ObjectiveThe objective of this research is to examine the relationship between digital maturity and hospital care provided to patients who are living with high social disparities.Materials and methodsThis cross-sectional observational study used digital maturity data from 2,247 acute-care hospitals in the United States, linked to CMS Cost Report data, CMS Hospital Service Area data, and ZIP-code-level Social Deprivation Index (SDI) data. EMRAM maturity was classified into three categories: Low=Stage 0, Medium=Stages 1–5, and High=Stages 6–7. The primary measure of social disparity was hospital-level weighted average SDI, dichotomized at the top 20%. Hospital-level administrative indicators included Medicaid caseload, charity-care burden, and bad-debt burden. Multinomial logistic regression was used as the primary model, adjusted for hospital characteristics and U.S. region. Results are reported as average differences in predicted probabilities of Low, Medium, and High EMRAM maturity. Pearson correlations and principal component analysis were used to assess convergence between SDI and hospital-level administrative proxy indicators.ResultsHospitals treating patient populations in communities with the top 20% of SDI were more likely to have Low EMRAM maturity and less likely to have High EMRAM maturity. In the adjusted multinomial logistic regression model, hospitals in the top SDI category were 5.9 percentage points more likely to have Low EMRAM maturity and 4.6 percentage points less likely to have High EMRAM maturity; the association with Medium EMRAM maturity was not statistically significant. Medicaid caseload and bad-debt burden were not significantly associated with EMRAM maturity. Charity-care burden was associated with EMRAM maturity differently by hospital ownership. Among nonprofit hospitals, top charity-care burden was associated with lower probability of Low EMRAM maturity and higher probabilities of Medium and High EMRAM maturity. Among proprietary hospitals, top charity-care burden was associated with lower probability of Low EMRAM maturity and higher probability of Medium EMRAM maturity, but not High EMRAM maturity. Among government hospitals, charity-care burden was not significantly associated with EMRAM maturity.Discussion and conclusionsHospitals serving populations with the highest social disparities were more likely to have Low EMRAM maturity and less likely to have High EMRAM maturity, suggesting that patients in these communities may have reduced access to hospitals with advanced digital maturity that supports coordinated, data-driven, safe, and high-quality care. Hospital administrative measures, including Medicaid caseload, uncompensated care, charity care, and bad debt, did not measure the same construct as community-level social deprivation. Charity-care burden was not uniformly associated with digital maturity across all hospitals; rather, its association differed by ownership type, with the strongest pattern observed among nonprofit hospitals. These findings should be interpreted as observational associations from pre-pandemic data and not as evidence of causal relationships.

Digital transformation is critical to strengthening public health infrastructure, yet implementation across jurisdictions remains uneven. In the United States, state-level public health systems vary widely in their digital capabilities. Missouri's Department of Health and Senior Services (DHSS) launched a digital modernization strategy to address these gaps. The objective of this work was to assess the digital maturity of Missouri's public health system and examine how a validated digital maturity framework can inform strategic planning and investment. This was a cross-sectional, quantitative study using primary data collected from 59 public health teams across six DHSS divisions in 2024. The validated Digital Health Indicator (DHI) framework was applied via structured interviews to assess digital maturity across four dimensions: governance and workforce, interoperability, person-enabled health, and predictive analytics. Descriptive statistics and ANOVA were used to compare results across divisions, with forest plots used to visualize pairwise differences. The mean DHI score was 35.6/100, with substantial variation across divisions (range: 7-68). The Division of Community and Public Health achieved the highest scores (mean 50.8), while the State Public Health Laboratory scored lowest (mean 19.0). Interoperability and predictive analytics showed the greatest variability. Organizational readiness was consistently high, but constrained by limited infrastructure and uneven workforce digital training. A standardized digital maturity framework can reveal systemic strengths and gaps within public health systems, guiding targeted, specific, measurable, achievable, relevant, and time-bound (SMART) digital investments. Missouri's experience demonstrates how structured assessment tools can support scalable and replicable digital transformation strategies applicable across U.S. states and other jurisdictions seeking to modernize public health services.

