General Oncology Research Articles

General versus disease-specific medical oncology consults and impact on inpatient quality of care.

321 Background: Hospitalization is a time of crisis for patients and caregivers. Subspeciality oncologists may bring more timely, effective support compared to a general oncologists. Attendings, fellows and advance practice providers (APPs) may benefit from focused expertise for consultative care and education. Methods: Subspeciality oncology consults launched July 2023, with consults staffed by 4 oncologists from: 1) breast 2) head and neck/thoracic 3) gastrointestinal and 4) genitourinary/melanoma. Previously, 3 oncologists staffed all patients, regardless of primary malignancy. Throughout the study period, oncologists were supported by at least 1 fellow or 1 APP. Using Epic and Tableau, we collected LOS, time to consult (TTC), ICU rate, hospice referral rate, 30-day readmission, 30-day emergency department (ED) visit data. Using Qualtrics, we collected fellow, attending, and APP satisfaction feedback pre- and post-intervention. Data was analyzed using R-4.40. Oncologists, fellows, and APPs completed Qualtrics surveys pre- and post-intervention regarding their experience. Results: Subspeciality oncology consults were associated with a significant decrease in LOS, TTC, and ICU rate. Median LOS decreased by 2.0 days (P<0.001), with median TTC decreasing by 1.0 hour (P=0.003). ICU rate decreased from 27.5% to 16.4% (P<0.001). There was no difference in hospice referrals or 30-day ED visits. A significant increase in 30-day readmission during post-intervention was observed (Table). Oncologists reported a high level of satisfaction with the program. Oncologist, fellow, and APP overall experience and educational rankings increased after the introduction of subspeciality consults. Inpatient productivity measured by wRVU increased by 30% following the intervention, without associated changes to outpatient productivity. Conclusions: Transition to a subspeciality oncology consult model improved inpatient quality of care, as well as clinician experience. Additionally, inpatient productivity increased without decrease in outpatient metrics. Subspeciality medical oncology consultation can improve inpatient quality of care, education, clinician satisfaction and productivity. Subspeciality oncology consult outcomes. General Consults (Baseline)* Subspeciality Consults (Intervention) P-value Median TTC (Hours) 4.0 (1.5-6.0)** 3.0 (0-5.0)** P=0.003 Median LOS (Days) 7.0 (4.0-13.0)** 5.0 (3.0-10.0)** P<0.001 ICU Rate 148 (27.5%) 161 (16.4%) P<0.001 Hospice Referral Rate 56 (10.4%) 95 (9.7%) 0.655 30-Day Readmission Rate 136 (25.3%) 301 (30.7%) 0.028 30-Day ED Rate 157 (29.2%) 315 (32.1%) 0.247 *Baseline data reflects outcomes for general oncology consult staffing, prior to initiation of subspeciality consult model (pre-intervention). **Interquartile Range (IQR).

Simultaneous Robot-assisted Lipoabdominoplasty and Cholecystectomy

Summary: In the current era of advanced technologies, robotic surgery is rapidly evolving. New articles are emerging on the use of robots in general surgery, urology, and oncology, with single cases in maxillofacial surgery. In this article, we describe the successful use of robotic techniques for simultaneously performing suturing repair of the diastasis of the rectus abdominis muscles, aesthetic correction of the anterior abdominal wall with lipoabdominoplasty, and cholecystectomy. That, according to our knowledge, has not ever been done before.

Essential Elements in Synoptic Operative Reports for Hepato-Pancreato-Biliary Cancer Surgery: An HPB/CGSO Training Program Survey.

Synoptic operative reports (SORs) are checklists or templates that contain standardized elements of an operation. These elements are associated with standardized inclusion of critical elements of the operative report that translate into numerous potential benefits. Whereas SORs for melanoma, breast, and colorectal cancer surgery have already been widely implemented, similar templates for hepato-pancreato-biliary (HPB) cancer surgery are currently lacking. An anonymous voluntary online survey was distributed to HPB attendings and fellows at HPB and complex general surgical oncology (CGSO) fellowship programs. The 54 participants in this study comprised 31 (57%) HPB surgery attendings, 15 (28%) HPB surgery fellows, and 8 (15%) CGSO fellows. Notably, only six (11%) participants reported consistent use of an HPB SOR. The most commonly reported barriers to SOR uptake were the "lack of a readily available template" (55%) and the "lack of consensus/guidelines" (49%). Despite these limiting factors, a majority of respondents indicated a strong willingness to use a standardized and readily available HPB SOR (mean, 4.13/5 ± 1.23). This interest did not differ between attendings and fellows (p = 0.52) or between the participants stratified by surgical experience (p = 0.58).Finally, the participants were provided a comprehensive list of possible elements to incorporate into a standardized pancreatic and hepatobiliary SOR. After the exclusion of elements with less than 75% agreement, the pancreatic SORs included 17 (57%) of 30 possible elements, and the hepatobiliary SORs included 19 (76%) of 25 possible elements. Broad consensus on several elements of the HPB SOR suggests that uptake should be accelerated in HPB surgery.

