Cancer Treatment Planning Research Articles

Improving lung nodule segmentation in thoracic CT scans through the ensemble of 3D U-Net models.

The current study explores the application of 3D U-Net architectures combined with Inception and ResNet modules for precise lung nodule detection through deep learning-based segmentation technique. This investigation is motivated by the objective of developing a Computer-Aided Diagnosis (CAD) system for effective diagnosis and prognostication of lung nodules in clinical settings. The proposed method trained four different 3D U-Net models on the retrospective dataset obtained from AIIMS Delhi. To augment the training dataset, affine transformations and intensity transforms were utilized. Preprocessing steps included CT scan voxel resampling, intensity normalization, and lung parenchyma segmentation. Model optimization utilized a hybrid loss function that combined Dice Loss and Focal Loss. The model performance of all four 3D U-Nets was evaluated patient-wise using dice coefficient and Jaccard coefficient, then averaged to obtain the average volumetric dice coefficient (DSCavg) and average Jaccard coefficient (IoUavg) on a test dataset comprising 53 CT scans. Additionally, an ensemble approach (Model-V) was utilized featuring 3D U-Net (Model-I), ResNet (Model-II), and Inception (Model-III) 3D U-Net architectures, combined with two distinct patch sizes for further investigation. The ensemble of models obtained the highest DSCavg of 0.84 ± 0.05 and IoUavg of 0.74 ± 0.06 on the test dataset, compared against individual models. It mitigated false positives, overestimations, and underestimations observed in individual U-Net models. Moreover, the ensemble of models reduced average false positives per scan in the test dataset (1.57 nodules/scan) compared to individual models (2.69-3.39 nodules/scan). The suggested ensemble approach presents a strong and effective strategy for automatically detecting and delineating lung nodules, potentially aiding CAD systems in clinical settings. This approach could assist radiologists in laborious and meticulous lung nodule detection tasks in CT scans, improving lung cancer diagnosis and treatment planning.

Comparison between BIRAD Scores and Histological features in Diagnosis of Breast Neoplasia at Warith International Cancer Institution.

Introduction: Accurate evaluation and classification of breast lesions using the Breast Imaging-Reporting and Data System (BIRADS) are crucial for appropriate management and treatment planning of breast cancer. This study explores the relationship between BIRADS scores and histological features in the diagnosis of breast neoplasia at the Warith International Cancer Institution in Karbala, Iraq. Methods: This descriptive study included 520 patients diagnosed with breast neoplasia with a pre-diagnostic malignancy probability (BI-RADS 3, 4, or 5) between June 2023 and June 2024. Based on the diagnostic imaging method, patients were classified into mammography and ultrasonography groups. Clinicopathological factors, including age, BI-RADS categories, and histological findings, were analyzed. Results: Mammogram findings revealed that 63.65% of patients had benign results, while 20.77% had findings indicative of malignancy. Ultrasound findings showed that 71.35% of patients had benign results, and 11.35% had findings suggestive of malignancy. Histological analysis indicated that 23.85% of patients had malignant results, 68.07% had benign findings, and 2.31% showed suspicious results. Patients aged 50 years and above had a significantly higher likelihood of detecting malignant breast lesions through mammography compared to younger patients. At the same time, no significant association was found between age groups and ultrasound findings. Conclusion: Mammography demonstrated high sensitivity and specificity in detecting breast neoplasia, although there were false positives and negatives. Ultrasound screening also effectively detected breast abnormalities, particularly in identifying lesions that required further evaluation. The study highlights the importance of age in influencing breast cancer detection through mammography, with older patients having a higher detection rate than younger patients.

Ultra-high b-value DWI in rectal cancer: image quality assessment and regional lymph node prediction based on radiomics.

