Genitourinary Clinic Research Articles

Impact of multidisciplinary tumor boards on clinical decision making in a genitourinary oncology clinic in Mexico city.

e23217 Background: Effective management of genitourinary neoplasms demands a comprehensive approach due to the diverse treatment options and the need for multiple specialists. Multidisciplinary tumor board (MDTB) meetings are a platform for experts to collectively assess and discuss the latest evidence and provide their expertise to tailor treatment plans for patients. Methods: Cases discussed during uro-oncology MDTB meetings at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán in Mexico City over a five-year period (01/2018 to 12/2022) were included. We analyzed the type of neoplasm, reason for case discussion, specialties involved and whether the final decision led to a modification of the original plan. Descriptive statistics were used for analysis. Chi-squared test was used to determinate differences and p value < 0.05 was considered statistically significant. A logistic regression analysis was performed for multivariate analysis. Results: Over the study period, 500 discussions involving 399 patients were included. 87% were men. Prostate, kidney, testicular, upper tract urothelial and bladder carcinoma, represented: 223 (44.6%), 117 (23.4%), 84 (16.8%), 37 (7.4%), 32 (6.4%) of cases, respectively. The majority were presented by urology (319 cases; 63.6%). The primary reason for presentation was surgical decisions in 54.6%. Regarding final conclusions, 55.8% underwent modifications in the treatment plan, 33.2% had no changes and 11% remained inconclusive, requiring further assessment. Individuals with metastatic disease had a higher likelihood of treatment plan changes in 61.6% vs 52.3% (OR 1.46 95%CI 1.01-2.12; p = 0.042). The 163 cases (32.6%) presented during the COVID-19 pandemic were more prone to have treatment modifications 62.6% vs 52.5% (OR 1.51 95%CI 1.03-2.22; p = 0.034); cases presented for surgical reasons during this period were more likely to have a change in treatment modality 74% vs 52.3% (OR 2.6 95%CI 1.34-5.04; p = 0.004). Implementation of results was successful in most cases (72%), with a median time of 3.6 weeks. Reasons for not implementing the plan included: patient decision, treating physician decision, comorbidities, death, and lack of resources. Factors associated with implementation in the multivariate analysis included: male gender (OR 2.81), cases presented during pandemic (OR 2.0), and by urology service (OR 1.92). Conclusions: Among patients presented in our uro-oncology MDTB meetings, more than half will have a change in the original treatment plan, and this agreed strategy is successfully implemented in most individuals. These sessions remained key for patient management during the COVID-19 pandemic.

Utilization of genetic counseling and testing for patients with prostate cancer following integration of a genetic counselor into a genitourinary cancer clinic.

343 Background: Individuals with prostate cancer may have a 10-20% chance of harboring genetic markers for inherited risk. It is critical that germline genetic testing (GGT) is integrated into prostate cancer care to improve therapy and promote prevention and early detection for individuals and their families. We hypothesized that embedding a genetic counselor (GC) into a multidisciplinary genitourinary (GU) Cancer Clinic would enhance referrals and subsequent GGT. We created a retrospective and prospective study to evaluate the impact on genetic counseling referrals, genetic risk assessments provided, and GGT frequencies before (2016-2018) and after (2019-2022) GC integration into the GU clinic at The James Cancer Hospital at The Ohio State University. Methods: A chart review of 2,593 individuals with prostate cancer seen in the GU program from 2016 to 2022 was performed. Data was analyzed by the Chi Square test. Results: Only 39 referrals to the cancer genetics program were documented in 2016-2019 with an increase to 367 during 2019-2022, despite the COVID pandemic. During the 2016-2019 period GGT was offered to 28% and completed in 26% of referred individuals, whereas GGT was offered to 77% (P<0.0001) and completed in 64% (P<0.0001) in the subsequent period. Individuals proceeding with genetic counseling and GGT were younger in the initial period and became more broadly based in subsequent years. Black patients represented only 8% of referrals in 2016-2019 but increased to 16% in the subsequent period. Individuals with a family history of prostate cancer (P<0.0001) as well as higher Gleason grade (P<0.0001), stage (P<0.0001), metastatic disease (P<0.0001), and PSA (P=0.0507) were more likely to choose genetic counseling. Conclusions: The integration of a GU focused GC into a multidisciplinary GU Cancer Clinic at an academic program dramatically increased genetic counseling referrals, and a greater proportion of individuals with prostate cancer proceeded with GGT. Future studies will analyze barriers and factors promoting referrals to a GC so that we may continue to offer individuals and their families' evidence-based treatment and prevention options.

Improving health education through a patient-clinician partnered intervention in the patient with genitourinary cancer.

