for further study. All specimens contained viable tumor and cell line generation was successful in one case.

NEURO-ONCOLOGY • November 2021
All families/caregivers expressed gratitude for the opportunity to participate and for the handling of the procedures. DISCUSSION: Despite the sensitive nature of these cases, clinicians should offer the option of a rapid autopsy to caregivers of pediatric patients based on the scientific need and the positive effect it has on grieving families. This paper outlines the logistical efforts required for these donations to take place and provides a framework for providers to offer rapid autopsy as an option for families through this program.

QOLP-36. PATTERN OF CARE OF BRAIN TUMOR PATIENTS IN THE LAST MONTHS OF LIFE: ANALYSIS OF A COHORT OF 3045 PATIENTS IN THE LAZIO REGION IN THE LAST 10 YEARS
Andrea Pace 1 , Valeria Belleudi 2 , Luigi Pinarelli 2 , Veronica Villani 1 , Francesca poggi 2 , Dario Benincasa 1 , and Marina Davoli 2 ; 1 IRCCS Regina Elena Cancer Institute, Rome, Lazio, Italy, 2 Lazio Regional Health Service, Rome, Lazio, Italy The final days of life of Brain Tumor patients (BT) present special challenges and often palliative care approach is underutilyzed. Several studies reported that BT patients in the last months of life receive frequent hospital readmissions and ER accesses as result of bad quality of End of Life care. Early integration of pallative care has been demonstrated to improve quality of care in advanced stage of disease and quality of death in cancer patients. With the aim to evaluate pattern of treatment and the rate of hospital readmission in the last months of life, we retrospectively analyzed a consecutive serie of BT patients discharged after a diagnosis of BT. METHODS: Data regarding hospital readmission and treatment received in the last two months of life were collected from the Lazio Region Healthcare database. Adult patients discharged with diagnosis ICD-9 191.* between 1/1/2010 until 31/12/2019, were included in this study. RE-SULTS: 6672 patients were identified and 3045 death before 31/12/2019 were included (median age 67 y;M1700). In the last month of life 42.6% received hospital reamission (4.6% intensive care unit) and 37.9% had ER accesses. 24.5% received chemotherapy and 12.1% radiotherapy. In the last 30 days 33% were readmitted in hospital and 24.2% were admitted in ER. 11.7% were treated with chemotherapy and 6% with radiotherapy. CONCLUSION: Strategies to improve quality of care at the end of life and to decrease rehospitalization and futile treatments are becoming increasingly important to improve quality of death and to reduce costs of Healthcare System.

