Genitourinary Cancer Patients Research Articles

Immune-Related Adverse Events of Genitourinary Cancer Patients, a Retrospective Cohort Study.

Immune checkpoint inhibitors (ICIs) have become common lines of therapy for genitourinary cancers (GUcs). Given their widespread use, understanding the risk factors, comparative profiles, and timing of immune-related adverse events (irAEs) is essential. We created an IRB-approved retrospective registry of all patients who received at least one dose of an ICI for any indication between 1 February 2011 and 7 April 2022 at a comprehensive cancer center and its outreach clinics. Dichotomous outcomes were modeled using multivariable logistic regression. Survival outcomes were compared using multivariable Cox regression. Among 3101 patients, 196 had renal cell carcinoma (RCC) and 170 had urothelial tumors. RCC patients were more likely to experience irAEs (OR 1.78; 95% CI 1.32-2.39), whereas urothelial carcinoma patients were not (OR 1.22; 95% CI 0.88-1.67). RCC patients were more prone to dermatitis, thyroiditis, acute kidney injury, and myocarditis, compared to other tumors, while urothelial carcinoma patients were not. The impact of irAEs on survival was not significantly different for GUcs compared to other tumors. RCC primaries have a significantly different irAE profile than most tumors, as opposed to urothelial primaries. Further, RCC was more likely to experience any irAEs. Heterogeneity of survival benefits by irAEs was not seen.

Custom scoring based on ecological topology of gut microbiota associated with cancer immunotherapy outcome

The gut microbiota influences the clinical responses of cancer patients to immunecheckpoint inhibitors (ICIs). However, there is no consensus definition of detrimental dysbiosis. Based on metagenomics (MG) sequencing of 245 non-small cell lung cancer (NSCLC) patient feces, we constructed species-level co-abundance networks that were clustered into species-interacting groups (SIGs) correlating with overall survival. Thirty-seven and forty-five MG species (MGSs) were associated with resistance (SIG1) and response (SIG2) to ICIs, respectively. When combined with the quantification of Akkermansia species, this procedure allowed a person-based calculation of a topological score (TOPOSCORE) that was validated in an additional 254 NSCLC patients and in 216 genitourinary cancer patients. Finally, this TOPOSCORE was translated into a 21-bacterial probe set-based qPCR scoring that was validated in a prospective cohort of NSCLC patients as well as in colorectal and melanoma patients. This approach could represent a dynamic diagnosis tool for intestinal dysbiosis to guide personalized microbiota-centered interventions.

Infliximab for Treatment of Immune Adverse Events and Its Impact on Tumor Response.

Background: Immune-related adverse events (irAEs) challenge the use of immune checkpoint inhibitors (ICIs). We performed a retrospective study to evaluate response to infliximab for immune-related adverse event management, and infliximab's effect on progression-free survival (PFS) and overall survival (OS) with a focus on melanoma and genitourinary cancers. Methods: We retrospectively reviewed records of all cancer patients exposed to infliximab after immune checkpoint inhibitor (ICI) treatment from 2004 to 2021 at the MD Anderson Cancer Center. Survival was assessed utilizing the Kaplan-Meier method. Univariate and multivariate logistic regression was utilized to evaluate predictors of infliximab response, OS, and PFS. Results: We identified 185 cancer patients (93 melanoma and 37 genitourinary cancers) treated with ICI and who received infliximab to treat irAEs. Within 3 months of treatment initiation, 71% of the patients responded to infliximab, 27% had no response, and 2% had unknown response. Among different irAEs, colitis was associated with increased response to infliximab at 3 months, irrespective of the type of malignancy. We evaluated best tumor response before and after infliximab in the entire cohort and again in the melanoma and genitourinary (GU); the findings were similar in the melanoma cohort and the entire cohort, where best tumor response before and after infliximab was not significantly different. In the melanoma cohort, acute kidney injury (AKI) was associated with increased risk of death, p = 0.0109, and having response to infliximab was associated with decreased risk of death, p = 0.0383. Interestingly in GU cancer patients, myositis was associated with increased risk of death, p = 0.0041, and having a response to infliximab was marginally associated with decreased risk of death, p = 0.0992. As regards PFS, in a multivariate Cox regression model, having a history of cardiovascular disease remained significantly associated with shorter PFS in the melanoma cohort. For patients with GU cancers, response to infliximab was associated with longer PFS. Conclusions: Our study is among the largest retrospective analyses of infliximab use for irAE management. Patients with colitis were the best responders to infliximab. AKI before initiation of infliximab in the melanoma subcohort and myositis in GU subcohort are associated with higher risk of death. Our results indicate no association between infliximab and cancer progression with the exception of genitourinary cancers.