This study aims to evaluate image quality and regional lymph node metastasis (LNM) in patients with rectal cancer (RC) on multi-b-value diffusion-weighted imaging (DWI). This retrospective study included 199 patients with RC who had undergone multi-b-value DWI. Subjective (five-point Likert scale) and objective assessments of quality images were performed on DWIb1000, DWIb2000, and DWIb3000. Patients were randomly divided into a training (n = 140) or validation cohort (n = 59). Radiomics features were extracted within the whole volume tumor on ADC maps (b = 0, 1000 s/mm2), DWIb1000, DWIb2000, and DWIb3000, respectively. Five prediction models based on selected features were developed using logistic regression analysis. The performance of radiomics models was evaluated with a receiver operating characteristic curve, calibration, and decision curve analysis (DCA). The mean signal intensity of the tumor (SItumor), signal-to-noise ratio (SNR), and artifact and anatomic differentiability score gradually weredecreased as the b-value increased. However, the contrast-to-noise (CNR) on DWIb2000 was superior to those of DWIb1000 and DWIb3000 (4.58 ± 0.86, 3.82 ± 0.77, 4.18 ± 0.84, p < 0.001, respectively). The overall image quality score of DWIb2000 was higher than that of DWIb3000 (p < 0.001) and showed no significant difference between DWIb1000 and DWIb2000 (p = 0.059). The area under curve (AUC) value of the radiomics model based on DWIb2000 (0.728) was higher than conventional ADC maps (0.690), DWIb1000 (0.699), and DWIb3000 (0.707), but inferior to multi-b-value DWI (0.739) in predicting LNM. DWIb2000 provides better lesion conspicuity and LNM prediction than DWIb1000 and DWIb3000 in RC. DWIb2000 offers satisfactory visualization of lesions. Radiomics features based on DWIb2000 can be applied for preoperatively predicting regional lymph node metastasis in rectal cancer, thereby benefiting the stratified treatment strategy. Lymph node staging is required to determine the best treatment plan for rectal cancer. DWIb2000 provides superior contrast-to-noise ratio and lesion conspicuity and its derived radiomics best predict lymph node metastasis. DWIb2000 may be recommended as the optimal b-value in rectal MRI protocol.

Physical Activity, Exercise and Cancer (PAEC) and the holistic approach to health for cancer patients/survivors

Physical activity is essential for cancer patients/survivors, protecting against cancer and other diseases. Healthy habits, including regular physical activity, are crucial for patients' well-being. It is important to integrate physical activity into cancer treatment plans to improve outcomes and quality of life. Experts advocate for making physical activity a standard part of cancer care and prescribing sports for all cancer patients. This approach could lead to a healthier future for individuals affected by cancer.

Assessment of Organ-at-risk Sparing in Esophageal Cancer: A Comparative Dosimetric Evaluation of Hybrid, Noncoplanar, and Coplanar RapidArc Plans

Aim: The purpose of this study is to improve the precision of radiation treatment and sparing of organ-at-risk (OAR) in patients with thoracic esophageal cancer (EC) affecting the heart, lung, and spinal cord. To improve and personalize cancer treatment plans, it assesses the dosimetric benefits of coplanar RapidArc (RAc), hybrid arc (RAHyb), and noncoplanar RapidArc (RAnc). Materials and Methods: Fourteen patients with EC were chosen for our investigation from our hospital’s database. RapidArc (RA) plan patients had already received treatment. Retrospectively, additional RAnc and RAHyb plans were made with a prescription dose of 50.4 Gy in 28 fractions for the planning target volume (PTV). A prescription dose of 95% of PTV was used, so that three different treatment planning procedures could be compared. The cumulative dose-volume histogram was used to analyze the plan quality indices homogeneity index (HI), conformity index (CI), conformation number (CN) as well as the OARs doses to the lung, heart, and spinal cord. Results: In comparison to RAc and RAnc techniques, the study indicated that RAHyb plans significantly increased D95%, CI and HI; Dmax and CN did not differ substantially. In addition, compared to RAc (lung: 16.15 ± 0.03 Gy and heart: 23.91 ± 4.67 Gy) and RAnc (lung: 15.24 ± 0.03 Gy and heart 23.82 ± 5.10 Gy) plans, RAHyb resulted in significantly lower mean lung doses (15.10 ± 0.03 Gy) and heart doses (21.33 ± 6.99 Gy). Moreover, the RAHyb strategy showed a statistically significant (P &lt; 0.05) lower average MU (452.7) than both the RAc (517.5) and RAnc (566.2) plans. Conclusion: The D95%, conformity, and homogeneity indices were better for hybrid arc plans compared to RAc and RAnc plans. They also successfully managed to reduce the lung and heart doses as well as the mean MU per fraction.

Unforeseen Complications of Pembrolizumab in Breast Reconstruction Post-Mastectomy.

Among patients with early triple-negative breast cancer, the combination of pembrolizumab with neoadjuvant chemotherapy enhances outcomes compared to chemotherapy alone.Early recognition is essential for managing pembrolizumab-induced complications, as demonstrated by the need for expander removal and debridement in this case.The unique adverse effects observed in this case underscore the importance of tailoring cancer treatment plans to individual patients, taking into account the potential risks associated with immunotherapy in the context of reconstructive surgery.

