Oncology Consultation Research Articles

The long journey of patients with anal carcinoma in a Mexican cohort.

e15504 Background: Yearly 1000 new cases of anal cancer will be diagnosed in the USA, in Mexico this information is limited. Increasing incidence is the reflection of improvements in knowledge of risk factors and diagnostic studies. Female sex, HPV infection, genital warts, number of sexual partners, receptive anal intercourse, smoking and HIV infection are well established risk factors. Methods: We performed a retrospective analysis of patients with pathology-confirmed anal carcinoma treated at an Oncology Reference Center in North-East Mexico from 2010 to 2020. Using the digital database of our center we searched the time passed since debut of symptoms to first medical contact, date of biopsy and first oncology consultation. Results: 81 patients were found in the database from January 2010 to December 2020. Forty-one patients were included in the final analysis, 11 patients where reassessed as rectal cancer and 29 patients only attended one consultation and did not continue follow up. Mean age at diagnosis was 61.4 +/- 13.8 years and 58.5% were women. 69% of patients had an education degree lower than highschool. HIV status was known only in 9.8% as they were living with HIV before the diagnosis of anal cancer was made, contrasting from 63.4% of cases who had unknown status at cancer diagnosis. The time from symptom onset until the patient attended a healthcare provider was a mean of 7.6 months (5 – 1000 days) and 11.4 months (9-1435 days) to receive a diagnosis. Patients had an average delay of 80 days from biopsy result to be evaluated by an oncologist. 44% of patients were initially misdiagnosed as hemorrhoids. None of the female patients had history of recent Pap smear test. 65% of patients had nodal involvement at presentation. Conclusions: There is notable delay between the onset of symptoms and diagnosis of anal cancer. This information is crucial for the general population and all healthcare providers not only oncology related workers. The stigma as well as the cultural barriers associated with this disease may negatively impact the prognosis and quality of life by delaying promptly treatment. Although it is a rare disease, conducting educational campaigns with the intention of improving clinical suspicion and an early recognition may shorten the long journey of patients bearing with anal carcinoma.

"A Pain Deep in Your Soul (Being) that is Not Physical:" Assessing Spiritual Pain in Integrative Oncology Consultations.

Spiritual pain contributes to the suffering of cancer patients. However, it is unclear whether patients seen outside of palliative care report spiritual pain and its relationship with symptom burden. Characteristics of patients reporting spiritual pain were examined, as well as the association of spiritual pain with symptom burden and how spiritual pain affected the factor structure of the Edmonton Symptom Assessment System (ESAS). A retrospective chart review was conducted of integrative oncology patients who completed the PROMIS10 and a modified ESAS (ESAS-FS) including financial distress and spiritual pain (pain deep in your soul/being that is not physical). Multiple logistic regression was used to assess associations between demographics and spiritual pain. T-tests compared ESAS-FS symptoms and global health for patients endorsing spiritual pain (0 vs. ≥1). Principal component analyses (oblique rotation) were also used to determine ESAS-FS symptom clusters. The sample (N=1662) was mostly women (65%) and 39% endorsed spiritual pain at least ≥one. Men and older individuals were less likely to endorse spiritual pain (ps < 0.05). Presence of spiritual pain was associated with worse symptoms on the ESAS-FS and global health (ps < 0.001). The ESAS-FS had two symptom clusters, with the psychological factor including depression, anxiety, wellbeing, sleep, financial distress, and spiritual pain (Cronbach's alpha 0.78). Assessing spiritual pain and understanding the effects of its presence or absence in the context of other physical and psychosocial symptoms may provide additional opportunities for preventing exacerbation of symptoms, improving quality of life, and enhancing overall experience of care.

Re-referral for post-op radiation in elderly breast cancer patients who initially omit RT but are unable to tolerate endocrine therapy.

