Health Center System Research Articles

A qualitative study identifying the navigation needs of patients with HCC.

263 Background: Hepatocellular carcinoma (HCC), the 2 nd leading cause of cancer mortality, disproportionately affects racial and ethnic minorities. Disparities in risk are compounded by profound differences in HCC treatment and survival. Black patients are consistently diagnosed at more advanced stages, least likely to receive treatment, and have the lowest survival. In other cancer types, navigation facilitates successful treatment and improves outcomes. To inform development of a longitudinal navigation program, we aimed to ascertain the needs of HCC patients, and identify obstacles limiting access to cancer treatment and supports needed for successful HCC treatment from the vantage point of patients and other stakeholders. Methods: In-depth, one-hour qualitative interviews were conducted with 40 individuals (14 patients, 7 caregivers, 8 advocates, and 11 providers) in English or Spanish. Providers included physicians, advanced practice providers, social workers, nurse navigators, and transplant coordinators involved in HCC care. We recruited patients, caregivers, and providers from the Sylvester Comprehensive Cancer Center and Jackson Health System; advocates were recruited through partnerships with Global Liver Institute and the Hepatitis B Foundation. Results: The interviews identified five overarching themes representing navigation needs of HCC patients: (1) Education/ Health Literacy, (2) Financial Resources, (3) Coordination of Care, (4) Emotional Management, and (5) Social Support. The table displays the themes and subthemes. Conclusions: This study provides valuable insight into the needs of HCC patients at the institutional and national levels. Successful navigation must include interventions that address these needs; study findings have informed our pilot navigation intervention. Navigation needs of HCC patients. Themes Subthemes Education Disease progression and prognosisTreatment optionsPreparation for various stages of disease and treatmentEducation and preparation for upcoming visitsImportance of follow-upNutrition and other health behaviors Financial Resources Insurance–treatment/medication coverage andcopaymentsTransportationHousing/ RentFoodConnection to other agencies/ community resources (Medicare/ Medicaid, funding programs, foundations/ non-profits targeting HCC, advocacy) Coordination of Care Scheduling multiple doctor/lab visitsFollow-up for attendance to visitsMedical records ordered and receivedImaging done correctly and receivedServices to manage symptoms (Nutrition, acupuncture, massage, etc.) Emotional Management Manage anxiety/ depression/ overwhelm/ confusion/ denial/ fatiguePsycho-oncology/psychiatrist referralAlcohol and substance abuse treatmentSupport groupsStress reduction/ coping strategiesMindfulness/ meditationYoga/ Movement Limited Social Support Mental healthTransportationTreatment adherence

Factors Associated With Nonprescription of Oseltamivir for Infant Influenza Over 9 Seasons.

The Centers for Disease Control and Prevention (CDC) recommends oseltamivir phosphate for children <2 years old with confirmed or suspected influenza as they are at high risk for complications. We analyzed infant characteristics associated with nonprescription of oseltamivir over 9 years. We conducted a retrospective electronic health record (EHR) review of infants <12 months old born between January 1, 2012 and December 31, 2019 within the University of Pittsburgh Medical Center health system in Southwestern Pennsylvania who had >2 well-child visits during their first year. Infants with a confirmed positive test for influenza were included in the analysis. Factors associated with infant oseltamivir nonprescription were assessed using multivariable logistic regression. Of 457 infants with confirmed influenza, 86% were prescribed oseltamivir. The proportion of infants prescribed oseltamivir increased from an average of 64.6% during the 2012-2016 influenza seasons to 90.4% during the 2016-2020 influenza seasons. Infants were more likely to not be prescribed oseltamivir if they experienced >2 days of influenza symptoms (odds ratio (OR): 9.4, 95% CI: 4.8, 18.7, P < .001), were diagnosed during the 2012-2016 influenza seasons (OR: 4.2, 95% CI: 1.8, 9.5, P < .001), tested positive for influenza via a multiplex/reverse transcriptase polymerase chain reaction test (OR: 6.7, 95% CI: 2.7, 16.3, P < .001; OR: 2.7, 95% CI: 1.1, 7.1; P = .04), or did not have a fever at point-of-care (OR: 2.3, 95% CI: 1.2, 4.6, P = .01). Adherence to CDC influenza antiviral treatment guidelines for infants is high and improved over time. However, the provision of targeted education to providers may further improve oseltamivir prescribing practices for high-risk children <12 months of age.

