Patients Undergoing Cancer Treatment Research Articles

Lichen Sclerosus in Cancer Patients.

To characterize the association between cancer therapies and the development of lichen sclerosus (LS) in a case series of patients. A retrospective chart review was performed to screen for patients who were diagnosed with LS while undergoing cancer therapy at Memorial Sloan Kettering Cancer Center between 2003 and 2019. Patients were excluded if they had been diagnosed with LS prior to starting cancer therapy. Clinical and treatment characteristics were analyzed. The final study sample included 29 female patients who developed LS in the setting of systemic cancer therapy. Median time to LS onset after cancer therapy initiation was 420 days. Primary tumor types included breast (10, 34.5%), gynecologic (8, 27.6%), gastrointestinal (5, 17.2%), cutaneous (2, 6.9%), lung (2, 6.9%), and hematologic (2, 6.9%). Cancer therapy regimens included hormonal therapy (10, 34.5%), chemoradiation (7, 24.1%), cytotoxic chemotherapy (7, 24.1%), PD-1/PD-L1 inhibitors (3, 10.3%), local radiation (1, 3.4%), and allogeneic stem cell transplant (1, 3.4%). Across all patients, the mean number of treatments for LS was 2.8. Twenty-three (79.3%) patients received the first-line therapy of ultrapotent topical steroids, but 16 (69.6%) required additional topical and systemic treatment. Limitations include retrospective design and referral bias. Breast cancer was the most common primary tumor among patients in this study. The most common cancer therapy regimen was hormonal therapy. Most patients required an escalation in therapy to manage their LS. For patients undergoing cancer treatment, concomitant LS management can present unique challenges due to the biological mechanism of some anticancer therapies and the pathophysiology of LS. There is limited data to guide treatment of LS for this population. Some of the patients included in this analysis had progression of LS and recurrence of cancer while undergoing management of both conditions, necessitating close follow-up.

Impact of New Legislation on Reproductive Medicine and Cancer Treatment

Legislation affecting reproductive rights and medical care can significantly impact patients undergoing cancer treatment, particularly when pregnancy is involved. In some jurisdictions, new laws restricting abortion or reproductive healthcare have raised ethical and medical concerns for oncologists and obstetrician-gynecologists. These laws may limit the options available to pregnant cancer patients or delay treatment due to concerns over fetal viability and legal liability.

Randomized clinical trial of a digital integrative medicine intervention among patients undergoing active cancer treatment

Exercise and mindfulness-based interventions have growing evidence for managing fatigue and comorbid symptoms; however, packaging them in a cohesive digital way for patients undergoing cancer treatment has not been evaluated. We conducted a randomized controlled trial to assess the impact of a 12 week digital integrative medicine program, Integrative Medicine at Home (IM@Home), versus enhanced usual care on fatigue severity (primary outcome), comorbid symptoms and acute healthcare utilization (secondary outcomes), in 200 patients with solid tumors experiencing fatigue during treatment. Fatigue severity decreased more in IM@Home than in the control (1.99 vs. 1.51 points; p = 0.04). IM@Home participants also had reduced symptom distress (p = 0.003), anxiety (p = 0.03), and depression (p = 0.02). Acute healthcare utilization was lower with IM@Home, with fewer emergency department visits (rate ratio 0.49; p = 0.04), hospitalizations (4% vs. 12.9%; p = 0.03), and shorter hospital stays (4.25 vs. 10 days; p < 0.001). These promising findings should be confirmed in phase III clinical trials. “Study registered at clinicaltrials.gov (NCT05053230) on 09-20-2021”.

Ovarian function in adolescents and young adults undergoing cancer treatment: biochemical and ultrasound marker analysis.