Disparities in the availability and access to Neuro-Oncology Trial-Supporting infrastructure in the United States.

We conducted an extensive assessment and quantification of the reach of the oncology clinical trial supporting infrastructure in the United States (US). While our primary focus was on identifying avenues to expand the reach of neuro-oncology clinical trials, we considered infrastructure layers with important implications for broader cancer research and care. Specifically, we examined the geographic, population, and socioeconomic reach of national collaboratives (including over 1,500 institutions), over 600 academic oncology and neurosurgery training programs, and networks of over 25,000 individual neuro-oncology, neurosurgery, and general oncology (including hematology/medical/gynecological oncology, surgical oncology, and radiation oncology) providers. Our study found that over 57% of the US population lacks direct access to trial-supporting infrastructure. More than 71% of the locations with infrastructure are urban, and over 72% are in socioeconomically-advantaged areas. Our findings reveal critical disparities in oncology care access and suggest actionable strategies to optimize and expand the existing infrastructure's reach.\.

763. TEXTBOOK ONCOLOGIC OUTCOME FOLLOWING TRIMODALITY THERAPY FOR ESOPHAGEAL ADENOCARCINOMA

Abstract Background Although the concept of textbook oncologic outcome (TOO) as an emerging quality benchmark has been validated in the general surgical oncology literature, data regarding the frequency of achieving TOO and its impact on subsequent survival outcomes in patients with esophageal adenocarcinoma (EAC) who undergo trimodality therapy remain undefined. Methods Patients with adenocarcinoma of the esophagus/gastroesophageal junction (GEJ, Siewert I/II) who underwent neoadjuvant chemoradiation and esophagectomy at a single institution (2000-2022) were retrospectively identified. Patients undergoing salvage resection were excluded. TOO was defined according to a published consensus definition: length of stay (LOS) ≤14 days, R0, ≥20 resected lymph nodes, no anastomotic leak (any grade), no Clavien-Dindo (CD) grade ≥3 complications, no hospital or intensive care unit (ICU) readmission, and no reoperation. Multivariable logistic regression was used to identify clinicopathologic features associated with TOO. Multivariable Cox regression and landmark analyses were used to quantify the association between TOO and OS. Results Of 1138 patients, TOO was observed in 38.2% (435): 90.9% (1034) R0, 60.9% (693) ≥20 lymph nodes, 89.9% (1023) no anastomotic leak, and 98.4% (1120) no in-hospital mortality. Features independently associated with reduced odds of TOO included: cervical anastomosis (OR 0.50, P=0.001), preoperative delay ≥90 days after neoadjuvant therapy (OR 0.62, P=0.004), induction chemotherapy (OR 0.74, P=0.039), coronary artery disease (OR 0.67, P=0.043). Among patients who underwent esophagectomy <90 days after neoadjuvant therapy and survived ≥30 days, TOO was independently associated with improved OS (HR 0.80, P=0.018). TOO remained associated with improved OS using 90-day (P=0.014) and 120-day (P=0.037) landmarks. Conclusions Although TOO is difficult to achieve following trimodality therapy for EAC, it is strongly associated with improved long-term overall survival. As such, further efforts are warranted to explore the utility of TOO as a quality benchmark in EAC patients and to validate its impact across varying practice settings.

Body Image Perception and Social Support Are Important Predictors of Quality of Life in Bladder Cancer Patients after Cystectomy with Urinary Diversion

Introduction: Systematic evaluations focusing on the perception of body image and social support in relation to quality of life (QoL) outcomes in patients radical cystectomy (RC) with urinary diversion (UD) are currently lacking. This study investigated the relationship between body image perception, social support, and QoL in bladder cancer patients who underwent RC with UD. Methods: A cross-sectional survey was conducted using validated general oncology tools to assess QoL in relation to newly implemented tools assessing body image perception and social support. Body image perception was assessed with the Self-Image Scale, and social support was assessed using the Illness-Specific Social Support Scale. Logistic regression models were used to analyze factors associated with QoL and body image, respectively. Results: The survey revealed a significant association of body image perception with QoL, as well as social support with body image perception. This is the first study to systematically evaluate these psychosocial factors in the context of QoL for RC patients, highlighting their critical role in patient-reported outcomes. Conclusion: Body image perception and social support are important psychosociological factors that affect QoL of bladder cancer patients post-RC. Targeted psychosocial interventions could be promising for improving QoL patients post-RC.

