Oncology Department Research Articles

The relationship between radiation oncology department NIH funding and institutional community inclusion/investment.

153 Background: Disparities in healthcare access and funding allocation persist among racial minorities and low-income populations. Radiation Oncology departments play a crucial role in cancer treatment, yet the extent to which these departments serve historically underrepresented communities following receipt of National Institutes of Health (NIH) funding remains unclear. This study accessed the relationship between radiation oncology departments that are awarded National Institute of Health (NIH) funding and Lown Institute Hospitals Index rankings for community benefit and inclusivity. Methods: Radiation oncology departments awarded funding from the NIH from 2019-2021 were retrospectively studied. The 2023 Lown Institute Hospital Index rankings for community benefit and inclusivity were examined. The community benefit metric measures financial assistance spending, community investment spending, and Medicaid as a portion of patient revenue. The inclusivity metric measures the similarities of income, race, and education level between the hospital patient population and the surrounding community. Kendall’s correlation coefficient (tau value) and linear regression were used to evaluate the relationship between measures of community benefit and inclusivity and NIH radiation oncology department research funding. Results: Twenty-two radiation oncology departments that received NIH funding (median = $ 419,555.00) were included. A statistically significant positive correlation was observed between the amount of radiation oncology NIH research funding received and institutional rankings for overall community benefit (tau = 0.378; P < 0.034), with a trend towards significance for institutional rankings for community investment spending (tau = 0.497; P < 0.053). No significant correlation was observed between the amount of radiation oncology department funding and institutional rankings for charity care spending (P = 0.430), Medicaid as a portion of patient revenue (P = 0.837), and service of patients from racial and or ethnic minorities (P = 0.505), with low income (P = 0.612), or with lower levels of education (P = 0.700). Conclusions: Our study highlights the relationship between recent NIH funding received by Radiation Oncology departments and their commitment to community health and inclusivity. Our findings indicate a significantly positive correlation between NIH funding received by radiation oncology departments and overall community benefit. This suggests that departments receiving NIH funding may be incentivized to allocate resources towards initiatives to improve community health outcomes beyond direct patient care. This study prompts further exploration into the mechanisms through which NIH-funded radiation oncology departments allocate resources and engage with their surrounding communities.

Utility of learning health systems in radiation oncology.

413 Background: Current health information systems lack a robust framework for longitudinal integration of internal experiences and external evidence into existing workflows. The result is labor intensive, error-prone and fragmented systems plagued with process gaps. Learning health systems (LHS) can be a potential solution to address these gaps. We created and implemented a novel LHS framework in radiation oncology (RO). We hypothesize that this framework can be leveraged to identify and implement opportunities for improvement using a patient-oriented endpoint of time from radiation simulation to treatment start (RSTS). Methods: An RO-LHS was developed through a collaboration between an academic, multi-facility radiation oncology department and an industry partner (Medlever). The end-to-end clinical workflow was embedded into the Medlever platform following an interdisciplinary, iterative analysis with representatives from key teams (clerical, finance and clinical). A novel nomenclature was created to label standardized, customizable templates, which choreograph logic-driven tasks that cover all sub-steps of RSTS. The primary endpoint of RSTS was compared pre- and post-implementation, stratified by key variables, such as facility, staff member, and radiation treatment modality. Results: The iterative workflow analysis identified >700 variables and decision points necessary for >200 cancer and benign conditions routinely managed in RO. >450 treatment protocols were templated.180 logic-driven tasks were created and linked to key parameters, resulting in a choregraphed precision workflow for each patient. Using the first iteration of the build, a total of 512 patients were managed during a 50-day period (03/01/2024-04/20/2024) and were compared to 2875 patients treated prior to implementation. Post-implementation, RSTS was shortened by 36.4% (p<0.001). We identified significant differences in RSTS by radiation modalities (protons vs all others), across facilities, and by providers (p<0.01 for all). Analysis of fractional domain of RSTS, 56% of the time was driven by physician-directed tasks, while 44% was comprised of physics and dosimetry-driven work. Physician-directed tasks had the greatest heterogeneity in time to completion. The biggest variation was noted for the contouring completion task. Significant differences were identified by provider (p<0.001) in nearly each step of the process, including steps not directly tied to physician’s work. Conclusions: Through an inter-disciplinary implementation of the first iteration of a LHS in our RO department, we have significantly shortened RSTS. The implementation and analysis has also enabled us to better understand underlying heterogeneities and identify further opportunities for optimization of RSTS. An LHS framework provides a generalizable solution that could be adapted in other RO clinics.