Treatment Free Remission (TFR) is an established goal for patients with the diagnosis of chronic myeloid leukemia (CML). The purpose of this prospective feasibility pilot study was assessing a new, real-world paradigm for safely stopping TKI treatment by monitoring molecular response through PCR tests determining BCR::ABL levels every 6 weeks instead of the recommended 4-week intervals. A successful re-establishment of MMR after loss of TFR was the primary endpoint. Eligibility criteria for this study included maintaining major molecular response 4 log reduction (MMR4) for 2 years and a total of TKI therapy for 5 years. The primary endpoint was successful maintenance of ≥ MMR at 6 months. 18 patients were enrolled, 13 of the 18 participants maintained TFR, and all 5 patients regained MMR with resumption of TKI treatment. We demonstrated that this pilot study was feasible in a community setting using 6-week intervals. This study will be expanded to other sites using a 6-week testing interval.

Estimation of reliability and stress–strength parameters is important in the manufacturing industry. In this paper, we develop shrinkage-type estimators for the reliability and stress–strength parameters based on progressively censored data from a rich class of distributions. These new estimators improve the performance of the commonly used Maximum Likelihood Estimators (MLEs) by reducing their mean squared errors. We provide analytical asymptotic and bootstrap confidence intervals for the targeted parameters. Through a detailed simulation study, we demonstrate that the new estimators have better performance than the MLEs. Finally, we illustrate the application of the new methods to two industrial data sets, showcasing their practical relevance and effectiveness.

Abstract Background Non‐small cell lung cancer (NSCLC) is often diagnosed at an advanced stage. Clinical trials have demonstrated that first‐line immunotherapy alone or in combination with chemotherapy improves overall survival. However, reports of survival outcomes in real‐world settings are limited. We assessed survival in advanced NSCLC patients treated with immunotherapy alone or in combination with chemotherapy in first‐ or second‐line at the Windsor Regional Cancer Program (WRCP) and compared it to existing literature. Methods We included patients diagnosed with stage IV NSCLC from January 2015 to December 2020 and treated with first‐line chemoimmunotherapy (ChemoImmuno1), chemotherapy followed by immunotherapy (Chemo1), or immunotherapy followed by chemotherapy (Immno1) in our survival analysis. Patients with oncogene‐addicted mutations were excluded. Results There were 160 patients of which 41.5% were female. Mean age was 68 years. Median overall survival from time of diagnosis was 474 days (95% CI: 249, 949) with an estimated 5‐year survival of 11.1% (95% CI: 4.5, 21.3). Median OS in ChemoImmuno1 was 9.6 months, in Chemo1 was 19.2 months from time of diagnosis and 10.5 months from time of initiation of immunotherapy, and in Immuno1 was 18.4 months, respectively. Estimated survival at three years from time of diagnosis for ChemoImmuno1 was 17.6% and for Immuno1 was 17.9%. For Chemo1, from diagnosis it was 20.1% and from second‐line therapy it was 15.4%. Survival outcomes were comparable to clinical trials and other studies. Conclusion Real‐world survival outcomes of immunotherapy for advanced NSCLC are comparable to the existing literature in this single center study.

Participation in clinical trials is a recommended component of cancer patient care, yet patient accrual is poor, especially in community-based hospitals, which account for up to 70% of beds in Ontario, Canada. Moreover, the lack of clinical trials at smaller centres adds a unique challenge to community-based oncologists who must look outside their centres for patient access to clinical trials. To address these challenges, the Clinical Trials Navigator program (CTN) is being piloted at a large community hospital and used to identify eligible clinical trials for patients outside of their treating centre.This current study compared physician and patient perceptions of clinical trial barriers and influencing factors in a community-based hospital setting. Through this work, we discovered a novel barrier to community-based patients entering clinical trials.Cancer patients and physicians were recruited to participate in online surveys related to barriers to clinical trial accrual and their use of the CTN. Participant survey responses were analyzed and compared.We found that physicians rated the CTN very likely to increase accrual to clinical trials. However, physicians had a significantly different attitude toward factors that most likely affected patient referral to a clinical trial outside of their primary treatment site: patient time and out of pocket cost. Physicians felt these were significant barriers, but patients did not. This discrepancy uncovers a critical barrier in improving clinical trials accrual, as physicians would be less likely to refer patients, even though an appropriate clinical trial was identified and the patient may be willing.