QOLP-37. MOOD DISTURBANCE IN PATIENTS WITH CENTRAL NERVOUS SYSTEM (CNS) TUMORS DURING THE COVID-19 PANDEMIC
Lily Polskin 1 , Valentina Pillai 1 , Elizabeth Vera 1 , Alvina Acquaye 1 , Nicole Briceno 1 , Anna Choi 1 , Alexa Christ 1 , Ewa Grajkowska 2 , Varna Jammula 1 , Heather Leeper 1 , Jason Levine 2 , Matthew Lindsley 1 , Jennifer Reyes 1 , Kayla Roche 1 , James Rogers 1 , Michael Timmer 1 , Lisa Boris 1 , Eric Burton 1 , Nicole Lollo 1 , Marissa Panzer 1 , Marta Penas-Prado 1 , Brett Theeler 3 , Jing Wu 1 , Mark Gilbert 1 , Terri Armstrong 1 , and Amanda King 1 ; 1 National Cancer Institute, National Institutes of Health, Bethesda, MD, USA, 2 National Institutes of Health, Bethesda, MD, USA, 3 National Institutes of Health, Uniformed Services University, Bethesda, MD, USA BACKGROUND: Primary CNS tumors are associated with uncertainty likely contributing to mood disturbance that is common throughout the disease trajectory. The intersection of the COVID-19 pandemic with a CNS tumor diagnosis may further impact the anxiety/depression experienced in this population. This study assessed key anxiety/depression symptoms in patients with CNS tumors prior to and during the COVID year. METHODS: Patient reported outcomes (PROs), including the PROMIS Anxiety and Depression Short Forms and EQ-5D-3L, were collected at the time of clinical or telehealth evaluation from the COVID year (March 2020-February 2021) and were compared to assessments through February 2020 (a NOB-normative sample), reflecting what we would typically see in our regular clinic evaluations. RESULTS: The COVID sample (N = 178) was primarily White (82%), male (55%), median age of 45 (range 18-79), and KPS ³ 90 (50%). The majority had high grade (70%) brain (83%) tumors with ³ 1 prior recurrence (60%) and 25% were on active treatment. Visits were primarily conducted via telehealth (64%) and 20% had progression at assessment. Compared to the NOB-normative sample, patients reported significantly higher depression scores (moderate-severe, 17% vs. 12%, p < 0.05), but not anxiety (18% vs. 16%). Eleven percent reported both moderate-severe anxiety and depressive symptoms (8% pre-COVID). Overall health assessed by the EQ-5D-3L was similar to the normative sample in all dimensions, apart from impact of moderate/extreme mood dis-turbance, which was more prevalent in the COVID year (53% vs. 43%, p < 0.05%). CONCLUSION: Patients with CNS tumors are at risk for significant symptoms of depression and anxiety; this risk was heightened during the COVID year. Further evaluation of clinical factors associated with risk are underway. These findings highlight the need for assessments and interventions that can be administered via telehealth to address the mental health needs of this vulnerable population.

RBIO-01. DEVELOPING THE FRAMEWORK FOR TUMOR TREATING FIELDS (TTFIELDS) TREATMENT PLANNING FOR A PATIENT WITH ASTROCYTOMA IN THE SPINAL CORD
Jennifer de Los Santos 1 , Smadar Arvatz 2 , Oshrit Zeevi 2 , Shay Levi 2 , Noa Urman 3 , Ariel Naveh 2 , and Tal Marciano 2 ; 1 Grandview Cancer Center, Birmingham, AL, USA, 2 Novocure, Haifa, Israel, 3 Novocure, Los Angeles, CA, USA The use of Tumor Treating Fields (TTFields) following resection and chemoradiation has increased survival in patients with Glioblastoma. Patientspecific planning for TTFields transducer array placement has been demonstrated to maximize TTFields dose at the tumor: providing higher TTFields intensity (≥ 1.0 V/cm) and power density (≥ 1.1 mW/cm3) which are associated with improved overall survival. Treatment planning was performed for a 48 year old patient following T10-L1 laminectomy, gross total resection, and postoperative chemoradiation for an anaplastic astrocytoma of the spinal cord. An MRI at 3 weeks following chemoradiation showed tumor recurrence. Based on the post-chemoradiation MRI, a patient-specific model was created. The model was created by modifying a realistic computational phantom of a healthy female. To mimic the laminectomy, the lamina in T10-L1 was removed, and the region assigned electric conductivity similar to that of muscle. A virtual mass was introduced into the spinal cord. Virtual transducer arrays were placed on the model at multiple positions, and delivery of TTFields simulated. The dose delivered by different transducer array layouts was calculated, and the layouts that yielded maximal dose to the tumor and spine identified. Transducer array layouts, in which the arrays were placed on the back of the patient with one array above the tumor and one array below the tumor, yielded the highest doses at the tumor site. Such layouts yielded TTFields doses of over 3.4mW/cm 3 which is well above the threshold dose of 1.1 mW/cm 3 reported previously [Ballo et al. Red Jour 2019]. The framework developed for TTFields dosimetry and treatment planning for this spinal tumor will have the potential to increase dose delivery to the tumor bed while optimizing placement that may enhance comfort and encourage device usage.