Specialized Cancer Centers Research Articles

Does Clinical and Biochemical Thyroid Dysfunction Impact on Endometrial Cancer Survival Outcomes? A Prospective Database Study.

Simple SummaryEndometrial cancer is the most common gynaecological cancer in high-income countries. Most women are diagnosed early and have an excellent prognosis, but those with advanced or recurrent disease have poor outcomes. The aim of this study was to determine whether clinical or biochemical thyroid dysfunction may contribute to survival outcomes following diagnosis and treatment for endometrial cancer. We analysed clinical data and serum thyroid hormone status of 333 women treated for endometrial cancer at a specialist cancer centre and followed up for a median of 35 months. Women with a diagnosis of hypothyroidism had improved overall, cancer-specific, and recurrence-free survival compared to those without. This may have important implications for our understanding of the mechanisms underpinning biologically aggressive disease and offer opportunities for therapeutic intervention.Endometrial cancer is the commonest gynaecological malignancy in developed countries, and women presenting with high risk or advanced disease have poor outcomes. Thyroid hormones play a key role in cellular metabolism and can influence cancer growth and invasion. Our aim was to evaluate the association between clinical and biochemical thyroid dysfunction and endometrial cancer survival outcomes. This was a prospective cohort study of women treated for endometrial cancer at a specialist centre. Clinical diagnosis of hypothyroidism was based on clinical and biochemical assessment, verified by general practitioner (GP) records. Pre-treatment serum samples were tested for thyrotropin (TSH), thyroid hormones (free T4 and total T3), and thyroid peroxidase antibodies. Kaplan–Meier survival estimates and log-rank tests were used to compare survival between groups, while Cox regression was used for multivariable analysis, adjusting for known confounders and effect modifications. In total, 333 women with median age and body mass index (BMI) of 66 years (interquartile range (IQR) 56, 73) and 33 kg/m2 (IQR 27, 41) respectively were included. A total of 51 (15.3%) women had a diagnosis of hypothyroidism, 39 (11.9%) had biochemical evidence of overt or subclinical hypothyroidism. Median follow-up was 35 months (IQR 21, 45) with 38 (11.7%) relapses and 50 (15.0%) deaths. Women with a diagnosis of hypothyroidism had improved overall survival (adjusted HR = 0.22, 95%CI 0.06–0.74, p = 0.02), cancer-specific survival (adjusted HR = 0.21, 95%CI 0.05–0.98, p = 0.04) and fewer recurrences (adjusted HR = 0.17, 95%CI 0.04–0.77, p = 0.02) than those who did not. Confirmatory studies should explore underlying mechanisms and the potential for therapeutic exploitation.

Impact of nurses' emotional intelligence on the implementation of a professional practice model in cancer care.

To examine the impact of emotional intelligence on the effective implementation of a professional practice model in a specialised cancer centre. The study used a cross-sectional design with 580 frontline nurses at King Hussein Cancer Center, Jordan. The sample was selected using a convenience sampling technique. Data were collected using two self-administered questionnaires to measure emotional intelligence and professional practice. The overall mean value of emotional intelligence was 5.60 out of 6 (SD=0.78), while the overall mean value for the implementation of the professional practice model was 4.76/5 (SD=0.59). The results showed that the overall mean value of emotional intelligence had a significant positive correlation with the effective implementation of the professional practice model (r=0.580, P<0.001), even after adjusting for the participants' demographics (P<0.001). Emotional intelligence can be considered a predictor for the effective implementation of a professional practice model.

Carfilzomib, Lenalidomide, and Dexamethasone Followed by Lenalidomide Maintenance for Prevention of Symptomatic Multiple Myeloma in Patients With High-risk Smoldering Myeloma