Anemia Profiles in Cancer Patients: Prevalence, Contributing Factors, and Insights From a Retrospective Study at a Single Cancer Center in Saudi Arabia.

Anemia, a common complication of cancer and its treatments, significantly affects cancer patients' survival and quality of life. Nevertheless, there is limited research conducted in the southern region of Saudi Arabia regarding its effects. This study aims to assess the prevalence of anemia, as well as its associated factors, among cancer patients undergoing active chemotherapy treatment. This retrospective study analyzed adult cancer patients who underwent chemotherapy at King Khaled Hospital's oncology department in Najran, Saudi Arabia, between 2017 and 2022. We aimed to determine the prevalence and contributing factors of anemia through comprehensive demographic and clinical assessment. Univariate analysis was performed to assess factors necessitating blood transfusion. A total of 95 cancer patients received chemotherapy, with a mean age of 52.2 ± 16.5 years. The majority were females (65.3%) aged between 18 and 64 years (74.7%). Gastrointestinal (42.1%) and breast (17.9%) cancers were the most prevalent malignancies. Most patients (56.8%) were in locally advanced stages. Anemia was present at admission in 48 (50.5%) patients with a higher prevalence among colorectal and genitourinary tract cancer patients. The mean hemoglobin (Hb) drop during treatment was 9.1 ± 2.1 g/dL. Anemia severity was stratified as follows: life-threatening (7.4%), severe (33%), moderate (31%), and lower limited (29%). Blood transfusions were required in 79% of cases. Advanced age, increased chemotherapy cycles, and anemia of chronic disease (ACD) were significantly associated with increased anemia severity (p<0.05). Increasing chemotherapy cycles also correlated with an increased need for blood transfusion (p<0.001). Older patients (≥65 years) had higher anemia at admission, poor Eastern Cooperative Oncology Group (ECOG) performance status, more Hb decrease during treatment, and increased need for blood transfusions (p<0.05) compared to younger patients (<65 years). The study noted a high prevalence of anemia (50.5%) in patients receiving active cancer treatment, specifically in the context of genitourinary and gastrointestinal tract cancers. Advanced age, frequent chemotherapy cycles, and ACD were associated with increased severity of anemia. Furthermore, older patients displayed a higher frequency of anemia, poorer performance status, and an increased requirement for transfusions with an escalating number of chemotherapy cycles.

Ensuring fair, safe, and interpretable artificial intelligence-based prediction tools in a real-world oncological setting

BackgroundCancer patients often experience treatment-related symptoms which, if uncontrolled, may require emergency department admission. We developed models identifying breast or genitourinary cancer patients at the risk of attending emergency department (ED) within 30-days and demonstrated the development, validation, and proactive approach to in-production monitoring of an artificial intelligence-based predictive model during a 3-month simulated deployment at a cancer hospital in the United States.MethodsWe used routinely-collected electronic health record data to develop our predictive models. We evaluated models including a variational autoencoder k-nearest neighbors algorithm (VAE-kNN) and model behaviors with a sample containing 84,138 observations from 28,369 patients. We assessed the model during a 77-day production period exposure to live data using a proactively monitoring process with predefined metrics.ResultsPerformance of the VAE-kNN algorithm is exceptional (Area under the receiver-operating characteristics, AUC = 0.80) and remains stable across demographic and disease groups over the production period (AUC 0.74–0.82). We can detect issues in data feeds using our monitoring process to create immediate insights into future model performance.ConclusionsOur algorithm demonstrates exceptional performance at predicting risk of 30-day ED visits. We confirm that model outputs are equitable and stable over time using a proactive monitoring approach.