Current Models for Congenital Heart Center Structure and Health System Integration.

Current Models for Congenital Heart Center Structure and Health System Integration.

Doing Meso-Level Integration: The cultural, relational, and communications practices that draw primary care closer to the broader system.

Introduction: In alignment with the conference’s first theme, this paper draws on qualitative research to address issues of change management implementation at the meso-level in integration. It uses a case study of integration efforts as they played out during the first wave of the COVID-19 Omicron variant in Alberta, Canada to identify practical ways of doing organization-to-organization integration in Primary Care (PC).&#x0D; Background: While the existing literature describes three high-level approaches to enabling the integration of health and social systems in a range of contexts, it is unclear how stakeholders in PC and health system organizations might practically operationalize these approaches. How, specifically, should those stakeholders go about: enacting a pro-integration culture; doing the relationship work required for integration; and communicating to support integration? Put differently, what are the practical change management behaviours that give life to these three key approaches and make integration real?&#x0D; Approach: A subset of semi-structured interviews with key informant stakeholders was drawn from a larger study of policy and change management implementation under pandemic conditions in Alberta, Canada. Participants in these interviews were directly involved in efforts to integrate PC into the province’s health system response to COVID-19 generally, and specifically into the response to the Omicron wave. The 10 interviews averaged 65 minutes in length and included key informants from both independent PC and central health system organizations. The Interpretive Description technique was used to analyze the interview transcripts and so identify practical enactments of pro-integration culture, relationship work for integration, and integration-supportive communication.&#x0D; Results: Key ways of enacting a pro-integration culture included: sending signals with staffing choices; making personal expressions of commitment to the values of integration; and ensuring communal commitments to those same values. Doing integration relationships involved: following through on rhetorical commitments; and persevering at proving oneself in the eyes of counterparts from other organizations. Finally, communicating in ways that supported integration involved: bidirectional communication that included listening as well as talking; the elimination of intermediaries to close the social and knowledge distance between PC and health system stakeholders; and actuating a mix of formal and informal communication channels rather than relying on purely formal committee work or informal contacts.&#x0D; &#x0D; Conclusions: Practical steps towards achieving meso-level organization involve making high-level approaches to culture, relationships, and communication real in everyday behaviour. Efforts to integrate PC into a broader pandemic response in Alberta Canada provide a window on these specific change management implementation behaviours and so how to ‘do’ integration. Doing pro-integration culture involves sending signals through staffing choices, personal, and group commitments. Doing integration relationships involves following through on commitments and persevering. Doing integration communications involves listening as well as talking, closing the distance between stakeholders, and taking advantage of formal and informal channels. Stakeholders seeking to integrate at the meso-level may wish to consider these practical action

Analysis of Centralized Efficiency Improvement Practices in Australian Public Health Systems.

Analysis of centralized efficiency improvement practices in Australian public health systems. Public health systems seek to maximize outcomes generated for resources used through efficiency improvement (EI) in response to funding and demand pressures. Despite this focus, evidence for EI approaches at the whole-of-system level is lacking in the literature. There is an urgent need for evidence-based approaches to centralized EI to address these pressures. This study aims to address this gap by answering the research question "How is EI conceptualized and managed by central public health system management entities in Australia?". Document analysis was selected due to its suitability for systematically searching and appraising health system documentation, with this study following Altheide's approach focusing on whole-of-system strategic plan and management framework documents originating from Australian public health organizations. Conceptualization of efficiency varied substantially with no consistent definition identified, however common attributes included resource use, management, service and delivery. Forty-two of 43 documents contained approaches associated with improving efficiency at the whole of system level. While no comprehensive framework for centralized EI was evident, we identified nine core approaches which together characterize centralized EI. Together these approaches represent a comprehensive evidence-based approach to EI at the whole of system level. The approaches to whole-of-system EI identified in this study are likely to be highly transferable across health systems internationally with approaches including strategic priority setting, incentivization, performance support, use of EI evidence, digital enablement and workforce capability development.