TPS525 Background: Health literacy is associated with health equity, acts as a cornerstone in optimizing patient care and is associated with improved quality of life. The objective of this project is to improve health literacy in patients with genitourinary cancer through a patient-clinician partnered education intervention. Synthesis of Literature Utilization of a targeted education program delivered in-person using voice instruction demonstrated the greatest significant effect on health-related quality of life; the additional of illustration and text further improved this metric. Optimal health related quality of life is associated with greater comprehension of disease and adherence to treatment plan, heightened self-efficacy, and improvement in patient-provider communication. Methods: The intervention is a patient-clinician partnered written form used in conjunction with verbal instruction. The patient documents reasons for the visit and primary concerns to be addressed prior to the provider encounter during the visit. The Action Plan then records the treatment plan and next steps discussed during the visit. A Confidence Ruler acts as a visual representation of patient confidence in the plan of care, acting as a prompt to the provider to ensure adequate information transfer at conclusion of the visit. The patient then retains the written form highlighting the care discussion for reference and recall as needed. Evaluation A five-point Likert test will measure change pre/post intervention; data will be analyzed in a cohort looking at improvement in overall mean. The HRQOL-14 and the CHLT-6 modified will be used to assess baseline health related quality of life and health literacy respectively followed by cohort analysis of the means to determine efficacy outcomes. The primary outcome is to improve health literacy in all patients within a genitourinary oncology clinic population using is a written tool in concurrence with verbal instruction with secondary focus on improving health-related quality of life in the same population. Recommendation Health literacy must be assessed each visit to optimize patient care outcomes and quality of life. Targeted health education must be patient specific and titrated to individual health literacy needs.

CPC04 A rare rupioid rash

Abstract A 59-year-old man was referred to an urgent skin cancer dermatology clinic with a 4-month history of multiple skin lesions on his trunk, arms and face. The lesions were painful, increasing in size, bleeding and oozing serous fluid. The patient reported being otherwise systemically well, with a history of mild eczema and a background of high alcohol intake. On examination, he had a striking rash with numerous large rupioid plaques with thick crusting and surrounding erythema on the trunk and limbs. Smaller plaques were seen on the face and neck. An infective aetiology was favoured with an initial differential diagnosis of ecthyma or atypical mycobacterial infection. A biopsy was taken, as well as screening blood tests. Treponemal antibodies were detected; rapid plasma reagin was reactive (1 : 32), as was Serodia Treponema pallidum particle agglutination test (1 : 1280), suggesting active syphilis infection. His biopsy demonstrated granulomatous inflammation, associated with neutrophils, plasma cells and increased mucin deposition. Immunohistochemical staining for T. pallidum confirmed corkscrew-like organisms within the basal epidermis and upper dermis, consistent with secondary syphilis; screening for concurrent HIV infection was negative. The patient was referred to a local genitourinary clinic for treatment with benzylpenicillin and for full sexual health screening. The word ‘rupioid’ describes oyster or limpet shell-shaped thick keratotic lesions and is derived from the Greek word rhupos, meaning ‘filth’. Differential causes for rupioid lesions include cutaneous T-cell lymphoma, psoriasis, scabies and syphilis. Rupioid syphilis is also termed ‘malignant syphilis’ or ‘Lues maligna’, describing well-demarcated plaques with thick, lamellate and adherent crusts. It is most frequently encountered in HIV-positive patients; in HIV-negative patients, the associated comorbidities are diabetes, alcoholism, drug abuse, psoriasis and hepatitis. Typically, there is rapid clinical improvement once antibiotic treatment is administered, but episodes of Jarisch Herxheimer reaction are reported. Syphilis diagnoses have tripled over the last 10 years, with cases in the heterosexual population rising most rapidly. Dermatologists have a pivotal role to play in diagnosing primary and secondary syphilis, thereby preventing the long-term sequelae of tertiary syphilis and controlling the rising prevalence of the disease in the general population. This case highlights a striking and rare manifestation of secondary syphilis which, once seen, will not be forgotten.

The migrated intrauterine contraceptive device presented as a vesical stone

Intrauterine devices (IUDs) are one of the most popular reversible contraception methods. However, if an event related to them is unanticipated, or if they are not located when missing, it can be dangerous. We present a case of chronic lower abdomen pain and recurrent urinary tract infection ongoing for 1.5 years. Despite the patient undergoing laparoscopic uterine myomectomy, her symptoms had not improved. The patient visited a genitourinary clinic for lower urinary tract symptoms and accepted cystoscopy and electrohydraulic lithotomy. Incidentally, a part of an IUD was found in the calculus. This case highlights the need for careful diagnosis and for locating missing IUDs to avoid serious complications.