e12507 Background: Omission of Radiation in the setting of Elderly patients 70 yo and above with ER+, cN0, pT1 tumors who receive adjuvant endocrine therapy (HT) is standard of care per NCCN. However, the average adherence rate of HT ranges from 41% to 72%, which is not optimal for patient outcomes. In our institution, we evaluated the treatments of all patients who qualified for omission of radiation upfront and the number of re-referrals for adjuvant radiation in Elderly Breast cancer patients who were unable to tolerate HT past 6 months. Methods: Data was obtained through the National Cancer Registry at our institution for 2021 and reviewed mid 2022. Inclusion criteria included patients diagnosed with Pathologically Invasive Breast Cancer AJCC Stage I-IIB age 70 and above. A total of 176 patients were eligible for review. 86 patients did not qualify for inclusion into study due to 7 receiving surgical treatment outside our system. Furthermore, 81 patients did not qualify due to the following reasons or combination: Mastectomy (19), Triple Negative, Greater than 2 cm, N+, AI only. A total of 90 patients qualified for omission and review. Six month HT therapy cut off was extrapolated by Barbieri et al who determined a 6 month delay of RT after surgery was not associated with an increased risk of relapse. Results: From the 90 patients who qualified for omission of radiation, 67 % (n = 60) of patients chose radiation omission, 30% (n = 27) of patients chose upfront radiation, and 3% (n = 3) of patients declined all therapy. Of the 60 patients who chose omission, 87% of patients had continued HT, however 2 patients passed away within 1 year of surgery. A total of 13% of patients (n = 8) who omitted radiation did not go past 6 months of HT, and only 2 out of 8 patients (25%) were referred back to radiation oncology and moved forward with treatment. For the 27 patients who chose radiation upfront even though they qualified for omission, the most common reason per records was the patient was unsure after initial multidisciplinary clinic that they would be able to tolerate HT. Interestingly, 27% of these patients ended up stopping HT within 9 months due to side effects. Conclusions: Omission of radiation is an option for Elderly Early stage breast cancer patients in the setting of HT. However, HT compliance is variable due to side effects. In our one year single institution study, only 25% of patients who omitted RT and did not get past 6 months of HT were sent back for radiation. We encourage an increased awareness and communication between Radiation Oncology and Medical Oncology regarding the option of radiation for patients who do not pass 6 months of HT. Our institution has implemented an Epic message system and Breast Navigation to aid in re-referral. It is also imperative at the time of Radiation Oncology consultation to discuss the possibility of intolerance to HT in the setting of omission may indicate radiation therapy at a later date.

Anal carcinoma: A retrospective analysis in a Mexican cohort.

e15502 Background: Anal carcinoma is a rare neoplasm, representing &lt; 1% of all neoplasms with rising incidence and mortality. More than 90% of cases are linked with high-risk human papillomavirus (HPV). Other factors such as HIV status, smoking and socioeconomic disparity may have important roles. Few data are available on the Mexican population. Methods: Retrospective analysis of patients with pathology-confirmed anal carcinoma treated at an Oncology Reference Center in North-East Mexico from 2010 to 2020. Using descriptive statistics, we report clinical and pathological features, time from symptom onset to diagnosis and treatment, as well as response and recurrence rate. Results: Forty-one patients were included in the final analysis. The mean age at diagnosis was 61.4 +/- 13.8 years and 58.5% were women. Smoking history was identified in 17 patients (41.5%). 9.8% were HIV-positive, however 63.4% of all patients had unknown status at cancer diagnosis. Mean duration of symptoms to diagnosis was 344 days (range 4-1435 days) and the median interval from symptom onset to registration for oncology consultation was 424 days (range 28-1695 days). Patients attended a median of 3 (range 1 to 7) previous clinical consultations before being referred to our center. It is noteworthy that 44% of patients had hemorrhoidal disease history. Squamous cell carcinoma was the most common histological subtype with 93% of all cases, arising from the anal canal in 78% of cases, while 22% corresponded to perianal cancer. Regarding the clinical stage at presentation, 2.4% of patients had localized disease, while 95% had regional spread and 2.4% presented with distant metastases at diagnosis. Treatment intent was curative in 85.4%. Treatment modalities included radiotherapy (97%), surgery (7%), chemotherapy (88%). Concurrent chemoradiotherapy was received by 85%. Most patients were treated with a total dose between 45 and 60 Gy to the tumor volume. Radiotherapy delays due to toxicity occurred in 31.7% of cases, these unplanned treatment interruptions correlated negatively with response rate (p &lt; 0.001). The chemotherapy regimen used was 5-fluorouracil (5-FU) with mitomycin C (MMC) in 29%, capecitabine monotherapy in 31.7%, 5-FU with cisplatin in 12.5%, capecitabine with MMC in 5%, and capecitabine with cisplatin in 5%. Among patients treated with curative-intent, 46% had a complete response and 37% had a partial response. Relapse occurred in 10 cases (24%), the majority being local relapses (54%). Distant relapse occurred in 15% of all cases. The median disease-free interval (DFI) was 32.5 months (range 0-252 mo). Colostomy rate was 29%, the median colostomy-free survival (CFS) was 10 months (range 3-15 mo). The comparative analysis between MMC-based chemotherapy and chemo without MMC did not show difference in response rate, recurrence, DFS and CFS. Conclusions: Due to its rarity and complex management patients with anal carcinoma should be treated at experienced centers.