Purpose This study examines the outcomes of locally advanced head and neck squamous cell carcinoma (HNSCC) following the adoption of conventional intensity -modulated radiotherapy (cIMRT) and volumetricmodulated arc therapy (VMAT) over a decade. The region under study has higher comorbidities associated with increased HNSCC incidence and poorer prognosis. Materials and methods A 10 -year retrospective review of electronic medical records included 296 patients with stage III, IVA, and IVB HNSCC (American Joint Committee on Cancer, Seventh edition). Survival outcomes were compared between VMAT and cIMRT using Kaplan -Meier survival curves and adjusted for relevant demographic factors using Cox's proportional hazards model. Analysis was performed using R software (R Foundation, Vienna, Austria). Results The median age of the cohort was 63 years, comprising of 80% males. The oropharynx was the most common primary tumor site. 264 (89%) received 50Gy or higher dose radiation by either cIMRT (22%) or VMAT (67%). At five years, locoregional control (LC) and overall survival (OS) rates were 79.5% and 56.7%, respectively. VMAT showed a significant improvement in five-year OS (63.4% versus 43.8% for cIMRT, p=0.0023) but no significant difference in five-year LC (81% VMAT versus 74.5% cIMRT, p=0.17). Grade 3-4 acute toxicity was observed in 22% of patients. Conclusions VMAT and cIMRT demonstrated excellent LC in locally advanced HNSCC despite high comorbidity rates. Notably, VMAT was associated with significantly better OS compared to cIMRT. These outcomes surpass historical data, suggesting that VMAT technology may lead to improved patient outcomes. However, larger randomized controlled trials and dosimetric studies are needed to confirm these findings.

Patient experience is globally recognized as an important indicator of health system performance, linked to health system quality and improving patient outcomes. Post COVID-19, health systems have embraced digital health and advanced digital transformation efforts; however, the relationship between digital health and patient experience outcomes is not well-documented. Using HCAHPS hospital survey data to measure patient experience, and HIMSS EMRAM Maturity Model data to measure digital maturity, a cross-sectional design using multivariate analyses examined the impact of digital maturity on patient experience in US hospitals. Our analysis shows that advanced digital maturity in US hospitals is associated with stronger patient experience outcomes, particularly relative to communication with nurses, doctors, and communication about medicines and therapies. The findings suggest that there are significant differences in patient experience associated with teaching versus nonteaching hospitals, urban versus rural hospitals. As hospitals advance and progress digital transformation initiatives, evidence to inform how transformation efforts can engage and advance patient experience will contribute to health system performance well into the future.

Background This study demonstrates that digital maturity contributes to strengthened quality and safety performance outcomes in US hospitals. Advanced digital maturity is associated with more digitally enabled work environments with automated flow of data across information systems to enable clinicians and leaders to track quality and safety outcomes. This research illustrates that an advanced digitally enabled workforce is associated with strong safety leadership and culture and better patient health and safety outcomes. Objective This study aimed to examine the relationship between digital maturity and quality and safety outcomes in US hospitals. Methods The data sources were hospital safety letter grades as well as quality and safety scores on a continuous scale published by The Leapfrog Group. We used the digital maturity level (measured using the Electronic Medical Record Assessment Model [EMRAM]) of 1026 US hospitals. This was a cross-sectional, observational study. Logistic, linear, and Tweedie regression analyses were used to explore the relationships among The Leapfrog Group's Hospital Safety Grades, individual Leapfrog safety scores, and digital maturity levels classified as advanced or fully developed digital maturity (EMRAM levels 6 and 7) or underdeveloped maturity (EMRAM level 0). Digital maturity was a predictor while controlling for hospital characteristics including teaching status, urban or rural location, hospital size measured by number of beds, whether the hospital was a referral center, and type of hospital ownership as confounding variables. Hospitals were divided into the following 2 groups to compare safety and quality outcomes: hospitals that were digitally advanced and hospitals with underdeveloped digital maturity. Data from The Leapfrog Group's Hospital Safety Grades report published in spring 2019 were matched to the hospitals with completed EMRAM assessments in 2019. Hospital characteristics such as number of hospital beds were obtained from the CMS database. Results The results revealed that the odds of achieving a higher Leapfrog Group Hospital Safety Grade was statistically significantly higher, by 3.25 times, for hospitals with advanced digital maturity (EMRAM maturity of 6 or 7; odds ratio 3.25, 95% CI 2.33-4.55). Conclusions Hospitals with advanced digital maturity had statistically significantly reduced infection rates, reduced adverse events, and improved surgical safety outcomes. The study findings suggest a significant difference in quality and safety outcomes among hospitals with advanced digital maturity compared with hospitals with underdeveloped digital maturity.