Telehealth Utilization in Neuro-Oncology: Commentary on a Single Institution Experience After the COVID-19 Pandemic.

During the COVID-19 pandemic, regulatory and reimbursement policy changes provided patients improved access to neuro-oncology by telehealth. Here we discuss benefits and limitations of telehealth use in neuro-oncology. We review utilization of telemedicine services following the COVID-19 pandemic. Utilization of telemedicine by neuro-oncology during the COVID-19 pandemic was 52%, compared to 27-29% for other solid tumors groups. Following the pandemic, between January 2021 and April 2024, telehealth utilization has remained high in neuro-oncology with approximately 30% of all visits completed by telemedicine, compared to 10-15% for other solid tumor groups. The striking difference between telehealth visit utilization in neuro-oncology and general medical oncology even after expiration of the COVID-19 Public Health Emergency expiration and end of pandemic-related restrictions, underscores the potential value of convenient access to care for patients with central nervous system tumors. Given widespread use of telehealth in neuro-oncology, prospective evaluation to determine the safety, usability, and acceptance of video-enabled, telehealth visits is critical. Such data may lead to broader adoption of telehealth, lead to regulatory and reimbursement reform for telehealth sustainability, and improve clinical trial access and accruals.

Current status of palliative care for patients with unresectable metastatic colorectal cancer in China: a questionnaire-based survey

Objective: To analyze the current adoption of palliative care by patients with unresectable metastatic colorectal cancer (mCRC) in China. Methods: From 1 March 2023 to 30 June 2023, a questionnaire survey was conducted by random sampling. An exclusive research platform for the Blue Book on Clinical Diagnosis and Treatment of Metastatic Colorectal Cancer. An online questionnaire was sent to medical oncologists (including chief physicians, associate chief physicians, attending physicians and residents) in general hospitals and oncology hospitals in four major regions of East, Central, South and Northeast China. The questionnaire contained 28 questions requesting basic information about doctors, the number of patients with mCRC, the status of treatment from first to fourth line and beyond, points concerning treatment of pain in patients with mCRC, and expectations for the future. A medical team was responsible for the quality control of data collected, whereas statisticians performed the data cleaning and sorting and statistical analysis. Results: A total of 300 clinical questionnaires were collected, including 217 (72%) from doctors in general hospitals and 83 (28%) from doctors in oncology hospitals. Senior physicians (including associate chief physicians and chief physicians) accounted for 65% of the respondents, attending physicians 30%, and residents 5%. Within 3 months (average for each month), 46.4±26.6% patients were diagnosed with recurrent or unresectable mCRC by each physician, 51.6±26.8% of the patients being in cancer hospitals and 44.4±26.3% in general hospitals. One hundred percent of patients receiving first-line treatment received palliative care, as did 80.3% of those receiving second-line treatment, 58.2% of those receiving third-line treatment, and 35.1% of those receiving ≥fourth-line treatment. The primary factor governing selection of first-line treatment was guideline recommendations, whereas comorbidities and the patients' physical status dictated second line to fourth line treatment. Standard first-line treatment was administered to 93.8% of eligible patients, standard second-line treatment to 94.3%; and standard third-line treatment to 73.5%. First-line therapy included targeted therapy in 63.6% of patients and immunotherapy in 2.8%; second-line therapy included targeted therapy in 63.0% of patients and immunotherapy in 2.0%; third-line therapy included targeted therapy in 59.2% of patients and immunotherapy in 2.2%; and fourth-line therapy included targeted therapy in 48.7% of patients and immunotherapy in 3.1%. First-line treatment lasted an average of 9.6 months, second-line treatment 6.7 months, third-line treatment 4.9 months, and fourth-line treatment 3.7 months. More than 70% of the patients maintained a good quality of life after receiving first and second-line treatment and more than 60% of them had ECOG performance scores of 0-1. After receiving third- and fourth-line treatment, 50%-60% of patients maintained a good quality of life and 40%-50% of them maintained ECOG performance scores of 0-1. The survey also revealed that the main deficiencies in treatment were limited effectiveness of third-line treatment, insufficient availability and opportunity for clinical research, popularity of new drugs or new drug combination strategies, and limited channels for participation in multidisciplinary diagnosis and treatment. Clinicians reported looking forward to participating in more clinical research on new drugs, hearing about the experience of experts in the field, and discovery of new targets and new drugs that increased the options for posterior line treatment of colorectal cancer. Conclusions: This report objectively summarizes the current situation, treatment difficulties, and expectations of frontline physicians concerning management of mCRC, thus providing a basis for decision-making and future direction for the diagnosis and research on treatment of mCRC.