Exploring Barriers in Self-Reporting of Errors and Near Misses: A Cross-Sectional Study on Radiation Oncology in Saudi Arabia.

Radiation therapy utilizes complex technologies to target tumors. Radiation therapy is not immune to human errors. Reporting medical errors and near misses is crucial to improving patient outcomes and ensuring the safety of future patients. This study aimed to measure the attitudes of radiotherapy staff members in Saudi Arabia regarding reporting errors and near misses in radiation therapy practice. It also examined the participants' reporting patterns and behaviors and explored the potential barriers to reporting errors and near misses as perceived by the participants. A cross-sectional study utilizing an online questionnaire was implemented. A sample of 70health professionals working in radiation oncology departments in Saudi Arabia, including radiation oncologists, medical physicists, and radiotherapists, were recruited to participate in this study from January to June 2023. The data was analyzed using chi-squared testing to compare different groups, and the Kruskal-Wallis was used to find any statistically significant differences between different groups. The study included 70 radiotherapy staff members. Professional roles did not significantly impact participants' decisions to report minor or major errors, with most consistently reporting errors to their supervisors regardless of role. The study revealed that fear of professional sanctions and the potential negative impact on a department's reputation are significant barriers to reporting errors or near misses. However, Only 17% of radiation oncologists did consider departmental sanctions as a barrier. Participants identified communication failure as the most significant source of errors in radiation oncology departments. The study also found a high level of agreement among the participants regarding the responsibility of reporting errors and near misses. The study investigated reporting errors and near misses in radiotherapy and considered the factors influencing them. The findings highlight the importance of effective communication and the implementation of an electronic reporting system.

Disparities in patient-reported distress in head and neck cancer.

257 Background: Distress is common among cancer patients, and impacts morbidity and mortality. Head and neck cancer (HNC) is considered one of the most emotionally distressing of all cancers, and given the stark racial disparities in HNC outcomes, we sought to examine racial and sociodemographic factors associated with clinically meaningful distress in a cohort of patients with HNC. Methods: We built a retrospective cohort of patients at a semi-urban, academic, National Cancer Institute (NCI)-designated comprehensive cancer center in the Southeastern United States. Cohort included patients with a diagnosis of HNC who received care from the Radiation Oncology department 5 weeks or less of initial diagnosis, from 2017 to 2022. Outcome of interest was clinically meaningful distress, a binary variable defined as a score of ≥4 on the distress thermometer (DT), a validated tool measuring distress, with scores ranging from 0-10. Main independent variables were sociodemographic factors (race/ethnicity, age, sex, marital status, and health insurance status). We further adjusted for clinical variables (stage of presentation, anatomical subsites, smoking and alcohol history), and problem list domain items. Using chi-square tests and multinomial regression analysis, we estimated differences in distress and odds of meaningful distress by sociodemographic factors, adjusting for clinical factors and problem list domains. Results: From a primary sample of 1,167 patients, 507 patients met our inclusion criteria. Nearly half (45.8%) of our sample had clinically meaningful distress, with a median DT score of 3 (IQR, 0-6). Total number of problem list items and physical concerns showed significant racial differences ( p < 0.05); however, in our final models, race was not significantly associated with clinically meaningful distress. Compared to those unmarried, married patients were significantly less likely to report distress (aOR = 0.62; 95% CI: 0.40, 0.95). Also, patients with emotional problems had double the odds of reporting clinically meaningful distress (aOR = 2.03; 95% CI: 1.02, 4.08). Other factors associated with significant clinical distress included tobacco history, and reported practical problems. Conclusions: Marital status and reported emotional problems are significantly associated with clinically meaningful distress in patients with HNC. Our study underscores the need for social support in mitigating distress and optimizing mental healthcare in our patient population. Further studies will explore distress trajectories across the HNC continuum and impact on HNC outcomes.