Impact of histopathological parameters in prognosis of oral squamous cell carcinoma

AbstractObjectiveSquamous cell carcinomas comprise approximately 90% of all oral malignancies. There is a wide geographical variation in the incidence of oral cancer, with South and South East Asia (SSEA) accounting for almost two third of new cases. The prognosis of oral cancer is influenced by a vast array of factors including demographic, clinical, histopathological and molecular factors. The objective this review is to analyse the impact of histopathological features assessed in hematoxylin and eosin stained sections on the prognosis of OSCC.Materials and MethodsMedline and Scopus data base search was performed in order to identify related articles on histopathological parameters in predicting prognosis of oral squamous cell carcinoma. The primary emphasis is on the studies conducted in SSEA, with an accompanying comparison of their findings with those from research conducted in other parts of the world.ResultsIt has been shown that the number of studies conducted in SSEA is not proportionate to the high prevalence of Oral Cancer in the region. There is no significant difference between the findings from SSEA compared to the rest of the world. It is clearly shown that most histopathological parameters can be accurately used to predict nodal metastasis and prognosis.ConclusionsHistopathological parameters can be used reliably in planning treatment of Oral cancer. Clinicians should combine clinical and histopathological parameters in drawing treatment plan for Oral Cancer.

The emerging role of PET/CT scanning in the treatment planning of ovarian cancer: A mini-review

AbstractGiven the many obstacles faced during the treatment of ovarian cancer, usually due to diagnosis at advanced stages, it is crucial to use different means to plan the therapeutic procedure in order to achieve optimal results. Positron emission tomography–computed tomography (PET/CT) is a recent hybrid method of medical imaging that can provide various information on the anatomic and biochemical status of a tumor, as well as possible metastases and hence provide better insights to clinicians for the therapeutic procedure. To this end, the present mini-review explores the role of PET/CT scanning in planning surgical procedures, systemic anticancer therapy and radiotherapy and summarizes the current status of studies that examine the use of PET/CT in the personalized therapy of ovarian cancer. Nonetheless, more clinical and observational studies are required to further verify the use of PET/CT in planning therapeutic procedures for patients with ovarian tumors.

Treatment plan quality on a new slip ring-mounted radiotherapy system for cervical and breast cancer: Dosimetry and plan complexity analysis

PurposeThis study focuses on evaluating the performance of ring-mounted LINAC TAICHI, a novel radiotherapy system, with treatment plans obtained from Raystation TPS (TAICHI-RS), by comparing its plans with those on the C-arm LINAC TrueBeam with Eclipse TPS (TrueBeam-E) in the context of cervical cancer and breast cancer treatments. The study aims to assess the dosimetric results and plan complexity metrics of this new system. Method and materialsThe research randomly selected 13 cervical cancer and 11 breast cancer patients treated with VMAT on the TAICHI LINAC. The plans were reproduced in Eclipse TPS for the TrueBeam LINAC using the same CT and structure sets. Dosimetric metrics, including dose distribution in the target volume and the dose received by OARs, were analyzed. Complexity metrics were also assessed to evaluate plan complexity. In addition, patient-specific quality assurance (PSQA) was measured for both TAICHI-RS and TrueBeam-E systems. ResultsResults have shown that in cervical cancer plans, both systems performed similarly in terms of OARs. In breast cancer plans, TAICHI-RS system demonstrated significant advantages, achieving better dose homogeneity, lower irradiated doses in OARs, and more uniform dose distributions in the target volume compared to TrueBeam-E system (P values < 0.05). Complexity metrics indicated that for cervival cancer, TAICHI-RS plans were generally more complex than TrueBeam-E plans, while they were similar for breast cancer. The average PSQA passing rates of TAICHI-RS versus TrueBeam-E systems were 98.5% versus 98.7% (2%/2 mm criteria) and 99.9% versus 99.9% (3%/3 mm criteria) for cervival cancer plans, and 95.7% versus 97.4% (2%/2 mm criteria) and 99.3% versus 99.5% (3%/3 mm criteria) for breast cancer plans respectively. ConclusionIn conclusion, the new TAICHI-RS system was demonstrated to be clinically useful and accurate in delivering treatment plans for cervical and breast cancer. The study suggests that TAICHI-RS system could offer advantages in breast cancer treatments particularly. Further multi-center research is recommended for comprehensive validation.