Gonadal dysfunction is a major late complication after cancer diagnosis and treatment. We aimed to study the prevalence of premature ovarian insufficiency (POI) and the potential reduction of ovarian reserve in a cohort of adolescent and young adult (AYA) patients undergoing cancer treatments, evaluating ovarian function and reserve markers. We also aimed to analyze how these markers are related to each other and to treatment-related risk factors. We performed a retrospective study, including all female AYA patients undergoing cancer treatment during childhood or adolescence who visited our pediatric gynecology outpatient clinic between January 1, 2018, and August 30, 2023. Serum levels of anti-Mullerian hormone (AMH) and follicle-stimulating hormone (FSH), antral follicle count (AFC) and mean ovarian volume were evaluated. The correlations between these markers and how their alterations are related to treatment-related risk factors were analyzed. The prevalence of POI in 95 patients was 18.9 %. A significant positive correlation was observed between AMH levels and both AFC and ovarian volume. AMH was the most reliable serum marker for ovarian function in terms of POI. Independent risk factors for ovarian dysfunction in relation to all the markers analyzed were hematopoietic stem cell transplantation (HSCT) and high doses of alkylating agents (≥6000 mg/m2). Gonadal dysfunction and infertility are quite common in AYA patients undergoing cancer treatment. High-dose alkylating agents and HSCT are the independent risk factors. AMH and FSH values, AFC and mean ovarian volume provide different but consistent information for closely monitoring patients after cancer treatment.

Development of a VTE prediction model based on automatically selected features in glioma patients

Venous thromboembolism (VTE) is a serious threat to patients undergoing cancer treatment, especially in advanced and metastatic diseases. In neuro-oncology, the incidence of VTE depends on the location and stage of the tumor. Some primary and secondary brain tumors have an increased propensity for thrombotic events. In this study, we applied state-of-the-art machine learning methods, particularly XGBoost, to create models to search for predictors associated with the risk of VTE in glioma patients. By comparing the diagnostic accuracy of our XGBoost models with traditional logistic regression approaches, we aim to advance the understanding of VTE prediction in this patient population. Our results add to the growing body of research on thrombosis risk assessment in cancer patients and may help in the development of personalized prevention and treatment strategies to reduce the risk of VTE in hospitalized glioma patients.

Hip fracture and cancer: descriptive epidemiological study demonstrating a paradigm shift in common orthopedic trauma

PurposeDespite the increase both in patients with cancer and those with proximal femoral fractures (PFFs), details of the characteristics of non-pathological PFFs in patients undergoing cancer treatment are unknown. The purpose of this retrospective study was to investigate the characteristics and issues of patients with active cancer who have non-pathological PFFs. MethodsThis was a retrospective, observational, descriptive epidemiological study. A total of 376 patients were admitted to Juntendo University hospital with a diagnosis of PFF. Six of these patients had metastasis-related pathological fractures and were excluded from this study. The remaining 370 patients comprised 100 men and 270 women. ResultsThe mean patient age was 78.6 ​± ​11.2 years. Fractures included 141 trochanteric femoral fractures and 229 femoral neck fractures. Of these, 39 (10.5%) of the patients had active cancer, 55 (14.9%) has a history of past cancer, and 276 (74.6%) had no cancer. Among the 39 patients with active cancer, 13 (33.3%) received glucocorticoids; furthermore, 10 (76.9%) of these 13 patients were not receiving medications to prevent osteoporosis. Lastly, 9 of the 39 falls were hospitalization-related, but 6 (66.7%) of these 9 patients did not undergo rehabilitation during hospitalization. ConclusionsApproximately one in ten patients with PFF in this study were undergoing cancer treatment. Moreover, one in four patients with PFF were cancer-related. Therefore, orthopedic surgeons should have basic knowledge about cancer management in hip fracture.