Clinico-epidemiological Features of Patients with Endometrial Carcinoma in Clinical Oncology Department in Ain Shams University Hospitals in Egypt

Clinico-epidemiological Features of Patients with Endometrial Carcinoma in Clinical Oncology Department in Ain Shams University Hospitals in Egypt

Sensitivity of frozen section analysis in patients with ovarian adult granulosa cell tumor, a multi-center study.

We aimed to demonstrate the sensitivity of frozen section for patients with adult granulosa cell tumor (AGCT) and analyze the clinico-pathological factors that may be associated with sensitivity. This is a multicenter study including data of 10 Gynecological Oncology Departments. Frozen-section results of patients who had ovarian AGCT at the final pathology report were retrospectively analyzed. The relation between clinico-pathological characteristics such as age, tumor size, Ca-125 level, presence of ascites, omental metastasis, menopausal status and peritoneal cytology, and the sensitivity of frozen section in patients with AGCT were evaluated. The sensitivity of frozen section diagnosis was determined by comparing the frozen section result with the final pathological diagnosis. Frozen section results of 274 patients with AGCT were obtained. The median age of the patients was 52years (range, 17-82years). Totally, 144 (52.7%, n = 273) patients were postmenopausal. The median tumour size was 90mm (range, 9-700mm). The median preoperative Ca-125 level was 23IU/mL (range, 2-995IU/mL). The sensitivity of frozen section for detecting AGCT was 76.3%. Any association between the sensitivity of frozen section and menopausal status, presence of ascites, positive cytology, omental metastasis, tumor size, Ca-125 level, age could not be shown. It is important to know the diagnosis of AGCT intraoperatively, and we demonstrated the sensitivity of frozen-section for these tumors as 76.3%.

Diffusion-weighted MRI in characterization of enlarged cervical lymph nodes

Background Diffusion-weighted MRI (DWI) has been shown to enhance the visibility of sub-centimetric lymph nodes (LNs) by suppressing background tissue, thereby facilitating LN identification in comparison to conventional sequences. Aim The purpose of this research is to evaluate the efficacy of DWI and apparent diffusion coefficient in distinguishing among cancerous and benign cervical lymphadenopathy. Patients and methods This prospective research includes 50 cases complaining of cervical LN swelling referred to MR units of Radiodiagnosis and Clinical Oncology department at Tanta University Hospital, with symptoms of enlarged cervical LN. Results The most frequently encountered lesion was lymphoma in 12 (24.00%) cases, followed by metastatic from thyroid carcinoma in 7 (14%) cases and metastasis from cancer parotid in 6 (12%) cases, 5 (10%) cases were diagnosed as metastasis from tongue, metastasis from oropharyngeal mass was found in 4 (8%) cases, 3 cases were diagnosed as TB and acute inflammatory with percentage of (6%) for each one, where there were 2 cases diagnosed with percentage of (4%). This study revealed that DWI is a technique for investigation of tumors histological content of LNs and used for distinguishing among benign and cancerous ones. Conclusion DWI with apparent diffusion coefficient map is a novel and promising method for distinguishing cancerous from noncancerous LN. The addition of DWI to standard MRI gives extra biological and functional information for characterizing cervical LN.

Molecular Identification of Cryptosporidiosis in Diabetes and Cancer patients

Cryptosporidium spp., a primary intestinal parasite and obligate intracellular parasite, infects a wide range of vertebrates, including human. The current study aimed to determine the infection rate of Cryptosporidium spp. among immunocompromised patients attending the Diabetes and Endocrinology Centre and Oncology Department at Al-Diwaniya Teaching Hospitals in Al-Diwaniya Providence, Iraq. The research period extended from the first of October 2023 until the end of February 2024. Eighty-seven stool samples were obtained from immunocompromised patients of various ages and both genders who attended the hospital. Stool samples were examined using the nested PCR technique. The results showed an overall infection rate of 22.98%. Researchers found that the infection rate was 20.83% among diabetic patients and 25.64% among cancer patients. Male patients had a recorded infection rate of 23.07%, whereas females recorded 22.85%. A high infection rate (60%) was observed among patients under the age of 15 and among those coming from rural areas, reaching 34.88%. Additionally, it was found that 42.42% of the infected individuals had contact with animals.

