Comprehensive Care Center Research Articles

Moderate haemophilia A: Recommendations from a Spanish panel of experts.

Diagnosing moderate haemophilia A (MHA) solely based on deficient FVIII protein levels limits its optimal management and delays the initiation of prophylaxis. Updating protocols and incorporating new variables into its diagnosis could prevent underestimating disease severity, avoiding early arthropathies and impairing patients' quality of life. To propose recommendations to improve the comprehensive management of people with MHA. Recommendations from a Spanish panel of eight experts from public comprehensive care centres (CCCs) for people with haemophilia and over 140 people with MHA in follow-up. In a previous analysis, the panel identified the unmet needs of people with MHA and the necessity to develop new specific recommendations for their management. The panel proposed recommendations in four areas: diagnosis, treatment, follow-up and referrals. They detailed the necessary steps and procedures for the diagnosis, adding other variables to the FVIII levels like bleeding phenotype, genetic profile and joint status to specify the severity and risk classification of people with MHA. Experts proposed an algorithm with unique independent criteria to facilitate the decision to initiate prophylaxis, where the recommended FVIII levels and variables coexist for treatment decision-making. Follow-up proposals addressed periodicity, recommended tests and required visits to CCCs. For referrals, experts proposed criteria and situations considered urgent for a transfer to a CCC for haemophilia patients. The proposals agreed upon by this expert panel can contribute to update and optimize the management of people with MHA, delaying joint deterioration, pain and disabilities, and improving their quality of life.

Implementation of Enhanced Recovery After Surgery (ERAS) Protocols and Return to Intended Oncologic Therapy: Where We Were and Where We are Going?

Objective: Enhanced recovery after surgery (ERAS) utilizes a multimodal, evidence-based approach to improvepatient postoperative recovery and return to functional baseline. Among gynecologic oncology patients, ERAS protocols are associated with a decrease in complication rate and shorter hospital stays. With the improved return to baseline function recovery times, oncology patients are able to begin adjuvant therapy within the recommended timeframe as to not impact overall survival. We performed a cohort study at the initiation of our gynecologic Oncology ERAD program to determine if this decreased time to planned adjuvant therapy among gynecologic oncology patients after laparotomy. Secondary endpoints included protocol adherence, length of stay, complication rates, and readmission. Methods: We performed a retrospective chart review of 137 pre-ERAS and 73 post-ERAS patients diagnosed at a NCI-designated comprehensive care center in NJ to compare gynecologic oncologic and peri-operative outcomes before and after implementation of ERAS protocols. The protocols were based on recommendations from the ERAS society for management of gynecologic and gynecologic oncologic patients. Twenty-five interventions were analyzed and 12 were included in the final analysis. Pre-ERAS patients were identified by ICD-10 diagnosis code and CPT laparotomy codes. Patient characteristics, length of hospital stay, and complications rates were recorded. Institutional review board approval was obtained from Rutgers University and the Scientific Review Board approval from the Cancer Institute of New Jersey. Results: Twenty-five protocol elements were investigated, with an overall decrease in readmission rate and complication rate between the pre- and postERAS cohorts. There was no difference in length of hospital stay (median, interquartile range of 5 [4-7] and 5 [3-7] in the pre-ERAS and post-ERAS groups, respectively (P=0.91). Similarly, the two groups did not differ based on time to intended oncologic therapy (38 [29-55] versus 37 [29-53]; P=0.94). Conclusions: This study highlights the need for further research on ERAS protocol on return to intended oncologic therapy which is known to improve overall oncologic outcomes

Abstract A145: Race and sex disparities in lung cancer screening and evaluation of alternative identifiers in patients’ electronic medical record to better identify lung cancer screening candidates