Impact of geography on receipt of medical oncology consultation and neoadjuvant chemotherapy for triple negative and HER2 positive breast cancer.

1530 Background: Consensus guidelines recommend consideration of neoadjuvant chemotherapy (NAC) for most patients with early-stage triple negative (TN) and HER2 positive (HER2+) breast cancer. Based on our previous work, most patients are not seen by a medical oncologist prior to surgery and do not receive NAC. Although potential barriers are not well understood, distance to cancer centres has been shown to mediate medical oncology referral and use of systemic therapy for other malignancies. We therefore aimed to characterize the impact of region of residence and cancer centre proximity on receipt of pre-treatment medical oncology consultation and NAC for patients with TN and HER2+ breast cancer. Methods: Using linked administrative healthcare datasets in Ontario, Canada, we performed a retrospective population-based geographic analysis of women diagnosed with stage I-III TN or HER2+ breast cancer from 2012-2019. Outcomes were pre-treatment medical oncology consultation and initiation of NAC. We created choropleth maps to assess the spatial distribution of outcomes across census divisions, displaying cancer centres and outcomes by colour gradient using geographic information system analysis. To assess the relationship between distance to the nearest cancer centre and outcomes, we performed a multivariable regression analysis adjusted for sociodemographic and clinical factors, including tumour extent and nodal status. Results: Within the cohort of 12,881 patients, there was no statistically significant relationship between incremental distance to the nearest cancer centre (≤5 vs. 5-10, 10-25, and ≥25 km) and rate of medical oncology consultation or receipt of NAC. Mapping analysis demonstrated high interregional outcome variability, ranging across census divisions from 12.2% to 64.3% for medical oncology consultation rate, and 9.3% to 64.3% for NAC rate. 77.7% of patients referred to medical oncology received NAC. Conclusions: Among patients with TN and HER2+ early breast cancer, rates of medical oncology consultation and NAC were not significantly impacted by distance to cancer centres but varied highly by region. This variability suggests that regional and/or provider practice patterns, rather than distance, may underlie discrepancies in referral for NAC. These findings can inform further studies and interventions aiming to improve equitable access to NAC for patients with TN and HER2+ breast cancer.

Predicting which cancer patients will see a psychiatrist or counsellor from their initial oncology consultation document using natural language processing.

e13544 Background: Patients with cancer often have unmet psychosocial needs. Early detection of who might require referral to a counsellor or psychiatrist may help improve their care. In this work, we investigated whether natural language processing (NLP) can predict which patients will see a counsellor or psychiatrist from a patient’s initial oncologist consultation document. NLP is the branch of artificial intelligence that uses language models to accomplish tasks using written text. A different application of NLP has recently been popularized through the ChatGPT online question-answering system. In this work, we used traditional and neural language models to predict whether patients will see a psychiatrist or counsellor based on their initial oncologist consultation document. Methods: This retrospective prognostic study used data from 47,625 of 59,800 patients who received initial cancer care at any of the 6 BC Cancer sites located in the province of British Columbia between April 1, 2011 and December 31, 2016. We excluded patients with multiple cancer diagnoses, or those that did not see a medical or radiation oncologist within 180 days of their cancer diagnosis. We trained neural language models to predict which patients would see a psychiatrist or counsellor in the twelve months following their initial oncologist consultation. We used the non-neural language model bag-of-words, as well as three neural models: convolutional neural networks (CNN), long-short term memory, and bidirectional encoder representations from transformers. Results: The models performed similar to or better than previous applications of artificial intelligence in predicting psychosocial needs. Our best-performing models, utilizing CNNs, achieved a balanced accuracy above 75% and a receiver-operator area-under-curve (AUC) above 0.80 when predicting which patients would see a psychiatrist. Performance was lower for predicting which patients would see a counsellor, with balanced accuracy and AUC exceeding 70% and 0.75, respectively. We examined what words or phrases our models used to make the predictions, finding symptom burden, certain cancers, and family history of cancer were positive predictors of future referral to psychosocial services. Conclusions: Our results suggest NLP can be used to predict which cancer patients require referral to a psychiatrist or counsellor from their initial oncologist consultation. Future research may be able to extend our work to predict other needs of cancer patients such as palliative care, or other cancer outcomes more generally.