Disparities in the Care Disruption During COVID-19 and in its Impacts on the Mental and Physical Well-Being of Cancer Survivors.

Our study explores cancer care disruption among different demographic subgroups. It also investigates these disruptions' impacts on cancer survivors' mental and physical well-being. Pooled cross-sectional survey data. Health Information Trends Survey for Surveillance Epidemiology and End Results, HINTS-SEER. n = 1234 cancer survivors participated in the study and completed the survey. Outcome variables were treatment disruption in cancer care, mental health and physical health perceptions, age, race, education, income, and sexual orientation. Multiple imputations were used to address missing data. Descriptive statistics were conducted to understand the perceptions of care disruption. Partial least squares structural equation models were employed for data analysis, adjusted for socio-demographics. COVID-19 impacted cancer treatment and follow-up appointments (69.45%), routine cancer screening (60.70%), and treatment plans (73.58%), especially among elderly patients. It changed the interactions with health care providers (HCP) for 28.03% of the participants. Older adults were 2.33 times more likely to experience treatment appointment disruptions. People who thought their contact with their doctors changed during COVID-19 were more likely to be older adults (65 or more) (OR = 3.85, P = .011), white (OR >1, P = .002), and with higher income (OR = 1.81, P = .002). The changes to cancer treatment and follow-up medical appointments negatively impacted the well-being of the patients (mental: β = -.006, P = .043; physical: β = -.001, P = .006), routine screening and preventative care visits (mental: β = -.029, P = .031; physical: β = -.003, P = .008), and cancer treatment plans (mental: β = -.044, P = .024; physical: β = -.021, P = .040). Our findings underscore the crucial requirement for implementing focused interventions aimed at alleviating the discrepancies in the accessibility of cancer care across diverse demographic groups, particularly during times of emergency, in order to mitigate any potential disruptions in care.

Mask the Unknown: Assessing Different Strategies to Handle Weak Annotations in the MICCAI2023 Mediastinal Lymph Node Quantification Challenge

Pathological lymph node delineation is crucial in cancer diagnosis, progression assessment, and treatment planning. The MICCAI 2023 Lymph Node Quantification Challenge published the first public dataset for pathological lymph node segmentation in the mediastinum. As lymph node annotations are expensive, the challenge was formed as a weakly supervised learning task, where only a subset of all lymph nodes in the training set have been annotated. For the challenge submission, multiple methods for training on these weakly supervised data were explored, including noisy label training, loss masking of unlabeled data, and an approach that integrated the TotalSegmentator toolbox as a form of pseudo labeling in order to reduce the number of unknown voxels. Furthermore, multiple public TCIA datasets were incorporated into the training to improve the performance of the deep learning model. Our submitted model achieved a Dice score of 0.628 and an average symmetric surface distance of 5.8~mm on the challenge test set. With our submitted model, we accomplished the third rank in the MICCAI2023 LNQ challenge. A finding of our analysis was that the integration of all visible, including non-pathological lymph nodes improved the overall segmentation performance on pathological lymph nodes of the test set. Furthermore, segmentation models trained only on clinically enlarged lymph nodes, as given in the challenge scenario, could not generalize to smaller pathological lymph nodes. The code and model for the challenge submission are available at &lt;a href='https://gitlab.lrz.de/compai/MediastinalLymphNodeSegmentation'&gt;https://gitlab.lrz.de/compai/MediastinalLymphNodeSegmentation&lt;/a&gt;

MR Molecular Imaging of Extradomain-B Fibronectin for Assessing Progression and Therapy Resistance of Prostate Cancer.