A retrospective study to evaluate the efficacy and safety of SARS-CoV-2 vaccine in patients with advanced genitourinary cancers

BackgroundCOVID-19 vaccination is one of the pivotal key tools against the ongoing pandemic, but its acceptance relies on efficacy and safety data among various populations, including patients with cancers. However, there is limited data on seroconversion rates, efficacy, and safety of the COVID-19 vaccine in patients with cancer. Breakthrough infections after vaccination have also been reported, which could further strengthen the refusal behavior of specific populations to be immunized. Our objective was to investigate the efficacy and safety of COVID-19 vaccination in real-world patients with advanced genitourinary cancers. Methods and resultsA retrospective study of the 738 patients with advanced metastatic genitourinary malignancy was conducted at our genitourinary oncology clinic from October 2020 to September 2021, out of which 462 patients (62.6%) were vaccinated. During the study period, two vaccinated, and six unvaccinated patients tested positive for SARS-CoV-2 (breakthrough infection rate: 0.4% vs. 2.2%, p = 0.027). Vaccine protection against infection was 81.8% (95% CI: 0.04–0.98). One vaccinated and 4 unvaccinated patients were hospitalized due to COVID-19 (0.2% vs. 1.4%, p = 0.048). Vaccine effectiveness in preventing hospitalization was 85.7% (95% CI: 0.02–1.33). Within one month of vaccination, 1.5% of patients (n = 7) had emergency visits, 0.8% (n = 4) were hospitalized for any reason, and of these, 3 (0.6%) experienced a delay in the receipt of their cancer therapy. ConclusionIn our hypothesis-generating data among patients with advanced genitourinary cancers, COVID-19 vaccination was efficacious and safe and was rarely associated with treatment disruptions. These data should help improve the acceptance of the COVID-19 vaccine in the general population and patients with cancer. The vaccine effectiveness in our patients is comparable with existing published data without cancer.

Gender, migration and violence among third country nationals accessing the sexual health clinic in Malta.

In 2020, the number of displaced people worldwide reached 41.3 million (IOM, 2020). Among them, are many migrants and refugees at risk of sexual and gender-based violence (SGBV). Healthcare providers have a key role to play in identifying migrant victims/survivors of violence. This paper seeks to assess STIs prevalence, sexual health and sexual violence among third country nationals (TCNs) attending the GUC in Malta. This is a mixed methods study carried out at the Genitourinary Clinic (GUC), which is the only public sexual health clinic in Malta. Demographic data, sexual history and diagnoses of patients attending the GUC between January 2018 and December 2019 were collected and retrospectively analysed. A SGBV risk assessment was performed through a semi-structured questionnaire. In the 24-month study period, a total of 12 654 patients accessed the GUC in Malta. Demographic data were collected on age, gender, nationality, marital status and sexual orientation. 16.4% (n = 2064) of these were extra-European migrants, predominantly male. 80 different nationalities were recorded, with the 5 most common being Nigerian, Filipino, Libyan, Syrian and Brazilian. The average age was 32.6 years. Over 110 sex workers were visited at the GUC in the study period - 20 were foreign, primarily from China. The presence of a 'massage parlour owner' during consultation, lack of control over passports and other factors were identified as warning signs of trafficking. 5 cases of sexual violence and forced prostitution involving girls from Sub-Saharan Africa and, in 2 cases, boys recently arrived in Malta by boat, were encountered. 6 African women accessing the service exhibited a type of female genital mutilation (FGM). Migration, sexual health and SGBV overlap in important ways. Further research and training in SGBV and migration in the healthcare setting and awareness-raising about existing services among the migrant population are required.

Tumor Marker Decline in Predicting Treatment Outcome among Poor-Risk Testicular Germ Cell Tumors-A Tertiary Cancer Center Data.

Lakshmi Haridas K.Introduction Testicular germ cell tumors are rare in India. Despite the advances in chemotherapy, poor-risk testicular nonseminomatous germ cell tumors (NSGCT) remain as a clinical challenge. Various prognostic factors have been described in this rare disease. The Indian data in this regard is scarce. Our study is the first attempt to assess the tumor marker decline with respect to treatment outcome in poor-risk NSGCT in Indian patients. Materials and Methods This retrospective study was done among newly diagnosed poor-risk NSGCT, treated at genitourinary clinic, at our tertiary cancer center during the period 2017 to 2019. The prognostic significance of tumor marker decline in them was correlated with 2-year progression-free survival (PFS) and 2-year overall survival (OS). Statistical Methods The association between two variables were assessed using chi-squared/Fischer's exact test. The PFS and OS were estimated using Kaplan-Meier method and the significance difference between survival curves was tested using log rank test. The risk for survival was estimated using cox regression analysis. A p -value of <0.05 was considered as significant. Results Out of 11 eligible patients, four (36%) had favorable tumor marker decline and seven (64%) had unfavorable decline. The 2-year PFS among favorable and unfavorable decline group were 66.7 and 42.9%, respectively ( p -0.358), and the 2-year OS was 66.7 and 71.4%, respectively ( p -0.974). Teratoma was not found to be a significant factor in our study. Tumors with only beta human chorionic gonadotropin (βHCG) elevation were observed to have good outcome. Postchemotherapy unresectable residual disease showed a significant trend toward inferior survival, the 2-year PFS was 38 versus 100% ( p -0.188) and the 2-year OS was 62.5 versus 100% ( p -0.334) in patients with and without unresectable residual disease, respectively. Conclusion Majority of our poor-risk NSGCT patients had unfavorable tumor marker decline and progressive events. However, the survival difference was not significant, given the small sample size. Tumors with only βHCG elevation were observed to have good outcome. Postchemotherapy unresectable residual disease showed a significant trend toward inferior survival.