Accuracy of incidental visual coronary artery calcium assessment compared with dedicated coronary artery calcium scoring

IntroductionCAC can be detected on routine chest computed tomography (CT) scans and may contribute to CVD risk estimation, but the accuracy of visual CAC scoring may be affected by the specialty of the interpreting radiologist and/or the use of contrast. MethodsThe accuracy of visual CAC estimation on non-gated CT scans was evaluated at UT Southwestern Medical Center (UTSW) and Parkland Health and Hospital System (PHHS). All adults who underwent CAC scanning and a non-gated CT scan within 6 months were identified and the scores from the two CTs were compared overall and stratified by type of reader and whether contrast was used. Visual CAC categories of none, small, moderate, and large were compared to CAC ​= ​0, 1–99, 100–399, and ≥400, respectively. ResultsFrom 2016 to 2021, 934 patients (mean age 60 ​± ​12 ​y, 43% male, 61% White, 34% Black, 24% Hispanic, 54% from PHHS) had both CT scans. Of these, 441 (47%) had no CAC, 278 (30%) small, 147 (16%) moderate, and 66 (7%) large CAC on non-gated CT. Visual CAC estimates were highly correlated with CAC scores (Kendalls tau-b ​= ​0.76, p ​< ​0.0001). Among those with no visual CAC, 76% had CAC ​= ​0 (72% of contrast-enhanced vs 85% of non-contrast scans, 88% of scans interpreted by CT radiologist vs 78% of those interpreted by other radiologist). In those with moderate-to-large visual CAC, 99% had CAC >0 and 88% had CAC ≥100, including 89% of those with contrast, 90% of those without contrast, 80% of those read by a CT radiologist, and 88% of those read by a non-CT radiologist. DiscussionVisual CAC estimates on non-gated CT scans are concordant with Agatston score categories from cardiac CT scans. A lack of visual CAC on non-gated CT scans may not be sufficient to “de-risk” patients, particularly for contrast-enhanced scans and those read by non-CT radiologists. However, the presence of moderate-to-large CAC, including on contrasted scans and regardless of radiologist type, is highly predictive of CAC and may be used to identify high-risk patients for prevention interventions.

Melanoma Detected Through Teledermatology Versus In-Person Visits.

Background: Early detection of melanoma improves survival; however, patients face long wait times to receive dermatology care. Teledermatology (TD) is a promising tool to optimize access to care and has shown promise for the identification of malignancies but has not been well studied for melanoma. We evaluated the utility of TD as a triage tool to allow high-risk lesions of concern to be seen more expeditiously. Methods: Patient sociodemographic factors and histological characteristics of 836 melanomas biopsied between March 2020 and November 2022 in the University of Pittsburgh Medical Center health system were retrospectively evaluated, stratified by initial appointment type of TD versus in-person visit. Results: Patients first seeking care through teledermatology had shorter wait times to initial evaluation (p < 0.001) and eventual biopsy (p < 0.001), and these melanomas had higher Breslow thickness (p < 0.001), were more ulcerated (p = 0.002), invasive (p = 0.001), and of a more aggressive subtype (p = 0.007) than those initially evaluated in-person. TD was also utilized by a higher proportion of younger (p = 0.001) and non-white (p = 0.03) patients who identified their own lesion (p < 0.001). Conclusions: TD may be a strategy to improve melanoma outcomes by providing an accessible avenue of expedited care for high-risk lesions associated with worse clinical prognosticators of disease.

Leveraging web-based prediction calculators to set patient expectations for elective spine surgery: a qualitative study to inform implementation

BackgroundPrediction calculators can help set outcomes expectations following orthopaedic surgery, however effective implementation strategies for these tools are unknown. This study evaluated provider and patient perspectives on clinical implementation of web-based prediction calculators developed using national prospective spine surgery registry data from the Quality Outcomes Database.MethodsWe conducted semi-structured interviews in two health systems, Vanderbilt University Medical Center (VUMC) and Duke University Health System (DUHS) of orthopedic and neurosurgery health care providers (VUMC: n = 19; DUHS: n = 6), health care administrators (VUMC: n = 9; DUHS: n = 9), and patients undergoing elective spine surgery (VUMC: n = 16). Qualitative template analysis was used to analyze interview data, with a focus on end-user perspectives regarding clinical implementation of web-based prediction tools.ResultsHealth care providers, administrators and patients overwhelmingly supported the use of the calculators to help set realistic expectations for surgical outcomes. Some clinicians had questions about the validity and applicability of the calculators in their patient population. A consensus was that the calculators needed seamless integration into clinical workflows, but there was little agreement on best methods for selecting which patients to complete the calculators, timing, and mode of completion. Many interviewees expressed concerns that calculator results could influence payers, or expose risk of liability. Few patients expressed concerns over additional survey burden if they understood that the information would directly inform their care.ConclusionsInterviewees had a largely positive opinion of the calculators, believing they could aid in discussions about expectations for pain and functional recovery after spine surgery. No single implementation strategy is likely to be successful, and strategies vary, even within the same healthcare system. Patients should be well-informed of how responses will be used to deliver better care, and concerns over how the calculators could impact payment and liability should be addressed prior to use. Future research is necessary to determine whether use of calculators improves management and outcomes for people seeking a surgical consult for spine pain.