Accurate assessment and characterization of the progression and therapy response of prostate cancer are essential for precision healthcare of patients diagnosed with the disease. MRI is a clinical imaging modality routinely used for diagnostic imaging and treatment planning of prostate cancer. Extradomain B fibronectin (EDB-FN) is an oncofetal subtype of fibronectin highly expressed in the extracellular matrix of aggressive cancers, including prostate cancer. It is a promising molecular target for the detection and risk-stratification of prostate cancer with high-resolution MR molecular imaging (MRMI). In this study, we investigated the effectiveness of MRMI with an EDB-FN specific contrast agent MT218 for assessing the progression and therapy resistance of prostate cancer. Low grade LNCaP prostate cancer cells became an invasive phenotype LNCaP-CXCR2 with elevated EDB-FN expression after acquisition of the C-X-C motif chemokine receptor 2 (CXCR2). MT218-MRMI showed brighter signal enhancement in LNCaP-CXCR2 tumor xenografts with a ∼2-fold contrast-to-noise (CNR) increase than in LNCaP tumors in mice. Enzalutamide-resistant C4-2-DR prostate cancer cells were more invasive, with higher EDB-FN expression than parental C4-2 cells. Brighter signal enhancement with a ∼2-fold CNR increase was observed in the C4-2-DR xenografts compared to that of C4-2 tumors in mice with MT218-MRMI. Interestingly, when invasive PC3 prostate cancer cells developed resistance to paclitaxel, the drug-resistant PC3-DR cells became less invasive with reduced EDB-FN expression than the parental PC3 cells. MT218-MRMI detected reduced brightness in the PC3-DR xenografts with more than 2-fold reduction of CNR compared to PC3 tumors in mice. The signal enhancement in all tumors was supported by the immunohistochemical staining of EDB-FN with the G4 monoclonal antibody. The results indicate that MRMI of EDB-FN with MT218 has promise for detection, risk stratification, and monitoring the progression and therapy response of invasive prostate cancer.

Optimized continuous homecare provisioning through distributed data-driven semantic services and cross-organizational workflows

BackgroundIn healthcare, an increasing collaboration can be noticed between different caregivers, especially considering the shift to homecare. To provide optimal patient care, efficient coordination of data and workflows between these different stakeholders is required. To achieve this, data should be exposed in a machine-interpretable, reusable manner. In addition, there is a need for smart, dynamic, personalized and performant services provided on top of this data. Flexible workflows should be defined that realize their desired functionality, adhere to use case specific quality constraints and improve coordination across stakeholders. User interfaces should allow configuring all of this in an easy, user-friendly way.MethodsA distributed, generic, cascading reasoning reference architecture can solve the presented challenges. It can be instantiated with existing tools built upon Semantic Web technologies that provide data-driven semantic services and constructing cross-organizational workflows. These tools include RMLStreamer to generate Linked Data, DIVIDE to adaptively manage contextually relevant local queries, Streaming MASSIF to deploy reusable services, AMADEUS to compose semantic workflows, and RMLEditor and Matey to configure rules to generate Linked Data.ResultsA use case demonstrator is built on a scenario that focuses on personalized smart monitoring and cross-organizational treatment planning. The performance and usability of the demonstrator’s implementation is evaluated. The former shows that the monitoring pipeline efficiently processes a stream of 14 observations per second: RMLStreamer maps JSON observations to RDF in 13.5 ms, a C-SPARQL query to generate fever alarms is executed on a window of 5 s in 26.4 ms, and Streaming MASSIF generates a smart notification for fever alarms based on severity and urgency in 1539.5 ms. DIVIDE derives the C-SPARQL queries in 7249.5 ms, while AMADEUS constructs a colon cancer treatment plan and performs conflict detection with it in 190.8 ms and 1335.7 ms, respectively.ConclusionsExisting tools built upon Semantic Web technologies can be leveraged to optimize continuous care provisioning. The evaluation of the building blocks on a realistic homecare monitoring use case demonstrates their applicability, usability and good performance. Further extending the available user interfaces for some tools is required to increase their adoption.

Visualizing veterans’ care: Understanding the breadth of older veterans’ paid and family support network and implications for cancer care in the older adult population.

e13777 Background: Many older adults rely on a complex network of paid and unpaid caregivers to age safely at home. Strong social networks have been long associated with improved cancer treatment outcomes in older adults. Yet medical records often only capture a primary family caregiver, and assessing support networks has not been a routine part of the equation in cancer treatment planning. We tested a novel visual tool, care mapping, with older veterans to better understand the scope of their caregiving networks. Methods: We created collaborative care maps with 10 dyads/triads of veterans and their primary paid and family caregivers receiving care at a large, urban, Veterans Health Administration medical center. Veterans were age 65+ and eligible for VA-paid home care. 50% of the veteran cohort had a cancer diagnosis. We compared the maps to veterans’ electronic medical records (EMRs) and assessed care network structure, function and adequacy. Results: For most veterans, care maps identified a larger number of care partners than EMRs alone. Functional, medical, socioemotional and spiritual supports included family, paid aides, neighbors, veteran service organizations and community groups. Unmet needs included inadequate home health workers to assist with functional decline associated with malignancy diagnosis. Veterans and caregivers largely described their networks as adequate, but mapping conversations surfaced a need for contingency care plans to relieve caregiver strain or if a caregiver could no longer provide support. Conclusions: Cancer care in older adults requires a broad, comprehensive approach and innovative ways to identify caregiver support. Such collaborative care maps can impact clinical outcomes by ensuring treatment adherence and symptom surveillance.