Background: Current management for triple negative breast cancer (TNBC) involves chemotherapy and immunotherapy systemic treatments. TNBC treatment remains a challenge, with up to 40% of those treated using standard methods for stage I to III TNBC experiencing recurrence. Currently, the optimal carboplatin regimen for TNBC is yet to be defined. In our previous study, we identified an optimal carboplatin containing chemotherapy regimen that improved patient outcomes. In this study, we expanded the cohort as an extension of the previous prospective study to further verify these promising results. Patients and Methods: We performed a retrospective review of 37 TNBC patients who had < 10% estrogen and progesterone receptor positivity and were human epidermal growth factor receptor-2 (HER2) negative. This study was originally done in an adjuvant setting, but patients with locally advanced tumors received neoadjuvant chemotherapy. Patients received dose-dense Adriamycin, cyclophosphamide, and paclitaxel every two weeks for sixteen weeks. Adriamycin (60 mg/m^2) and cyclophosphamide (600 mg/m^2) were given intravenously every two weeks for four cycles, followed by paclitaxel (175 mg/m^2) every two weeks for four cycles. Carboplatin with an area under the curve of 6 was added to cycles two and four of paclitaxel. Last, we changed the parameters of continuing chemotherapy to allow platelet counts > 70,000 × 10^9. Only paclitaxel could be modified for neuropathy. Results: Of 37 patients enrolled in this trial, 35 patients survived without recurrence, one required a dose reduction in paclitaxel, and one has incomplete staging as grade is still pending. The two patients that did experience recurrence died. Of these two patients, the first had American Joint Committee on Cancer (AJCC) 7 stage IIIC cancer, and the second had two separate TNBCs at presentation – AJCC-7 IIB cancer of the right breast and AJCC-7 IIA cancer of the left breast. Under the AJCC-8 system, the first patient had AJCC-8 IIIB cancer, while the second patient had AJCC-8 IIIB cancer of the right and left breasts. These data suggest a completion rate of 97%, overall survival (OS) rates of 95% (AJCC-7 & 8), and progression free survival (PFS) rates of 95% and 94% (AJCC-7 & 8, respectively; Table 1). Additional stage-specific survival metrics and patient staging information are available in Table 1. Median follow-up in this study was 3.14 years. This is consistent with data from our previous study with significant PFS benefit over historic chemotherapy. All patients completed this regimen with no dose reductions of carboplatin and a 32% dose reduction in paclitaxel due to neuropathy. Toxicity was established in our previous study. The favourable toxicity profiling of the regimen allowed maximal tolerance for patients. Conclusion: Although administration of carboplatin with chemotherapy for TNBC is known to be beneficial, the ideal carboplatin containing regimen has not been identified because of concerns regarding toxicity and low completion rates. Here, an optimal carboplatin-containing regimen identified in our previous clinical trial led to 95% overall survival rates (AJCC-7 & 8), 95% and 94% progression free survival rates (AJCC-7 & 8, respectively), and a 97% completion rate for 37 TNBC patients. A limitation is that this is a small single center trial, and plans are underway to test this regimen with immunotherapy in a larger randomized control trial. Table 1: Patient Staging and Survival Metrics. Citation Format: Geoffrey J. Rempel, Claire S. Rim, Abdulkadir Hussein, Alina Bocicariu, Swati Kulkarni, Rasna Gupta, John Matthews, Amin Kay, Lisa Porter, Caroline Hamm. Identification of Optimal Carboplatin Containing Regimen for Triple Negative Breast Cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-07-60.