Abstract Introduction: The US Preventive Services Task Force (USPSTF) recommends lung cancer screening with a low dose CT scan in patients who are 50 – 80 years old with at least a 20 pack-year smoking history and currently smoke or quit in the last 15 years. Yet, only 5.8 percent of eligible Americans were screened in 2022. We investigated demographic screening patterns and evaluated for alternative identifiers in patients’ electronic medical record (EMR) to identify lung cancer screening candidates at a large and diverse cancer center in Los Angeles. Methods: We examined 607 patients with non-small cell lung cancer (NSCLC) treated at the University of Southern California Norris Comprehensive Care Center or Los Angeles General Medical Center from 2009-2023. EMR data included age of diagnosis, sex, race/ethnicity, smoking history, and stage at diagnosis; for patients with unknown number of pack years (n=25) they counted as not qualified for screening. Identifiers investigated were International Classification of Disease, Tenth Revision (ICD-10) code for chronic obstructive pulmonary disease (COPD), prescription of inhaled steroids, and documented lung cancer history. Fisher’s exact test was used to compare proportion of qualified screeners among groups. Results: 35% (215/607) of patients would have qualified for lung cancer screening according to the USPSTF guidelines, including a greater proportion of males 52% (164/313) versus females 17% (51/293) (p<0.0001). In males, Non-Hispanic Whites (NHW) 59% (55/93) had a greater proportion that would qualify compared to Hispanics 41% (31/75) (p=0.0295). In females, NHW 34% (30/89) had the highest proportion of qualifiers while Asians 6% (6/104) and Hispanics 9% (6/66) had the lowest proportion of qualifiers (p<0.0001). 65% (215/332) of smokers qualified for screening; males had a higher percentage who qualified for screening versus females (164/234, 70% vs. 51/98, 52%, p=0.0024). By race, NHW male smokers had the highest proportion of qualifiers 77% (55/71) while Hispanic women had the lowest proportion of qualifiers 50% (6/12). 27% (89/332) of patients were found to have an ICD-10 code for COPD, including 18% (21/117) had an ICD-10 code for COPD who did not qualify. 19% (63/332) smokers received a prescription for inhaled steroids, including 15% (18/117) of them who didn’t qualify for screening. 12% had a family history of lung cancer (39/332), while 9% (10/117) of these patients didn’t qualify for screening. Conclusion: There were significant race and sex screening disparities among known NSCLC patients including under 10% of Asian and Hispanic females. There were about 10-15% known lung cancer patients who would not have qualified for screening found to have an ICD-10 code for COPD, an inhaled steroids prescription, or documented family history. These alternative identifiers may serve as identifiers for lung cancer screening candidates in the EMR to help address race and sex disparities in screening. Future directions should include simulation of these identifiers in larger patient datasets. Citation Format: Darin Poei, Aubree Mades, Iris Yao, Nick Ahn, Ajay Prasad, Jennifer Tsui, Jacob S Thomas, Jorge J Nieva, Robert Hsu. Race and sex disparities in lung cancer screening and evaluation of alternative identifiers in patients’ electronic medical record to better identify lung cancer screening candidates [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A145.

Abstract A105: Clinical characteristics of Hispanic patients ages 50 and younger with lung adenocarcinoma: A multi-center experience

Abstract Introduction: While uncommon, there has been an increase in non-small cell lung cancer (NSCLC) cases in patients under the age of 50 with little data on young Hispanic patients with NSCLC. This multicenter study describes the clinical characteristics of young Hispanic lung adenocarcinoma patients between two cities with a large Hispanic population. Methods: This retrospective study examined 90 Hispanic patients (18-50 years old) with metastatic lung adenocarcinoma treated at University of Miami (Miami) Sylvester Comprehensive Care Center (n=50), University of Southern California (USC) Norris Comprehensive Care Center/Los Angeles General Medical Center (n=26), and the Memorial Cancer Institute at West (Memorial) (n=14) from 2009-2023. We looked at age at diagnosis, sex, smoking history, stage at diagnosis, brain metastasis at diagnosis, mutations, tyrosine kinase inhibitor (TKI) exposure, and survival status at 24 months, 36 months, and 60 months. Fisher’s exact test was used to compare differences between USC (n=26) in Los Angeles, California, USA and Miami/Memorial (n=64) in Miami, Florida, USA. Results: 63.33% (n=57) of the patients were female. The median age at diagnosis was 41.5 years, including 8.89% (n=8) diagnosed from age 18-30, 33.33% (n=30) diagnosed from age 31-40, and 57.78% (n=52) diagnosed from age 41-50. 63.33% (n=57) identified as never smokers, 30.00% (n=27) identified as former smokers, and 6.67% (n=6) identified as current smokers. 85.56% (n=77) were found to have metastatic disease at diagnosis, including 34.44% (n=31) with brain metastasis at diagnosis. 28.89% (n=26) had an EGFR mutation, 28.89% (n=26) were ALK positive, and 8.89% (n=8) had a KRAS mutation. 55 (61.11%) had been exposed to a TKI. Between treatment sites, there was a greater prevalence of brain metastasis at USC versus Miami/Memorial (15/26, 57.69% vs. 16/64, 25.00%, p<0.01) and a trend towards greater prevalence of EGFR and KRAS mutations (EGFR: 11/26 (42.31%) vs. 15/64 (23.44%), p = 0.12; KRAS: 4/26 (15.38%) vs. 4/64 (6.25%), p = 0.22) and TKI exposure (19/26, 73.08% vs. 36/64, 56.25%, p=0.15) at USC versus Miami/Memorial. Regarding survival for stage IV patients, 37/61 (60.65%) of patients were alive at 24 months, 22/51 (43.1%) at 36 months, and 14/46 (30.4%) at 60 months with a trend towards more USC patients being alive at 36 months (10/18, 55.56% vs. 12/33, 36.36%) and 60 months (6/15, 40% vs. 8/31 25.8%). Conclusion: Young Hispanic lung adenocarcinoma patients are predominantly female, never smokers, diagnosed with metastatic disease, and enriched in EGFR and ALK mutations. There are differences in prevalence of brain metastasis, EGFR and KRAS mutations, TKI exposure, and survival between the USC and Miami/Memorial young lung adenocarcinoma patients. These notable frequencies may be attributed to the different Hispanic subgroups in the west coast versus southeastern USA. This study highlights the need for more attention towards Hispanic ethnicity in the young lung cancer population. Citation Format: Kyle Edwards, Darin Poei, Suset Almuinas de Armas, Coral Olazagasti, Zhonglin Hao, Jorge J. Nieva, Luis E Raez, Gilberto Lopes, Estelamari Rodriguez, Robert Hsu. Clinical characteristics of Hispanic patients ages 50 and younger with lung adenocarcinoma: A multi-center experience [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A105.