Chemotherapy-Induced Febrile Neutropenia Managed on an Outpatient Basis at the Pediatric Hematology and Oncology Department of the Ibn Sina Children’s Hospital in Rabat

Introduction: Febrile neutropenia (FN) is an important cause of morbidity and mortality in patients with cancer. The general objective of this study was to collect data and analyze the factors influencing management of the febrile neutropenia at the day hospital at the pediatric department of Hematology and Oncology (SHOP) of Rabat.

Effect of Cold Application on Pain Relief during Intravenous Cannulation for Cancer Patients

Background: The cannulation of intravenous Analgesia is rarely experienced after this unpleasant procedure, which can also induce stress and worry. Objective: The purpose of the study was to ascertain how cold affected the degree of pain during intravenous cannulation. Methodology: A randomized controlled trial was carried out at the oncology department of AL-Al-Haboubi Teaching Hospital in Dhi-Qar from January 4, 2024, until February 3, 2024. After the sample was selected, 102 patients were divided into two groups in order to achieve the study's objective: 50 patients were assigned to the control group and 52 patients to the experimental group. The experimental group was given cold gel, and self-report data collection was used. A visual analogue scale of 10 cm was used to measure pain. Results: The experimental group's post-test results showed a low mean pain score (28.76+20.491), while the control group's data analysis results showed a high mean score (M+SD 76.54+20.427) and severe discomfort during cannulation insertion. The mean pain score during cannulation insertion varied significantly (p=.001) between the experimental and control groups following the use of cold treatment. Conclusions: According to the study's findings, the cool approach helped to lessen intravenous cannulation pain. Recommendations: The study advised patients to be chilled when receiving intravenous cannulation.

Immune checkpoint inhibitor induced hypophysitis: a specific disease of corticotrophs?

The aim of this study was to define functional and anatomical pituitary disease at the time of presentation following immune checkpoint inhibitor (ICI) therapy and to describe any changes in pituitary function over time. We conducted a retrospective observational audit of patients on ICI therapy at our centre between January 2013 and September 2023. We reviewed all patients on ICI therapy under the care of the oncology department at University Hospital Plymouth, a 1000-bedded hospital serving a population of 500,000 people. From this group, we identified all individuals referred to the endocrinology department with a suspected diagnosis of adrenal insufficiency. Patients were established on adrenal steroid replacement and subsequently underwent formal pituitary testing. People were included if they had pituitary disease, as evidenced by low ACTH, other pituitary dysfunction and/or abnormalities on pituitary imaging. Nine hundred and fifty-four patients received ICI therapy during the study period, and 37 (a prevalence of 3.9%) developed hypothalamic-pituitary-adrenal axis dysfunction. Their mean age was 65 years, and 70% were male. About 86.5% of the total patients affected were treated for metastatic malignancies. Ten of the 37 patients died during follow-up as a direct consequence or complication of their primary cancer diagnosis. The median interval for the onset of symptoms was 4 months. Following repeated testing, there was no recovery in cortisol or ACTH levels for any individual. Other permanent anterior pituitary hormone defects were unusual. Hypophysitis associated with immunotherapy appears to specifically target the corticotrophs, with no evidence of recovery over time. There was a specific abnormality seen in MRI scans of 7 of 27 patients who had scans, which appeared to be a particular feature of immune-mediated hypophysitis. These were confined to the anterior aspect of the pituitary gland, appearing as striations, and were not visible on any of the scans performed more than 3 months after the likely onset of the disease. These data show that immune-related hypophysitis is a common complication of immune checkpoint inhibitor therapy. This may result in an imaging abnormality within the areas of the pituitary that are richest in corticotrophs. The endocrine consequence of this is a permanent defect in ACTH and, therefore, cortisol production.