This book presents some post-estimation and predictions strategies for the host of useful statistical models with applications in data science. It combines statistical learning and machine learning techniques in a unique and optimal way. It is well-known that machine learning methods are subject to many issues relating to bias, and consequently the mean squared error and prediction error may explode. For this reason, we suggest shrinkage strategies to control the bias by combining a submodel selected by a penalized method with a model with many features. Further, the suggested shrinkage methodology can be successfully implemented for high dimensional data analysis. Many researchers in statistics and medical sciences work with big data. They need to analyse this data through statistical modelling. Estimating the model parameters accurately is an important part of the data analysis. This book may be a repository for developing improve estimation strategies for statisticians. This book will help researchers and practitioners for their teaching and advanced research, and is an excellent textbook for advanced undergraduate and graduate courses involving shrinkage, statistical, and machine learning. The book succinctly reveals the bias inherited in machine learning method and successfully provides tools, tricks and tips to deal with the bias issue. Expertly sheds light on the fundamental reasoning for model selection and post estimation using shrinkage and related strategies. This presentation is fundamental, because shrinkage and other methods appropriate for model selection and estimation problems and there is a growing interest in this area to fill the gap between competitive strategies. Application of these strategies to real life data set from many walks of life. Analytical results are fully corroborated by numerical work and numerous worked examples are included in each chapter with numerous graphs for data visualization. The presentation and style of the book clearly makes it accessible to a broad audience. It offers rich, concise expositions of each strategy and clearly describes how to use each estimation strategy for the problem at hand. This book emphasizes that statistics/statisticians can play a dominant role in solving Big Data problems, and will put them on the precipice of scientific discovery. The book contributes novel methodologies for HDDA and will open a door for continued research in this hot area. The practical impact of the proposed work stems from wide applications. The developed computational packages will aid in analyzing a broad range of applications in many walks of life.

e12511 Background: Triple-negative breast cancer (TNBC) has been associated with poorer long-term outcomes compared to other breast cancer subtypes. Due to the lack of targeted therapies, the use of adjuvant chemotherapy is the mainstay of treatment, and its efficacy has demonstrated to be correlated with tumor size. Currently, different national guidelines exist regarding chemotherapy in early stage I TNBC. This study aims to examine the outcomes of the use of adjuvant chemotherapy in stage I TNBC stratified by tumor size and treated in Ontario, using the ICES database. Methods: Records of stage I TNBC patients diagnosed in 2012 to 2014 were collected from the ICES database and analysed. Kaplan-Meier curves and log-rank tests were used to compared differences in overall survival (OS) between groups. Stage I TNBC cancer patients were analyzed by tumor size: T1a (< 0.5 cm), T1b (> 0.5 cm and < 1.0 cm) and T1c (>1.0 cm and < 2.0 cm). A Cox proportional hazard model was used to determine significance of variables. Results: Of the 610 stage I TNBC patients, 183 had tumor sizes ≤ 1cm, representing stages T1aN0M0 and T1bN0M0, and 427 had tumor sizes > 1cm to 2cm, representing stage T1cN0M0. Patients with tumor sizes ≤ 1cm who received adjuvant chemotherapy did not have a significant difference in OS compared to those who did not receive adjuvant chemotherapy (p = 0.41, hazard ratio (HR) = 0.40, 95% confidence interval (CI) 0.021-2.5). However, patients with tumor sizes > 1cm to 2cm who received adjuvant chemotherapy demonstrated a significantly better OS compared to those without (p = 0.023, HR = 0.40, 95% CI 0.16-0.86). Conclusions: Patients with TNBC stage T1cN0M0 should receive adjuvant chemotherapy for better OS. For stages T1aN0M0 and T1bN0M0, patients may be overtreated and avoidance of adjuvant chemotherapy can be considered at this time. Prospective studies should investigate the efficacy of adjuvant chemotherapy in TNBC patients with stage T1aN0M0 and T1bN0M0.