Doing primary care integration: a qualitative study of meso-level collaborative practices

BackgroundThe integration of Primary Care (PC) into broader health systems has been a goal in jurisdictions around the world. Efforts to achieve integration at the meso-level have drawn particular attention, but there are few actionable recommendations for how to enact a ‘pro-integration culture’ amongst government and PC governance bodies. This paper describes pragmatic integration activity undertaken by meso-level participants in Alberta, Canada, and suggests ways this activity may be generalizable to other health systems.Methods11 semi-structured interviews with nine key informants from meso-level organizations were selected from a larger qualitative study examining healthcare policy development and implementation during the COVID-19 pandemic. Selected interviews focused on participants’ experiences and efforts to ‘do’ integration as they responded to Alberta’s first wave of the Omicron variant in September 2021. An interpretive descriptive approach was used to identify repeating cycles in the integration context, and pragmatic integration activities.ResultsAs Omicron arrived in Alberta, integration and relations between meso-level PC and central health system participants were tense, but efforts to improve the situation were successfully made. In this context of cycling relationships, staffing changes made in reaction to exogenous shocks and political pressures were clear influences on integration. However, participants also engaged in specific behaviours that advanced a pro-integration culture. They did so by: signaling value through staffing and resource choices; speaking and enacting personal and group commitments to collaboration; persevering; and practicing bi-directional communication through formal and informal channels.ConclusionsAchieving PC integration involves not just the reactive work of responding to exogenous factors, but also the proactive work of enacting cultural, relationship, and communication behaviors. These behaviors may support integration regardless of the shocks, staff turnover, and relational freeze-thaw cycles experienced by any health system.

Descriptive and Concordance Data for Asynchronous Teledermatology Consultations for Dermatitis: A Retrospective Study.

Background: Implementation of teledermatology for assessing dermatitis patients provides comparable diagnostic and management outcomes to in-person visits, but studies on consumer to physician asynchronous teledermatology (eDerm) consults submitted by patients in large dermatitis cohorts are limited. The objective of this study was to retrospectively assess associations of eDerm consults with diagnostic accuracy, management, and follow-up in a large cohort of dermatitis patients. Methods: One thousand forty-five eDerm encounters between April 1, 2020, and October 29, 2021, recorded in the University of Pittsburgh Medical Center Health System Epic electronic medical record were reviewed. Descriptive statistics and concordance were analyzed using chi-square. Results: Asynchronous teledermatology modified/changed treatment in 97.6% of cases and had the same diagnosis between teledermatology and in-person follow-up in 78.3% of cases. Patients following up in the time line requested were more likely to follow-up in person (61.2% vs. 43.8%) than those who did not. Patients with intertriginous dermatitis (p = 0.003), preexisting conditions (p = 0.002), who required follow-ups (<0.0001), and moderate-high severity scores of 4-7 (p = 0.019) were more likely to follow up in the time line requested. Limitations: Lack of similar in-person visit data did not allow us to compare descriptive and concordance data between eDerm and clinic visits. Conclusions: eDerm offers a quick accessible solution to provide comparable dermatologic care for patients with dermatitis.