Symptom trajectories over time by cannabis use status among patients undergoing cancer treatment

Adults with cancer may perceive cannabis as beneficial for managing their cancer-related symptoms, but the evidence supporting its medical use is varied and inconclusive. This study characterized associations of cannabis use with cancer-related symptom trajectories. Participants were adults undergoing cancer treatment at the Stephenson Cancer Center (SCC; n = 218) in Oklahoma; they were 71% female, 10% minoritized race, and 45% had stage III or IV cancer. Participants completed surveys at baseline and 2-, 4-, and 6-months post-baseline. Assessments queried about cannabis use behavior, physical and psychological distress via the Rotterdam Symptoms Checklist (RSCL), respiratory symptoms via the American Thoracic Society Questionnaire (ATSQ), and quality of life indices (physical and social functioning, pain interference, sleep quality, fatigue) via the Patient Reported Outcomes Measurement Information System (PROMIS-29). Cannabis use status was categorized based on self-reported past 30-day cannabis use at each assessment as non-use [no use at any assessment], occasional-use [use at 1–2 assessments], or consistent-use [use at 3–4 assessments]. Longitudinal hierarchical linear modeling evaluated associations of cannabis use status with average symptoms and symptom trajectories across all four assessments. One-third (33%) of participants reported past 30-day cannabis use at ≥ 1 assessment. Participants who reported cannabis use (occasional-use and consistent-use) had more severe symptoms overall across assessments. While most cancer symptom trajectories did not differ by cannabis use status, participants who reported consistent cannabis use uniquely showed worsening physical function over time. Cannabis use was associated with greater cancer-related symptom severity over time.

Self-perceived oral health, toothbrushing frequency and quality of life of patients undergoing cancer treatment

Objective: The objective of this study was to evaluate the association of both exposures self-perceived oral health and daily brushing frequency and the outcome quality of life of cancer patients. Methods: This is a descriptive-analytical cross-sectional study, carried out with 399 cancer patients treated by an institution in Minas Gerais, Brazil. Tooth brushing frequency and self-perceived oral health were obtained through interviews and quality of life through the EORTC QLQ-C30 instrument. Statistical analysis consisted of descriptive and bivariate analyses followed by the use of multiple linear generalized models. Results: Most participants reported self-perception of good oral health (89.2%), being that 55.6% brush their teeth three or more times daily. Better quality of life was observed in the social capacity and diarrhea subscales, whereas worse quality of life was recorded in the insomnia and emotional capacity subscales. Self-perceived poor oral health was associated with worse quality of life scores in two symptoms [fatigue (p = 0.007) and pain (p = 0.024)] and the following subscales: functional capacity (p = 0.006), emotional capacity (p = 0.013), cognitive capacity (p = 0.008), and social capacity (p = 0.022), independently of socioeconomic and health conditions. Tooth brushing frequency was not associated with any subscale. Conclusion: Self-perception of poor oral health was associated with a worse quality of life, however, the frequency of toothbrushing did not affect the quality of life of cancer patients.

Risk of Financial Toxicity Among Adults Undergoing Lung and Esophageal Resections for Cancer

BackgroundAlthough financial toxicity, defined as the harmful financial burden experienced by patients undergoing cancer treatment, has been of growing interest, data in thoracic oncology are lacking. This study aimed to examine the risk of financial toxicity among patients undergoing surgical resection of thoracic malignant diseases. MethodsAdults undergoing lobectomy, pneumonectomy, or esophagectomy for cancer were identified in the 2012 to 2021 National Inpatient Sample. Risk of financial toxicity was defined as health expenditure (total hospitalization costs for the uninsured and maximum out-of-pocket costs for the insured) exceeding 40% of postsubsistence income. Multivariable logistic regressions were used to identify factors associated with financial toxicity risk. ResultsOf 384,340 patients, 69.5% had government-funded insurance, 27.2% had private insurance, and 1.0% were uninsured. Compared with patients with insurance, uninsured patients were more commonly Black and Hispanic and less commonly electively admitted. Mortality, complications, length of stay, and costs were comparable regardless of insurance status. Approximately 68.9% of uninsured and 17.3% of insured patients were at risk of financial toxicity, and the incidence of financial toxicity remained stable over time. After risk adjustment, complications were associated with a greater than 2-fold increased risk of financial toxicity among uninsured patients (adjusted odds ratio, 2.21; 95% CI, 1.38-3.55). Among the insured patients, Black, Hispanic, and publicly insured patients demonstrated a greater risk of financial toxicity, while patients undergoing minimally invasive operations and receiving care at metropolitan hospitals exhibited a lower risk of financial toxicity. ConclusionsConcordant with previous work examining financial toxicity in abdominal oncologic surgery, thoracic surgery demonstrates a comparable burden of financial toxicity. Referral policies and care subsidization may be considered in patients at risk for financial toxicity who are undergoing resections for thoracic malignant diseases.