Observed germline BRCA1/2 and TP53 tumor genomic profiling allele frequencies.

e22533 Background: Tumor genomic profiling (TGP) is increasingly used to assist with cancer treatment planning. While these tests are not intended to find germline variants, they are a possible incidental outcome. Currently there are no clear guidelines on when to suspect if a somatic variant identified on TGP may need confirmatory germline genetic testing. Variant allele frequency (VAF) is one tool commonly used to assess if a variant may be germline. While some studies have demonstrated germline VAF ranges on TGP, the data is limited. The purpose of this study was to review VAF ranges of BRCA1/2 and TP53 variants at a large reference laboratory to better understand VAF ranges of confirmed germline variants. Methods: A retrospective review of test results from 184 patients who underwent TGP and hereditary cancer germline testing at a large reference laboratory was performed. Patients were included in the study if they had both TGP and germline testing performed, regardless of the order of testing. Results were analyzed to determine variants identified and VAF. Analysis of BRCA1/2 and TP53 variants included patients who had variants identified on TGP and had germline testing that would have confirmed the variants if present in the germline. The VAFs were obtained, and simple statistics were used to describe the findings. Results: Twenty-one patients were found to have 23 BRCA1/2 variants identified on TGP (2 patients had 2 BRCA1/2 TGP variants). Of these TGP variants, 16 were confirmed on germline testing (69.6%). The TGP VAF for these patients ranged from 38.2% to 85.1%. The mean was 61.0% and the median was 61.8%. The remaining 7 TGP variants that were not confirmed on germline testing ranged from 7.2% to 63.4%. The mean was 31.1% and the median was 28%. Thirty-eight patients were found to have 41 TP53 variants identified on TGP (3 patients had 2 TP53 TGP variants). Of these patients, 1 had a TP53 variant confirmed on germline testing with a VAF of 44.7%. The 40 remaining variants in this dataset were not confirmed on germline testing. The VAF for these 40 variants ranged from 1.3% to 95.3%. The mean was 38.4% and the median was 34.5%. Conclusions: In this study, 69.6% of BRCA1/2 TGP variants were confirmed on germline testing compared to 2.4% of TP53 TGP variants. Confirmed germline variants identified on TGP had VAFs that were &gt; 38%. It’s important to note that TP53 variants may have very high VAFs (up to 95.3% in this study) and not be.

Development and implementation of a geriatric oncology interprofessional case-based educational intervention for cancer care providers.

9020 Background: Geriatric assessment (GA) is recommended as part of the standard of care for older adults with cancer. However, the GA has not been fully adopted as part of routine practice in oncology in Mexico, mainly due to lack of qualified personnel and limited knowledge. We designed an interprofessional case-based educational intervention to address the main barriers for implementation of GA in oncology. Methods: We followed Kern’s six-step approach to design a continuing professional development (CPD) activity. Our targeted learners consisted of teams comprised of one oncologist and one geriatrician who practiced at the same site in Mexico. By the end of the intervention, participants would be able to perform GA in older adults with cancer, and to integrate information obtained through a GA in a cancer treatment plan through adequate interventions. We used Project ECHO’s model to create a CPD activity consisting of 12 weekly 75-minute online sessions via Zoom, with content selected from international geriatric oncology guidelines. At baseline, and at the end of the course, participants answered a 36-item multiple choice knowledge assessment (scale 0-100), a survey on self-perceived competence in GA skills (scale 0-10), and an adaptation of the Association for Community Cancer Centers Geriatric Oncology Gap Assessment Tool, which assesses subjective performance of the GA (scale 0-4). Participants also completed a satisfaction questionnaire. We compared baseline and post-intervention scores through paired t tests; results from the satisfaction questionnaire are reported descriptively. Results: We included 56 participants (28 geriatricians and 28 oncologists). Median participant attendance was 10 sessions (IQR 9-11). Thirty-eight participants completed the satisfaction questionnaire: median satisfaction was 10/10 (range 8-10). There was no difference in satisfaction scores between oncologists and geriatricians. Mean baseline knowledge score was 59.5±12.8 and mean post-intervention knowledge score was 74.4±9.7 (p&lt;0.001, effect size 1.14). Mean baseline competence score was 6.42±2.5 and mean post-intervention competence score was 9.02±0.78 (p&lt;0.001, effect size 1.03). Mean baseline performance score was 2.58±0.65 and mean post-intervention knowledge score was 3.29±0.5 (p&lt;0.001, effect size 1.64). Increases in knowledge, competence, and performance scores were observed both in oncologists and in geriatricians separately. Conclusions: This interprofessional curriculum on GA in oncology was feasible and acceptable, and led to significant increases in knowledge, competence, and performance among participants. Project ECHO’s case-based learning model is adequate to provide interprofessional education, which is crucial in multidisciplinary areas such as geriatric oncology.