(447) Use of Audio Recordings in the Consultation of Patients Seeking Gender-Affirming Surgery

Abstract Introduction It has been demonstrated that patient memory for medical information is often poor and inaccurate. Providing patients with an audio recording of their consultation has been shown to increase patient recall of information, improves confidence in their treatment decisions, and decreases decision regret. Patients have also reported increased satisfaction with their treatment, felt more involved in their decision making, and reported an improved relationship with the health professional. Objective The use of audio recordings has primarily been investigated in the setting of oncologic consultation and has been described in other patient settings as well; however, to our knowledge this is the first reported use of audio recordings in consultation for gender-affirming surgery. Methods We conducted a pilot study and began offering all new patients the opportunity to have their consultations recorded. 100% of the patients who were given the option to have the consultation recorded chose to do so. At the end of the consultation the recording was uploaded to a USB, which was either given to the patient to take home immediately or was mailed to their home address within a few days of their consultation. A copy of each consultation was retained by the providers as a record. We then sent out a survey to all patients who had received a copy of their audio consultation to query the utility of having access to an audio recording of their consultation. Results 15/27 patients who had their consultation recorded responded to our survey (6 transfeminine and 9 transmasculine). Mean age was 30.4. One patient reported they did not receive their recording in the mail, leaving 14 respondents to answer questions about the audio. Survey responses are shown in Table 1. Conclusions In our series, patients reported that having access to an audio recording of their consultation was beneficial and was viewed overwhelmingly positively. To our knowledge, this is the first study examining the use of audio recordings in the surgical consultation process for patients seeking genital gender-affirming surgery. Disclosure No

EARLY-STAGE TESTICULAR CANCER MANAGEMENT REFERRING TO EUROPEAN ASSOCIATION OF UROLOGY (EAU) GUIDELINES: A SURVEY IN INDONESIA

Objective: This study aimed to determine the management of early-stage testicular cancer among urologists in Indonesia by using a survey. Material &amp; Methods: This research was a descriptive-analytic study using a survey method through a Google-forms questionnaire distributed to urologists throughout Indonesia who were willing to participate. Data were collected from September 1 to 30, 2021. Results: Of the total respondents, 15 (14.2%) respondents were consultant urologic oncologists, and 90 (85.71%) respondents were non-consultant urologists or consultant urologists non-oncology. There was no difference in the treatment given by consultant uro-oncologists and non-consultant urologists/consultant urologists non-oncology in the management of surveillance of stage IA-IB seminoma (66.7% vs. 55.6%, p-value = 0.207), chemotherapy of stage IIA-IIB seminoma (100.0% vs. 90.0%, p-value = 0.080), surveillance of stage I non-seminoma cancers (46.7% vs. 41.1%, p-value = 0.304), and chemotherapy of stage IIA and IIB non-seminoma cancers (80% vs. 91.1%, p-value = 0.193). Conclusion: In general, as many as 84.4% of oncology consultant urologists and 83.7% of non-consultant urologists/consultant urologists non-oncology have performed initial diagnostic examinations, treatment, and follow-up following testicular cancer management guidelines according to the European Association of Urology 2021.

Interactions between Australian cancer physicians and the pharmaceutical industry: a qualitative study

ObjectivesTo understand how and why Australian cancer physicians interact with the pharmaceutical industry.DesignQualitative study using semistructured interviews, performed by a medical oncologist. Thematic analysis using a combination of deductive and...

Can knowledge based treatment planning of VMAT for post-mastectomy locoregional radiotherapy involving internal mammary chain and supraclavicular fossa improve performance efficiency?