The impact of life events on child and adolescent psychiatry consultations

Purpose: Children are exposed to many adverse life events, and this may cause psychiatric disorders. In this study, we aimed to investigate the effects of two different life events, the COVID-19 pandemic and the earthquake, on the consultations requested. Materials and Methods: 1268 consultations requested from the child and adolescent psychiatry department between March 2019 and March 2023 were reviewed from hospital records. The specified period was divided into four distinct parts with one-year intervals: pre-pandemic, the first year of the pandemic, the second year of the pandemic, and post-pandemic. The age, gender, diagnoses of the cases, the department requesting consultation and the reason for consultation were recorded. Results: There were statistically significant differences between periods in terms of departments requested consultation, consultation reasons, and diagnoses. Compared to previous periods, a decrease was found in pediatric emergency and general pediatric clinic consultations in the post-pandemic period. In contrast, an increase was seen in nephrology and intensive care unit department consultations because of earthquakes. In the first year of the pandemic, more consultations were requested from the hematology & oncology department compared to other years. While the rate of consultations requested for suicide attempts decreased in the post-pandemic period, consultations for psychiatric assessment increased. Conclusion: Consultation-liaison psychiatry, which is at the center of interdisciplinary interaction, maintains its importance in the prevention and early diagnosis of psychological symptoms that can develop due to both organic events and the effect of trauma itself after the life events.

Effect of training based on Orem's self-care deficit theory on breast cancer patients' management of chemotherapy-related side effects and self-care behaviors: A randomized controlled trial

PurposeTo examine the effects of training based on Orem's self-care deficit theory on breast cancer patient's physical, social, and psychological well-being and self-care behaviors during chemotherapy. MethodsThis randomized controlled trial was based on a pretest–posttest experimental design. The study sample consisted of 62 breast cancer patients (n = 31 for each of the intervention and control groups) receiving cyclophosphamide–epirubicin or cyclophosphamide–adriamycin treatment in the medical oncology department of a university hospital in Tekirdağ, Turkey. The breast cancer patients in the intervention group received training based on Orem's self-care deficit theory regarding physical, social, and psychological well-being and self-care behaviors during chemotherapy. The researcher conducted two face-to-face follow-ups (during the second and third chemotherapy cycles, 3 weeks apart) and a posttest assessment. Pretest and posttest symptom scores and self-care survey results were compared for both groups. ResultsThe Nightingale Symptom Assessment Scale (N-SAS) first follow-up, second follow-up, and posttest scores showed that the intervention group experienced fewer negative changes in quality of life than the control group based on the physical, social, and psychological subdimension and total scale scores (p < .05). The most positive changes in the intervention group's self-care behaviors were observed for items about caring for and protecting hair, using protective gloves when doing chores, monitoring weight, and limiting social meetings when blood values were low to protect against possible infection. ConclusionTraining based on Orem's self-care deficit theory positively influenced breast cancer patients' management of chemotherapy-related side effects and self-care behaviors. Chemotherapy-related side effects should be evaluated frequently. Moreover, patients' needs should be determined, and training should be tailored to their needs.

Prevalence of Hypothyroidism in Children with Transfusion Dependent Thalassemia Patient Attending in A Tertiary Care Hospital of Bangladesh

Background: Blood transfusions and iron chelation are standard treatments for β-thalassemia major and Hb E-Beta-Thalassemia. However, repeated transfusions raise body iron levels, leading to secondary hemosiderosis and complications in the heart, endocrine system, and liver. Thyroid dysfunction results from gland infiltration, chronic hypoxia, free radical damage, and iron overload. This study aimed to find out the prevalence of hypothyroidism in transfusion-dependent thalassemic children attending Bangladesh Shishu Hospital &amp; Institute. Methods: A descriptive cross-sectional study was conducted at the Thalassemia Centre, Department of Hematology and Oncology, Bangladesh Shishu Hospital &amp; Institute, from December 2019 to November 2020. The study included 140 children with thalassemia, aged 5 to 16 years, who were receiving blood transfusions. Data were collected using a structured questionnaire with participant consent. Statistical analysis was performed using SPSS version 23.0. Results: In this study, hypothyroidism was observed in 26.2% of patients, with 23.5% having subclinical and 2.9% overt hypothyroidism. In most of the patients (n=85), aged 11-16 years, 58.3% had normal thyroid function, 36.5% had subclinical, and 4.7% had overt hypothyroidism, which was statistically significant (p&lt;0.05). Of the 91 patients with hemoglobin levels below 11.5 g/dL, 85.7% had normal thyroid function, 13.2% had subclinical hypothyroidism, and 1.1% had overt hypothyroidism, also significant (p&lt;0.05). In the group with ferritin levels of 1200-2000 ng/mL, 78.1% had normal thyroid function, 18.8% had subclinical hypothyroidism, and 3.1% had overt hypothyroidism, which was not statistically significant (p&gt;0.05). Conclusion: Subclinical hypothyroidism is commonly seen in thalassemia patients aged 5 to 16 years who undergo regular blood transfusions. Regular physical exams and thyroid function assessments are crucial to detect overt hypothyroidism early. Timely hormone replacement can

Children With Acute Lymphoblastic Leukemia in Romania: Results From a Decade-Long Single-Center Study.