Does HFpEF represent a risk factor and a marker of cardiotoxicity in patients undergoing cancer treatment?

Abstract Background The prevalence of heart failure with preserved ejection fraction (HFpEF) increases with the aging of our population and shares risk factors with cancer. Furthermore, HFpEF conveys a worse prognosis if it remains unrecognized and untreated. However, it is not considered as a surrogate marker in the baseline risk stratificatoin of patients that will undergo potentially cardiotoxic cancer treatments. Moreover, the definition of cardiotoxicity focuses mainly on systolic dysfunction, based on left ventricular ejection fraction and global longitudinal strain changes. Data on the prevalence of new-onset HFpEF during cancer treatment are limited. Purpose We evaluated the prevalence of HFpEF in cancer patients followed in our cardio-oncology clinic, with new cancer therapy-related cardiovascular toxicity (CTR-CVT) events in patients with known HFpEF prior to cancer therapy. We also assessed the prevalence of patients diagnosed with HFpEF while undergoing cancer therapy. Methods A total of 630 cancer patients referred for either baseline evaluation, on-treatment surveillance, long-term follow-up or new complaints suspect for cardiovascular disease were included in this real-world observational study, with a mean follow-up duration of 507 days. They underwent comprehensive workup in accordance with the ESC guidelines, including clinical assessment, electrocardiogram, echocardiography and biomarker testing. Results From the total population, 36 (5.7%) were diagnosed with HFpEF prior to cancer treatment initiation. Among these, 18 (50%) developed CTR-CVT during follow-up, mainly heart failure events (cancer-therapy related cardiac dysfunction or HFpEF decompensation). Independent of baseline characteristics, 233 patients (37.0%) developed a heart failure event during or after cancer treatment. Of these, 92 patients (14.6% of the total population, 39.5% of all HF events on treatment) developed a HFpEF event during or after cancer treatment. Of these HFpEF events, 42 patients (45.7%) were known with pre-existing cardiovascular disease, of whom only 14 (15.2%) with pre-existing HFpEF. In 50 patients (54.3%) the HFpEF diagnosis was made de novo during (or after) cancer treatment. Patients developing HFpEF were mostly female (n=54, 58.7%) and relatively young (mean age 62.0 years). Most HFpEF events occurred in breast cancer patients (n=32, 34.7%), prostate cancer patients (n=13, 14.1%) and multiple myeloma patients (n=9, 9.8%). Conclusions HFpEF is frequently overlooked, but conveys a high risk of developing CTR-CVT and should therefore be taken into account in the baseline risk stratification. Furthermore, HFpEF is responsible for an important morbidity burden during or after cancer cardiotoxic treatments, even in patients without prior diagnosis of HFpEF at baseline evaluation. Further studies are needed to evaluate if this population may benefit from specific management and treatment strategies in order to improve prognosis.Prevalence of HFpEF in cancer patients

Patient Experiences of Using Wearable Health Monitors During Cancer Treatment: A Qualitative Study