Sexually transmitted infections epidemiology and risk assessment at the main correctional facility in Malta (2017-2019).

Inmates suffer from mental and physical ailments combined with substance misuse and addiction which are often underreported or disregarded by sufferers, for fear of being stigmatized. This vulnerable group has complex medical and psychosocial needs and hence gathering data is essential for a holistic approach to care. Understanding the interplay between sexually transmitted (STIs) and blood borne infections, substance misuse and mental health is essential to enable targeted interventions and outreach programmes. The aim was to analyse the occurrence of STIs, hepatitis and tuberculosis in inmates at the main custodial facility in Malta; to assess risk behaviours and vulnerabilities through an outreach programme; to offer treatment and referral and to develop recommendations for screening of prison inmates. A mixed methodology study was used which involved analysis of health data pooled from the Genitourinary Clinic (GUC) and Corradino Correctional Facility (CCF) in Malta. In the study period, 206 inmates were tested for STIs, 67.9% males, aged between 14 and 72. Only 27% were not sexually active in the 6 months prior to testing. Among those sexually active, 31% had had sex with casual partners and 43% had never used condoms for sexual intercourse. Seventy-five percent admitted to drug use. The most common STI diagnosed was HPV (16.5%), followed by syphilis (5.8%). Genital dermatoses were also frequent (9.2%). The prevalence of Hepatitis C was high (24.5%), in relation to intravenous drug use. The authors advocate for more collaboration between sexual health clinics and prisons to address educational interventions and STIs' testing. Cultural and linguistic barriers should be considered when devising national health strategies and screening recommendations in custodial settings. Adequate follow-up should extend into the community setting once inmates leave the prison to ensure a continuum of care.

Implementation of an oral chemotherapy adherence tool at an NCCN comprehensive cancer center.

265 Background: Adherence to oral chemotherapy (OC) is a critical factor in achieving optimal oncologic outcomes. Correct dosing, education, and symptom management are essential to maximizing adherence. As part of the 2020 Quality Oncology Practice Initiative Certification Program Fox Chase Cancer Center (FCCC), a NCCN Comprehensive Cancer Center, learned that only 33% of patients on OC had a documented OC plan, 7% were assessed for adherence, and 0% had documentation reflecting efforts to address non-adherence. Methods: Our goal was to create and implement an electronic medical record (EMR) tool (Oral Chemo Smart Form) to address the variance and deficiencies in monitoring adherence to OC. The Smart Form (SF) was designed to include fields to document the OC plan (drug, indication, dose, schedule, duration of cycle, initial start/end date) as well as provide a standard for documentation of education, management of toxicity and non-adherence. We integrated the SF into nursing, pharmacy, and physician workflows to capitalize on shared EMR tools. A series of Plan-Do-Study-Act cycles were conducted over 8 weeks within pilot clinics. Weekly review of the SF and feedback forms generated real-time progress reports which were serially appraised and shared with stakeholders. Results: Two oncologists (piloted in Genitourinary and Breast Cancer clinics), two pharmacists, and several nurses used the SF March 15, 2021 to May 7, 2021. Over these 8 weeks, 223 patients on OC were seen in clinic. If the OC was dispensed from FCCC, pharmacists were to complete the SF at the time of initial OC prescription, 7 days after dispensing, and with each refill. Pharmacists also identified patients receiving OC through a specialty pharmacy and routed a message to clinic nurses via an EMR message pool. The message became the trigger for nurses to call patients within two weeks to troubleshoot dispensing issues and/or complete the SF. Oncologists were to complete the SF with each clinic visit for a patient on OC. Feedback from the clinical and pharmacy teams motivated changes in the content fields of the SF and workflow. Ultimately, 45% of patients on OC had the SF completed. An OC plan was documented in 41% of patients, compared to 33% at baseline; 87% had an administration schedule compared to 81%. There was an increase in the number of patients contacted following start of OC, 35% from 4%. Medication adherence was assessed in 35% of patients, up from 7%. Documented discussions addressing medication adherence increased to 78%, from 0%. Conclusions: Introduction of the Oral Chemo SF in pilot clinics improved documented OC plans and administration schedules. Its use introduced a standard process for monitoring safety, assessing and addressing non-adherence, while troubleshooting specialty pharmacy dispensing issues. The SF will be implemented throughout FCCC and further evaluated with efforts focused on adopting and streamlining this as standard work.