A Qualitative Study on the Impact and Feasibility of a Simulation-Based Program for Shared Decision-Making in Non-Small Cell Lung Cancer Care.

In the pursuit of improved clinical outcomes and patient experience in health care, shared decision-making (SDM) stands as a pivotal concept garnering increasing attention, but SDM utilization varies widely, often leading to confusion regarding team members' roles. This study explores knowledge, skills, and attitudes of oncology clinicians engaged in a pioneering educational initiative at a comprehensive cancer care center, aimed at enhancing frontline SDM capabilities. Utilizing a prospective cohort qualitative approach, the team conducted interviews with 6 clinicians in a multidisciplinary oncology program who were engaged in an SDM continuing education program. In the program, participants were immersed in experiential learning activities including standardized didactic sessions and simulation-based SDM case role-play activities. Thematic analysis of interview data revealed 5 major categories: 1) perceptions of SDM; 2) training; 3) patient-centered care; 4) challenges and constraints; and 5) leadership buy-in. Participants perceived benefits, including adopting a better approach to integrate SDM into their practice, heightened engagement, emphasizing team collaboration, and embracing a patient-centric care model. This study underscores the transformative impact of education and training on enhancing SDM capabilities among oncology clinicians and is not intended for generalizability. By promoting a basic understanding and application of SDM principles, practicing clinicians can be better empowered to improve health care outcomes and experience. Our findings contribute to the broader endeavor of embedding practical SDM principles within clinical practice, thereby fostering a more patient-centered and effective health care environment.

New Psychometric Evidence of the Life Satisfaction Scale in Older Adults: An Exploratory Graph Analysis Approach.

The objective of the present study was to analyze the psychometric properties of a life satisfaction scale in older Peruvian adults using an exploratory graph analysis (EGA) approach. A total of 407 older adults aged between 60 and 95 years (M = 69.5; SD = 6.7) from three comprehensive elderly care centers (CIAMs) in Lima, Peru, were recruited. A non-probabilistic convenience sampling was used. The Satisfaction with Life Scale (SWLS) was analyzed using EGA with the Gaussian GLASSO model to assess its dimensionality and structural consistency. The relationship with other variables was analyzed using scales such as the GAD-7 and PHQ-9. The network structure of the SWLS indicates a single dimension. Additionally, network loadings (nodes) were examined, showing high values (>0.35) for most items except item 1, which had a moderate loading (>0.25). Structural reliability showed that a single dimension was identified 100% of the time. The post hoc CFA considering the unidimensional network structure obtained through EGA showed satisfactory fit (χ2/df = 3.48, CFI = 0.96, TLI = 0.92, SRMR = 0.02, RMSEA = 0.07 [90% CI 0.05, 0.08]). Finally, internal consistency reliability was acceptable (ω = 0.92). The SWLS measure is robust and consistent. These findings are a valuable reference for advancing research on aging in Peru, as they provide a practical, valid, and reliable measure.

Functional and aesthetic outcome of different technique for lip reconstruction after ablative surgery of lip carcinoma at a comprehensive cancer care center in Nepal

Functional and aesthetic outcome of different technique for lip reconstruction after ablative surgery of lip carcinoma at a comprehensive cancer care center in Nepal

Implementation of trauma-informed care strategies in a comprehensive maternal-fetal care center.