High-risk smoldering myeloma has a 5-year risk of progression to symptomatic multiple myeloma of approximately 75%. Treatment with lenalidomide decreases the risk of progression; however, novel triplet regimens are superior, and earlier disease may be more treatment sensitive. To evaluate the use of carfilzomib, lenalidomide, and dexamethasone (KRd) with lenalidomide maintenance therapy as early intervention in high-risk smoldering myeloma and to determine the rates of minimal residual disease (MRD)-negative complete response (CR). In this single-arm, single-center, phase 2 nonrandomized controlled trial, responses were evaluated at every cycle during KRd treatment and every 3 cycles subsequently. Bone marrow biopsies and imaging were performed by cycle 8 and then annually. The study enrolled patients from May 29, 2012, to July 23, 2020, at the National Institutes of Health Clinical Center, a highly specialized tertiary cancer center. Patient key eligibility criteria included a diagnosis of high-risk smoldering myeloma based on the Mayo Clinic, Spanish, and/or Rajkumar, Mateos, and Landgren criteria. Patients received eight 4-week cycles of intravenous carfilzomib 36 mg/m2 (first 2 doses, 20 mg/m2), dexamethasone (20 mg, cycles 1-4; 10 mg, cycles 5-8 twice weekly), and lenalidomide 25 mg (days 1-21) followed by twenty-four 28-day cycles of maintenance lenalidomide 10 mg (days 1-21). Stem cell harvest and storage were optional. The primary outcome was the MRD-negative CR rate. Key secondary outcomes included duration of MRD-negative CR and progression to multiple myeloma. A total of 54 patients (median age, 59 years [range, 40-79 years]; 30 men [55.6%]; and 2 Asian [3.7%], 15 Black [27.8%], 1 Hispanic [1.9%], and 36 White [66.7%] patients) were enrolled, with a median potential follow-up time of 31.9 months (range, 6.7-102.9 months). The MRD-negative CR rate was 70.4% (95% CI, 56.4%-82.0%), with a median sustained duration of 5.5 years (95% CI, 3.7 years to not estimable). The 8-year probability of being free from progression to multiple myeloma was 91.2% (95% CI, 67.4%-97.9%), and no deaths occurred. Nonhematologic grade 3 adverse events occurred in 21 patients (38.9%) and included thromboembolism, rash, and lung infection, with no grade 4 events. Results of this phase 2 nonrandomized controlled trial suggest that treatment of high-risk smoldering myeloma with novel triplet regimens, such as KRd and lenalidomide maintenance therapy, may alter the natural history of smoldering myeloma by significantly delaying development of end-organ disease. Randomized clinical trials are needed to confirm this favorable benefit-to-risk profile. ClinicalTrials.gov Identifier: NCT01572480.

Acute Lymphoblastic Leukemia, Version 2.2021, NCCN Clinical Practice Guidelines in Oncology.

The NCCN Guidelines for Acute Lymphoblastic Leukemia (ALL) focus on the classification of ALL subtypes based on immunophenotype and cytogenetic/molecular markers; risk assessment and stratification for risk-adapted therapy; treatment strategies for Philadelphia chromosome (Ph)-positive and Ph-negative ALL for both adolescent and young adult and adult patients; and supportive care considerations. Given the complexity of ALL treatment regimens and the required supportive care measures, the NCCN ALL Panel recommends that patients be treated at a specialized cancer center with expertise in the management of ALL This portion of the Guidelines focuses on the management of Ph-positive and Ph-negative ALL in adolescents and young adults, and management in relapsed settings.

Work Stress, Coping Strategies, and Health-Related Quality of Life among Nurses at an International Specialized Cancer Center.

Objective:The main objective of this study is to identify work stress, coping strategies, and health-related quality of life and the relationship between them among oncology nurses. Methods:A cross-sectional design was conducted at King Hussein Cancer Center. A convenience sampling technique was used to select 446 nurses. A self-administered questionnaire was utilized using three scales: the Work Stressor Inventory for Nurses in Oncology, Revised Ways of Coping Checklist, and Research and Development 36-Item for Health Survey. Results:The results showed that the levels of work stress (2.61/5), using coping strategy scale (1.59/4), and health-related quality of life scale (50.54/100) were moderate. The total mean value of the work stress scale had a significant positive correlation with the total mean value of the coping strategy scale (r=0.322*, p < 0.05) and a significant negative correlation with health-related quality of life. Moreover, there is no significant correlation between the total mean value of the coping strategy scale and the health-related quality of life scale (r=0121, p >0.05). Age and years of experience were negatively correlated with health-related quality of life (r=0.217 and 0.182 respectively, p < 0.05). Conclusion:Oncology nurses had a moderate level of work stress, coping strategy scale, health-related quality of life scale. Work stress has a significant correlation with using coping strategies and health-related quality of life among oncology nurses. Proper training regarding effective coping strategies is required. More studies are recommended to examine work stress, coping strategy, and health quality of life among oncology nurses.

Impact of Insurance Status on Oncologic and Perioperative Outcomes After Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy.