Acute lymphoblastic leukemia (ALL) is the most prevalent cancer in children, with continuously improving survival rates. As few studies in Romania have analyzed ALL patients and disease characteristics or survival, we conducted a retrospective study on 158 patients diagnosed with ALL admitted to the Department of Pediatric Oncology and Hematology at the Emergency Hospital for Children, Cluj-Napoca, Romania, from January 2011 until April 2021. The most important objectives of the study are to establish full profiles of the patients and ALL, remission rates, relapses, and deaths, an epidemiology analysis to determine the incidence of ALL for comparison with the standard European population, and also to assess survival by the most important parameters, including minimal residual disease (MRD). This was a retrospective study that focused on patients with newly diagnosed ALL from January 2011 to April 2021 in the Department of Pediatric Hematology and Oncology of the Emergency Hospital for Children, Cluj-Napoca, Romania. The inclusion criteria were: patients with de novo ALL, patients who were younger than 18 years of age, and patients with signed informed consents. The exclusion criteria included patients who were older than 18 years of age; patients with relapsed ALL; and patients who did not have a signed informed consent. A total of 158 patients were included in the study, aged between 0 and 17 years. The information about patient characteristics and all variables was taken from the patients' files, where informed consent is mandatorily stored. Descriptive statistics were used to evaluate variables such as age, gender, leukocyte number, immunophenotype, prednisone response, risk group assessment, cytogenetics, relapse, and MRD. Kaplan-Meier curves were used to assess survival, for which patients were divided into two subcohorts: a 2011-2015 subcohort and a 2016-2020 subcohort. The statistical analyses used Prism version 10.2.3 (GraphPad Software, La Jolla, CA). For the analysis, we used Kaplan-Meier curves, the log-rank (Mantel-Cox) test, the log-rank test for trends, the Gehan-Breslow-Wilcoxon test, survival proportions, the chi-square test, and correlations. A shift in risk groups was observed after the introduction of MRD testing in 2017, with more patients being stratified in the medium-risk group (MRG) and high-risk group (HRG). At the survival analyses between bone marrow (BM) aspiration and MRD on day 15, we discovered that patients with MRD>10% had much higher overall survival (OS) and event-free survival (EFS) compared to patients with >25% blasts in the BM; 24(11.4%) patients relapsed, of which, nine (3.8%) were very early relapses and 10 (4.1%) were late relapses. The five-year OS and EFS for patients with the T-cell immunophenotype of ALL and those with leukocyte counts >100,000/mm3were identical to those at one year. The OS of the 2016-2020 subcohort was higher than that of the 2011-2015 subcohort, and more patients were stratified into MRG and HRGs due to the implementation of MRD testing. Minimal residual disease testing helped to improve significantly the survival rates of patients with more than 10% residual disease. None of the patients with very early relapses entered complete remission (CR), but all late relapses achieved CR. All events experienced by patients with the T-cell immunophenotype, or leukocyte counts of >100,000/mm3 occurred in the first year after diagnosis.

Using 3D facial information to predict malnutrition and consequent complications.

Phase angle (PhA) correlates with body composition and could predict the nutrition status of patients and disease prognosis. We aimed to explore the feasibility of predicting PhA-diagnosed malnutrition using facial image information based on deep learning (DL). From August 2021 to April 2022, inpatients were enrolled from surgery, gastroenterology, and oncology departments in a tertiary hospital. Subjective global assessment was used as the gold standard of malnutrition diagnosis. The highest Youden index value was selected as the PhA cutoff point. We developed a multimodal DL framework to automatically analyze the three-dimensional (3D) facial data and accurately determine patients' PhA categories. The framework was trained and validated using a cross-validation approach and tested on an independent dataset. Four hundred eighty-two patients were included in the final dataset, including 176 with malnourishment. In male patients, the PhA value with the highest Youden index was 5.55°, and the area under the receiver operating characteristic curve (AUC) = 0.68; in female patients, the PhA value with the highest Youden index was 4.88°, and AUC = 0.69. Inpatients with low PhA had higher incidence of infectious complications during the hospital stay (P = 0.003). The DL model trained with 4096 points extracted from 3D facial data had the best performance. The algorithm showed fair performance in predicting PhA, with an AUC of 0.77 and an accuracy of 0.74. Predicting the PhA of inpatients from facial images is feasible and can be used for malnutrition assessment and prognostic prediction.