Practice Readiness? Trends in Chief Resident Case Logs vs Subsequent Case Log Data in Clinical Practice.

Limited information exists regarding the association between resident surgical case experience and subsequent case mix in practice. We compare the case log distribution residents completed during their chief year to those completed by these graduates in their first 2 years in independent practice. Resident chief year case logs from 10 institutions were analyzed across 4 categories of index procedures: (1) general urology, (2) endourology, (3) reconstructive urology, and (4) urologic oncology. Current Procedural Terminology codes for associated index procedures were used to query case log data during their first 2 years in practice collected by the American Board of Urology. Interactions were tested between the trends of chief year case logs relative to trends in practice case logs. Amongst 292 residents, a total of 104,827 cases were logged during chief year and 77,976 cases in the first 2 years as an attending. Most cases completed during chief year were in oncology followed by general urology, endourology, and reconstructive urology. As attendings, most cases completed were in general urology, followed by endourology, reconstructive urology, and oncology. Chief year case logs showed decreasing trends in the median number of case logs in reconstructive urology, endourology, and general urology, while case logs in independent practice noted increasing trends in all index procedure categories over time. Urology residents perform more cases during their chief year compared to their first 2 years of independent practice. Case types completed as chief residents vs subsequent clinical practice also differ significantly. These observations may have implications for residency training, particularly regarding curriculum design.

True Rate of Allergy among Pediatric Inpatients with Penicillin Allergy Labels (TRIAL).

Penicillin allergy is a common drug allergy diagnosis in pediatric patients; however, upon appropriate allergy testing, many of these patients are found not to have a true allergy. For patients with a reported allergy, alternative antibiotics are prescribed, which are less effective, more toxic, or more expensive. There is a lack of data evaluating allergies in hospitalized children and comparing allergy assessments conducted by pediatric allergists and pharmacists. To estimate the percentage of pediatric patients admitted with reported penicillin allergy who did not have a true penicillin allergy. This single-centre prospective cohort study included inpatients between 6 months and 17 years of age, with a documented penicillin allergy, who were admitted to the general pediatric and oncology units of a tertiary care children's hospital between November 2019 and March 2023. The allergy history, evaluation, and risk categorization were performed by pharmacists. The history was reviewed with the allergist, and the patient was then referred, underwent skin testing, or received oral amoxicillin challenge with monitoring for 1 hour. Thirty patients were included, of whom 29 (97%) had delabelling of their penicillin allergy. Four patients (13%) had delabelling on the basis of history alone, without risk assessment. Twenty-five (83%) of the patients were assessed as having low risk; 24 of these had delabelling following oral challenge, and 1 did not complete the oral challenge because of transfer to another hospital. One patient (3%) was assessed as having moderate risk, with delabelling on the basis of results of skin testing and oral challenge. The pharmacist's and allergist's risk assessments were in agreement in 29 (97%) of the 30 cases. Pediatric patients, including those with oncologic malignancies, are often mislabelled as having a penicillin allergy. Pharmacists are able to accurately determine true allergy risk and delabel penicillin allergies for pediatric patients in the hospital setting.

How to reduce the carbon footprint: In the operating room, in the hospital, on the planet: The participation of General Oncology Hospital of Athens "Saint Savvas”.