Abstract B007: mychoiceTM User-Testing – Insights from diverse cancer patients

Abstract (A) Although clinical trials (CTs) aim to establish new strategies for reducing cancer morbidity and mortality, participation remains suboptimal, especially for racial and ethnic minorities, and few studies have evaluated tailored communication tools to address barriers/facilitators to CT participation across diverse groups.(B) mychoiceTM is a novel, culturally tailored online CT education tool designed to foster shared decision making between patients (pts) and their providers. The mychoiceTM tool was developed over 5 years utilizing community engagement, perceptual mapping, a clinically based RCT, and in-depth user-testing (UX) which we will discuss further here. UX was conducted to further guide the implementation of mychoiceTM in routine clinical settings and to understand when is the ideal time for patients to receive CT education as well as obtain feedback on the tool’s content and usability. A mixed methods approach was utilized and included a talk-aloud walk through of the mychoiceTM tool, an in-depth interview targeting specific sections, and a post-survey. In order to maintain a representative sample, pts were contacted from reviewing their EMR data that met the enrollment criteria (age≥18 yrs, able to speak and read English, in active or completed treatment ≤ last 6 months), and CT participation status (participated in a CT, offered a CT but did not participate, or were never offered), race, and gender at Fox Chase Cancer Center and Temple University Health System. In total, 27 pts completed UX. 16 participants (59%) were non-white (NW), and nearly 90% of NW participants were black. Participants were 52% female, and 48% male, and split fairly evenly amongst CT participation status (26% participated, 37% offered but never participated, 37% never offered and never participated).(C) Preliminary results showed that responses were generally consistent between NW and W participants. Nearly all patients said that they would use mychoiceTM if it was given to them by their provider, and the majority of both groups (81% of NW pts and 64% of W pts) said that they would like to receive mychoiceTM prior to making a treatment decision. While all pts found that the tool would have been helpful with making a treatment decision, NW pts found the tool generally more helpful than W pts did. 56% of NW pts gave it a 5 (extremely helpful), while only 36% of W pts rated it the same. 45% of W pts gave it a 3 (moderately helpful), while only 36% of NW pts did. Patients across both groups recommended potential content additions including: additional information on side effects, cancer specific resources, and ways to find support which will be included in the next iteration.(D) While mychoiceTM was well received overall, preliminary findings show that the tool is particularly helpful among NW pts. These findings are consistent with those from the previously conducted RCT and will guide the next steps in the tools growing research initiatives and upcoming implementation study. Citation Format: Linda Fleisher, Cassidy Kenny, Shayna Yeates Yeates, Zoe Landau, Patrick Kelly, Sarah Bass, Diane Ammerman, Canan Bilgin, Esprit Ma. mychoiceTM User-Testing – Insights from diverse cancer patients [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr B007.

Late-onset cutaneous lupus erythematosus patients have distinctive clinical features and demographics versus early-onset patients.

Cutaneous lupus erythematosus (CLE) can present later in life, but frequency and risk factors of late-onset CLE patients are not well characterized. The study determined frequency of late-onset CLE and compared the demographic and disease characteristics between early-onset and late-onset CLE in a cohort of patients with CLE. To determine the frequency and compare clinical features of early-onset and late-onset CLE. This was a cross-sectional study of CLE patients seen in outpatient dermatology clinics at University of Texas Southwestern Medical Center (UTSW) and Parkland Health and Hospital System, Dallas, TX, from April 2009 to May 2019. The primary outcome was the age of CLE onset, stratified by early-onset (<50years) and late-onset CLE (≥50years). Predictor variables significantly associated with CLE onset groups were identified by univariate and multivariable logistic regression analyses. Of the 291 CLE patients studied, 79% were early-onset, and 21% were late-onset. Multivariable logistic regression analyses identified that Caucasian race (odds ratio (OR): 2.23, 95% Confidence Interval (CI): 1.19-4.19, p = 0.013), having a CLE subtype other than chronic (OR: 2.18, 95% CI: 1.02-4.65, p = 0.044), and drug-induced cases (OR: 4.65, 95% CI: 1.18-18.24, p = 0.028) were significantly associated with late-onset CLE. Early-onset CLE patients were more likely to have oral ulcers (OR: 3.58, 95% CI: 1.46-8.78, p = 0.005) and renal disorders (OR: 4.02, 95% CI: 1.10-14.71, p = 0.036). This was a single center study. Age of onset was self-reported and late-onset CLE cohort has a small sample size. Our diverse cohort of CLE patients had about one out of five patients with CLE experiencing disease onset after 50years old. These patients have distinct demographic and clinical presentations compared to early-onset CLE patients. Providers should remain mindful of CLE in older patients with photosensitive rashes and mild systemic symptoms.

673 Metabolomic profiling of cutaneous lupus erythematous

Cutaneous lupus erythematosus (CLE) is a chronic autoimmune disease that disproportionately impacts patients with skin of color. Metabolic reprogramming plays a critical role in modulating the innate and adaptive immune response, but its role in cutaneous autoimmune conditions, like CLE, is less well studied. Thus, untargeted liquid chromatography-mass spectrometry metabolomics was performed to characterize the skin and serum of CLE patients. Eleven CLE patients (8 Black and 2 Hispanic Whites) and 14 normal controls were recruited from outpatient dermatology clinics at the University of Texas Southwestern Medical Center and Parkland Health and Hospital System in Dallas, TX.