Launching an Electronic Patient-Reported Outcomes Initiative in Real-Time Clinical Practice.

Patient-reported outcomes play an essential role in improving care across the cancer continuum. This paper reports on the experience of a tertiary care center to standardize the use, collection, and reporting of patient-reported outcomes (PROs) in 10 disease-specific survivorship clinics. To minimize the burden of patients to complete surveys, an institutional committee with oversight on all patient surveys required an application be reviewed and approved before their distribution in a clinic. To begin collecting PROs, each clinic submitted an application tailored to its clinical operations, staffing, and scheduling characteristics. The dates for the submission of each application were staggered over a 2-year period, which contributed to a lack of uniformity in the project (ie, approval dates, start dates, collection and reporting of results). The delays were primarily due to the time and resources required to build the electronic version of the PRO survey into the institutional electronic medical record. To date, 6 of 10 survivorship clinics submitted applications, 5 were approved, and 4 launched the electronic MD Anderson Symptom Inventory (eMDASI) through the patient portal. Metrics collected between January 2019 and December 2020 for the thyroid, bone marrow transplant, genitourinary, and head and neck clinics indicated the numbers of eMDASIs sent to patients varied by clinic, with the lowest from the bone marrow transplant survivorship clinic (6) and the highest (746) in the thyroid Clinic. The total number of eMDASIs returned by the patients ranged from 2 (bone marrow transplant) to 429 (thyroid). Overall, patients' return rates of the eMDASI ranged from 33.3% to 57.7%. Several strategies were implemented to increase the delivery, submission, and completion of eMDASIs. Our findings indicate the integration and implementation of PROs in survivorship clinics are achievable. Further work is needed to enhance the ePROs web-based process to adequately compare PROs across diverse cohorts of cancer survivors .

Implementation of an Electronic Medical Record Tool for Early Detection of Deep Vein Thrombosis in the Ambulatory Oncology Setting: The Cleveland Clinic Experience

BACKGROUND:Venous thromboembolism (VTE) is a major cause of morbidity, and the second leading cause of mortality in cancer patients. VTE is associated with delay in cancer directed therapy, increased frequency and duration of hospitalization and overall healthcare costs. However, validated scoring systems for assessing risk of VTE are not widely used in clinical practice. We hypothesized that creation of a computerized risk calculator could help identify at-risk individuals in the ambulatory oncology setting; further, screening for VTE in high risk patients could lead to early detection of deep vein thrombosis (DVT) and avoid potential emergent consequences, including hospitalization.METHODS:A computerized alert was built into the electronic medical record system (EPIC) that automatically calculates a score using a validated risk tool [Khorana Score (KS), Blood 2008] based on the primary site of cancer, leukocyte and platelet counts, hemoglobin, and body mass index. During silent lead-in phase I (8/2016-1/17), we evaluated the accuracy of the electronic alert to detect high-risk patients and prospectively followed them for events. During this period, we limited the test to patients presenting to gastrointestinal, thoracic, genitourinary and lymphoma clinics. Patients presenting for consultation without planned treatment/follow up of at least 3 months at our institution were excluded. In phase II (6/17-12/17), we improved the electronic alert to warn physicians in real time about high risk patients and offered lower extremity ultrasonography as a screening test for early detection. In this phase, we only included patients with KS ≥ 3, and an available CBC <2 weeks from alert.RESULTS:During phase I, the alert identified 194 consecutive patients as being at risk (see table 1). The majority of the patients with a positive alert were male (54%) with the most prevalent malignancy being lung and pancreatic adenocarcinomas. The subsequent rate of DVTs at 6 months in patients with a KS of 4 was 18.75% (3/17), patients with KS of 3 was 16.9% (11/65), KS of 2, 13.1% (8/61), and KS of 1, 6.25% (3/48) (Figure 1). See table 1.Time from score calculation to DVT was an average of 33.2 days. 30% of patients developed a DVT within 4 weeks of alert, 50% within 60 days, and 65% within 90 days. 45% of patients diagnosed with DVT were alerted during their initial or second clinic visit. 55% of patients were diagnosed while inpatient and another 30% in the emergency room. Mean emergency room visits for patients with DVT were 1.75 compared to 0.89 for all patients. Mean all cause admissions and length of stay during this period were 2.43 and 15.01 days for patients with DVT, compared to 0.93 and 5.06 respectively for all 194 patients. Mortality rates were 45% for patients with DVT compared to 17% for the study population.In phase II, 59 patients have been identified as high risk by the alert. Of these, 6 were already on therapeutic anticoagulation or had a recent history of DVT. Of the remainder, screening lower extremity ultrasonography was ordered on 10 patients; three (30%) had a LE DVT and were started on therapeutic anticoagulation. One other patient did not have screening ultrasonography ordered, and was diagnosed with DVT within 14 days and started on therapeutic anticoagulation. Additional data collection is ongoing and will be presented at the meeting.CONCLUSION:An electronic medical record risk calculator can be a valuable clinical tool in earlier detection of DVTs in high-risk cancer patients. An initial silent run-in phase demonstrates the ability of this tool to identify high-risk patients at substantially increased risk for VTE, emergency room visits, hospitalization and mortality. An ongoing phase II pilot of early screening demonstrates high rates of subclinical DVT but low rates of ordering screening tests by providers. Ongoing efforts to increase acceptance of screening ultrasonography and data collection may potentially reduce subsequent hospitalization and other adverse consequences for cancer patients. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Cancer patient satisfaction with telehealth: Survey results from a large NCI-designated cancer institute.