Introduction: Nowadays, climate change is seen as a visible threat that we are asked to face every day by posing new political challenges. Hospital waste is estimated at 1% of solid waste and 2.1% of the annual greenhouse gas emissions of each country. More specifically, operating theaters are the main source of pollution coming from Hospitals, with anesthesia departments responsible for 25% of these pollutants. Method: The General Oncology Hospital of Athens "Saint Savvas" and in particular the Anesthesiology Department, in collaboration with the Surgery, participates in the global effort to reduce CO2 emissions to protect the environment, adopting the 5R program (Recycle, Rethink, Research, Reduce, Reuse) and the ESAIC (European Society of Anaesthesiology and Intensive Care) guidelines "How to reduce the carbon footprint in the surgery, in the hospital, on the planet". Qualitative data analysis was performed on outcomes Results: Decreased desflurane consumption per surgery by -7.31% and overall, in the year 2023 by -1.59%. Reduced battery consumption from -73.89% to -100%. From the money saved, the items of the Anesthesiology Department's medical supply warehouse increased by +16.56%, while the percentage value decreased by -11.39%. Conclusion: With the adoption of the 5R program, it seems that financial and material resources are saved and the consumption of volatile gases per operation is significantly reduced.

Quality of Life Questionnaire Validation for Patients with Pelvic Bone Tumors

Quality of life of patients with orthopedic oncological pathology is one of the most important indicators of therapy and rehabilitation effectiveness, a parameter important for establishment of comprehensive approach involving teamwork from doctors and psychologists. Currently, there are many instruments for quality of life evaluation in patients with various chronic diseases including oncological but a specialized questionnaire for patients with pelvic bone tumors does not exist. Nonetheless, characteristics of quality of life of patients with this pathology should be considered for optimal management of psychological and rehabilitation measures, and their dynamics can serve as criteria of treatment and rehabilitation effectiveness.Aim. To develop and test a quality of life questionnaire for patients who underwent surgery on the pelvic bones.Materials and methods. The Quality of Life Questionnaire Pelvic Bone Tumor – 30 (QLQ PBT-30) was developed and tested in 37 patients with tumors of the pelvic bones (20 (54.1 %) males and 17 (45.9 %) females) who were under-going treatment at the General Oncology Division of the N.N. Blokhin National Medical Research Center of Oncology. Mean patient age was 48.15 ± 8.95 years.Results. Psychometric characteristics of the QLQ PBT-30 (validity, reliability) are quite high. Factor analysis confirms correspondence of the factor structure of the questionnaire to the proposed key. Every question contributes to the method structure confirmed by high values of Cronbach’s α.Conclusion. Specialized questionnaire for patients who underwent surgical treatment on pelvic bones can be recommended for use in orthopedic oncology practice for more accurate evaluation of quality of life of patients with tumors of the pelvic bones.

Resident and Fellow Performance and Supervision in Surgical Oncology Procedures.

Previous research has highlighted concerns among trainees and attendings that general surgery training and fellowship are inadequately preparing trainees for practice. Providing trainees with supervision that matches their proficiency may help bridge this gap. We sought to benchmark operative performance and supervision levels among senior surgery residents (post-graduate year 4 or 5) and fellows performing general surgical oncology procedures. Observational data were obtained from the Society for Improving Medical Procedural Learning (SIMPL) OR application for core general surgical oncology procedures performed at 103 unique residency and fellowship programs. Procedures were divided into breast and soft tissue, endocrine, and hepatopancreatobiliary (HPB). Case evaluations completed by trainees and attendings were analyzed to benchmark trainee operative performance and level of supervision. There were 4,907 resident cases and 425 fellow cases. Practice-ready performance, as assessed by trainees and faculty, was achieved by relatively low proportions of residents and fellows for breast and soft tissue cases (residents: 38%, fellows: 48%), endocrine cases (residents: 22%, fellows: 41%), and HPB cases (residents: 10%, fellows: 40%). Among cases in which trainees did achieve practice-ready performance, supervision only was provided for low proportions of cases as rated by trainees (residents: 17%, fellows: 18%) and attendings (residents: 21%, fellows 25%). In a sample of 103 residency and fellowship programs, attending surgeons rarely provided senior residents and fellows with levels of supervision commensurate to performance for surgical oncology procedures, even for high performing trainees. These findings suggest a critical need for surgical training programs to prioritize providing greater levels of independence to trainees that have demonstrated excellent performance.