The Role of Transgenerational Transmission in the Psychological Adjustment of Women With Breast Cancer

Introduction: Getting sick with cancer is a traumatic event for the affected person and can result with various psychological difficulties, and invasive methods of treatment further deepen them. The previously experienced psychological trauma of a close person can influence the response of a person who is currently experiencing trauma, because the far-reaching power of posttraumatic consequences extends through a natural biological barrier far into the next generation (the so called "transgenerational impact of traumatization"). Objective: To assess the impact of transgenerational transmission on the development of PTSD in women with breast cancer. Methods: The sample consisted of 120 women treated at the Oncology Department of University Hospital Center Osijek, included in liaison psychiatric treatment. A detailed clinical examination with a psychiatric interview was used with the application of DSM-IV diagnostic criteria, a specially structured non-standardized questionnaire for the assessment of etiological factors and the Los Angeles Symptom Checklist of PTSD symptoms (LASC) for determining PTSD. Results: No statistical significance was obtained between the presence of a family member with cancer and the average total score on the LASC in women with newly diagnosed breast cancer. Conclusion: Although there was no correlation between the existence of a family member suffering from cancer and the development of PTSD in the test subjects, during psychotherapy procedures we observed the existence of symptoms that did not meet the criteria for establishing a diagnosis of PTSD, but could interfere with the development of various psychological responses. By including cancer patients in psychotherapy procedures, we can prevent the development of more severe psychological responses in the second generation, which due to the genetic influence in the inheritance of the disease, will develop cancer, and the psychological disorder associated with it, and achieve a far reaching effect on strengthening adaptation mechanisms.

Abstract C149: Relationship between PD-L1 expression and clinicopathological characteristics in Hispanic/ Latino women with breast cancer

Abstract Background: Programmed death ligand 1 (PD-L1) expression in breast cancer serves as a prognostic marker, particularly in aggressive subtypes like triple-negative breast cancer (TNBC), where it helps in predicting response to immune checkpoint inhibitors and guides immunotherapy use. Although several studies have assessed the prevalence of PD-L1 expression in breast cancer, data from the Hispanic population, especially in Latin American countries, is lacking. This study evaluates PD-L1 expression and its correlation with pathological features in Colombian women. Methods: Women with breast cancer tested for PD-L1 were selected from the archives of the Oncologic Pathology Department at the National Cancer Institute of Colombia from September 2021 to May 2024. Information from their pathology reports was extracted, and correlation analyses were carried out using Fisher's exact test Results: A total of 60 reports were screened, comprising 56 cases of ductal invasive breast carcinoma and 1 case of lobular invasive breast carcinoma. 48 individuals were tested using the PD-L1 22C3 antibody, with 41.67% of them being positive for PD-L1 expression. Among the 48 tumors tested with 22C3, 35 cases were classified as TNBC, and 13 cases corresponded to luminal B subtype with a low positive expression (1-10%) of estrogen receptors. The percentage of positive PD-L1 cases was 37.14% for TNBC and 53.85% for the luminal B subtype. Furthermore, 5 HER2-low cases were identified with 2 of them being positive for PD-L1 expression. In the correlation analyses, PD-L1 positive expression was significantly associated with a more aggressive histologic grade compared to PD-L1 negative tumors (p = 0.007). No significant association was found between PD-L1 expression and HR, HER2, or KI67 status, nor with age, necrosis, lymphovascular involvement, perineural invasion, desmoplastic response, or immune cell infiltration. Among the 12 individuals tested for PD-L1 with the SP142 antibody, none showed positive expression, precluding correlation analyses. Conclusion: This study highlights a significant association between PD-L1 expression and aggressive histologic grade in Colombian women with breast cancer. The findings underscore the potential of PD-L1 as a prognostic marker and its relevance in guiding immunotherapy in this population. Further research is needed to explore PD-L1 expression in broader Hispanic groups to better understand its clinical implications. Citation Format: Daniel Mendivelso-González, Patricia López- Correa, Nicolás Prada-Aceros, Alfredo E Romero-Rojas, Rafael Parra-Medina. Relationship between PD-L1 expression and clinicopathological characteristics in Hispanic/ Latino women with breast cancer [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C149.