To validate and evaluate the performance of knowledge-based treatment planning for Volumetric Modulated Arc Radiotherapy for post-mastectomy loco-regional radiotherapy. Two knowledge-based planning (KBP) models for different dose prescriptions were built using the Eclipse RapidPlanTM v 16.1 (Varian Medical Systems, Palo Alto, USA) utilising the plans of previously treated patients with left-sided breast cancer who had undergone irradiation of the left chest wall, internal mammary nodal (IMN) region and supra-clavicular fossa (SCF). Plans of 60 and 73 patients were used to generate the KBP models for the prescriptions of 40 Gy in 15 fractions and 26 Gy in 5 fractions, respectively. A blinded review of all the clinical plans (CLI) and KBPs was done by two experienced radiation oncology consultants. Statistical analysis of the two groups was also done using the standard two-tailed paired t-test or Wilcoxon signed rank test, and p<0.05 was considered significant. A total of 20 metrics were compared. The KBPs were found to be either better (6/20) or comparable (10/20) to the CLIs for both the regimens. Dose to heart, contralateral breast,contralateral lung were either better or comparable in the KBP plans except of ipsilateral lung. Mean dose (Gy) for the ipsilateral lung are significantly (p˂0.001) higher in KBP though the values were acceptable clinically. Plans were of similar quality as per the result of the blinded review which was conducted by slice-by-slice evaluation of dose distribution for target coverage, overdose volume and dose to the OARs. However, it was also observed that treatment times in terms of monitoring units (MUs) and complexity indices are more in CLIs as compared with KBPs (p<0.001). KBP models for left-sided post-mastectomy loco-regional radiotherapy were developed and validated for clinical use. These models improved the efficiency of treatment delivery as well as work flow for VMAT planning involving both moderately hypo fractionated and ultra-hypo fractionated radiotherapy regimens.

MP54-02 VARIATION IN CONTENT DISCUSSED BY SPECIALTY IN CONSULTATIONS FOR CLINICALLY LOCALIZED PROSTATE CANCER

You have accessJournal of UrologyCME1 Apr 2023MP54-02 VARIATION IN CONTENT DISCUSSED BY SPECIALTY IN CONSULTATIONS FOR CLINICALLY LOCALIZED PROSTATE CANCER Nadine A. Friedrich, Michael Luu, Rebecca Gale, Dong Shin, Reva Polineni, Alex Shiang, Stephen J. Freedland, Brennan Spiegel, and Timothy J. Daskivich Nadine A. FriedrichNadine A. Friedrich More articles by this author , Michael LuuMichael Luu More articles by this author , Rebecca GaleRebecca Gale More articles by this author , Dong ShinDong Shin More articles by this author , Reva PolineniReva Polineni More articles by this author , Alex ShiangAlex Shiang More articles by this author , Stephen J. FreedlandStephen J. Freedland More articles by this author , Brennan SpiegelBrennan Spiegel More articles by this author , and Timothy J. DaskivichTimothy J. Daskivich More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003307.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients often consult with Urology, Radiation Oncology, and Medical Oncology when considering treatment options for prostate cancer. However, it is unknown what content each specialty discusses during consultations. METHODS: We transcribed consultations of men with localized prostate cancer across 3 urologists, 3 radiation oncologists, and 3 medical oncologists. Coders independently coded consultations for narrative content. Reviewers identified 11 content areas: Overview of prostate cancer; medical history; assessment of baseline risk; cancer prognosis; life expectancy/competing risks; discussion of active surveillance, radical prostatectomy, focal therapy, and radiation therapy; physician recommendations; and shared decision making (SDM). We then calculated the number of words devoted to each content area per consult as a proxy for time spent. We then compared incidence rate ratio (IRR) for content-specific word count across specialties using a multivariable Poisson regression. RESULTS: Our analytic sample included 5,569 segments of conversation across 28 Urology, 11 Radiation Oncology, 11 Medical Oncology consultations. In addition to spending more time discussing surgical treatments, Urologists also spent 1.8-fold more time discussing cancer prognosis than both Medical Oncologists and Radiation Oncologists (p<0.03 for both). Urologists also spent 11-fold more time discussing competing risks than Radiation Oncologists (p<0.0001). Medical Oncologists devoted 2.6-fold more time on SDM than Urologists (p<0.0001). Medical Oncologists spent 10-fold more time discussing life expectancy/competing risks than Radiation Oncologists (p<0.0001). In additional to spending more time discussing radiation therapy, Radiation Oncologists spent 1.7-fold more time on SDM than Urologists (p<0.04). CONCLUSIONS: Multidisciplinary specialists focus effort on different areas of content in consultations, beyond the specific treatments they offer. Urologists appear to more thoroughly discuss prognosis than other specialists but spend the least amount of time on SDM. Source of Funding: Dr. Daskivich is supported by career development award CA230155 from the NIH/NCI. Dr. Friedrich was funded by NIH grant T32CA240172-03 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e753 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nadine A. Friedrich More articles by this author Michael Luu More articles by this author Rebecca Gale More articles by this author Dong Shin More articles by this author Reva Polineni More articles by this author Alex Shiang More articles by this author Stephen J. Freedland More articles by this author Brennan Spiegel More articles by this author Timothy J. Daskivich More articles by this author Expand All Advertisement PDF downloadLoading ...