1579 Background: Telehealth (TH) utilization for patients at our cancer institute increased in 2020 in response to the COVID-19 pandemic, however oncology-specific TH patient satisfaction is unknown. Methods: Monthly TH utilization at a single large NCI-designated institute from 3/1/2020-11/30/2020 was reviewed. Utilization was calculated as chargeable TH visits (new video, established video, phone) as a proportion of all consult/follow up visits. Patient satisfaction surveys for oncology TH visits for MD/PA/NP providers were reviewed from 4/1/2020-11/30/2020. Surveys were sent after every TH visit, unless the patient had a prior visit in the past 3 months. Percent (%) top box score (TBS) was defined as proportion of responses in the highest possible response category (i.e. very good). % TBS was reported for 14 survey items in 4 domains: technology, access, care provider (CP), and overall assessment. Satisfaction was assessed over time and according to patient factors: generation, gender, insurance type, employment status, and clinic site. The Cochrane-Armitage trend test was used to compare proportions of TBS responses across monthly time points. Results: TH comprised 21% (22,055/103,461) of all encounters in the study period. TH use increased from 9% in 3/2020 to a peak of 47% in 4/2020. In 11/2020, TH use was 18%. 28.0% (2,286/8,173) of TH patient surveys were returned. Multiple patient satisfaction metrics were improved over time (Table). Patients had higher satisfaction with phone compared to video visits with regards to technology (86% vs 76%) and access (80% vs 72%). Millennials (born 1981-1995) had higher satisfaction with access to TH (87%) compared to Gen X (1965-1980) (77%), Baby Boomer (1946-1964) (74%), and Silent Generation (1928-1945) (72%), however all generations had similar levels of satisfaction with technology (range 77-80%). Disabled patients had higher overall satisfaction of TH (82%) versus those working full time or retired (71%). Patients with commercial insurance had worse overall satisfaction of TH compared to other insurance types (65% vs 72%). Patients with encounters in genitourinary, thoracic, and endocrine oncology clinics had the highest levels of overall satisfaction (75%) compared to other clinics (69%). There were no observed differences in TH satisfaction according to gender. Conclusions: TH cancer patient satisfaction is high and has improved over time, however satisfaction differs by patient demographics. Further data are needed to best select patients appropriate for TH.[Table: see text]

2021 European guideline on HIV testing in genito-urinary medicine settings.

Testing for HIV is critical for early diagnosis of HIV infection, providing long-term good health for the individual and prevention of onward transmission if antiretroviral treatment is initiated early. The main purpose of the 2021 European Guideline on HIV Testing in Genito-Urinary Settings is to provide advice on testing for HIV infection in individuals aged 16years and older who present to sexually transmitted infection, genito-urinary or dermato-venereology clinics across Europe. The guideline presents the details of best practice and offers practical guidance to clinicians and laboratories to identify and offer HIV testing to appropriate patient groups.

Implementation of clinician-facing prostate cancer therapeutic clinical trial decision tool at a comprehensive cancer center.