Efficacy and safety of transcatheter arterial chemoembolization followed by hepatic arterial infusion chemotherapy combined with TKI and PD-1 inhibitors as first-line treatment for advanced hepatocellular carcinoma

To evaluate the efficacy and safety of transcatheter arterial chemoembolization (TACE) followed by hepatic arterial infusion chemotherapy (HAIC) combined with TKI drugs and PD-1 inhibitors as the first-line treatment for advanced hepatocellular carcinoma (HCC). We retrospectively analyzed the data of 70 patients with advanced HCC treated in the Department of Oncology of Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine between July, 2020 and June, 2023. 23 of the patients received TACE combined with HAIC and TKI (TACE+HAIC+ TKI group) and 47 received TACE combined with HAIC, PD-1 inhibitors and TKI (TACE+HAIC+PD-1+TKI group). The clinical characteristics, laboratory test results, efficacy, outcomes and adverse events of the patients were compared between the two groups. The TACE+HAIC+TKI and TACE+HAIC+PD-1+TKI groups had significantly different objective remission rates (ORR; 60.87% vs 36.17%, P=0.031), comparable disease control rates (95.65% vs 93.62%, P=0.068), and different median progression-free survival (PFS) time (10.2 vs 11.8 months, P=0.003) and median overall survival (OS) time (15.7 vs 19.5 months, P=0.035). After propensity score matching (PSM), the median PFS and OS time of the two groups was 10.1 vs 14.5 months (P= 0.024) and 14.2 vs 21.2 months (P=0.221), respectively. The 1-year PFS rates of the 2 groups were 24.0% vs 52.2%, and the 1-, 2-and 3-year OS rates were 72.3% vs 93.1%, 23.9% vs 63.8%, and 23.9% vs 36.5%, respectively. The incidence of proteinuria was significantly higher in TACE+HAIC+PD-1+TKI group than in TACE+HAIC+TKI group (21.28% vs 0, P=0.025), but the incidences of grade 3-4 treatment-related adverse events were all similar between the two groups. The first-line treatment with TACE+HAIC+PD-1+TKI is safe and effective for advanced HCC and can significantly prolong the survival of the patients.

Effectiveness of Hospital Fit on Physical Activity in Hospitalized Patients: A Stepped-Wedge Cluster-Randomized Trial and Process Evaluation.

This study investigates the effectiveness of using Hospital Fit as part of usual care physiotherapy on the physical activity (PA) behavior of hospitalized patients compared to patients who received physiotherapy before implementation of Hospital Fit. In addition, a process evaluation is conducted. A prospective, multi-center, mixed-methods stepped wedge cluster randomized trial was performed at the cardiology and medical oncology departments of two Dutch university medical centers. Patients were included in the non-intervention or intervention phase. During the non-intervention phase, patients received usual care physiotherapy. During the intervention phase, Hospital Fit was additionally used. Mean time spent walking, standing, lying/sitting per day and the number of postural transitions from lying/sitting to standing/walking positions were measured using an accelerometer and analyzed using linear mixed models. A process evaluation was performed using questionnaires and semi-structured interviews with patients and focus-group interviews with healthcare professionals. A total of 77 patients were included, and data from 63 patients were used for data analysis. During the intervention phase, the average time spent walking per day was 20 min (95% confidence interval: -2 to 41 min) higher than during the non-intervention phase (p = 0.075). No significant differences were found for mean time spent standing per day, mean time spent lying/sitting per day, or the number of postural transitions per day either. During the intervention phase, 87% of patients used Hospital Fit at least once, with a median daily use of 2.5 to 4.0 times. Patients and healthcare professionals believed that Hospital Fit improved patients' PA behavior and recovery. Insufficient digital skills and technical issues were described as challenges. Although patients and healthcare professionals described Hospital Fit as an added value, no statistically significant effects were found.