To identify traumatic stress symptoms among expectant parents with a confirmed congenital anomaly and describe the ways in which a maternal-fetal care center, with an embedded multidisciplinary psychosocial support team, provides specific trauma-informed strategies to mitigate psychological distress from the first patient contact throughout prenatal care practice. Traumatic stress symptoms in response to the confirmed congenital anomaly were assessed using the Impact of Events Scale-Revised. With Institutional Review Board approval, a total of 4,391 pregnant parents and 3,570 partners were analyzed based on routine universal screening performed in a single maternal-fetal care center. Exploratory, descriptive analyses examined rates of overall traumatic stress symptoms and subscale scores. 28.7% of pregnant parents and 24.2% of expectant partners reported elevated traumatic stress symptoms in response to their confirmed congenital anomaly, with clinically significant risk endorsed among 16.2% and 13.4%, respectively. Symptoms of intrusion and avoidance were most notable among parents. Methods of trauma-informed care provided by the multidisciplinary care team in collaboration with the psychosocial support team to identify, support, and intervene with high-risk parents are described. Recognizing that expectant parents who receive a prenatal diagnosis of a congenital anomaly are at heightened risk for experiencing traumatic stress symptoms, multidisciplinary care teams should offer trauma-informed strategies and psychosocial support services, including parental mental health screening, psychosocial assessment, and clinical intervention, as part of routine prenatal care to reduce the negative effect of emotional distress in the expectant parents prior to birth. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Real‐world use of emicizumab in Chinese children with hemophilia A: Retrospective data from a comprehensive care center

ABSTRACTImportanceEmicizumab (EMI) is efficacious and safe for hemophilia A (HA) prophylaxis. However, its high cost poses a challenge in China.ObjectiveTo explore the possibility of using reduced‐dosage EMI in Chinese HA children.MethodsWe conducted a retrospective study for HA children in our Comprehensive Care Center. Data were collected pre‐ and post‐EMI treatment to evaluate bleeding rates. Laboratory analyses included factor VIII (FVIII)‐like activity and EMI concentration measurements.ResultsThirty‐four HA children receiving EMI prophylaxis for a median (range) 24.5 (2.5–47.9) months by June 2023. Of these, 25 (73.5%) were under 3 years of age, 26 (76.5%) had severe hemophilia and 12 (35.3%) were minimally treated or previously untreated patients. Thirty‐one (91.2%) of the 34 patients received reduced‐dosage EMI for economic reasons. EMI concentration and FVIII‐like activity measured showed a strong correlation. Overall, while on EMI, their annual treated bleeding rate (ATBR) and annual bleeding rate (ABR) decreased significantly (2–0) while their zero‐bleeding rate (ZBR) increased significantly (11.5%–65.4%). After 6 months of EMI, there was no significant difference in ATBR and ABR among various maintenance dosages. However, ZBR was significantly lower in dosages under 4 mg/kg (P = 0.0156). Receiver operator characteristic curves suggested the following cutoff values for zero bleeding: EMI 4‐weekly maintenance dosage 3.8 mg/kg, EMI concentration 48.1 μg/mL, and FVIII‐like activity 15.4 IU/dL.InterpretationWe showed EMI effectively prevented bleeding even at reduced dosages. However, the bleeding risk may be higher with EMI 4‐weekly maintenance dosage <3.8 mg/kg, EMI concentration <48.1 μg/mL, and FVIII‐like activity <15.4 IU/dL for zero bleeding. It is important that dosage reduction be done rationally. Dosage tailoring is possible.

Polysomnography parameters in a large cohort of people with multiple sclerosis

BackgroundDisordered and disturbed sleep is quite common among people with multiple sclerosis (PwMS). It is associated with fatigue one of most disabling symptoms in MS. This study aims at comparing polysomnographic (PSG) sleep parameters in a large single cohort of PwMS from a single center to that of the published norms. Hence establishing PSG parameters in PwMS. MethodsThis is a retrospective review of 299 consecutive adult PwMS who were seen and evaluated with an overnight PSG at a Comprehensive MS Care Center between 11/19/2001 to 9/17/2014. Data extracted from the PSG included Total Sleep Time (TST), sleep efficiency (SE), sleep onset latency (SOL), Relative REM latency, total apnea-hypopnea indices (AHI), spontaneous arousal indices (AI), total periodic leg movements indices (PLMI) and, sleep architecture metrics including percentage spent in stages N1/N2, N3, and REM. ResultsPwMS, compared to normative data, had, on average, 85.9 min shorter TST (p < 0.001), 27.3 min longer SOL (p < 0.0001), 62.1 min longer REM latency (p < 0.0001), 10.7 % lower SE (p < 0.0001), 16.4 % more N1/N2 (p < 0.0001) and 11.4 % less N3 (p < 0.0001). REM latency The prevalence of Obstructive Sleep Apnea (OSA) was high at 60.7 % and the mean AHI was higher by 11.1 events per hour (p < 0.0001). ConclusionsThis study establishes PSG parameters in the largest PwMS cohort reported to date. It is important to be vigilant of sleep complaints in PwMS. Future prospective large single cohort studies with standardized methods are needed to further understand sleep disturbances in PwMS as well as their causes and implications.

Development of a PROMIS multidimensional cancer-related fatigue (mCRF) form using modern psychometric techniques.