Introduction The gold standard treatment of stage I non-small cell lung cancer (NSCLC) is surgical resection. For medically inoperable patients, stereotactic body radiation therapy (SBRT) can provide comparable local control (LC) and overall survival (OS). The objectives of this study are to determine the three-year LC and OS for SBRT compared to early-stage NSCLC patients treated with alternative radiation modalities at our institution. Materials and methods This retrospective study included a total of 139 consecutive patients who were diagnosed with stage I (T1-2 N0 M0) NSCLC and treated with radiation therapy at our institution between 2015 and 2020. Patient demographics and clinical data were obtained from chart reviews. Treatment subgroups were: SBRT (48Gy/4 or 60Gy/8), hypofractionation (60Gy/15), conventional fractionation (60Gy/30 or 50Gy/20), and palliative radiation (20Gy/5, 30Gy/10, or 40Gy/15). Kaplan-Meier curves were plotted for LC and OS. We also performed Cox's proportional hazard regression analysis. Results The median patient age was 74 (range 52-91). The numbers of patients in each treatment subgroup were: SBRT (44), hypofractionation (78), conventional fractionation (8), and palliative (9). Differences in age, gender, and histopathological cell type between subgroups were not statistically significant. Metastatic progression was the most common outcome amongst treatment failures, followed by local recurrence and regional spread. Median post-treatment follow-up in months for each subgroup was: SBRT (20.2), hypofractionated (20.7), conventional fractionation (13.9), and palliative (14.4). Post-treatment three-year LC was found to be significantly better with SBRT (94%) versus hypofractionation (71%), conventional fractionation (80%), and palliative (71%). OS at three years were SBRT (67%), hypofractionation (59%), conventional fractionation (66%), and palliative (44%). As a whole. 72% (100/139) of patients had biopsyproven NSCLC. Analysis showed biopsy status had no statistical significance with regards to LC or OS. Every 20 years of age had a 3.2x risk of death (95% CI: 1.425-7.268). Concerning the treatment modalities, there were significant differences for the hazard of death compared to SBRT: hypofractionation had 2.58x increased risk while palliative had 5.83x increased risk. The proportion of patients who experienced post-treatment radiation pneumonitis or dermatitis were: SBRT (7%. 2%), hypofractionation (8%, 3%), conventional fractionation (13%, 25%), and palliative (0%, 0%), respectively. No patients who experienced grade III or higher toxicities were observed as defined by Common Terminology Criteria for Adverse Events (CTCAE). Conclusion Our experience confirms SBRT can provide durable three-year local control with a comparable rate of post-treatment complications versus other radiation modalities for early-stage NSCLC. SBRT appears to be noninferior to hypofractionation with regards to three-year LC.

Addition of platinums to combination chemotherapy for triple negative breast cancer (TNBC) has shown efficacy and is increasingly accepted in the clinic, yet optimal delivery is unknown. A prospective clinical trial with TNBC patients was conducted to determine the optimal chemotherapy regimen to deliver carboplatin with standard dose dense ACT. Tissue microarray was conducted to isolate markers indicative of response to treatment. 90 TNBC patients were enrolled onto our trial. The most successful version placed the carboplatin on the second and final paclitaxel treatment with liberal hematological parameters. Our final regimen had the lowest grade 3 or 4 toxicities, no delays, no dose reductions of carboplatin, and 32% reduction in paclitaxel doses. Stage I (AJCC7) patients did well with carboplatin-based chemotherapy with zero relapse rate. Reduction in protein levels of androgen receptor and PD-L1 were found to be potential indicators of patient relapse. We have optimized a protocol for the addition of carboplatin to standard of care chemotherapy in TNBC patients. Early data indicates reduced protein levels of androgen receptor and PD-L1 as indicators of response to treatment. Trial registration This trial was registered at Canadian Cancer Trials. http://www.canadiancancertrials.ca/

This research outlines a digital imaging method under development to systemize a rapid in-field corrosion evaluation measure, to evaluate and monitor the degree of corrosion on target corrosion-prone parts on light-duty vehicles. This procedure uses digital imaging to study and compare corrosion levels of 228 vehicles that were treated with aftermarket applications of corrosion prevention products versus 141 vehicles that were untreated. It introduces a Corrosion Index (CI) as a common measure. Single-factor and two-factor analysis of variance (ANOVA) of the digitally-based corrosion measurements show statistically significant correlations between CI and treatment (treated versus untreated), as well as CI, vehicle age, and treatment. The ANOVA results show that the aftermarket-treated vehicles have statistically significantly less corrosion than the untreated vehicles, demonstrating that digital image analysis is a viable method of measuring corrosion on corrosion-prone vehicle parts, offering the potential to monitor and track the performance/efficacy of aftermarket corrosion treatment in real-time.