Real-World Studies Link Nonsteroidal Anti-inflammatory Drug Use to Improved Overall Lung Cancer Survival.

Inflammation is a cancer hallmark. Nonsteroidal anti-inflammatory drugs (NSAIDs) improve overall survival (OS) in certain cancers. Real-world studies explored here if NSAIDs improve non-small cell lung cancer (NSCLC) OS. Analyses independently interrogated clinical databases from The University of Texas MD Anderson Cancer Center (MDACC cohort, 1987 to 2015; 33,162 NSCLCs and 3,033 NSAID users) and Georgetown-MedStar health system (Georgetown cohort, 2000 to 2019; 4,497 NSCLCs and 1,993 NSAID users). Structured and unstructured clinical data were extracted from electronic health records (EHRs) using natural language processing (NLP). Associations were made between NSAID use and NSCLC prognostic features (tobacco use, gender, race, and body mass index, BMI). NSAIDs were statistically-significantly (P < 0.0001) associated with increased NSCLC survival (5-year OS 29.7% for NSAID users versus 13.1% for non-users) in the MDACC cohort. NSAID users gained 11.6 months over nonusers in 5-year restricted mean survival time. Stratified analysis by stage, histopathology and multicovariable assessment substantiated benefits. NSAID users were pooled independent of NSAID type and by NSAID type. Landmark analysis excluded immortal time bias. Survival improvements (P < 0.0001) were confirmed in the Georgetown cohort. Thus, real-world NSAID usage was independently associated with increased NSCLC survival in the MDACC and Georgetown cohorts. Findings were confirmed by landmark analyses and NSAID type. The OS benefits persisted despite tobacco use and did not depend on gender, race, or BMI (MDACC cohort, P < 0.0001). These real-world findings could guide future NSAID lung cancer randomized trials.

Addressing Inequities in SARS-CoV-2 Vaccine Uptake: The Boston Medical Center Health System Experience.

Academic medical centers could play an important role in increasing access to and uptake of SARS-CoV-2 vaccines, especially in Black and Latino communities that have been disproportionately affected by the pandemic. This article describes the vaccination program developed by the Boston Medical Center (BMC) health system (New England's largest safety-net health system), its affiliated community health centers (CHCs), and community partners. The program was based on a conceptual framework for community interventions and aimed to increase equitable access to vaccination in the hardest-hit communities through community-based sites in churches and community centers, mobile vaccination events, and vaccination on the BMC campus. Key strategies included a communication campaign featuring trusted messengers, a focus on health equity, established partnerships with community leaders and CHCs, and strong collaboration with local health departments and the Commonwealth of Massachusetts to ensure equitable allocation of the vaccine supply. Process factors involved the use of robust analytics relying on the Centers for Disease Control and Prevention's Social Vulnerability Index (SVI). The vaccination program administered 109938 first doses, with 94703 (86%) given at community sites and 2466 (2%) given at mobile sites. Mobile vaccination events were key in reaching younger people living in locations with the highest SVIs. Challenges included the need for a robust operational infrastructure and mistrust of the health system given the long history of economic disinvestment in the surrounding community. The BMC model could serve as a blueprint for other medical centers interested in implementing programs aimed at increasing vaccine uptake during a pandemic and in developing an infrastructure to address other health-related disparities.

Abstract P3-20-08: Does contralateral prophylactic mastectomy improve survival in triple negative breast cancer?