IntroductionWearable health monitors (WHM) offer minimally invasive, ambulatory monitoring of physiological parameters and activity. WHMs are being used increasingly in healthcare but adoption for patients undergoing cancer treatment is limited in part due to a lack of understanding of patient intentions as they receive treatment. The aim of this study explores the patient experience of using WHMs during their cancer pathway, including barriers and enablers of WHM use. MethodsA phenomenological qualitative approach was used with single semi-structured interviews conducted in focus groups with individuals enrolled in the EMBRaCE-GM study, where WHMs were worn for up to six months prior to, during and after treatment of either colorectal, lung, or head and neck cancer, or leukaemia/lymphoma. ResultsWe identified three major themes: perceived patient benefits, barriers to the adoption of WHMs and the importance of treatment partnerships between patients and healthcare professionals. WHMs promoted positive behaviour change, prioritisation of own health, and represented a form of ‘digital advocacy’. Potential barriers were aesthetic, experiential and technological. WHM introduction was time-sensitive, with patients finding their use acceptable at different stages in their cancer pathway. Patients desired reciprocal interaction with WHMs and were less concerned with data accuracy. DiscussionThis study identifies factors influencing patient decisions to use WHMs as part of cancer treatment. Novel findings include the optimal time to start wearing WHMs and the validity of measurements perceived as less of a concern for patients (in contrast to clinicians) who use wearable data with their own experiences as part of a sense-making exercise. Future work should focus on balancing patient and clinician expectations to provide guidance on the feasibility of WHM in routine clinical practice.

6905 The Necessity For New Criteria To Evaluate Overbasalization In East Asian Patients With Type 2 Diabetes Using Basal Insulin

Abstract Disclosure: H. Jang: None. Background: Overbasalization, which refers to adjusting the dose of basal insulin beyond an appropriate dose, should be avoided when using basal insulin in patients with type 2 diabetes. It is recommended to evaluate overbasalization when the basal insulin dose exceeds 0.5 units/kg/day or when post-meal glucose levels are &amp;gt; 180 mg/dL. However, this is an expert opinion, and specific criteria for East Asians have not been presented. Methods: Patients with type 2 diabetes using basal insulin (insulin glargine U-100, insulin glargine U-300, insulin degludec, NPH) at Seoul National University Bundang hospital from December 2020 to November 2023, with fasting plasma glucose (FPG) levels between 80 mg/dL and 130 mg/dL, were retrospectively analyzed. Patients with CKD ≤ grade 3b (estimated glomerular filtration rate &amp;lt; 45 mL/min/1.73m2), those taking medications such as steroids that may affect blood glucose levels, and patients undergoing cancer treatment were excluded. Results: A total of 548 patients were analyzed. The mean age of the subjects was 64.7 ± 12.4 years, with 299 (54.6%) being male, and the mean body mass index was 25.1 ± 6.6 kg/m2. The mean duration of diabetes was 18.1 ± 9.6 years. The mean HbA1c level was 7.7 ± 1.1%, while the mean fasting plasma glucose and median fasting C-peptide levels were 105.4 ± 13.9 mg/dL and 1.4 [0.8, 2.1] ng/mL, respectively. Insulin degludec being the most commonly administered (279 [50.9%]). The mean 2-hr postprandial glucose was 206.3 ± 64.8 mg/dL, with 350 (63.9%) having 2-hr postprandial glucose &amp;gt; 180 mg/dL. The administered insulin dose was 0.35 ± 0.17 units/kg/day, and 101 (18.4%) had an insulin dose &amp;gt; 0.5 units/kg/day. Conclusion: In East Asian patients with type 2 diabetes receiving basal insulin, although high 2-hr postprandial glucose levels suggest the possibility of overbasalization, the administered dosage of basal insulin was relatively low. Considering the lower insulin secretion capacity in East Asians, it is thought that new, specific criteria for overbasalization in East Asians are necessary. Presentation: 6/3/2024

Prospective silent deployment and evaluation of an intelligent machine learning model for prediction of emergency department visits during cancer treatment.