A growing body of research has shown that underinsured patients are at increased risk of worse health outcomes compared with insured patients. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is largely performed at highly specialized cancer centers and may pose challenges for the underinsured. This study investigates surgical outcomes following CRS-HIPEC for insured and underinsured patients with peritoneal carcinomatosis. We performed a retrospective cohort study of 125 patients undergoing CRS-HIPEC between 2013 and 2019. Patients were categorized into two groups. The insured group was comprised of patients with private insurance at the time of CRS-HIPEC or who obtained it during the follow-up period. The underinsured group consisted of patients with Medicaid, or self-pay. Perioperative and oncologic outcomes were compared between the two groups. A total of 102 (82.3%) patients were insured, and 22 (17.7%) patients were underinsured. There were no significant differences in age, medical morbidities, primary tumor characteristics, peritoneal carcinomatosis index, or completion of cytoreduction score between the two groups. The median overall survival (OS) for insured patients was 64.8 months and was 52.9 months for underinsured patients (p = 0.01). Additionally, insured patients had a significantly longer follow-up time. Underinsurance status also was associated with increased hospital and intensive care unit length of stay, and higher rate of Clavien-Dindo classification III-IV complications. In this retrospective study conducted at a large, urban, specialized cancer center, private insurance status was associated with increased overall survival and longer follow-up period. Furthermore, underinsurance status was associated with increased perioperative morbidity.

The use of nutrition support near the end of life for hospitalized patients with advanced cancer at a reference center: Two realities

To assess the frequency and factors associated of the provision of nutrition support (NS) in the last 30 days of life in patients with advanced cancer in the palliative or non-palliative setting. Retrospective cohort study in palliative and non-palliative care units at a specialized cancer center for oncology in Brazil. The use of oral nutrition supplements (ONS) and enteral (EN) and parenteral (PN) nutrition in the 30 days before death were assessed. The 239 patients included were predominantly older (>60 years; 63.2%) and female (61.1%). The use of ONS was lower in palliative than non-palliative care during the last 30 (52% vs. 6%), 7 (42% vs. 4%), and 3 (23% vs. 2%) days before death (all P < .001). The use of EN and PN was lower in palliative care, decreasing with the approach of death. The independent factors associated with ONS in non-palliative care were (odds ratio): breast tumor (3.03), hypoalbuminemia (1.10), and nutrition risk (16.98); in palliative care, only the Karnofsky Performance Status (KPS) ≥40% (1.24) was associated to the use of ONS. The use of EN and PN was associated with head-neck (HN) tumor in both settings (5.41) in non-palliative and (8.74) in palliative. Others independent factors were: hypoalbuminemia (3.12) in non-palliative care and KPS (1.31) in palliative care. The use of NS near the end of life was high in the non-palliative and less frequent in palliative care setting. The factors associated with NS differed according to the clinical oncology setting, with one of the factors in palliative care being a better prognosis.

Abstract 423: Pooled analysis of matching score and patient outcome in I-PREDICT and WINTHER studies