Comparative analysis of actionable gene reporting in targeted panels versus comprehensive NGS testing for solid tumor samples.

11185 Background: The landscape of actionable genes significantly influences clinical decisions in cancer diagnosis, prognosis, and treatment planning. In a clinical context, the selection of NGS panels hinges on striking a balance among informative data, insurance coverage, and the preferences of patients and healthcare providers. Molecular pathology reference laboratories commonly employ large-scale next-generation sequencing (NGS) testing, curating smaller, disease-specific targeted panels. This study investigates the prevalence of unreported actionable genes in real-world clinical samples subjected to disease-specific panels. Methods: We analyzed SNV/InDel DNA variants in 795 clinical solid tumor samples using the Illumina TSO 500 platform for comprehensive NGS panel testing of 517 genes. Comprehensive NGS panel-tested samples were intersected with disease-specific targeted NGS panels for breast (54 genes), brain (62 genes), colorectal (36 genes), and lung (44 genes). An artificial filter was applied to align targeted panels with patient disease. Variants were classified based on pathogenicity, and benign variants were filtered out. Detected variants were assessed for actionable mutations as defined by the FDA recognized OncoKB actionable gene database criteria. Additionally, 1484 lung patient samples tested with a lung-specific targeted panel were de-identified and unmasked to the comprehensive NGS tumor profiling to investigate the prevalence of actionable alteration beyond those covered by the disease-specific panel. Results: The study revealed that 3.2% of breast, 0% of brain, 66.2% of colorectal, and 2.7% of lung samples had additional actionable mutations undisclosed by the targeted panels. The number of actionable genes beyond those included in the targeted panels were 14 for breast, 2 for brain, 25 for lung, and 41 for colorectal cancer. This underscores the importance of comprehensive testing to fully capture each patient tumor’s actionable mutation profile. Conclusions: Our findings detect masked actionable mutations in down-sampled targeted panels and highlight the need for comprehensive testing to accurately identify actionable mutations in various cancer types. Reporting actionable mutations can significantly influence clinical decision-making, emphasizing the importance of NGS test selection in routine molecular diagnostics as well as the impact of integrating comprehensive NGS testing.

Integration of patient navigation into clinical operations of an outpatient cancer center.

e23091 Background: Recognizing the critical importance of expanding access to high-quality, integrated cancer care, Dana-Farber Cancer Institute’s (DFCI) Cancer Care Equity Program developed a multi-year plan to integrate a centralized, systems-based patient navigation (PN) program focused on supporting adult medical oncology patients from historically marginalized groups. The goal was to proactively address patients’ socio-economic, emotional, and structural barriers to attending medical appointments and adhering to cancer treatment plans through care coordination, physical accompaniment, and resource provision. Methods: Inclusion of the new program in DFCI’s operating goals supported prioritization of the work across the cancer center. A multidisciplinary workgroup developed standard operating procedures grounded in evidence-based approaches while leveraging existing clinical operations. The Freeman Navigation Model informed PN scope of work with a focus on historically marginalized communities. DFCI’s Community Health Needs Assessment guided the decision to prioritize patients from zip codes with significant disparities related to social determinants of health. Utilization of electronic health records for PN documentation ensured effective communication with care teams and enabled accurate and consistent data collection and reporting. Alignment of the program’s measurement strategy with national PN metrics and development of a data dashboard allowed for ongoing monitoring and evaluation. Results: The program was implemented sequentially in five cancer treatment centers: gastrointestinal, breast, thoracic, and gynecologic oncology as well as hematologic malignancies. 517 patients were contacted and 1,736 barriers to cancer care were addressed at time of analysis. Preliminary findings from the first cancer treatment center suggest a decreased no show rate in the second year of the program. Conclusions: The multidisciplinary approach to integrating an evidence-based PN program into clinical operations supported general adoption among care teams and timely replication across cancer types. The infrastructure developed for the program could potentially support implementation of Centers for Medicare and Medicaid Services reimbursement for PN services. Next steps include confirming preliminary findings in a larger sample, conducting a cost-benefit analysis, and expanding the program across the clinical enterprise. [Table: see text]