19 Background: The conventional model for clinical trial (CT) recruitment relies on clinicians to identify potential CTs for patients. Internet technology can be leveraged as a decision tool to enhance the CT recruitment process. Methods: An internet-based, clinician-facing decision tool was developed in genitourinary medical oncology clinic at a Comprehensive Cancer Center (CCC). The tool provided access to a real-time, tailored list of treatment CTs actively recruiting patients with PCa at the CCC based on clinical characteristics inputted by user. The clinical data was summarized. All clinicians (n = 9) with access to the decision tool completed a survey to assess effectiveness and satisfaction. Results: During a 9-month pilot period, user engagement increased from a baseline of 36 to 136 cases per month, with a total of 644 cases overall. Among cases, 525 had metastatic disease, 436 of which were metastatic castration resistant PCa (mCRPC). Overall, 145 cases were classified as having oligo-metastatic ( &lt; = 3) PCa, 93 of whom were also mCRPC. Prior treatments received included abiraterone in hormone-sensitive PCa (HSPC 19.3%, CRPC 48.7%); enzalutamide (HSPC 3.7%, CRPC 34.9%) apalutamide (HSPC 1.3%, CRPC 6.9%), taxane (HSPC 17.2%, CRPC 27.8%), radium-223 (6.1%), sipuleucel-T (18.3%), parp inhibitors (4%), or check-point inhibitors (6%). Clinician-inputted genomics of cases included CDK12 (20.9%), MSI-high disease (13.6%), BRCA1/2 (32.7%), ARID1a (7.3%), ATM (21.8%), FANCA (4.5%), or CHEK2 (6.4%) and HDAC2 (0.9%). Among survey respondents, use of tool in clinic was reported sometimes (22%), often/always (78%). Results of decision tool were reported to inform treatment sometimes (22%) or often/always (78%). Respondents confidence in often/always knowing all available CTs increased from a baseline of 0% to 89%, and 89% of users reported very/complete satisfaction with decision tool. Conclusions: An internet-based CT decision tool for provides detailed clinical characteristics of patients for whom CTs are being considered at a CCC. Clinicians using the decision tool report high levels of satisfaction. The tool was effective in increasing confidence in knowledge of current available CTs. Data gathered in the decision tool may inform future CT development. Future research with expanded use of decision tool among referring clinicians will assess its impact in promoting diversity among CT participants.

Sexually transmitted infections' epidemiology and knowledge, attitude and practice survey in a set of migrants attending the sexual health clinic in Malta.

The number of international migrants is estimated at 272million people worldwide. In Europe, migrants face the disproportionate burden of infectious diseases, including hepatitis B and C, HIV and sexually transmitted infections (STIs). High-risk behaviours, sexual abuse, poor living conditions and barriers to accessing health care may affect migrants' sexual health, leading to infections. The study evaluates STIs and HIV prevalence and knowledge, attitude and practice (KAP) in non-European migrants attending the sexual health clinic in Malta. It also seeks to explore situations of human trafficking (HT), sex/gender-based violence (S/GBV) and female genital mutilations (FGM). This is a mixed-method study, based on quantitative and qualitative research within a single centre. An anonymous pretested questionnaire was administered to non-European migrants attending the genitourinary clinic (GUC) with the assistance of an ethnocultural agent. Demographics, STI diagnoses and risk behaviours were collected from the GUC database, linked to the questionnaires and analysed. A total of 143 migrants took part in the study, 73% were young male and 16.7% men who have sex with men (MSM). Forty-one different nationalities were recorded, and the top ones were Nigerian (12%), Filipino (7.4%) and Chinese (5.4%). Concerning risk behaviours, 33.8% of respondents had never used a condom and 76.5% had had sex with multiple partners in the 6months prior to the study. STI prevalence was 73.1%. Of the patients interviewed, six females were Chinese sex workers employed in massage parlours, potentially trafficked to Malta. The study outcomes support the need of improving awareness about STIs/HIV risk and testing. In migrants at particular risk for HIV, combination prevention strategies should include access to pre-exposure prophylaxis and antiretrovirals independently from migrants' legal status. Finally, STIs/HIV prevention in migrants should be linked with interventions tackling HT and other forms of S/GBV.

Summary and considerations in genitourinary cancer patient care during the COVID-19 Pandemic.

ABSTRACTPurpose:To provide a summary and recommendations for the set-up of strategies for cancer patients care in genitourinary oncology clinics during the pandemic and in the recovery period.Material and Methods:A non-systematic review of available literature on the management of urological malignancies during the COVID-19 pandemic was performed to summarize recommendations to improve the diagnosis and treatment of urological cancers during and after the contingence, including clinical and research aspects.Results:Urological cancer diagnosis and management should be tailored according to the severity of the COVID-19 crisis in each region and the aggressiveness of each tumor. Clinicians should adhere to strict protocols in order to prioritize the attention of patients with high-risk malignancies while optimizing resources to avoid the saturation of critical care services.Conclusions:During the COVID-19 pandemic urological cancer care has been severely impaired. For proper patient management, multidisciplinary approach is encouraged tailoring therapy according to COVID-19 regional behavior and local institutional resources. Patients with high-risk malignancies should be prioritized.