NURS-11. NEURO-ONCOLOGIC EMERGENCY MANAGEMENT

Abstract BACKGROUND Due to disease location, neuro-oncology patients experience emergencies that are infrequently encountered in general oncology and require unique interventions. Paramount among these emergencies is vasogenic cerebral edema (CE). Urgent and accurate interventions are needed to decrease associated morbidity and mortality. In an educational institution, access to knowledge of next steps is crucial. This prompted further inquiry of best practice into recognition of increasing intracranial pressure (ICP) and management of cerebral edema using a literature review and reflection on institutional experience. METHODS A literature review was conducted using pubmed to identify articles through January 2014. The Key words used in the search included “neuro-ongologic emergencies” “brain herniation management” “cerebral edema. RESULTS The searched yielded 3237 results. Of these, 3236 were excluded. Ten full text articles were relevant and included in the review. In combination with the literature and institutional experience of neuro-oncological emergencies, interventions and outcomes were evaluated to provide recommendations for treatment in the event of an emergency. CONCLUSION CE is not an uncommon finding with malignant brain tumors given disrupted blood brain barrier. This subsequently increases ICP and left unmanaged, can lead to brain herniation. Signs and symptoms can vary depending on tumor location and extent of edema. Most common exam findings to be aware of include headache, nausea, vomiting, altered pupil exam, abnormal eye movements, and altered consciousness. Ultimately surgical intervention may be the definitive treatment, non-surgical management is important. Literature review supported the use of both high dose dexamethasone and hyperosmolar solutions are temporizing measures to decrease CE. Additional measures such as positioning, treatment of pain or fever, are also recommended. Prompt recognition and intervention of CE are crucial to improved patient outcomes. An educational poster with recommendations for best practice when encountering neuro-oncological emergencies will be created. Dissemination of findings will be done at local, national and international levels.

Assisted dying in Swedish healthcare: a qualitative analysis of physicians’ reasoning about physician-assisted suicide

To explore Swedish physicians’ arguments and values for and against physician-assisted suicide (PAS) extracted from the free-text comments in a postal survey. A random selection of approximately 240 physicians from each of the following specialties: general practice, geriatrics, internal medicine, oncology, surgery and psychiatry. All 123 palliative care physicians in Sweden. A qualitative content analysis of free-text comments in a postal questionnaire commissioned by the Swedish Medical Society in collaboration with the Karolinska Institute in Stockholm. The total response rate was 59.2%. Of the 933 respondents, 1107 comments were provided. The free-text comments entailed both normative and factual arguments for and against PAS. The analysis resulted in two main categories: (1) “Safe implementation of PAS is unachievable” (with subcategories “Criteria of PAS difficult to fulfil” and “PAS puts societal norms and values at risk”) and (2) “The role of PAS in healthcare” (with subcategories “No medical need for PAS”, “PAS is not a task for physicians”, “No ethical difference to other end-of-life decisions” and “PAS is in the patient’s best interest”). The respondents brought up well-known arguments from academic and public debate on the subject. Comments from physicians against PAS were more often emotionally charged and used devices like dysphemisms and slippery-slope arguments.

Abstract PO2-08-11: The MAGIC study: Universal whole genome tumour and germline sequencing of newly diagnosed breast cancer identifies a high proportion of ER+ BRCA-like tumours