407 Background: Patients undergoing cancer treatment often need to visit the emergency department (ED), straining the healthcare system. We aim to use long-term electronic health record (EHR) data to deploy and evaluate a previously built warning system designed to accurately identify those at risk of ED visits. This system, once validated, will enable clinicians to take early, personalized actions to prevent these ED visits, saving resources and enhancing the quality of life for cancer patients. Methods: Machine learning models were trained usinglongitudinal retrospective EHR data from patients receiving intravenous systemic therapies for gastrointestinal cancers at the Princess Margaret Cancer Centre, aiming to predict ED visits within 30 days of each treatment. Treatments followed by ED visits within one day were excluded to ensure the system focuses on detecting early warning signs rather than imminent ED visits. The models, including tree-based methods and neural networks, were tuned with Bayesian hyperparameter optimization and calibrated using isotonic regression. A temporal split was applied to establish a held-out retrospective test cohort. The best model was silently deployed for prospective validation in patients with gastrointestinal cancer through our internally developed 'MIRA' platform that supports clinical integration. Within MIRA, the patients' EHR data with treatments scheduled the next day are extracted from the EHR system and forwarded to the model for analysis. Results: In the retrospective cohort from January 1, 2014, to December 31, 2019, 1,997 patients underwent 24,350 treatments, with 2,219 (9.11%) leading to ED visits within 30 days. The top-performing model, an extreme gradient boosting tree, achieved an area under the receiver operating characteristic curve (AUROC) of 0.68 and an area under the precision-recall curve (AUPRC) of 0.19 in the held-out test set. Although the evaluation of the system through prospective silent deployment is ongoing, here we report on patients with treatments during March 2024, with adequate 30-day follow up by April 30th, 2024. During this period, 357 patients received 676 treatments, with ED visits within 30-days following 60 (8.88%) treatments. The deployed system achieved an AUROC of 0.66 (confidence interval: 0.60-0.72) and an AUPRC of 0.22 (confidence interval: 0.15-0.32), which closely aligns with those observed during its retrospective testing. At a 10% alarm rate, model has a positive predictive value of 0.33 and sensitivity of 0.22. Conclusions: During a silent prospective deployment, our system predicted ED visits in cancer patients undergoing medical treatment. These findings indicate that the system should be integrated into the clinical workflow and combined with interventions to prevent ED visits.

Evaluation Of A State-wide, Community-based Exercise Program In Patients Undergoing Cancer Treatment: A Subgroup Analysis Of The Life Now Exercise Program

Evaluation Of A State-wide, Community-based Exercise Program In Patients Undergoing Cancer Treatment: A Subgroup Analysis Of The Life Now Exercise Program

Radiation-associated cardiovascular disease in patients with cancer: current insights from a cardio-oncologist.

Radiation-associated cardiovascular disease (RACD), a complex disease characterized with pericarditis, myocardial damage, valvular heart diseases, heart failure, vasculopathy and ischemic heart disease, has a generally poor prognosis. While RACD may be acute, it often manifests in the late years or even decades following radiation exposure to the chest. With an increasing number of cancer survivors, RACD is likely to become an important issue in cardio-oncology. This review discusses pre-radiation therapy (RT) preparation, peri-RT patient management and long follow-up planning post-RT from a cardiology perspective. Additionally, a novel technique of stereotactic radiotherapy, which has been applied for the treatment of intractable cardiac arrhythmias, is presented. Appropriate patient examination and management during and after RT are essential to support patients undergoing cancer treatment to improve long life expectancy. A multidisciplinary team is needed to determine how to manage patients who receive RT to reduce RACD, to detect early phases of RACD and to provide the best treatment for RACD. Recent studies increasingly report advances in diagnosis using new equipment that has the potential to detect early phases of RACD, along with growing evidence for the optimal treatment for RACD. This review provides an overview of recent studies and guidelines to report on the latest findings, and to identify unresolved issues surrounding RACD that require validation in future studies.