Abstract A081: Trial Library: A pilot study to examine feasibility, acceptability, and preliminary estimates of efficacy for an online clinical trial matching website on patient-prompted conversations for prostate cancer clinical trials

Abstract Background: The ability of clinical trials to effectively translate into therapeutic interventions for the general population can be limited by a lack of representative participants in these trials. There is an acute need to develop informational resources regarding cancer clinical trials that meet the linguistic and literary needs of under-represented and vulnerable populations. Current practices utilize a one-size-fits-all approach that may be inaccessible to a diverse audience. Given the increased utilization of online resources for health information among a diverse patient population and across age groups, we developed a website, called Trial Library, which may serve as a prostate cancer clinical trial matching tool. We hypothesize that use of the Internet-based clinical trial matching tool in clinic will increase the number of patient-initiated conversations with physicians about clinical trial options, and by extension, improve enrollment to therapeutic cancer clinical trials among a diverse participant pool. Procedures/Design/Aims: This is a nonrandomized, nontherapeutic interventional pilot study. The study will be performed in genitourinary medical oncology clinic at UCSF Helen Diller Family Comprehensive Cancer Center. We will measure the feasibility and acceptability of a clinical trial matching tool that includes two unique features: user-validated clinical trial content and navigation schema. We will measure preliminary estimates of efficacy of the online clinical trial matching tool in triggering patient-promoted conversations regarding clinical trials and ultimately clinical trial enrollment. Discussion: Trial Library is designed to be an accessible informational resource for patients from diverse levels of health literacy and English proficiency. This pilot study will provide important preliminary results to inform the design of the website and subsequent testing outside of clinic. Additionally, this website will ultimately serve as a model for clinical trial information that can be translated across tumor types. Note: This abstract was not presented at the conference. Citation Format: Hala T. Borno, Brian Bakke, Anke Hebig Prophet, Yoon-Ji Kim, Jan Yaeger, Jessica Chao, Pelin Cinar, Celia Kaplan, Eric Small, Christy Boscardin, Ralph Gonzales. Trial Library: A pilot study to examine feasibility, acceptability, and preliminary estimates of efficacy for an online clinical trial matching website on patient-prompted conversations for prostate cancer clinical trials [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A081.

Development of a multidisciplinary colorectal and pelvic health program: Program implementation and clinical impact

IntroductionPediatric patients with complex colorectal and genitourinary conditions often require coordinated multidisciplinary care; however, this coordinated care can be hard to structure and deliver. The purpose of this paper is to review the development and implementation of a multidisciplinary colorectal and pelvic health program, one year after the program's initiation. MethodsThis is an observational retrospective 1-year study (10/1/2017 to 9/30/2018). In fiscal year (FY) 2018, a multidisciplinary colorectal and pelvic health program was initiated.The program development incorporated bimonthly team meetings, educational conferences, and initiation of three clinics: a complex colorectal and genitourinary reconstruction clinic, a bowel management clinic, and a colonic motility clinic. Conditions treated included complex anorectal and cloacal malformations, Hirschsprung disease, and idiopathic constipation. The fiscal year was selected to provide comparative administrative data after program implementation. ResultsDuring the study period, 121 patients underwent comprehensive collaborative evaluation of which 58 (47%) were new to the institution compared to 12 (19%) new patients in the previous year (p < 0.001). In FY 2018, there were 130 procedures performed and 512 collaborative visits with an average of 47 visits per month. This was a 3.4-fold increase in visits compared to FY2017 (171 visits). Of the new patients, 60% (35/58), traveled a median of 181 miles, representing 33 statewide counties, and 4 states compared to a median of 93 miles in the previous fiscal year (p = 0.004). ConclusionThe development of a colorectal and pelvic health program is feasible and requires a collaborative approach, necessitating multiple service lines within an institution. Program creation and implementation can result in rapid institutional clinical growth by filling a local and regional need through coordinated multidisciplinary care. Level of evidenceIV

Local Recurrence of Prostate Cancer to the Intersphincteric Space: A Case Report

The patient is an otherwise-healthy 69-year-old Caucasian male with a history of prostate cancer who underwent uncomplicated robot-assisted laparoscopic prostatectomy. Following the prostatectomy, his tumor was histologically assessed a Gleason score of 4 + 3, with areas of cribriform pattern, pathologic stage T2 (tumor confined within the prostate) and was removed with free surgical margins (R0). One year later, the patient presented to a genitourinary cancer clinic with biochemical recurrence with elevated prostate-specific antigen (PSA) levels from postoperatively undetectable to 0.17 ng/mL at a 1-year follow-up and 0.37 ng/mL 6 months later.