Abstract Background: Identification of germline mutations in hereditary breast cancer (HBC) genes can have profound benefits in the treatment of breast cancer (BC) and manging risk for patient and the family. In addition, sequencing of the tumours can reveal clinically relevant somatic features, such as homologous recombination deficiency (HRD) and mutational signatures, that can guide treatment which are not discernible by germline sequencing alone. We hypothesised that current standard of care where women diagnosed with BC are not routinely offered tumour sequencing is suboptimal as fails to exploit all therapeutic vulnerabilities which can be exploited in the treatment of BC. The MAGIC study is the first prospective trial in Australia of unselected invasive BCs in general oncology practice combining both germline and tumour sequencing. Methods: The MAGIC study included a total of 651 consecutive consented patients presenting with non-metastatic BC between June 2020 to March 2023. It included invasive BC, high-grade DCIS and pleomorphic LCIS. The sequencing was conducted in two phases; for phase one, 157 cases underwent whole genome sequencing (WGS) on both germline and matched BC DNA while for phase two, 494 cases underwent only germline whole exome sequencing. Germline variants were interrogated for pathogenic variants in BRCA1, BRCA2, PALB2, ATM, CHEK2, BARD1, BRIP1, RAD51B, RAD51C, RAD51D, MLH1, MSH2, MSH6, PMS2, CDH1, PTEN, STK11, TP53 and NTHL1. Tumour homologous recombination (HR) repair deficiency was calculated using HRDetect (Nat Med 2017;23:517). For BCs showing a high HRDetect score ( >0.75) all HBC gene promoter CpG islands were assessed for hypermethylation using the Twist NGS Methylation system. Mutational signatures were calculated from somatic mutations identified from whole genome sequenced BCs using the DeconstructSig package in R (Genome Biol. 2016;17:31) and referenced against the COSMIC v2 signature catalogue. Results: Actionable germline variants in any HBC gene were identified in 7.7% of cases (7.8% of invasive and 6.1% of in situ BC) with 5.2% having an actionable mutation in an HR pathway gene (BRCA1, BRCA2, PALB2 and RAD51C). Most cases with pathogenic variants showed bi-allelic inactivation in the tumour. All BRCA1, BRCA2 and PALB2 tumours showed high HRDetect and/or HRD scores consistent with loss of HR repair function, indicating them to be the underlying hereditary driver of the BC. One BC with a pathogenic PMS2 variant showed retention of the wild-type allele with no evidence of a mismatch repair mutational signature suggesting PMS2 was not the driver of this BC. Of the 157 BC in phase one that underwent WGS and did not have a germline pathogenic HBC gene variant, 16% (18/117 invasive and 3/13 DCIS) had an HRDetect score of >0.7 indicative of a homologous recombination repair defect and therefore biologically a “BRCA-like” tumour. Of these 21 BRCA-like cases, only 3 invasive BCs had clear somatic bi-allelic inactivation of an HBC gene that could explain the high HRDetect score (2 BRCA1 and 1 BRCA2). One of the 21 BRCA-like cases had a germline variant of unknown significance (VUS) in an HBC gene (a BRCA2 missense variant in an ER+ tumour. The tumour showed loss of the wild-type allele). Of the BRCA-like cases, 71% were ER positive which included 3 invasive lobular cancers. Conclusion: Tumour sequencing identified three times as many cases that might be eligible for HR repair defect targeted therapy than germline testing alone (16% versus 5.2%). Unlike a previous study (Ann Oncol., 2019 30:1071-1079), the majority of the BRCA-like BCs were ER+ with no evidence of a VUS in a known HBC gene suggesting these are driven by novel germline or somatic mutations in genes involved in DNA HR repair. Citation Format: Ian Campbell, Lisa Devereux, Kirsten Hogg, Luxi Lal, Michelle Sinclair, Lesley Stafford, Magnus Zethoven, Anita Skandarajah, Paul James, Geoffrey Lindeman, Bruce Mann, Dilanka De Silva. The MAGIC study: Universal whole genome tumour and germline sequencing of newly diagnosed breast cancer identifies a high proportion of ER+ BRCA-like tumours [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 PO2-08-11.

Abstract PO3-10-06: Parenting While Living with Cancer - Providing Better Outcomes for Families During the Cancer Journey

Abstract For over 20 years, Kesem has been dedicated to supporting children impacted by a parent’s cancer. To better understand the stresses on a family navigating cancer, Kesem completed a several month research program rooted in Diversity, Equity, and Inclusion (DEI) and consisting of ethnographic research, quantitative surveys, focus groups, benchmarking, and data analytics. We are using this research to develop a deeper understanding of the personal stories of families impacted by a cancer diagnosis and of the current data from experts in the field. Kesem is sharing our research findings in order for the general oncology space to better serve parents living with cancer. The research included three weeks of ethnographic research completed in rural Mississippi, the Pacific Northwest, and southern Nevada. The research team completed 124 interviews in 18 cities, gathering deep insights about being a parent while living with cancer. The team also reviewed over 30 databases and conducted a survey of approximately 150 parents with cancer. Little has been published about parental cancer in the past decade. Using literature reviews and data such as the 2020 decennial census, we have been able to generate a more accurate assessment of need than ever, confirming earlier estimates that there are approximately five million children in the United States who have a parent with cancer. This means that the average percentage of children under 18 who have experience with parental cancer is between 3.6%–5.5%. The following key takeaways from this research are helpful for all who support patients, including oncologists, nurse navigators, and patient advocates: Based on this research and our ongoing internal survey results, we know that patients generally have less anxiety when they know their children will receive a lifetime of support. Children who are supported are more likely to create a community of support for themselves, do better academically, and have increased mental health. This leads to better outcomes for the entire family. Citation Format: Alicia Kabir. Parenting While Living with Cancer - Providing Better Outcomes for Families During the Cancer Journey [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 PO3-10-06.

Early integration of basic palliative care in cancer: scoping review of cross-sectorial models – components, facilitators, barriers

BackgroundShared care between oncology specialists and general practice regarding the delivery of palliative care (PC) is necessary to meet the demands for a cohesive PC. The primary objective of this...