A Spectrum of Disease

Breast implant associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon and emerging malignancy caused by textured breast implants. The most common patient presentation is delayed seromas, other presentations include breast asymmetry, overlying skin rashes, palpable masses, lymphadenopathy, and capsular contracture. Confirmed diagnoses should receive lymphoma oncology consultation, multidisciplinary evaluation, and PET-CT or CT scan evaluation prior to surgical treatment. Disease confined to the capsule is curable in the majority of patients with complete surgical resection. BIA-ALCL is now recognized as one disease among a spectrum of inflammatory mediated malignancies which include implant-associated squamous cell carcinoma and B cell lymphoma.

Congenital pleuropulmonary blastoma in a newborn with a variant of uncertain significance in DICER1 evaluated by RNA-sequencing

BackgroundPleuropulmonary blastoma (PPB) is a rare mesenchymal malignancy of the lung and is the most common pulmonary malignancy in infants and children. Cystic PPB, the earliest form of PPB occurring from birth to approximately two years of age, is often mistaken for a congenital pulmonary airway malformation, as the two entities can be difficult to distinguish on imaging and pathology. Diagnosis of PPB should prompt workup for DICER1 syndrome, an autosomal dominant tumor predisposition syndrome. We report a newborn with a congenital PPB presenting with tachypnea and hypoxia, who was found to have variant of uncertain clinical significance (VUS) in DICER1.Case presentationA term female infant developed respiratory distress shortly after birth. Initial imaging was concerning for a congenital pulmonary airway malformation versus congenital diaphragmatic hernia, and she was transferred to a quaternary neonatal intensive care unit for management and workup. Chest CT angiography demonstrated a macrocytic multicystic lesion within the right lower lobe without systemic arterial supply. The pediatric surgery team was consulted, and the neonate underwent right lower lobectomy. Pathology revealed a type I PPB. Oncology and genetics consultants recommended observation without chemotherapy and single gene sequencing of DICER1, which identified a germline VUS in DICER1 predicted to alter splicing. RNA-sequencing from blood demonstrated that the variant resulted in an in-frame deletion of 29 amino acids in a majority of transcripts from the affected allele. Due to the patient’s young age at presentation and high clinical suspicion for DICER1 syndrome, tumor surveillance was initiated. Renal and pelvic ultrasonography were unremarkable.ConclusionWe present the case of a term neonate with respiratory distress and cystic lung mass, found to have a type I PPB with a germline VUS in DICER1 that likely increased her risk of DICER1-related tumors. Nearly 70% of patients with PPB demonstrate germline mutations in DICER1. Review of RNA sequencing data demonstrates the difficulty in classifying splice variants such as this. Penetrance is low, and many patients with pathogenic DICER1 variants do not develop a malignancy. Best practice surgical and oncologic recommendations include an individualized approach and tumor board discussion. This case highlights the importance of a multidisciplinary team approach and the utility of international registries for patients with rare diagnoses.

O.6.2Patients’ perception of physician empathy is sensitive to the content of the oncology consultation: Presenter(s): Mattias Tranberg, Lund University, Sweden

O.6.2Patients’ perception of physician empathy is sensitive to the content of the oncology consultation: Presenter(s): Mattias Tranberg, Lund University, Sweden

Sexuality and marital satisfaction in patients followed for breast cancer in a regional hospital

IntroductionBreast cancer is the leading cancer in women in developed and developing countries. Treatment strategies can affect sexuality in the short or long term.ObjectivesThe aim of our study was to assess sexuality and martial satisfaction in patients followed for breast cancer.MethodsCross-sectional descriptive study including patients followed for breast cancer at the outpatient medical oncology consultation of Hadj Ali Soua regional hospital from January to March 2021. We passed the Female Sexual Function Index (FSFI) and the martial adjustment test (MAT).ResultsFifteen patients were included with a mean age of 49.87 ± 8.48 years and a mean age at diagnosis of 46.73 ± 7.55 years. At the TNM classification, 66.6% of the patients had a T1 or T2 at the time of diagnosis and 80% had an N0. All patients received a surgical intervention, which was conservative in 53.3% of cases. No patient underwent breast reconstruction. Chemotherapy and hormone therapy were prescribed in 86.7% of patients. Radiotherapy and targeted therapy were prescribed in 12 and 2 case, respectively. Amenorrhea, hot flushes and vaginal dryness were noted in 98.7%, 26.7% and 7.6% of patients, respectively. Sexual disorders were found in 53.3% of cases, which settled in a chronic mode in 75% of cases and progressed in a continuous mode in half of cases. The assessment of physical and erotic life was revealed to be neat in 73.3% of the patients. The mean score of the FSFI questionnaire was 17.25 [2.6-31.9]. Eleven patients (73.3%) had sexual dysfunction. A low marital satisfaction was found in 34% of cases.ConclusionsThe medical consultation to identify sexuality disorders in correlation with the martial dissatisfaction in women followed for new breast cancer is crucial allowing a better management of this pathology.Disclosure of InterestNone Declared