Individualized treatment estimates to inform on personalized cancer care decisions for treatment selection and treatment management.

e13571 Background: Clinical trials report average effects of treatments at a population level. However, clinicians must balance treatment benefits against risks to personalize therapy. Here, we present a statistical framework which incorporates real-world data to estimate efficacy and symptom burden for an individual patient. We then assess the potential impact of continuing immunotherapy beyond progression in patients with metastatic solid malignancies on immune-related adverse events, progression, and survival. Methods: We corrected for sampling biases with inverse propensity score weighting (IPTW), and used the IPTW-transformed data to train predictive models of patient outcomes under each option. The models utilize a peer-based similarity based on 222 routinely-collected patient characteristics, such as cancer and treatment specific factors, laboratory tests, demographics, vitals, stage, comorbidities and symptoms, which are extracted from the electronic health record or natural language processing of clinician narratives, and Social Determinants of Health from Census data. We developed our methods on “Dataset A”: 5,919 breast and genitourinary (GU) cancer patients at a tertiary cancer center. We computed individualized treatment effect (ITE) estimates on “Dataset B”: 5,486 breast, GU, and thoracic cancer patients who received immunotherapy. Results: Our approach eliminated biases in Dataset A: the IPTW-transformation reduced the between-group standardized mean difference across identified confounders from an average of 0.225 to an average of 0.022. The similarity model exhibited strong discrimination (ROC-AUC &gt; 0.75), and identified associations between patient characteristics and outcomes that matched clinicians’ expectations. Validations are ongoing to assess the ITE estimates on a held-out subset of Dataset B. These include subgroup analyses for metastatic triple-negative breast cancer and non-small cell lung cancer. Conclusions: We introduce a method to estimate the efficacy and toxicity of interventions, actions, or treatment decisions, which replicates the statistical robustness of a clinical trial while obtaining individualized insights. This framework provides causal estimates of symptom burden and risks of progression and survival to inform clinical decisions, including continuation of immunotherapy beyond progression. After IPTW, confounders in Dataset A were balanced between the treatment groups, with weighted standardized mean differences &lt;0.1. [Table: see text]

Telemonitoring program for genito-urinary cancer patients treated with oral anticancer agents.

e18731 Background: Oral anticancer agents (OAA) used has dramatically increased in treating genito-urinary (GU) cancer. Patients with metastatic prostate and kidney cancers, have advanced age, with comorbidities. The risks of OAA for this population with adverse effects, drug interactions and ambulatory administration must be detected, prevented and managed to decrease toxicity, improve compliance and efficacy. Here, we report the data of our comprehensive cancer center telemonitoring program named Outside the walls of the hospital (OWH), combining medical oncologist coordination, clinical pharmacist (CP) evaluations, and nurse follow-ups. Methods: Data from patients treated with OAA for advanced and metastatic prostate or kidney cancers in our center during year 2022 were retrospectively evaluated. At the start of OAA, the patients benefit from a consultation with the oncologist, clinical nurse (CN), and CP. For each drug, a standard telemonitoring program has been planned according to the patient's age and comorbidities. Results: The mean age of the patients was 68 years (44-90), 42% of the patients were over 70 years, 84% were men and 96% were in a metastatic setting. Out of 347 GU patients, 118 were included in the OWH telemonitoring program in 2022, representing 14% of the whole cancers patients enrolled in this program. Of these 118 new GU patients, 80% had a CP consultation, 76% for next generation hormonal therapy (NGHT) for advanced or metastatic prostate cancer and 24% for tyrosine kinase inhibitors (TKI) for kidney cancer. At least one drug interactions was detected for 54% of patients (61% of the NGHT and 35% of TKI). The associations was strongly discouraged for 18% because of an increase or decrease in drug concentration requiring a switch or an adaptation of dosage at the outset (statin (11 patients), oral anticoagulant (5 patients), analgesic (1 patient)). At least 1 complementary alternative medicine was used by 29% with 55% of them had an interaction with OAA. During follow-up, the frequency of consultations with CN or physician is reduced over time, in order to give priority to telemonitoring and visits to the oncologist for tumor assessment and if necessary at the request of the nurse or the patient. Conclusions: The OWH program makes it possible to limit medical visits by ensuring safe monitoring. It promotes patient empowerment and allows for medical visits when necessary, in the current context of declining medical demographic for an often elderly and fragile population.