To develop a PRO assessment of multidimensional cancer-related fatigue based on the PROMIS fatigue assessments. Cancer patients reporting fatigue were recruited from a comprehensive cancer care center and completed a survey including 39 items from the PROMIS Cancer Item Bank-Fatigue. Component and factor structures of the fatigue items were explored with Monte Carlo parallel factor and Mokken analyses, respectively. Psychometric properties were determined using item response theory, ensuring unidimensionality, scalability, and item independence. Fatigue scores from a sample of 333 fatigued cancer patients (mean age = 59.50, SD = 11.62, 67% women) were used in all scale development analyses. Psychometric analyses yielded 3 dimensions: motivational fatigue (15 items), cognitive fatigue (9 items), and physical fatigue (9 items). The subscales showed strong unidimensionality, were scalable, and were free of differential item function. Confirmatory factor analyses in a new sample of 182 patients confirmed the findings. The resulting 33-item PROMIS multidimensional cancer-related fatigue (mCRF) form provides a novel measure for the assessment of the different dimensions of cancer-related fatigue. It is the only multidimensional scale specific for cancer patients that has been developed using modern psychometric approaches. With its 3 dimensions (motivational, cognitive, and physical fatigue), this scale accurately captures the fatigue experienced by cancer patients, allowing clinicians to optimize fatigue management and improve patient care. The scale could also advance research on the nature and experience of cancer-related fatigue.

Clinical Outcomes of Rural Patients with Diabetes Treated by ECHO-Trained Providers Versus an Academic Medical Center.

Despite clinical practice guidelines prioritizing cardiorenal risk reduction, national trends in diabetes outcomes, particularly in rural communities, do not mirror the benefits seen in clinical trials with emerging therapeutics and technologies. Project ECHO supports implementation of guidelines in under-resourced areas through virtual communities of practice, sharing of best practices, and case-based learning. We hypothesized that diabetes outcomes of patients treated by ECHO-trained primary care providers (PCPs) would be similar to those of patients treated by specialists at an academic medical center. Specialists from the University of New Mexico (UNM) launched a weekly diabetes ECHO program to mentor dyads consisting of a PCP and community health worker at ten rural clinics. We compared cardiorenal risk factor changes in patients with diabetes treated by ECHO-trained dyads to patients treated by specialists at the UNM Diabetes Comprehensive Care Center (DCCC). Eligible participants included adults with type 1 diabetes, type 2 diabetes on insulin, or diabetes of either type with A1c > 9%. The primary outcome was change from baseline in A1c in the ECHO and DCCC cohorts. Secondary outcomes included changes in body mass index (BMI), blood pressure, cholesterol, and urine albumin to creatinine ratio (UACR). Compared to the DCCC cohort (n = 151), patients in the ECHO cohort (n = 856) experienced greater A1c reduction (-1.2% vs -0.6%; p = 0.02 for difference in difference). BMI decreased in the Endo ECHO cohort and increased in the DCCC cohort (-0.2 vs. +1.3 kg/m2; p = 0.003 for difference in difference). Diastolic blood pressure declined in the Endo ECHO cohort only. Improvements of similar magnitude were observed in low-density lipoprotein cholesterol in both groups. UACR remained stable in both groups. ECHO may be a suitable intervention for improving diabetes outcomes in rural, under-resourced communities with limited access to a specialist.

Ceftriaxone-resistant viridans streptococci bacteraemia among patients treated at a large comprehensive cancer care centre: a retrospective eighteen-year study.

Viridans streptococci (VS) are opportunistic oral commensals and a common cause of bacteraemia in neutropenic patients. In this retrospective single centre cohort study, we investigated the prevalence of ceftriaxone resistance in VS (CRO-R VS) blood isolates between January 2005 and December 2022 from patients treated at a tertiary care hospital. Blood culture isolates were identified using biochemicals and mass spectrometry. Susceptibility testing was performed by Kirby-Bauer and Epsilometer tests. Demographic data, clinical outcomes and antimicrobial use were assessed through electronic medical record review. Among 791 patients with VS bacteraemia, 31 (4%) had confirmed CRO-R VS bacteraemia over the 18-year period; 20/31 (65%) were patients also treated at the Fred Hutchinson Cancer Center and were the focus of this study. Of these 20 patients, 18 (90%) had a known haematologic malignancy; 14 (70%) had undergone haematopoietic cell transplant (HCT); 18 (90%) were neutropenic at the time of culture. Two (10%) patients died within 30 days of CRO-R VS bacteraemia. All the CRO-R isolates (20/20) were members of the Streptococcus mitis group, 12 were multi-drug resistant; all were susceptible to vancomycin. Most patients received vancomycin once blood cultures were positive for a Gram-positive organism. During the study period, the frequency of VS isolate susceptibility testing increased; however, there was no concomitant increase in the percentage of CRO-R isolates at our facility. These data are important in an era where cefepime monotherapy is often used and reinforces the importance of routine resistance testing among VS bacteraemia.