Factors associated with sexual disorders in women followed for breast cancer

IntroductionBreast cancer is the most frequently encountered malignant tumor among women in Tunisia and in the world. The quality of sexual life of patients with breast cancer is impaired by multifactorial mechanisms.ObjectivesThe aim of our study was to determine the factors associated with sexual disorders in patients followed for breast cancer.MethodsCross-sectional analytic study including patients followed for breast cancer at the outpatient medical oncology consultation of Hadj Ali Soua regional hospital from January to March 2021. We collected sociodemographic and clinical data with an assessment of sexuality (FSFI), marital satisfaction (MAT), psychological profile (HAD) and quality of life (SF36).ResultsFifteen patients were included with a mean age of 49.87 ± 8.48 years and a mean age at diagnosis of 46.73 ± 7.55 years. At the TNM classification, 66.6% of the patients had a T1 or T2 at the time of diagnosis and 80% had an N0. All patients received a surgical intervention, which was conservative in 53.3% of cases. No patient underwent breast reconstruction. Chemotherapy and hormone therapy were prescribed in 86.7% of patients. The mean score of the FSFI questionnaire in our study was 17.25. Eleven patients (73.3%) had an FSFI score below 26.55. We found negative correlations between age and FSFI score (r=-0.622; p=0.013). We noted statistically significant negative correlations between FSFI and HAD-D (r=-0.606; p=0.017) and FSFI and HAD-a (r=-0.707; p=0.01) as well as significant correlations between FSFI and the following items: RE (r=0.84p=0.000), SF (r=0.684 p=0.005), GH (r=0.671 p=0.006) and MCS (r=0.788 p=0.000).ConclusionsFocusing on a small sample of patients followed for breast cancer, our study provides an assessment of the sexual function in its various areas and shows how sexuality is deeply intertwined with other sections of medical management.Disclosure of InterestNone Declared

Anxiety and depression among breast cancer patients

IntroductionNeoplastic disease affects all aspects of life. People with cancer may experience a variety of emotions and reactions to their new reality that may be mild or intense, transitory or permanent.ObjectivesThe aim of our study was to assess the psychological distress of patients with breast cancer.MethodsCross-sectional descriptive study including patients followed for breast cancer at the outpatient medical oncology consultation of Hadj Ali Soua regional hospital from January to March 2021. We used the “Hospital Anxiety and Depression Scale (HAD-S)” for the assessment of anxiety and depression.ResultsFifteen patients were included with a mean age of 49.87 ± 8.48 years and a mean age at diagnosis of 46.73 ± 7.55 years. At the TNM classification, 66.6% of the patients had a T1 or T2 at the time of diagnosis and 80% had an N0. All patients received a surgical intervention which was conservative in 53.3% of cases. No patient underwent breast reconstruction. Chemotherapy and hormone therapy were prescribed in 86.7% of patients. The mean anxiety and depression scores according to the HAD-S were 9.53 and 4.93, respectively. The majority of our patients had no depressive symptoms (80%) against only 2 patients (13.33%) with depressive symptoms. On the other hand, most of our patients were anxious: 6 patients (40%) showed probably clinically relevant levels of anxiety (score of 11 or higher) and 5 patients showed possibly clinically relevant levels of anxiety (scores of 8 or higher) (33,33%).ConclusionsOur study revealed a high prevalence of psychological distress. The presence of clinical psychologists in the medical oncology department and the training of nursing staff in psycho-oncology are essential for the overall care of patients with cancer.Disclosure of InterestNone Declared

