Abstracts from the Abstracts from the Mid-Atlantic Section of the AUA 2021

MA-AUA 2021 Abstracts Moderated Poster Session 1: Prostate Cancer Financial Toxicity of Prostate Cancer Survivorship: a National Cross- Sectional Assessment of Indirect Financial Burden C. Herrera 1 , C. Guerra 1 , V. Narayan 1 , T. Guzzo 1 , R. Mamtani 1 , D. Lee 1 , G. Tasian 1,2 , R. Talwar 1 1 University of Pennsylvania, Philadelphia, FL, USA; 2 Children’s Hospital of Philadelphia, Philadelphia, PA, USA Introduction and Objective: Financial toxicity as a consequence of cancer has only recently been assessed in prostate cancer (PCa). No current studies evaluate indirect costs of PCa survivorship. We aim to describe patient- reported indirect financial burden within a cross-sectional cohort of PCa survivors across the United States. Methods: Using Medical Expenditure Panel Survey (MEPS) data from the Agency for Healthcare Research and Quality (AHRQ), we identified 264 PCa survivors who completed the Cancer Self Administered Questionnaire (CSAQ) in 2016 and 2017. We assessed the presence and specific themes of indirect financial burden, an affirmative response to questions endorsing burden in employment, work ability, and insurance as a consequence of the subject’s cancer. Results: Overall, 31.4% (n=83) men endorsed ≥1 measure indicating some degree of indirect financial burden. The 5 most common were extended time off fromwork, changes to work schedule, extended paid time off, interference with physical tasks, and less productivity at work since PCa diagnosis (Figure 1). Younger age (p<0.05), health insurance type (p<0.05), and caregiver presence (p<0.05) were noted in men with indirect financial burden (Table 1). Upon logistic regression, age (OR 0.98, 95%CI 0.96-0.99, p<0.05) and caregiver presence (OR 2.29, 95%CI 1.71-5.00, p<0.05) remained significant. Conclusions: In this novel analysis, nearly 1/3 of men report some degree of indirect financial burden. We identify several commonly endorsed domains, including physical and mental disturbances at work and extended leave from work. In understanding the intricacies of cancer financial toxicity, it is important to consider indirect sequelae of diagnoses and treatments to provide patient-centered care. Large Scale Implementation of Opioid PrescriptionReduction after Robotic Prostatectomy – 2 year Evaluation from the Pennsylvania Urologic Regional Collaborative (PURC) C. Keith 1 , N. Streeper 1 , A. Quinn 2 , A. Bernstein 3 , T. Chandrasekar 2 , K. Syed 4 , A. Kutikov 3 , J. Danella 5 , S. Ginzburg 6 , T. Lanchoney 7 , J. Tomaszewski 8 , E. Trabulsi 2 , A. Reese 9 , M. Smaldone 3 , R. Uzzo 3 , T. Guzzo 9 , J. Raman 1 , D. Lee 10,11 1 Penn State Milton S. Hershey Medical Center, Hershey, PA, USA; 2 Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, PA, USA; 3 Fox Chase Cancer Center, Philadelphia, PA, USA; 4 Health Care Improvement Foundation, Philadelphia, PA, USA; 5 Geisinger Medical Center, Danville, PA, USA; 6 Einstein Healthcare Network, Philadelphia, PA, USA; 7 UrologyHealth Specialists, BrynMawr, PA, USA; 8 Cooper University, Camden, NJ, USA; 9 Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA; 10 Division of Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; 11 Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA Introduction and Objective: Diversion of post-operative medication is a major contributor to opioid misuse. It is necessary for urologists to help combat the opioid epidemic while still providing effective painmanagement. The objective of this study is to evaluate the impact of implementing an opioid reduction protocol for robotic prostatectomy (RALP) within a regional collaborative where opioid abuse is endemic. Methods: An opioid reduction protocol was implemented for patients undergoing RALP at three institutions within the Pennsylvania Urologic Regional Collaborative (PURC). We compared prescribing practices 12months before and after the intervention, with a one-month washout period. We measured opioid prescriptions on discharge and patient reported pain levels at their first post-operative visit. All opioid prescriptions were converted into equivalents of oxycodone 5mg tablets. Pain scores were captured with a visual analog scale of 0-10. Results: Overall, 1,518 patients underwent RALP, with a median age of 63.6 years (IQR 58.4-68.0). For the 12 months before implementation, a median of 20 oxycodone 5mg tablets were prescribed on discharge (IQR 14-30) and after this decreased to a median of 0 tablets (IQR 0-14, p<0.001). Despite the decrease in opioid prescriptions, there were no significant changes in pain scores (median value 0/10, p=0.78, Fig. 1). Overall, 14 less opioid tablets were prescribed per RALP, leading to a total of 10,248 less opioid tablets in Pennsylvania over a 1-year period. Conclusions: Adequate pain control is feasible without opiates for the majority of patients undergoing RALP, allowing for significant reductions in the number of opioids entering the community. Urologists have an important role in reducing opioid oversupply. Policies to encourage opioid stewardship should be designed to encourage adoption of such programmatic change. MP1-10 MP1-09 9