The Structure and Function of Oral Cancer Control in Kerala, India: A Narrative Review of Cancer Control Policy Documents from 1988 to 2020

The government of Kerala was the first state in India to come out with a comprehensive plan for cancer control based on National Cancer Control Program. The purpose of this review was to identify the structure and function of cancer control in Kerala, India with specific reference to oral cancer. A systematic search was done in PubMed using the keywords “Health Policy”, “Cancer”, “Oral cancer”, “Guiding document” and “Kerala”. All government of Kerala health-related websites were searched electronically for cancer-related policy documents. The medical library catalogs of the two government Comprehensive Cancer Care Centres in the state were searched. All available Government documents, institutional documents, other online resources related to cancer prevention were collected. A checklist was prepared to review the documents. Out of 18 documents identified, two cancer-specific policy documents and two health policy documents were included in the review.The cancer control strategies outlined in the reviewed documents presented a pragmatic vision for cancer control in low-resource settings. The concept called the ‘Kerala Cancer Care Grid’ outlined in one of the documents is a novel strategy to address the geographical inequality in access to cancer care. It recognized interdepartmental coordination and partnership with private sector institutions and community organizations as crucial for achieving comprehensive cancer control. In the reviewed documents, oral cancer was discussed mainly in the context of early detection, health education, and capacity building at the primary care level.

Socioeconomic disparities in survival outcomes of patients with SCLC with brain metastases: A nationwide analysis.

e20133 Background: Despite advances in the management of cancer, socioeconomic disparities have been reported to impact survival outcomes. However, recent state of disparities in SCLC patients with brain metastases (BM) remains unknown. We explored socioeconomic disparities in survival outcomes of SCLC BM patients. Methods: We conducted a retrospective cohort study and included patients diagnosed with SCLC BM in 2018-2019 in the National Cancer Database. Patients were grouped as White, Black, American Indian, Aleutian or Pacific Islander (AAPI), or Asian. Socioeconomic and survival outcomes were analyzed and reported using median overall survival (mOS) (95% CI). Cox proportional hazard models adjusted for sex, race, facility type, education, and income and reported using hazard ratios for death (HR) (95% CI). Results: Of 2369 SCLC BM patients, 85% (N=2018) were White, 11% (N=259) Black, 0.4% (N=10), and 1.8% (N=43) Asian. 58% were Medicare-insured, and 21% earned &gt;$74,063. 40% were treated at comprehensive cancer care centers (CCC). Log-rank test revealed no significant difference in survival between races. Hispanic did not have a significant survival benefit compared to non-Hispanic patients. Medicare-insured patients have a significantly worse mOS of 7.56 months (6.90-8.28) compared to 13.77 months (12.62-16.07) in private-insured patients. Cox multivariate analysis (Table) showed improved survival in Asian (HR - 0.55, 0.34-0.89, P=0.014) and Black (HR- 0.82, 0.69-0.98, P=0.029) compared to White patients. Patients treated at CCCC had worse survival (HR-1.26, 1.11-1.42, P&lt;0.001) than in academic centers. Patients who earn more reported higher survival (HR-0.82, 0.68-0.98, P=0.030). Conclusions: Race did not significantly impact survival based on unadjusted analysis. Medicare-insured patients have unfavorable outcomes. On adjusted analysis, Asian and Black patients appear to have better survival. Treatment at community centers has worse survival. Focused efforts are warranted to bridge this gap and reduce disparities due to socioeconomic factors. [Table: see text]

Incidences of Pregnancy During Concurrent Use of Hormonal Contraceptives and Antiretroviral Therapy at Nakuru County Referral and Teaching Hospital in Kenya

With concerns on the efficacy and effectiveness of hormonal contraceptives and antiretroviral therapy in curbing incidences of unplanned pregnancies among women living with Human Immunodeficiency virus infection, a study to examine these concerns was carried out at Nakuru County Referral and Teaching Hospital (NCRTH). A cross-sectional retrospective study was carried out at the Comprehensive Care Centre (CCC) at NCRTH from March 2023 to April 2023 with a sample size of 226 participants however the estimated sample size using the Taro Yamane formula was 358. Data was collected using structured questionnaires with both open and close-ended questions and analyzed using the Statistical Package for Social Sciences (SPSS). Frequency tables, bar graphs, and percentages were used to present descriptive statistics. Chi-square was used to conduct inferential statistics, and P&lt;0.05 was considered significant. The majority (86.7%) of participants were on TLD (Tenofovir, Lamivudine, Dolutegravir). Most participants (37.17%) had used ART for 6-10 years. 79.65% of participants avoided pregnancy with concurrent hormonal contraceptives and ART, while 20.35% experienced pregnancies. 15.22% of pregnant participants also used other medications, especially anti-TBs, due to drug-drug interactions. Injectables were the most common contraceptive (41.3%) used by participants who had pregnancy incidences. A significant association was noted between the incidence of unplanned pregnancy and the use of combined oral contraceptives. Incidences of unplanned pregnancies were higher among those aged 30-34 (32.61%), married (73.91%), with secondary education (43.48%), self-employed (60.87%), and Protestant (73.91%). From this study, TLD was the most commonlyused antiretroviral, injectables were the most commonly used contraceptive, and the majority of the participants had used antiretrovirals for 6-10 years. Despite the concurrent use of hormonal contraceptives and antiretrovirals to avoid pregnancy incidences, 20.35% of the participants had unplanned pregnancy incidences. 15.22% of these participants who got pregnant were using other medications. Unplanned pregnancies were more common among certain demographic groups. From this study, data on pregnancy incidents during concurrent use of hormonal contraceptives and antiretroviral therapy is availed however limitations such as study design and time limit necessitatemore research. To reduce the risk of unplanned pregnancies and ensure the appropriate use of hormonal contraceptives, more support and counseling programs should be established for women using antiretrovirals.