A retrospective review of primary prophylaxis with granulocyte-colony stimulating factor (G-CSF) for patients with genitourinary malignancies receiving chemotherapy during the COVID-19 pandemic and implications for the future.

115 Background: To mitigate the risks of chemotherapy associated neutropenia, during the COVID-19 pandemic, all genitourinary (GU) cancer patients treated with chemotherapy at the Princess Margaret Cancer Centre (PMCC) were offered primary prophylaxis with GCSF. We hypothesize that this reduced rates of febrile neutropenia, hospitalizations, healthcare costs and improved overall outcomes, compared to GU cancer patients treated with chemotherapy without GCSF in the 2 years prior to the pandemic. Methods: We performed a retrospective review of GU cancer patients, receiving curative or palliative intent chemotherapy, with or without primary GCSF prophylaxis between January 2018 and June 2022. GCSF was given either as a single dose or as consecutive doses post chemotherapy. Main outcomes were incidence of febrile neutropenia, hospitalization, health care expenditures as well as disease specific outcomes. Results: Overall, 248 patients with prostate cancer (44%), urothelial cancers (33%) germ cell (21%), and rare GU cancers (4%) were identified. Median age was 70 (range 19-91), 92% were male, 65% were ECOG 0/1. Treatment intent was neoadjuvant (13%), adjuvant (20%), or palliative (67%). Main regimens used were docetaxel, cabazitaxel, carboplatin, cisplatin/etoposide, gemcitabine/cisplatin and BEP. Median follow-up was 10.5 months (0.23-52.3 months). A total of 206/248 received primary GCSF prophylaxis. During chemotherapy, the median white blood cell levels were higher in the GCSF group compared to the non-GCSF group (14.1*10*9/L vs 2.90*10*9/L, p&lt;0.0001); and neutropenia rates were markedly lower (2% vs. 93%, P=&lt;0.0001). Hospital admission rates were significantly lower in G-CSF users compared to non-users (19% vs. 69%, P&lt;0.0001). Symptomatic disease progression 13% was the leading cause of admission in the G-CSF group. Infectious causes such as UTI, pneumonia, COVID-19, and sepsis were seen in only 12% of the G-CSF group compared to 31% in the non-users. G-CSF was generally well tolerated with just 0.97% discontinuing G-CSF. Conclusions: During the COVID-19 pandemic, primary prophylactic G-CSF use in GU cancer patients, undergoing chemotherapy significantly lowered rates of both febrile neutropenia and hospitalizations and could be a cost-effective strategy in this patient population that warrants further study.

Evaluation of Microsatellite Instability Molecular Analysis versus Immuno-Histochemical Interpretation in Malignant Neoplasms with Different Localizations.

MMR gene germline mutations are considered a major genetic disorder in patients with hereditary nonpolyposis colon cancer (HNPCC) or Lynch syndrome; A total of 15% of sporadic colon carcinomas are MSI-High. MSI has also been observed in other cancers, such as endometrial, gastric, and ovarian cancer. The aim of the current study was to correlate and outline the optimal method between the molecular testing of the instability of microsatellite DNA regions (MSI status) and the loss of protein expression by immunehistochemistry (MMR). A total of 242 paraffin-embedded tissues from gastrointestinal, gynecological, genitourinary, lung, breast, and unknown primary cancer patients were analyzed for the expression of MLH1/MSH2/MSH6/PMS2 by immunohistochemistry, as well as for the molecular analysis of MSI status using PCR-based molecular fragment analysis. A total of 29 MSI-High patients were detected molecularly, while 23 patients were detected by immunohistochemistry, with rates that are comparable according to the literature. Based on the agreement coefficient of the two methods, a substantial agreement emerged (Kappa = 0.675 with standard error = 0.081, p &lt; 0.001). Despite the substantial agreement, both methods ought to be established to determine MSI-H/dMMR status in all cancer types as a first-line screening test.

Perceptions of COVID-19 Vaccination in Patients with Genitourinary Cancers: A Survey Study

Since the approval of the COVID-19 vaccines, their safety and efficacy has been widely demonstrated in patients with cancer. However, there remain patients with reservations regarding vaccination. We aimed to assess genitourinary cancer patients’ perceptions of the vaccines as well as barriers and influencers of decision-making through the completion of a questionnaire. While vaccine-associated concerns were observed, most patients with genitourinary cancers were willing to receive the vaccine. Moving forward, differing strategies could be considered to enhance patient education on the utility of vaccination in the setting of cancer and beyond.