English

This study describes the influence of chemotherapy on patients&#39; eating habits in the context of resource-limited countries. This is a descriptive and analytical cross-sectional study of patients who have been prescribed chemotherapy and followed throughout this treatment at the Yalgado Ouedraogo University Hospital. We collected data on the initial eating habits and dietary coping strategies during chemotherapy during medical oncology consultations. One hundred and two patients were collected, aged 49.19 years on average. We compared the food consumption and dietary diversity scores before and during chemotherapy, the usual diet of our patients is local cereals and tubers accompanied by vegetables and animal proteins. During chemotherapy, 81.4% of patients experienced both quantitative and qualitative taste and olfactory changes. The mean food consumption score was 58.5 before and 57.5 during chemotherapy (p = 0.005). The mean dietary diversity score during chemotherapy is 5.27 versus 4.9 before chemotherapy (p &lt; 0.0001). During chemotherapy, 50 patients had fewer meals, and 20 had increased their dietary intake. Making nutritionists and dieticians available to cancer patients would improve their food experience during chemotherapy. Key words: Cancer, nutrition, chemotherapy, diet.

Predicting the Survival of Patients With Cancer From Their Initial Oncology Consultation Document Using Natural Language Processing

Predicting short- and long-term survival of patients with cancer may improve their care. Prior predictive models either use data with limited availability or predict the outcome of only 1 type of cancer. To investigate whether natural language processing can predict survival of patients with general cancer from a patient's initial oncologist consultation document. This retrospective prognostic study used data from 47 625 of 59 800 patients who started cancer care at any of the 6 BC Cancer sites located in the province of British Columbia between April 1, 2011, and December 31, 2016. Mortality data were updated until April 6, 2022, and data were analyzed from update until September 30, 2022. All patients with a medical or radiation oncologist consultation document generated within 180 days of diagnosis were included; patients seen for multiple cancers were excluded. Initial oncologist consultation documents were analyzed using traditional and neural language models. The primary outcome was the performance of the predictive models, including balanced accuracy and receiver operating characteristics area under the curve (AUC). The secondary outcome was investigating what words the models used. Of the 47 625 patients in the sample, 25 428 (53.4%) were female and 22 197 (46.6%) were male, with a mean (SD) age of 64.9 (13.7) years. A total of 41 447 patients (87.0%) survived 6 months, 31 143 (65.4%) survived 36 months, and 27 880 (58.5%) survived 60 months, calculated from their initial oncologist consultation. The best models achieved a balanced accuracy of 0.856 (AUC, 0.928) for predicting 6-month survival, 0.842 (AUC, 0.918) for 36-month survival, and 0.837 (AUC, 0.918) for 60-month survival, on a holdout test set. Differences in what words were important for predicting 6- vs 60-month survival were found. These findings suggest that models performed comparably with or better than previous models predicting cancer survival and that they may be able to predict survival using readily available data without focusing on 1 cancer type.

Exploring a multi-disciplinary model of supportive cancer care for monoclonal antibody treatment-related dermatological symptoms.

The present study examined the perspectives of healthcare providers (HCPs) in designing a multi-disciplinary model of supportive cancer care for the relief of dermatology-related symptoms caused by monoclonal antibody therapies. The study employed a mixed research methodology, with qualitative research embedded within a pragmatic prospective study of a registry protocol study. Patients undergoing oncology therapy with MoAB, anti-HER2, and anti-PD-L1 monoclonal antibodies were identified among a cohort of patients referred to an integrative oncology (IO) consultation for symptom relief and improved quality of life (QoL). Case studies with significant dermatology-related concerns were selected and presented to a panel of 6 HCPs trained in medical oncology, oncology nursing, family medicine, supportive cancer care, and IO. HCP narratives were qualitatively analyzed and assessed using ATLAS.Ti software for systematic coding. Of the 924 patients referred to the IO consultation, 208 were treated with monoclonal antibodies, from which 50 were selected for further evaluation. Of these, 7 cases were presented to the HCP team who were asked to identify treatment gaps requiring a multi-disciplinary approach. Qualitative analysis identified 3 major themes: a biophysical perspective; a psycho-social-spiritual perspective; and the implementation of integrated care. There is a need for a multi-disciplinary approach when treating patients suffering from monoclonal antibody treatment-related skin toxicities. HCP-reported themes highlight the need to identify patients for whom such an approach is warranted; conditions in which a psycho-social-spiritual perspective should be considered, in addition to a bio-physical approach; and considerations of who should be designated as the patient's primary case manager.