Abstract Background: Despite increased incidence of contralateral prophylactic mastectomy (CPM), there is insufficient evidence that it improves survival in women at average risk for breast cancer. In addition to BRCA1/2 mutation carriers, patients with estrogen-receptor negative tumors have been examined as a subgroup that may seek to benefit from CPM. In this study, we sought to investigate whether CPM improves survival in patients with triple negative breast cancer (TNBC).Study Design: Survival outcomes were evaluated for all TNBC patients from a multi-institutional database from 1999-2018 at New York Presbyterian - Weill Cornell Medical Center and Henry Ford Health System. Median follow-up time was 44.4 months.Results: 802 TNBC patients were evaluated. The median age was 57 years. 17% patients underwent CPM. Factors associated with CPM were White American race, younger age, presence of lymphovascular invasion (LVI), lack of mammography screen-detection, mastectomy surgery, postoperative adjuvant radiotherapy, and having had genetic testing. A borderline significant trend was observed in improved overall survival among patients undergoing CPM versus those not having CPM (5-year OS 95.1% vs. 85.0%; p = 0.05). Subset analysis of patients younger than 50 years of age at diagnosis demonstrated no improvement in overall survival for patients undergoing CPM versus those that declined CPM (94.3% v. 88.7%; p = 0.21). Conclusion: Our data demonstrate a trend in improved 5-year overall survival in TNBC patients undergoing CPM. However, in patients younger than 50 years at diagnosis, CPM did not confer a survival advantage. Citation Format: Genevieve A Fasano, Solange Bayard, Yalei Chen, Jennifer Marti, Rache Simmons, Alexander Swistel, Jessica Bensenhaver, S David Nathanson, Lindsay Petersen, Erica Proctor, Melissa Davis, Lisa Newman. Does contralateral prophylactic mastectomy improve survival in triple negative breast cancer? [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-20-08.

HbA1c and FIB-4 as serologic markers for the risk of progression of stage A heart failure.

The use of glycosylated hemoglobin as a diabetic glycemic control and cardiovascular risk marker is well documented. It has also been suggested as a marker for early diastolic hemodynamic changes leading to clinical heart failure, but is less well characterized. This study explored the association between elevated glycosylated hemoglobin and liver Fibrosis-4 values and worsening measures of diastolic cardiac function in order to assess their potential as early serologic markers in cardiovascular disease prevention.A retrospective cohort analysis was conducted in 102 patients presenting to the Parkview Medical Center health system who had received a full resting echo characterized by normal systolic ejection fraction and clinical risk factors associated with stage A heart failure in conjunction with glycosylated hemoglobin and Fibrosis-4 scores within a 3-month time window. Using regression analysis, measures of diastolic cardiac function were assessed in conjunction with rising glycosylated hemoglobin levels characterized as <6.5 and >6.5 and Fibrosis-4 scores after controlling for the presence of hypertension, coronary artery disease and valvular heart disease. Glycosylated hemoglobin levels >6.5 were significantly associated with a higher E/e’ ratio and closely associated with an elevated left atrial volume index both indicative of elevated left atrial pressure as a sensitive marker for diastolic cardiac dysfunction. Fibrosis-4 scores did not appear to be clinically associated with progression of diastolic dysfunction.Thus, glycosylated hemoglobin may act as an early marker for identifying patients at increased risk for the progression of stage A heart failure. Fibrosis-4 scores do not appear to be related.

HbA1c and FIB-4 as serologic markers for the risk of progression of stage A heart failure

The use of glycosylated hemoglobin as a diabetic glycemic control and cardiovascular risk marker is well documented. It has also been suggested as a marker for early diastolic hemodynamic changes leading to clinical heart failure, but is less well characterized. This study explored the association between elevated glycosylated hemoglobin and liver Fibrosis-4 values and worsening measures of diastolic cardiac function in order to assess their potential as early serologic markers in cardiovascular disease prevention.A retrospective cohort analysis was conducted in 102 patients presenting to the Parkview Medical Center health system who had received a full resting echo characterized by normal systolic ejection fraction and clinical risk factors associated with stage A heart failure in conjunction with glycosylated hemoglobin and Fibrosis-4 scores within a 3-month time window. Using regression analysis, measures of diastolic cardiac function were assessed in conjunction with rising glycosylated hemoglobin levels characterized as &lt;6.5 and &gt; 6.5 and Fibrosis-4 scores after controlling for the presence of hypertension, coronary artery disease and valvular heart disease. Glycosylated hemoglobin levels &gt; 6.5 were significantly associated with a higher E/e’ ratio and closely associated with an elevated left atrial volume index both indicative of elevated left atrial pressure as a sensitive marker for diastolic cardiac dysfunction. Fibrosis-4 scores did not appear to be clinically associated with progression of diastolic dysfunction.Thus, glycosylated hemoglobin may act as an early marker for identifying patients at increased risk for the progression of stage A heart failure. Fibrosis-4 scores do not appear to be related.

Epidemiology, Comorbidities, and Prescription Patterns of Korean Prurigo Nodularis Patients: A Multi-Institution Study.