Abstract Introduction: Comprehensive genomic profiling (CGP) of tumors is available at many specialized cancer centers, potentially allowing oncologists to individualize patient therapy based on tumor molecular features. However, clinicians still lack a systematic approach to deal with the wealth of information provided by CGP. The proportion of plausible drug-matched alterations over the total number of alterations detected by CGP (Matching Score, MS) has been postulated to predict the likelihood of patient benefit. We performed a systematic analysis of MS and its association with the outcome of patients treated according to tumor DNA alterations within two recent precision oncology trials. Materials and Methods: We downloaded the supplementary data from WINTHER (NCT01856296) and I-PREDICT (NCT02534675) studies. We included patients who received treatment for one or more single-gene alterations, excluding eight patients that received immunotherapy due to high tumor mutational burden, PD-L1 positivity or microsatellite instability. We used MS cut-offs of 0.25 (as in WINTHER) and 0.5 (as in I-PREDICT) and also MS as a continuous variable to study its association with clinical variables such as age, sex, tumor type, and number of previous treatment lines (Kruskall-Wallis and Wilcoxon-rank tests), as well as disease control rate (DCR), progression-free survival (PFS) and overall survival (OS) (Cox proportional hazards models). Results: The pooled analysis included 144 patients. Median age was 60 years (range 21-86) and 64% had received ≥ 2 lines of therapy. Most patients had colorectal (37%), lung (14%), or breast (11%) tumors, and 58% were treated with 2 or more drugs. MS was not associated with any clinical variable nor with DCR. MS &amp;gt; 0.25 (n=98; 68%) was associated with longer PFS (median 3.5 vs. 1.9 months, HR [95%CI]: 0.60 [0.41-0.87]) but not with OS. In contrast, MS &amp;gt; 0.5 (n=41; 28%) was associated with longer OS (median 14.1 vs. 6.5 months, HR [95%CI]: 0.50 [0.29-0.54]) but not with PFS. As a continuous variable, increasing MS values were associated with better OS (HR [95% CI]: 0.43 [0.20-0.95]) and with a non-significant trend towards better PFS (HR [95% CI]: 0.54 [0.21-1.05]). In a multivariable model adjusted for Age and study, PFS/OS probabilities improved consistently with increasing MS values from 0 to 0.5. With MS values &amp;gt; 0.5, OS probabilities kept increasing while PFS probabilities plateaued. Conclusions: The significant and consistent relationship between MS and OS (in contrast with PFS) may be explained by patients with higher MS values having more targeted therapies available for successive treatment lines, although we cannot exclude the existence of other confounding prognostic variables. We note that, as better drugs are developed and new knowledge is incorporated into the clinic, the value of CGP will probably increase over time, improving the number of patients with actionable alterations and their outcome. Citation Format: David Casadevall, Michal Marczyk, Xavier Monzonis, Lajos Pusztai, Joan Albanell. Pooled analysis of matching score and patient outcome in I-PREDICT and WINTHER studies [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 423.

Pattern of Practices of Oncologists of Bangladesh in the COVID-19 Era

Purpose: The aim of this study was to investigate the impact of coronavirus disease-2019 (COVID-19) on the practice of oncology care in Bangladesh during the first pandemic surge in 2020. Materials and Methods: This was a cross-sectional survey-type study, based on a questionnaire, which was shared via email to national oncologists and enhanced by snowballing in April–May 2020. Results: A total of 48 responders joined the survey, mostly clinical and radiation oncologists practicing in specialized cancer centers of the major cities. Patients’ triage for COVID-19 was implemented in 60% of the settings surveyed, and an impact on the clinical care was unanimously reported. Delays and interruptions in cancer treatments were common, as was a reduction of patient volume treated with radiation therapy (RT). Mechanisms for priority-setting to inform clinical decisions were set by 80% of the oncologists, including changes in the treatment protocols––more commonly for palliative care interventions and regarding the RT fractionation; also, alternative therapeutic options were more commonly discussed, particularly when patients were candidate to multimodal treatments. Value-driven and choose-wisely approaches were emphasized. Telemedicine was identified as a mechanism to reduce access to hospitals, but only for selected services (e.g., follow-up) by 78%. Protecting hospitals and health workers were identified as priority interventions to shape effective COVID-19 responses. Conclusion: This survey serves as a case study of adaptations of cancer care during COVID-19 in low- and middle-income countries. Elements of priority-settings and value-driven decision-making emerged, although the long-term impact cannot be stated, at this time.

DIFFICULTIES IN MORPHOLOGICAL DIAGNOSIS OF MELANOCYTIC LESIONS: A CASE REPORT

Introduction. Skin cancer is one of the most common malignancies, however melanoma accounts for only 1.8 % of all skin cancers. Melanoma is rare but aggressive tumor. Early detection and appropriate treatment of the tumor are critical and result in improved overall and recurrence-free survival rates. Histopathological reporting plays a critical role in guiding the surgical oncologist’s treatment plan for melanocytic lesions. The experience and knowledge of the pathomorphologist are decisive in the future fate of the patient.Case description. We report a case of a 36-year-old female patient who presented with a pigmented lesion on the skin of the trunk. In the regional cancer center at her place of residence, she underwent surgical removal of this lesion with a surgical margin of about 1 cm. The histological diagnosis was reported as melanoma. Diagnosis of melanoma was also confirmed in another medical center that did not specialize in the treatment of patients with skin tumors, but the tumor thickness was changed to a smaller one. However, in the federal cancer center that specialized in the treatment of patients with skin melanoma, the diagnosis of melanoma was not confirmed. The patient was diagnosed with nevus. The paper discusses in detail the reasons for the erroneous diagnosis of a malignant neoplasm, indicating the stages of differential diagnosis.Conclusion. This clinical case demonstrates that a reference analysis of borderline melanocytic lesions under conditions of specialized cancer centers with experienced pathologists is required. We have described objective difficulties in pathomorphological diagnosis, which can additionally be aggravated by the absence of important clinical and instrumental information, artifacts during excision biopsy, macroscopic examination, and orientation of tissue fragments in the embedding paraffin block.