The Effect of Mindfulness Based Cognitive Therapy (MBCT) for Optimizing Efficacy Self-Care in Cancer Patients Undergoing Treatment

Cancer is a disease that can threaten a person's life which can occur in every cancer sufferer, apart from that cancer can also cause psychological problems such as low efficacy of patient self-care which will have an impact on treatment compliance in cancer patients.Objective: The aim of this study was to determine the effect of the MBCT intervention on whether it could increase self-care efficacy in cancer patients undergoing cancer treatment. Method: The method used in this research is an experiment with a pretest-posttest design with control group design. The research subjects were 20 people who were divided into experimental and control groups with inclusive. Data analysis used the Wilcoxon and Mann-Whitney tests. Results: The results showed an increase in self-care efficacy after administering the mindfulness-based cognitive therapy (MBCT) intervention with a self-care efficacy value of Z = -2.660 and p = 0.008. Conclusions: The research results show that mindfulness based cognitive behavior therapy (MBCT) can increase patient confidence in carrying out treatment regularly. Cancer patients who Applying MBCT in everyday life they can also feel the effects such as tense muscles becoming more comfortable, better conscious breathing begins to feel the impact on the subject's calmness, and increased ability to detect the body. Mindfulness-based cognitive therapy (MBCT) changes the behavior of each participant to be able to accept themselves in any situation, more easily adapt to changes that occur in their physical and life and establish social relationships with other people.

Aetiology, susceptibility and outcomes of fever in patients receiving chemotherapy in Malawi: a prospective study.

To evaluate causes of fever, including resistance patterns, in patients undergoing cancer treatment in Malawi. In this prospective cohort study, enrolled patients undergoing chemotherapy at Kamuzu Central Hospital in Lilongwe, Malawi were given a thermometer. If a temperature of ≥38°C was recorded, they were instructed to return for hospitalization, standardized fever workup, and antibiotics. All patients were followed through 90 days post-fever event or completion of chemotherapy. One hundred and five patients were screened and 50 were enrolled. Of the enrollees, 26 (52%) were men and 26 (52%) were HIV positive, with a mean ART duration of 7 years and CD4 count of 293 cells/µL. The most common diagnoses were aggressive non-Hodgkin lymphoma (40%) and Hodgkin lymphoma (22%). Twenty-three febrile events were recorded from 15 patients. Of the 23 events, a causative agent was isolated in 13 cases: Escherichia coli (6), Plasmodium falciparum (3), Streptococcus pneumoniae (2), Pseudomonas aeruginosa (1) and Citrobacter freundii (1). Of the six E. coli isolates, all were found to be resistant to fluoroquinolones and 4/6 (66%) were resistant to cephalosporins. All patients but one survived; the death was attributed to Pseudomonas bacteraemia. This study describes laboratory-confirmed causes of neutropenic fever (NF) in cancer patients in Malawi. Gram-negative rods, followed by malaria, were the most common source of infection. Gram-negative rods were associated with high rates of antimicrobial resistance. Malaria and resistant bacterial infections should be considered for NF treatment and prevention in sub-Saharan Africa.