Prurigo nodularis (PN) is a chronic dermatosis typified by extraordinarily itchy nodules. However, little is known of the nature and extent of PN in Asian people. This study aimed to describe the epidemiology, comorbidities, and prescription pattern of PN in Koreans based on a large dermatology outpatient cohort. Patients with PN were identified from the Catholic Medical Center (CMC) clinical data warehouse. Anonymized data on age, sex, diagnostic codes, prescriptions, visitation dates, and other relevant parameters were collected. Pearson correlation analysis was used to calculate the correlation between PN prevalence and patient age. Conditional logistic regression modeling was adopted to measure the comorbidity risk of PN. A total of 3591 patients with PN were identified at the Catholic Medical Center Health System dermatology outpatient clinic in the period 2007–2020. A comparison of the study patients with age- and sex-matched controls (dermatology outpatients without PN) indicated that PN was associated with various comorbidities including chronic kidney disease (adjusted odds ratio (aOR), 1.48; 95% confidence interval (CI), 1.29–1.70), dyslipidemia (aOR, 1.88; 95% CI, 1.56–2.27), type 2 diabetes mellitus (aOR, 1.37; 95% CI, 1.22–1.54), arterial hypertension (aOR, 1.50; 95% CI, 1.30–1.73), autoimmune thyroiditis (aOR, 2.43; 95% CI, 1.42–4.16), non-Hodgkin’s lymphoma (aOR, 1.95; 95% CI, 1.23–3.07), and atopic dermatitis (aOR, 2.16, 95% CI, 1.91–2.45). Regarding prescription patterns, topical steroids were most favored, followed by topical calcineurin inhibitors; oral antihistamines were the most preferred systemic agent for PN. PN is a relatively rare but significant disease among Korean dermatology outpatients with a high comorbidity burden compared to dermatology outpatients without PN. There is great need for breakthroughs in PN treatment.

1185. Oseltamivir Prescribing Patterns for Infants with Influenza and Factors Associated with Guideline Adherence

Abstract Background The Centers for Disease Control and Prevention (CDC) recommends oseltamivir be given to children &amp;lt; 2 years old with confirmed or suspected influenza as they are at high risk for complications. We sought to analyze oseltamivir prescribing patterns and to describe factors associated with adherence and non-adherence to CDC guidelines. Methods We used a retrospective cohort of infants ≤ 12 months old born from January 1, 2011 to December 31, 2019 within the University of Pittsburgh Medical Center health system in Southwestern Pennsylvania and who had ≥ 2 well-child visits during their first year. Infants with laboratory-confirmed influenza from January 1, 2011 to April 30, 2020 were included. Electronic health records were reviewed to describe oseltamivir prescriptions and influenza-related characteristics. Factors associated with adherence and non-adherence to CDC influenza treatment guidelines were assessed with univariate logistic regression. Results Of 422 infants with laboratory-confirmed influenza, 86% were prescribed oseltamivir. The proportion of infants prescribed oseltamivir increased from an average of 63% during 2011-2016 to 90% during 2016-2020 (OR:5.2; 95%CI: 2.9-9.5). 96% of prescriptions instructed twice daily dosing, 2% had once daily, and 2% were unknown frequency. 91% of prescriptions were for 5 days, 7% had no duration, and 2% were for &amp;gt; 5 days. Infants ≥ 6 months of age compared to &amp;lt; 6 months were less likely to be prescribed oseltamivir (83.3% vs. 100%; p&amp;lt; 0.001); tested for influenza in the emergency room/urgent care (OR: 0.3; 95%CI: 0.2-0.6), or admitted to the hospital (OR:0.5; 95%CI:0.2-0.9). Infants were more likely to be treated with oseltamivir if they had a known influenza positive contact (OR:2.3; 95%CI:1.0-5.2) or had fever ≥ 38.0C (OR:2.0; 95%CI:1.2-3.5). There was no difference in prescribing practices based on history of prematurity or chronic medical conditions. Conclusion Adherence to CDC influenza treatment guidelines for infants is high and has improved over time. However, targeted education at high-risk contact points may further improve guideline adherence. Disclosures John V. Williams, MD, GlaxoSmithKline (Advisor or Review Panel member, Independent Data Monitoring Committee)Quidel (Advisor or Review Panel member, Scientific Advisory Board) Judith M. Martin, MD, Merck Sharp and Dohme (Consultant)