Opportunities and Challenges for Augmented Reality in Family Caregiving: Qualitative Video Elicitation Study.

Although family caregivers play a critical role in care delivery, research has shown that they face significant physical, emotional, and informational challenges. One promising avenue to address some of caregivers' unmet needs is via the design of digital technologies that support caregivers' complex portfolio of responsibilities. Augmented reality (AR) applications, specifically, offer new affordances to aid caregivers as they perform care tasks in the home. This study explored how AR might assist family caregivers with the delivery of home-based cancer care. The specific objectives were to shed light on challenges caregivers face where AR might help, investigate opportunities for AR to support caregivers, and understand the risks of AR exacerbating caregiver burdens. We conducted a qualitative video elicitation study with clinicians and caregivers. We created 3 video elicitations that offer ways in which AR might support caregivers as they perform often high-stakes, unfamiliar, and anxiety-inducing tasks in postsurgical cancer care: wound care, drain care, and rehabilitative exercise. The elicitations show functional AR applications built using Unity Technologies software and Microsoft Hololens2. Using elicitations enabled us to avoid rediscovering known usability issues with current AR technologies, allowing us to focus on high-level, substantive feedback on potential future roles for AR in caregiving. Moreover, it enabled nonintrusive exploration of the inherently sensitive in-home cancer care context. We recruited 22 participants for our study: 15 clinicians (eg, oncologists and nurses) and 7 family caregivers. Our findings shed light on clinicians' and caregivers' perceptions of current information and communication challenges caregivers face as they perform important physical care tasks as part of cancer treatment plans. Most significant was the need to provide better and ongoing support for execution of caregiving tasks in situ, when and where the tasks need to be performed. Such support needs to be tailored to the specific needs of the patient, to the stress-impaired capacities of the caregiver, and to the time-constrained communication availability of clinicians. We uncover opportunities for AR technologies to potentially increase caregiver confidence and reduce anxiety by supporting the capture and review of images and videos and by improving communication with clinicians. However, our findings also suggest ways in which, if not deployed carefully, AR technologies might exacerbate caregivers' already significant burdens. These findings can inform both the design of future AR devices, software, and applications and the design of caregiver support interventions based on already available technology and processes. Our study suggests that AR technologies and the affordances they provide (eg, tailored support, enhanced monitoring and task accuracy, and improved communications) should be considered as a part of an integrated care journey involving multiple stakeholders, changing information needs, and different communication channels that blend in-person and internet-based synchronous and asynchronous care, illness, and recovery.

The Prevalence of BRCA1 and BRCA2 Mutations in Breast Cancer Patients

Aim: Genetic mutations in BRCA1 and BRCA2 are crucial for breast cancer risk assessment and treatment planning. Methods: This prospective observational study at Jinnah Postgraduate Medical Centre, Pakistan, involved female breast cancer patients aged 18 or older. The sample size calculation was based on a 3.4% prevalence rate of BRCA mutations, aiming for a 95% confidence level. Data on demographic, clinical characteristics, and genetic testing for BRCA mutations were collected and analyzed using SPSS version 23. Results: Among the study participants, 10% exhibited BRCA1 or BRCA2 mutations. The majority were diagnosed at stage 3 tumor development, with invasive ductal carcinoma being the predominant histological type. No significant familial predisposition to breast cancer was noted among the majority. Educational status and ethnicity showed varying associations with BRCA mutation presence. Conclusion: The study highlights a modest incidence of BRCA mutations among Pakistani breast cancer patients, underscoring the importance of genetic testing for risk assessment and targeted treatment. The findings support the need for comprehensive genetic screening programs in Pakistan, considering the diverse demographic and clinical characteristics of the population. Keywords: BRCA mutations, breast cancer, genetic testing, Pakistan, risk assessment, targeted treatment.