Decreased Early Mortality in Young Adults with Acute Lymphoblastic Leukemia Treated at Specialized Cancer Centers in California

BackgroundA population-based study suggested that adolescent and young adults with acute lymphoblastic leukemia (ALL) have superior survival when treated at specialized cancer centers (SCC; versus community hospitals). However, the association of location of initial care with early mortality (death within 60 days) has not yet been evaluated in children and adolescents and young adults with ALL. Therefore, we examined the impact of location of initial care, sociodemographic factors and complications on early mortality in children (0-18 years) and adolescent and young adults (AYAs; 19-39 years) with ALL.MethodsUsing the California Cancer Registry linked to a hospitalization database in California, we identified children and AYAs with first primary diagnosis of ALL who received inpatient treatment within 60-days of diagnosis between 1991 and 2014. SCCs were defined as Children's Oncology Group or National Cancer Institute (NCI)-designated cancer centers for children and NCI-designated cancer center for AYAs. Children and AYAs were classified as receiving all or part/none of their care at a SCC within 60-days of diagnosis. Mulitple logistic regression was used to identify factors associated with receiving all initial care at a SCC and to build a propensity score separately for children and AYAs. Inverse probability-weighted, multivariable logistic regression models estimated the associations between location of care, sociodemographic characteristics, clinical factors and complications with early mortality. Results are presented as odds ratios (ORs) and 95% confidence intervals (CI).ResultsOf the 6,531 patients with ALL in our study, the overall early mortality rate for was 2.1% in children and 6.3% in AYAs. The majority of children received all of their care at an SCC (n=4752, 85.4%) compared to only 36.1% of AYAs (n=1779). Rates of early mortality varied significantly by location of care and age (children: all care at an SCC 1.9% vs part/none 3.2%, p=0.04; AYAs: all care at an SCC 3.9% vs part/none 7.7%, p=0.002). Among children, factors associated with receiving all care at a SCC were younger age, Hispanic race/ethnicity (vs non-Hispanic white), more recent diagnosis and having public/no insurance (vs private). Factors associated with receiving all care at a SCC among AYAs were younger age, non-Hispanic white race/ethnicity (vs Hispanic), public/no insurance, and living in a lower socioeconomic status (SES) neighborhood. In multivariable, inverse probability weighted models, receiving all care at a SCC (versus part/no care) was associated with significantly lower early mortality in AYAs (OR 0.44, CI 0.27-0.74), but not in children (OR 0.61, CI 0.34-1.08). Higher early mortality in children was associated with complications of bleeding (OR 5.73, CI 2.76-11.90), sepsis (OR 2.02, CI 1.01-4.04), renal (OR 4.1, CI 2.17-7.76) and respiratory failure (OR 5.48, CI 2.66-11.29). In AYAs, higher early mortality was associated with older age (>29), having a comorbidity (OR 1.83, CI 1.08-3.10) and complications of liver failure (OR 8.03, CI 2.41-26.76), renal failure (OR 2.45, CI 1.33-4.52) and respiratory failure (OR 11.89, CI 5.87-24.09). Early mortality was not associated with race/ethnicity, neighborhood SES or health insurance for either age group. Rates of complications were similar by location of care in children and AYAs except for thrombosis in children (all: 0.40% vs part/none: 1.00% p=0.03) and renal failure in AYAs (all: 14.3% vs part/none: 10.7% p=0.03).ConclusionsOur results suggest that treatment at a SCC is associated with a significantly lower early mortality for AYA patients after adjusting for sociodemographic and clinical factors. We observed a borderline difference in mortality by location of care in children, likely because, in contrast to AYAs, the vast majority of children are seen at SCCs. The reduction in mortality at SCCs may be due to access to clinical trials and other specialized services available at these types of institutions. DisclosuresWun:Janssen: Other: Study steering committee and research support (site PI); Pfizer: Other: Study steering committee and research support (site PI).

Medical Oncology Education in Egypt Over the Past 50 Years: the Experience of the National Cancer Institute of Cairo University.