#2624 Point of care creatinine for early detection of community acquired acute kidney injury in a primary health care centre in Nigeria

Abstract Background and Aims Community acquired Acute kidney injury (AKI) and leads to poor outcomes in low and middle-income countries due to delayed diagnosis however its epidemiology is poorly studied due to lack of biochemical diagnosis. Supported by the International Society of Nephrology, we evaluated the accuracy of point of care creatinine (POC Cr) technology using capillary samples [1] and its use implementing a clinical algorithm to select patients at risk of AKI for POC Cr testing in the Hospital Emergency Department in Port Harcourt in Nigeria. In this phase of the project POC Cr was used in a large primary care health centre for early detection and management of community acquired AKI. Method The study is conducted in Ozuoba Model Comprehensive Primary Health Care Centre. The centre has 4148 patient attendances per month (20.3% medical, 18.8% obstetrics and 60.8% paediatrics) with 11.1% considered acute requiring short admission at the centre usually for intravenous fluids. Historically, decision making is based largely on clinical judgement and renal function tests when requested from external laboratories are reported in &amp;gt; 48 hours. During this project POC Cr was offered on high-risk patients based on the clinical algorithm from the previous stage (Fig. 1) and patients with detected AKI were offered short admission for intravenous fluids and antibiotics. Results To date 54 patients have been screened with POC Cr. Median age is 25.5 years, minimum 2 months, maximum 85 years, interquartile range (48-10), 62% are females, 57% presented with malaria diagnosis and 9% with gastroenteritis. Mean (standard deviation) of POC Cr was 105 (54) µmol/L. There were 5 cases (9%) of AKI (Cr &amp;gt;150 µmol) detected in patients aged 5 months, 13 months, 7 years, 19 years and 31 years. All were treated with short admission and intravenous fluids and were discharged after clinical improvement. Knowledge of the presence of AKI altered management in all patients prompting short admission. Conclusion Community acquired AKI is common in young patients with malaria and early biochemical diagnosis can improve outcomes. The study continues to recruit and aims to investigate the characteristics of community acquired AKI in Africa and to contribute to the design of optimal and sustainable pathway for early detection and management of AKI.

Positive impacts of universal newborn screening on the outcome of children with sickle cell disease in the province of Quebec: A retrospective cohort study.

A universal newborn screening program for sickle cell disease (uNS-SCD) was implemented in the province of Québec (Qc) in November 2013, close in time to the recommendation of early initiation of hydroxyurea (HU) therapy for children. This retrospective cohort study evaluated the impact of such a program on children first seen between January 2000 and December 2019. Cohorts pre-SCD-uNS in Qc (pre-QcNS) (n=253) and post-QcNS (n=157) for patients seen prior to or after Nov 2013 were compared. Kaplan-Meier curves, Poisson regression, and logistic regressions were used for statistical analysis, using Software R version 4.2.1. Median age at first visit decreased significantly from 14.4 [interquartile range: 2.4-72.0] to 1.2 months [1.2-57.6] (p<0.001). The percentage of children born in Qc undiagnosed at birth and referred after a first SCD-related complication dropped from 42.6% to 0.0% (p<0.0001). The median age of HU introduction for patients with SS/Sβ°-thalassemia decreased from 56.4 [31.2-96.0] to 9.0 months post-QcNS [8.0-12.1] (p<0.001). Event-free survival improved significantly for any type of hospitalization as well as for vaso-occlusive crisis (VOC) (140-257 days (p<0.001) and 1320 vs. 573 days (p<0.002), respectively), resulting in a reduction from 2 [interquartile range: 1.0-3.0] to 1.0 hospitalizations/patient-year [0.6-1.4] (p<0.001). Children with SS/Sβ°-thalassemia referred post-QcNS also had fewer emergency department visits for VOC (RR: 0.69, 95% confidence interval: 0.54-0.88). The Universal NS program allows early detection and referral of children with SCD to comprehensive care centers. Earlier access ensures that children benefit from essential preventive interventions, reducing disease burden. This cohort study highlights that uNS-SCD is an essential public health measure.