P160 MODELLING CARDIOVASCULAR TOXICITY IN CELLULO ASSOCIATED WITH ANTITUMORALS

Background and Objective: Gastrointestinal cancer (GIC) stands as a leading cause of cancer-related mortality worldwide. Currently combination chemotherapy, particularly metal-based drugs, often induces side effects, limiting their clinical efficacy. Cardiotoxicity, a common complication associated with various therapeutic agents, manifests through vascular endothelial dysfunction, a hallmark of ischemic coronary disease. Our aim is to design novel metal-based drugs with enhanced efficacy, specificity, and mitigated off-target cytotoxicity. We identified the isomers trans and cis-[PtI2(isopropylamine)2] (I5 and I6, respectively), as promising candidates against GIC, both in vitro and in vivo 1. RNA seq was performed in 6 different GIC cells. The Gene Set Enrichment Analysis (GSEA) revealed a significant enrichment of inflammation-related genes and downregulation of angiogenesis-associated pathways in treated cells. Our objective now is to develop preclinical studies of the cardiovascular toxicity of I5 and I6. Methods: Cardiovascular effects of these drugs were studies using a in cellulo model system (AC16, HUVEC cell lines). Biological and biochemistry approaches and techniques were used to assess senescence, mitochondrial respiration, viability by MTS and wound healing assays. Results: Our findings indicate that both I5 and I6 decrease cellular viability, induce senescence (as evidenced by β-galactosidase activity), and generate reactive oxygen species compared to commonly used cisplatin. Additionally, I5 impact oxidative phosphorylation (OXPHOS) and glycolysis metabolism. Furthermore, a wound healing assay suggests that the migration of cells is modulated in response to treatment with these compounds. Conclusions: Accurate preclinical assessment of the effects of novel drugs on the vascular endothelium is imperative to address treatment-induced endothelial dysfunction before envisioning clinical trials. Understanding the impact of anti-cancer agents on the vascular endothelium will not only inform therapeutic strategies to prevent or reverse treatment-induced cardiotoxicity but may also serve as a vital tool for predicting, monitoring, and preventing adverse cardiovascular outcomes in patients undergoing cancer treatment. 1 Commun Biol 7, 353, doi:10.1038/s42003-024-06052-5 (2024).

Are Sodium-Glucose Cotransporter-2 Inhibitors the Cherry on Top of Cardio-Oncology Care?

The increasing aging of the population combined with improvements in cancer detection and care has significantly improved the survival and quality of life of cancer patients. These benefits are hampered by the increase of cardiovascular diseases being heart failure the most frequent manifestation of cardiotoxicity and becoming the major cause of morbidity and mortality among cancer survivor. Current strategies to prevent cardiotoxicity involves different approaches such as optimal management of CV risk factors, use of statins and/or neurohormonal medications, and, in some cases, even the use of chelating agents. As a class, SGLT2-i have revolutionized the therapeutic horizon of HF patients independently of their ejection fraction or glycemic status. There is an abundance of data from translational and observational clinical studies supporting a potential beneficial role of SGLT2-i in mitigating the cardiotoxic effects of cancer patients receiving anthracyclines. These findings underscore the need for more robust clinical trials to investigate the effect on cardiovascular outcomes of the prophylactic SGLT2-i treatment in patients undergoing cancer treatment.

Availability of Cranial Prostheses for Black Patients at Comprehensive Cancer Centers.

For patients who seek to camouflage cancer-related hair loss, cranial prostheses such as wigs and hair pieces exist. We sought to determine the availability of yaki-textured, type IV curls, and afro wigs at boutiques in Comprehensive Cancer Centers (CCCs). The 56 CCCs in the United States were surveyed to see whether they had an affiliated wig boutique for patients experiencing hair loss. Boutique workers were then asked a series of seven questions regarding cranial prostheses options for patients seeking yaki-textured, type IV curls, and afro wigs. The availability of wigs was compared with US Census data on population size and density of Black residents. Of the 56 CCCs, 27 (46%) institutions had active affiliated hair boutiques. We were able to reach 19 (70%) of the 27 boutiques, of which 53% (n = 10) offered yaki-textured wigs, 37% (n = 7) offered type IV curls or afro wigs, and 47% (n = 9) offered neither. Two additional boutiques offered in-store catalogs for Black patients who were interested in naturally appearing wigs. Although two institutions offered a wig bank that was free to all patients, neither had yaki-textured or afro wigs in stock. There was no significant relationship between population size or density of Black residents and availability of these wigs. Many Black patients undergoing cancer treatment interested in cranial prosthesis do not have consistent access to wigs with textures comparable with type IV hair at CCCs. With increased inventory of racially inclusive wigs, partnerships with third-party vendors, and support for the previous authorization process, we can better support Black patients experiencing cancer-related hair loss.