The germline mutational landscape of genitourinary cancers and its indication for prognosis and risk

BackgroundGermline mutations represent a high risk of hereditary cancers in population. The landscape and characteristics of germline mutations in genitourinary cancer are largely unknown, and their correlation with patient prognosis has not been defined.MethodsVariant data and relevant clinical data of 10,389 cancer patients in The Cancer Genome Atlas (TCGA) database was downloaded. The subset of data of 206 genitourinary cancer patients containing bladder urothelial carcinoma (BLCA), kidney chromophobe carcinoma (KICH), kidney renal clear cell carcinoma (KIRC), kidney renal papillary cell carcinoma (KIRP) and prostate adenocarcinoma (PRAD) cancer with germline mutation information was filtered for further analysis. Variants were classified into pathogenic, likely pathogenic and non-pathogenic categories based on American College of Medical Genetics and Genomics (ACMG) guidelines. Genome Aggregation Database (gnomAD) database was used to assist risk analysis.ResultsThere were 48, 7, 44, 45 and 62 patients with germline mutations identified in BLCA, KICH, KIRC, KIRP and PRAD, respectively. Pathogenic germline mutations from 26 genes and likely pathogenic mutations from 33 genes were revealed. GJB2, MET, MUTYH and VHL mutations ranked top in kidney cancers, and ATM and CHEK2 mutations ranked top for bladder cancer, while ATM and BRCA1 mutations ranked top for prostate cancer. Frameshift, stop gained and missense mutations were the predominant mutation types. BLCA exhibited the highest ratio of stop gained mutations (22/48 = 45.8%). No difference in patient age was found among pathogenic, likely pathogenic and non-pathogenic groups for all cancer types. The number of male patients far overweight female patients whether PRAD was included (P = 0) or excluded (P < 0.001). Patients with pathogenic or likely pathogenic germline mutations exhibited significantly worse overall survival rate than the non-pathogenic group for all genitourinary cancers. More important, analyses assisted by gnomAD database revealed that pathogenic or likely pathogenic germline mutations significantly increased the risk for genitourinary cancer in population, with the odds ratio at 14.88 (95%CI 11.80–18.77) and 33.18 (95%CI 24.90–44.20), respectively.ConclusionsThe germline mutational status for genitourinary cancers has been comprehensively characterized. Pathogenic and likely pathogenic germline mutations increased the risk and indicated poor prognosis of genitourinary cancers.

Change of genitourinary cancer patients' perception and expectations over the course of pharmacotherapy.

To determine the course of treatment while considering the patients' desires, we examined trends regarding patients' perception and expectations over the course of cancer pharmacotherapy. We retrospectively reviewed interview sheets filled in by patients with advanced urogenital cancers when they started a new pharmacotherapy regimen between 2014 and 2020. The responses to the following questions were analyzed: 1) How did your doctor explain the treatment objectives?; 2) Are you willing to receive treatment?; and 3) When the standard treatment becomes difficult to continue, would you like to try another treatment even if it may cause severe side effects? A total of 277 patients answered the interview sheet. The percentage of patients who accurately perceived the treatment objectives among patients receiving 1st, 2nd, and 3rd line regimens was 67%, 79%, and 93%, respectively. The percentage significantly improved over the course of pharmacotherapy (p = 0.0057). The percentage of patients who indicated that they were willing to receive treatment in 1st, 2nd, and 3rd line regimens was 80%, 83%, and 86%, respectively. The percentage of patients who indicated that they wanted to try another treatment when the standard treatment became difficult to continue in 1st, 2nd, and 3rd line regimens was 56%, 64%, and 59%, respectively. The percentage of patients who accurately perceived the objective of pharmacotherapy increased over the course of pharmacotherapy. The rate of patients who were willing to receive treatment and try other treatments when the standard treatment became too difficult to continue remained consistently high.

Treatment and Bleeding Complications of Cancer-Associated Venous Thromboembolism: A Korean Population-Based Study.