This manuscript outlines the progress of education in the field of medical oncology in Egypt over the past 50 years. The manuscript illustrates the origin of the Egyptian medical oncology program since the creation of the only specialized cancer center in the country, the National Cancer Institute of Cairo University (NCI-Cairo) in 1969, from Cairo University Medical School. The manuscript also outlines the NCI-Cairo’s educational program for developing a cadre of academic medical oncologists for NCI-Cairo, other Egyptian medical institutions, and countries in the Middle East and Africa. We also emphasize the capacity building that resulted over the past 50 years from academic and professional standpoints, the changing curriculum in medical oncology, and the differences between the medical oncology and clinical oncology education programs in the country. Medical oncology research resulted from international collaborations and highlighted needs for cancer prevention and control. Finally, we propose possible future directions for medical oncology education and research in the country and a roadmap for low- and middle-income countries (LMICs) that are developing their medical oncology programs.

Enrolment of older adults with cancer in early phase clinical trials-an observational study on the experience in the north west of England.

older patients represent the majority of cancer patients but are under-represented in trials, particularly early phase clinical trials (EPCTs). observational retrospective study of patients referred for EPCTs (January-December 2018) at a specialist cancer centre in the UK. The primary aim was to analyse the successful enrolment into EPCTs according to age (<65/65+). The secondary aims were to identify enrolment obstacles and the outcomes of enrolled patients. Patient data were analysed at: referral; in-clinic assessment and after successful enrolment. Among patients assessed in clinic, a sample was defined by randomly matching the older cohort with the younger cohort (1:1) by tumour type. 555 patients were referred for EPCTs with a median age of 60years, of whom 471 were assessed in new patient clinics (38% were 65+). From those assessed, a randomly tumour-matched sample of 318 patients (159 per age cohort) was selected. Older patients had a significantly higher comorbidity score measured by ACE-27 (P < 0.0001), lived closer to the hospital (P = 0.045) and were referred at a later point in their cancer management (P = 0.002). There was no difference in suitability for EPCTs according to age with overall 84% deemed suitable. For patients successfully enrolled into EPCTs, there was no difference between age cohorts (20.1 vs. 22.6% for younger and older, respectively; P =0.675) and no significant differences in their safety and efficacy outcomes. older age did not affect the enrolment into EPCTs. However, the selected minority referred for EPCTs suggests a pre-selection upstream by primary oncologists.

Patient-reported financial toxicity following management of localized prostate cancer.

e17053 Background: Cancer patients’ potential for severe financial toxicity (FT) is well-established, however there is limited data on the magnitude of this challenge associated with treatment of localized prostate cancer (PC). The extent to which men consider potential financial implications prior to selection of a treatment strategy remains poorly understood. Methods: Between 5/2020-10/2020, 1233 insured PC patients treated at a comprehensive cancer center completed a one-time FT survey which included the COmprehensive Score for financial Toxicity (COST) instrument, impressions of PC costs and financial coping strategies. Inclusion criteria was localized disease and treatment with either radical prostatectomy (RP) or definitive radiotherapy (RT) in the previous 4-26 months (mo) or at least 6mo of active surveillance (AS) prior to survey. To assess possible temporal differences in FT, responses were grouped into 6, 12, 18 and 24 months after treatment start, and we plotted COST against time, using generalized additive models to allow for non-linearity. Results: Overall, 988 men were eligible for analysis: 347 (35%) underwent RP, 384 (39%) underwent RT, and 257 (26%) were on AS. The median age at survey completion was 67 years (quartiles 62, 72). Men were predominantly white (89%), English-speakers (99%) and married (84%). The median (quartiles) COST score for all patients was 33 (26, 38) with possible range of 0-44 with lower scores indicating greater FT; median values were identical with similar quartiles (+/- 1 point) when stratified by treatment type. There were no significant changes in median COST between men surveyed at the four time points for any treatment subgroup. In total, 66 men (7.1%) reported spending &gt; 20% of annual income on treatment and 10% felt that PC has created at least somewhat of a financial hardship for their family. Top drivers of burdensome cost included medical bills (37%) and transportation costs (21%). Most (83%) reported giving little or no consideration to possible costs prior to making a PC treatment decision, yet the majority (77%) felt that out of pocket costs should be communicated to a patient prior to decision making. Most believed patients should definitely (46%) or possibly (33%) have the opportunity to discuss financial concerns with the radiation oncologist or urologist. Conclusions: Our study is the first reported use of the COST instrument to assess subjective financial distress in localized PC patients. Our results demonstrate that the overall degree of FT in this cohort of insured patients treated at a specialized cancer center is low. While potential financial burden does not strongly influence treatment decision making in this cohort, most want this information and an opportunity to discuss financial concerns with their oncologist. Next steps include identification of predictors for high FT risk and extension of our survey to hospital systems with differing demographic profiles.