High prevalence of severe pain is associated with low opioid availability in patients with advanced cancer: Combined database study and nationwide questionnaire survey in Japan.

Opioid availability for the palliative care of patients with advanced cancer is increasing globally. However, opioid availability remains extremely low in Japan. We investigated whether pain is appropriately controlled by low-dose opioid prescriptions in patients with advanced cancer in Japan. A web-based nationwide survey for caregivers from 2000 community comprehensive support care centers was performed in Japan to assess details about pain in the 30 days before patients died of end-stage cancer. Separately, the data for opioid prescription doses and medical services in the 90 days before the death of patients with cancer were extracted from a health insurance claim database. Responses from 1034 responders were retrieved and 665 patients were included. In total, 254 patients (38.2%) complained of severe-to-intolerable cancer-related pain. The median cumulative prescription dose of opioids in the 90 days before patient death was 311.0 mg by oral morphine equivalent doses. Multiple regression analyses across prefectures revealed that the proportion of patients with severe-to-intolerable cancer-related pain was negatively associated with the cumulative opioid consumption expressed as morphine-equivalent doses within 90 days before death. The very low availability of opioids for patients with end-stage cancer could result in high rate of severe-to-intolerable cancer-related pain patients. There were several limitations in this study, and the interpretations of the findings should be carefully. However, the increase in the absolute dose of opioids could improve the palliative care framework to the pain control levels of the global standard.

Abstract PO5-10-06: A Pilot Study for Clinical Research Nurse Navigation at an Urban NCI-Designated Comprehensive Cancer Center

Abstract Background: Breast cancer is now the leading cause of cancer death for non-Hispanic Black women in Georgia with non-Hispanic Black women 40% more likely to die of breast cancer compared to White women. Inadequate representation of patients in clinical trials may contribute to health care inequity, though prior work has also shown disparate outcomes on similar clinical trials at Emory, suggesting differences in tumor biology may also be contributing to the disparity. Improving diversity in trial participation is imperative to better understand these differences, particularly with newer molecularly targeted therapies. We aimed to utilize Clinical Trials Nurse Navigation to increase clinical trial enrollment at an urban NCI-designated comprehensive care center in Atlanta, Georgia. Methods: A prospective pilot study was conducted investigating the role of a Clinical Research Nurse as a dedicated Clinical Trials Nurse Navigator to identify, pre-screen, and refer potential patients to both breast and next generation sequencing (NGS)-driven basket clinical trials at the Winship Cancer Institute at Emory University. The role also included centralizing all molecular data from patients with stage IV breast cancer into a database as a tool to refer patients to NGS-driven clinical trials. This role expands upon the Institute’s current research nursing scope to better meet the needs of our diverse patient population. Our catchment area is 35% non-Hispanic Black or African American. The nurse prescreened patients with stage IV breast cancer from breast oncology clinic templates and the breast NGS database to match them with clinical trials, with a particular emphasis on patients with stage IV triple negative breast cancer. The study began in January 2022 and is currently ongoing. Results: Since study initiation in January 2022, there has been a 27% increase in breast cancer clinical trial enrollment over a 12-month period. Over the last 6 months from January 2023, this has increased even further with 57 patients enrolled onto breast cancer clinical trials compared to a total enrollment of 70 patients onto breast cancer clinical trials in 2022 (Table 1). Of these patients, 11% enrolled in NGS-driven clinical trials in 2022 to present compared to 0% in 2021. Twenty-two (31.4%) non-Hispanic Black women enrolled onto breast cancer clinical trials in 2022 with another 21 (36.8%) non-Hispanic Black women enrolled thus far in 2023 (Table 1). Conclusion: Disparities in clinical trial enrollment may contribute to racial inequities in breast cancer outcomes. Implementation of clinical research nurse navigation has successfully improved clinical trial enrollment and diversity in clinical trial enrollment at our urban cancer center. Through increasing clinical trial prescreening, centralizing an NGS database, and dedicated nurse support to allow patients to navigate onto clinical trials, we achieved a 21% improvement in clinical trial enrollment from 2021 to 2022 and are on track to increase enrollment by 200% by the end of 2023. Clinical trials nurse navigators serve as an essential link between clinical trial patients and their providers, and should strongly be considered a key component of all clinical trials programs. Table 1 Breast Working Group Patient Enrollment by Race and Ethnicity, 2019-2023 Citation Format: Lizzie Huckaby, Maisey Ratcliffe, Madison Canning, Demetria Smith-Graziani, Kevin Kalinsky, Manali Bhave. A Pilot Study for Clinical Research Nurse Navigation at an Urban NCI-Designated Comprehensive Cancer Center [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-10-06.