This study investigated the treatment pattern and the rate of bleeding complications in real-world practice in cancer-associated venous thromboembolism (CT) patients. We used the Korean Health Insurance Review and Assessment Service database (2014-2018). Among patients with venous thromboembolism, patients with concomitant malignancy diagnostic codes were categorized as CT, while all others were categorized as non-CT. Treatments were categorized as direct oral anticoagulant (DOAC), parenteral anticoagulant (PAC), warfarin, and mixed anticoagulants. We identified 27,205 CT and 57,711 non-CT patients. DOACs were the most frequently used anticoagulants. The proportion of patients treated with PAC was higher in CT than in non-CT patients (35.7 vs. 19.5%; p < 0.01). In CT, the cumulative incidence of any/major bleeding was higher with DOAC (8.1%/3.9%) than with PAC (7.5%/3.2%; p = 0.04 and 0.01, respectively). However, there was no difference in major bleeding when compared with warfarin (p = 0.11) or mixed anticoagulants (p = 0.94). Overall, gastrointestinal (GI) cancer patients showed higher risks of bleeding. The cumulative incidence of major GI bleeding was higher with DOAC than with PAC (4.9 vs. 3.0%; p < 0.01), while there was no difference compared with warfarin (p = 0.59) or mixed anticoagulants (p = 0.80). Major bleeding with each DOAC showed no difference among entire CT (p = 0.94), GI cancer (p = 0.27), and genitourinary cancer (p = 0.88) patients. Five years after their introduction into clinical practice, DOACs have become the most prescribed anticoagulant in Korea. In our patient population, bleeding complications occurred more frequently in CT than in non-CT, especially in patients treated with DOACs.

Social Determinants Contribute to Disparities in Test Positivity, Morbidity and Mortality: Data from a Multi-Ethnic Cohort of 1094 GU Cancer Patients Undergoing Assessment for COVID-19

Background: The COVID-19 pandemic exploits existing inequalities in the social determinants of health (SDOH) that influence disease burden and access to healthcare. The role of health behaviours and socioeconomic status in genitourinary (GU) malignancy has also been highlighted. Our aim was to evaluate predictors of patient-level and neighbourhood-level factors contributing to disparities in COVID-19 outcomes in GU cancer patients. Methods: Demographic information and co-morbidities for patients screened for COVID-19 across the Mount Sinai Health System (MSHS) up to 10 June 2020 were included. Descriptive analyses and ensemble feature selection were performed to describe the relationships between these predictors and the outcomes of positive SARS-CoV-2 RT-PCR test, COVID-19-related hospitalisation, intubation and death. Results: Out of 47,379 tested individuals, 1094 had a history of GU cancer diagnosis; of these, 192 tested positive for SARS-CoV-2. Ensemble feature selection identified social determinants including zip code, race/ethnicity, age, smoking status and English as the preferred first language—being the majority of significant predictors for each of this study’s four COVID-19-related outcomes: a positive test, hospitalisation, intubation and death. Patient and neighbourhood level SDOH including zip code/ NYC borough, age, race/ethnicity, smoking status, and English as preferred language are amongst the most significant predictors of these clinically relevant outcomes for COVID-19 patients. Conclusion: Our results highlight the importance of these SDOH and the need to integrate SDOH in patient electronic medical records (EMR) with the goal to identify at-risk groups. This study’s results have implications for COVID-19 research priorities, public health goals, and policy implementations.

PET-CT in Clinical Adult Oncology—IV. Gynecologic and Genitourinary Malignancies

Concurrently acquired positron emission tomography and computed tomography (PET-CT) is an advanced imaging modality with diverse oncologic applications, including staging, therapeutic assessment, restaging and longitudinal surveillance. This series of six review articles focuses on providing practical information to providers and imaging professionals regarding the best use and interpretative strategies of PET-CT for oncologic indications in adult patients. In this fourth article of the series, the more common gynecological and adult genitourinary malignancies encountered in clinical practice are addressed, with an emphasis on Food and Drug Administration (FDA)-approved and clinically available radiopharmaceuticals. The advent of new FDA-approved radiopharmaceuticals for prostate cancer imaging has revolutionized PET-CT imaging in this important disease, and these are addressed in this report. However, [18F]F-fluoro-2-deoxy-d-glucose (FDG) remains the mainstay for PET-CT imaging of gynecologic and many other genitourinary malignancies. This information will serve as a guide for the appropriate role of PET-CT in the clinical management of gynecologic and genitourinary cancer patients for health care professionals caring for adult cancer patients. It also addresses the nuances and provides guidance in the accurate interpretation of FDG PET-CT in gynecological and genitourinary malignancies for imaging providers, including radiologists, nuclear medicine physicians and their trainees.

