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We thank Dr Proctor for his thoughtful letter. Perhaps our most successful project, which applies to all patients, involves our simulator. In the past, simulation was frequently delayed because the patient record was missing information (eg, the consent form or serum creatinine). By standardizing our simulation procedures, we eliminated the 22 hours per month of overtime that was previously required. It also seems likely that our bone and brain metastases project has decreased the overall cost of care by decreasing the administrative burden of multiple visits, as well as saving the patient's caregiver missed days of work.