Oncotype Dx score associated to pathological features to better prognosticate the risk of recurrence for breast cancer patients.

e12562 Background: Oncotype Dx (ODX) prognosticates the risk of recurrence and predicts the benefit of adjuvant chemotherapy in estrogen-receptor-positive breast cancer (BC). However, it puts aside important clinical features. Our objective is to develop a model that uses routine clinical parameters associated with Oncotype Dx score to estimate the recurrence rate in our population. Methods: We retrospectively reviewed ODX and pathology reports from 371 early BC patients diagnosticated between 2014 and 2016 in a specialized cancer center, with a 5 year follow up. Variables were selected first with a univariate cox regression, then the statistically significant variables underwent a multivariate cox regression. The β coefficients from selected variables were used to create the prediction formula. Results: Among the tested variables, ki67, estrogen receptor (ER) and ODx score were significantly associated with Recurrence. The linear predictor is: (0.1331 x Ki67) + (0.4232 x ER)+(0.2112xODx score). The threshold score for this equation was set on 33 (median value) to discriminate low and high estimated risks for recurrence. The correct classification rate (CCR) for the training and validation sets was 76% and 68%, respectively. Conclusions: It is possible to optimize the Oncotype Dx to better determine a recurrence score with selected pathological features.

Cancer care system strengthening (Pendharkar model) offers uninterrupted care continuum during COVID19 pandemic.

e13540 Background: District cancer care programme is operational in more than 150 districts of India. This programme has created nodal cancer units n government run district general hospitals offering cancer related services including chemotherapy and palliative care. During pandemic (COVID19), due lockdown, cancer patients were not able to access tertiary level specialised cancer centres. Aim of this presentation is to reaffirm the necessity of health system strengthening at peripheral level. Methods: With the aim of decentralization and task shifting, district cancer care programme is being implemented in 8 states of India. One general duty medical officers and paramedical staff is trained to assist cancer patients. The physician work under 24 x7 mentorship of oncology team. The government has created a physical cancer care unit with availability of some essential chemotherapy drugs as well. Cancer patients can access these units for assistance in diagnostics, follow-up, toxicity care, chemotherapy and palliative care. Results: We analysed data from few districts in year 2020. The number of patients vesting the units showed an increase during months of total lockdown. Data from 14 districts were analysed. It shows that number of outpatient visits and chemotherapy sessions were higher during strict lockdown. From January 2020 to December 2020 there were 19,273 outpatient visits, and 9,788 inpatient visits. During months of a strict lockdown-March, April, May, June the number increased.7,729 sessions of chemotherapy were performed and more than 2,230 new cases were registered during this year. Conclusions: The pandemic has brought new challenges and has compelled us to learn ways of care continuum. The most important has been the necessity of decentralisation of specialised care, its evenly and equitable distribution. District cancer care programme, as a measure of health system strengthening, which is being evolved in India has further emphasized the importance of such a system building.

Long-term outcomes of resection for locoregional recurrence of colon cancer: A retrospective descriptive cohort study

IntroductionResection for isolated distant recurrence of colon cancer is well accepted. Resection for locoregionally recurrent colon cancer (LRCC) is not well studied. We evaluated the long-term outcomes of curative-intent resection for LRCC. MethodsAll patients undergoing curative-intent resection for LRCC at three specialized cancer centers affiliated with the University of Toronto were identified (1993-2017). Follow-up included serial clinical assessment, colonoscopy, CEA, and cross-sectional imaging. Overall survival (OS), cancer-specific survival (CSS) and time to re-recurrence were estimated using Kaplan-Meier method and cumulative incidence function. The association between resection margins and outcome was assessed with Cox models. Results117 patients were included in the study cohort. Median follow-up was 53 months (IQR: 34-101). OS was 75% (95% CI: 68-84) at 5 years, and 69% (95% CI: 59-79) at 10 years. CSS was 78% (95% CI: 70-86) at 5 years and 72% (95% CI: 63-83) at 10 years. The rate of re-recurrence was 22% (95% CI: 14-31) at 5 years, and 27% (95% CI: 16-39) at 10 years. Negative resection margin (R0) was associated with improved OS (HR 3.33, 95% CI: 1.85–6.00, p < 0.01). There were no postoperative deaths; complications with Clavien-Dindo grade > II occurred in 12% of patients. Perioperative chemotherapy was used in 63% of patients and radiotherapy in 37%. ConclusionIn selected patients with LRCC, excellent OS, CSS and low re-recurrence rates were observed, and R0 resection predicted better outcomes. These findings support consideration of resection for LRCC in fit patients after review at a multidisciplinary cancer conference.