Abstract 5260: Association between physical activity interventions after a genitourinary cancer diagnosis and incidences of depression and anxiety: A scoping study

Abstract Background: Symptoms of depression and anxiety are common among cancer patients. Physical activity interventions have been conducted to improve psychological outcomes in cancer patients. Our goal with this scoping review was to synthesize evidence on the association of exercise interventions on depression and anxiety symptom presentation among men diagnosed with a genitourinary cancer. Methods: We undertook a structured search of PubMed and Embase databases to identify physical activity interventional studies (randomized and non-randomized) and depression or anxiety among male genitourinary cancer patients. Study inclusion criteria included: studies must have been interventional, within a population of male genitourinary cancer patients (prostate, bladder, kidney, testicular), with reported quantitative measures of depression or anxiety, separately for individual cancer sites and males for non-male-specific cancer sites. Using these criteria, records underwent a first-stage title-and-abstract screen followed by a second-stage full-text screen. Records meeting all eligibility criteria were included. Following standardized data extraction, data were synthesized in narrative format. All study procedures were performed by two reviewers, with conflicts resolved by consensus. Results: The search yielded 1,465 records. Following screening, 22 studies met inclusion criteria and were included in the synthesis. Of the outcomes of interest, 21 studies assessed depression (20 prostate and 1 testicular cancer), 16 studies assessed anxiety (15 prostate and 1 testicular cancer), and 1 study assessed depression and anxiety combined (prostate cancer). No trials in kidney or bladder cancer met eligibility criteria. Exercise interventions in included trials ranged from high-intensity interval training (HIIT) to stretching-based practices. The included testicular cancer study found a non-significant between-group decrease in depression (effect = -0.2) and anxiety (effect = -1.6) scores following HIIT intervention. Nearly all studies in prostate cancer found improvements following the exercise intervention, several with statistically significant results. Of note, the results from 2 Qigong exercise interventions reported promising therapeutic benefits, with one study reporting a significant decrease in anxiety from baseline comparing Qigong vs stretching control interventions (p=0.003); results were non-significant for depression (p=0.09). Conclusion: Available evidence demonstrates suggests a beneficial impact of exercise interventions on reducing depression and anxiety symptoms in men with genitourinary cancer. More research is needed on the role of exercise interventions on psychological condition reporting in patients of kidney, bladder, and rarer genitourinary cancers. Citation Format: Sydney Grob, Colleen B. McGrath, Lorelei A. Mucci. Association between physical activity interventions after a genitourinary cancer diagnosis and incidences of depression and anxiety: A scoping study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5260.

Financial impact of immunotherapy-related adverse events among inpatient admissions with solid malignancies.

e18825 Background: Immune checkpoint inhibitors (ICPis) have shifted the landscape of cancer treatment from conventional cytotoxic regimens. The mechanism of action involves suppression of immunologic checkpoints that often results on a unique spectrum of side effects associated with immune-mediated inflammations. The Aim of this study is to evaluate the financial impact from immune-related adverse events (IrAEs) reflected in hospitalized patients undergoing anti-neoplastic immunotherapy using the data from a nation-wide database. Methods: We performed retrospective analysis with the National Inpatient Sample (NIS) using ICD10-CM and PCS codes to identify patients with solid tumors hospitalized for immunotherapy between October 2015 and 2018. Inpatient data from patients with or without having developed IrAEs during the hospitalizations were compared in this study. IRAEs included systemic symptoms, diarrhea/colitis, hepatic and endocrine adverse events. Baseline characteristics and inpatient complication variables were collected and analyzed between these two groups. Results: From 5,795 admissions of ICPi-treated cancer patients, 1,160 patients or 20 % of these hospitalizations presented with IrAEs, females represented (37.5%) with an age of 57 years though not statistically different from admissions without IrAE. On the other hand, length of stay was statistically longer (7 vs 5 days, p &lt; 0.05) with higher admission expenses ($184,255 vs $ 133,305, p &lt; 0.05) from IRAE-associated admissions. Higher IrAEs were observed among patients who were ICPi-treated for genitourinary (GU) cancers (22% vs 15%, p &lt; 0.05). IRAE as an independent risk factor was associated with higher costs even when adjusted for other risk factors, significantly contributed to a higher admission expenses by a coefficient at $46,624 (SE +/- $13,943). Conclusions: Although ICPi-therapies have offered various clinical benefits among cancer patients. They have also contributed to both direct and indirect costs of cancer management. Our analysis showed a higher IrAE incidence associated with ICPi-treated GU cancer patients, patients who developed IRAEs had a longer hospital stay and higher in-hospital mortality, resulting in higher care expenses as one of the indirect financial burdens of ICPi therapies, no differences were observed between gender, race, or income.[Table: see text]