Retrospective descriptive analysis of the demographic and clinicopathological presentation of breast cancer patients in Kasr Al-Ainy Hospital over 5 years

Background Breast cancer is the most common type of cancer and the second leading cause of mortalities among women. Early-stage diagnosis of breast cancer increases the chances of survival, and therefore, reduces mortality rates. A national initiative was implemented in Egypt in 2019 when women above the age of 18 years were granted free screening at 3538 healthcare units, and 114 hospitals nationwide. Objective To describe the sociodemographic factors and clinicopathological presentation of breast cancer among the patients presented to Cairo University Hospital over 5 years. Patients and methods We conducted a descriptive historical study at Kasr Al-Ainy Teaching Hospital of Cairo University, we retrospectively assessed all women with primary breast cancer diagnosed over 5 years during the period from the July 1, 2017 to the July 1, 2022. Data was collected from medical records, operative notes, radiology reports, and pathology reports from the database system of the Oncology Department of Cairo University Hospitals (Kasr Al-Ainy). The patient data is put into a spreadsheet that focuses on the demographic and clinicopathological characteristics of the patients (age, size of the tumor, side of breast affected, histopathology findings, imaging characteristics, immunohistochemistry, and TNM staging of breast cancer). Results We enrolled a total of 509 female patients who were screened for early detection of breast cancer during the past 5 years in general surgery, radio diagnosis, and oncology departments, Kasr Al-Ainy Teaching Hospital; they showed a mean age of 53.7±11.7 years and ranged between 26 and 88 years. In the current study molecular subtyping showed that 24.4% were Luminal A, 34% were Luminal B1, 19.4% were Luminal B2, 9.2% were HER2-enriched and 13% were triple-negative breast cancer subtype. We found that neoadjuvant therapy was prescribed for 190 (37.3%) patients, 36 (19%) of those patients achieved pCR, while the remaining patients had residual disease in the postoperative specimen. Conclusion We concluded that in our center, Egyptian females are diagnosed with breast cancer earlier compared with developed countries; however, the current study reports approximately the same percentages of molecular subtypes, rates of pCR, and metastatic disease at the time of presentation compared with developed countries.

Abstract 2565: Vitamin D deficiency and outcomes in prostate cancer patients: A real-world database

Abstract Introduction: Vitamin D is essential for many bodily functions, including bone health and the prevention of osteoporosis and rickets. In recent years, the importance of vitamin D metabolism in immune system regulation and cancer prevention has been studied with increased focus. With the advent of cancer immunotherapies this has become more important. Multiple recent publications document that vitamin D deficiency is prevalent in cancer patients. This has also been observed specifically in prostate cancer patients, with a high percentage of these deficient patients being of African- American ancestry. It has been theorized that high levels of vitamin D deficiency among African American prostate cancer patients could contribute to worse cancer outcomes and increased health disparities. However, routine vitamin D testing has not been commonly performed in the oncologic community. We hypothesized that deficient levels of vitamin D could lead to inferior prostate cancer outcomes in men with a wide range of ethnic and socio-economic backgrounds. In this project we recorded vitamin D levels in prostate cancer patients at a large community oncology group and evaluated them by stage, pathologic data, survival, race/ethnicity, and other clinical features. Methods: This study is a retrospective, observational study of the data from the electronic medical records of patients with prostate cancer who received vitamin D level testing at Florida Cancer Specialists & Research Institute from 2008- 2023, throughout the state of Florida. All data used in this study will constitute secondary data, it will have been collected originally for clinical use in the general oncology practice setting. No date parameters or patient limits will be applied to this study, and all eligible patients are included. Results: 451 patients with prostate cancer had determination of vitamin D levels, out of a total of 27,772 prostate cancer patients in the database. 38% of the prostate cancer patients analyzed had low 25-OH vitamin D levels (<32 ng/ml). Patients with low vitamin D levels had an average Gleason score of 7.46. Patients with low vitamin D levels who died had an average survival of 144 months. Patients with low vitamin D levels who presented with localized disease had a 35% chance of eventually developing castrate-resistant disease. 45% of the low vitamin D group developed metastatic disease during their course of treatment. Further comparisons of vitamin D levels with pathologic data, survival/longevity, race/ethnicity, and clinical course will be evaluated and presented. Citation Format: Lowell L. Hart, James Reeves, Stacey Garofalo, William Amick. Vitamin D deficiency and outcomes in prostate cancer patients: A real-world database [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2565.