Current Diagnosis and Treatment Options for Cutaneous Adnexal Neoplasms with Follicular Differentiation.

Neoplasms derived from follicular tissue are extremely rare. Clinically, they are reported as non-symptomatic, slow-growing nodules. These lesions are mainly benign, but the malignant type can occur. Mainly middle-aged people (50–60 years of age) are affected. These carcinomas are mainly localized on the head and neck or torso. They can be locally aggressive and infiltrate surrounding tissue and metastasize to regional lymph nodes. In the minority of cases, distant metastases are diagnosed. Quick and relevant diagnosis is the basis of a treatment for all types of tumors. The patient’s life expectancy depends on multiple prognostic factors, including the primary tumor size and its mitotic count. Patients should be referred to a specialized skin cancer center to receive optimal multidisciplinary treatment. This article tries to summarize all the information that is currently available about pathogenesis, diagnosis, and treatment methods of follicular tumors.

Using Failure Mode and Effects Analysis in Improving Nursing Blood Sampling at an International Specialized Cancer Center.

Background:The process of blood sampling is considered one of the primary and most common nursing invasive procedures carried out daily. Any failure at any point could have a severe negative impact on patient outcomes. Purpose:This project aimed to assess and improve the nursing blood sampling process in a specialized cancer center using failure mode and effect analysis (FMEA). Methods:An observational analytical design of the nursing blood sampling process using FMEA was conducted in King Hussein Cancer Center in Amman, Jordan. Seven steps were conducted, including a review of the blood sampling process, brainstorming potential failures, listing potential effects of each failure mode, assigning a severity rating for each potential effect, assigning a frequency/occurrence rating for each failure mode, assigning a detection rating scale for each failure mode, and calculating the Risk Priority Number (RPN) for each effect. Results:Eight (out of 28) main critical failure modes with more than 200 RPN were identified in the blood sampling process. Accordingly, five themes were developed to guide the corrective actions. These themes included: process and responsibility modifications, resource and information technology utilization, patients and family engagement, safety culture, and education and training after implementation of the corrective actions. This resulted in a 58 % reduction in the RPN of major failure modes. Conclusion:Many factors lead to blood sampling errors. A critical focus should be conducted on the preparation phase due to the possible errors that may occur. Proper identification of patients and blood sample tests are the keys to a significant decrease in blood sampling errors.

Impact of location of inpatient cancer care on patients with Ewing sarcoma and osteosarcoma-A population-based study.

Ewing sarcoma (EWS) and osteosarcoma (OS) require multidisciplinary treatment. Care at specialized cancer centers (SCC: Children's Oncology Group affiliated and/or National Cancer Institute-designated cancer center) has been found to improve outcomes in patients with leukemia, but studies have not considered location of care and outcomes in EWS and OS patients, an ideal group to evaluate given their specialized multidisciplinary treatment needs. Patients hospitalized with primary EWS and OS (2000-2014) were identified using the California Cancer Registry linked with hospitalization data. Patients were divided into age groups (0-18, 19-39, ≥40years), and classified on whether they received all versus part/none of their inpatient treatment at a SCC within 1year of diagnosis. Multivariable Cox proportional hazards regression identified factors associated with survival. There were 531 ES and 959 OS patients. Five-year overall survival was better for patients with EWS (all: 63% vs. part/none: 42%) and OS (all: 64% vs. part/none: 47%) who received all of their treatment at a SCC. After adjusting for sociodemographic and clinical factors, receiving all inpatient cancer treatment at a SCC was associated with superior overall survival (EWS HR: 0.49, CI 0.37-0.67; OS HR: 0.78, CI 0.63-0.97). Our results suggest that treatment for EWS and OS at a SCC is associated with significantly improved survival even after adjustment for known prognostic factors. The superior survival among those treated at SCCs may be due to having greater access to clinical trials and services at SCCs.