Venous thromboembolism (VTE) is a known complication of hospitalization for acute medical illness; hospitalized patients with cancer represent a particularly high thrombotic risk population. However, there is significant underuse of thromboprophylaxis in medical inpatients with cancer. The objective of this study is to characterize the use of thromboprophylaxis in hospitalized patients with cancer at Windsor Regional Hospital (WRH), a large, community-based hospital in Ontario, Canada. Specifically, we investigated use of both pharmacologic and mechanical thromboprophylaxis, along with clinical determinants underlying lack of VTE prophylaxis to better understand our local practice patterns. This study is a retrospective, single center cohort study of 120 adult patients admitted to WRH with a primary solid tumor diagnosis (n=57) and hematologic cancer diagnosis (n=63) over a 3-month period. Chart review was performed for the first ten days of admission or until discharge. Multi-variate analyses were employed to determine clinical predictors of thromboprophylaxis use. Sixty-one (51%) medical inpatients with cancer received pharmacologic thromboprophylaxis during their hospitalization. The majority of patients (n=39; 68.4%) with a solid tumor malignancy received prophylaxis, while only twenty-two (34.9%) patients with a hematologic malignancy were provided pharmacologic VTE prophylaxis. In the subgroup of patients without contraindications to pharmacologic prophylaxis, 60% of patients with a primary hematologic diagnosis and 75% of patients with a primary solid tumor diagnosis received pharmacologic prophylaxis (Figure 1). 4 of 58 patients who did not receive pharmacologic prophylaxis received mechanical prophylaxis during admission (6.9%). Risk of VTE stratified by Khorana score >2 or ≤2 was not associated with use of pharmacologic prophylaxis (p=0.255). Platelet nadir <25x109/L (OR=0.12, 95% CI 0.0256-0.4087), active hormonal therapy (OR=0.11, 95% CI 0.0055-0.6707) and pulmonary disease at baseline (OR=4, 95% CI 1.0031-22.9064) were the only patient variables significantly related to the odds of pharmacologic prophylaxis. Given the limited number of patients in the study with pulmonary disease and maintained on hormonal therapy at baseline, the statistical significance may not correlate to clinical significance. In conclusion, thromboprophylaxis is an integral adjunct to the management of medical inpatients with active cancer yet is often neglected in clinical practice. In our population, nearly half of patients were not provided VTE prophylaxis. Severe thrombocytopenia and active hormonal therapy were negative predictors of pharmacologic thromboprophylaxis use while the presence of pulmonary disease favored prescription of prophylaxis on admission. Further studies are needed to better understand the rationale underlying omission of VTE prophylaxis in medical inpatients with cancer, and raise awareness of measures to prevent VTE in this patient population. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Triple-negative breast cancer (TNBC) isassociated with inferior outcomes. The use of adjuvant chemotherapy is the mainstay of treatment, and its efficacy was demonstrated to be correlated with tumor size. Different guidelines exist regarding chemotherapy in early-stage TNBC. This study uses ICES database to examine the outcomes of the use of adjuvant chemotherapy in stage I TNBC in Ontario stratified by tumor size. Records of TNBC patients diagnosed in 2012 to 2014 were collected from ICES database. Stage I patients were analyzed by tumor size: T1a (≤ 0.5 cm), T1b (> 0.5 cm and ≤ 1.0 cm), and T1c (> 1.0 cm and ≤ 2.0 cm). Kaplan–Meier curves, log-rank test statistic, and Cox’s proportional hazard regression were used to compare differences in overall survival (OS) between chemotherapy and no-chemotherapy groups. Of 610 patients, 183 had tumor sizes ≤ 1 cm, representing stages T1aN0M0 and T1bN0M0, and 427 had tumors > 1 cm to 2 cm, representing stage T1cN0M0. Patients with tumors ≤ 1 cm who received chemotherapy did not have a significant difference in OS compared to the no-chemotherapy group (p = 0.41, hazard ratio (HR) 0.40, 95% confidence interval (CI) 0.021–2.5). However, patients with tumor sizes > 1 cm to 2 cm who received chemotherapy demonstrated significantly better OS compared to those without (p = 0.023, HR = 0.40, 95% CI 0.16–0.86). Patients with TNBC stage T1cN0M0 should receive adjuvant chemotherapy. For TNBC tumors ≤ 1 cm, avoidance of chemotherapy can be considered. Prospective research should further investigate the efficacy of chemotherapy in TNBC stages T1a-bN0M0. Trial Registration University of Windsor REB#16-119.