Inpatient complications of immunotherapy-associated colitis in solid malignancies: Real-world data analysis.

2657 Background: Immune checkpoint inhibitors (ICPis) and their containing regimens have been proven beneficial for the treatment of multiple malignancies, while immune-related adverse events (IrAEs) have become constant safety challenges in their clinical management through all ICPi therapies. Diarrhea resulted from immune-mediated colitis has been one of the most common IrAEs. The Aim of this study is to evaluate the real-world incidence and factors that contributed to colitis among patients hospitalized for anti-neoplastic immunotherapy using a large nation-wide database. Methods: We performed a retrospective analysis with the National Inpatient Sample (NIS) using ICD10-CM and PCS codes to identify patients with solid tumors hospitalized for immunotherapy between October 2015 and 2018. A comparison analysis was made between patients who developed diarrhea (or colitis) or not during their hospitalizations. Patient characteristics included past medical history, location, charges, length of stay (LOS) and inpatient complications variables, data were compared between the two groups. Results: The data from 5,795 admissions for immunotherapy were included, of which 615 (10.61%) inpatient events were complicated by diarrhea (colitis). Patients with diarrhea tended to be males (60%), slightly older at age 57 years, higher percentage of white patients (78%) though not statistically significant from those who did not have colitis. On the other hand, the length of inpatient stay was statistically longer (7 vs 5 days, p &lt; 0.05), and associated with higher expenses ($214,612 vs $ 134,195, p &lt; 0.05). In addition, inpatient admissions with colitis were more towards larger academic hospitals (80% vs 67%, p = 0.01). ICPi-treated patients with genitourinary (GU) cancers were observed more with colitis among these admissions (27% vs 15%, p &lt; 0.05). Though no difference from mortalities observed, serious complications, such as acute kidney injury (AKI) (44% vs 20%, p &lt; 0.05) and non-septic shock rates were higher (7% vs 2%, p = 0.01) among colitis admissions. Conclusions: This real-world data analysis of inpatient admissions from ICPi-treated cancer patients demonstrated colitis with diarrhea as a common safety concern over ICPi-therapies, a higher risk among patients of GU primaries, higher risk with serious medical complications: acute renal dysfunction and non-septic shock, led to increased length of stays (LOS) and financial burden. Special attention and further study may be placed among ICPi-treated GU cancer patients. [Table: see text]

MP12-02 PROSPECTIVE EVALUATION OF CIRCULATING TUMOR DNA (ctDNA) IN DETECTING EARLY PROGRESSION ON IMMUNE CHECKPOINT INHIBITORS IN PATIENTS WITH ADVANCED GENITOURINARY CANCERS

MP12-02 PROSPECTIVE EVALUATION OF CIRCULATING TUMOR DNA (ctDNA) IN DETECTING EARLY PROGRESSION ON IMMUNE CHECKPOINT INHIBITORS IN PATIENTS WITH ADVANCED GENITOURINARY CANCERS

CLO22-062: The Impact of COVID-19 Infection Among Genitourinary Cancer Patients in Los Angeles County: A Retrospective Analysis

CLO22-062: The Impact of COVID-19 Infection Among Genitourinary Cancer Patients in Los Angeles County: A Retrospective Analysis