Background Radiation oncology residents work alongside a diverse group of interdisciplinary team members, yet receive little formal training in inclusive interprofessional teaching (1). We previously developed and piloted a virtual interactive Residents-As-Teachers (RaTe) curriculum at a single institution, with the first module addressing teaching medical students in the outpatient clinic (2). Here we describe the second module, "Creating an Inclusive Interdisciplinary Learning Environment," designed to equip residents with frameworks for recognizing implicit bias, understanding the influence of social identity and stereotype threat, applying practical strategies for fostering belonging, and defining roles and interprofessional collaboration in the clinical learning environment. Methods All radiation oncology medical and physics residents at a single institution will be invited to voluntarily participate (n=13). The module follows the format of Module 1: an asynchronous, interactive video didactic with reflective activities, a self-assessment tool, and curated resources. Content is organized into three sections: (1) implicit bias and social identity - including privilege, stereotype threat, applied clinical vignettes, and individual and team-level mitigation strategies; (2) equity and inclusion in the learning environment: a five-step framework covering setting the tone, checking in, reflecting on messaging, incorporating equity into teaching, and responding and readjusting; and (3) understanding radiation oncology team roles and fostering interprofessional collaboration. Consenting trainees will complete pre- and post-intervention questionnaires assessing self-reported confidence and intended behavior change. Results Data collection is targeted for April 2026. Pre- and post-intervention questionnaires will utilize Likert scale items to assess self-reported confidence in inclusive teaching practices and intended behavior change. We hypothesize that participants will report increased confidence in recognizing implicit bias and applying inclusive teaching strategies. We also anticipate participants will report greater awareness of interprofessional team member roles and increased confidence in supporting collaborative practice. Consistent with Module 1 results, we anticipate the majority of residents will indicate they are "Very Likely" or "Somewhat Likely" to change their teaching practices because of the intervention. Conclusion This module broadens the RaTe curriculum to address inclusive interprofessional teaching, a gap of particular relevance in radiation oncology, where residents collaborate across multiple disciplines to deliver high-quality care. By integrating foundational diversity, equity, and inclusion concepts with radiation oncology-specific clinical scenarios and interprofessional role education, this module aims to produce measurable shifts in resident awareness and teaching behavior. Findings will inform continued curriculum expansion and may serve as a model for specialty-specific residents-as-teachers programs seeking to embed equity and inclusion into clinical teaching development.

PURPOSE:The integration of artificial intelligence auto-contouring (AAC) in radiation oncology has streamlined the delineation of organs at risk (OARs). Assessing OAR contours is a vital skill in radiation oncology. This study assessed the impact of AAC on residents' contouring education and skill acquisition and its consequences for educational programming. METHODS AND MATERIALS:We conducted a cross-sectional survey of residents and resident-facing faculty at 2 tertiary centers that implemented AAC within the prior year. Respondents completed anonymous Likert (1-5) and free-text items; group differences were analyzed using 2-sample t tests (p ≤ .05). Free-text comments underwent thematic analysis. RESULTS:Responses were received from 24 of 30 residents (80%) and 20 of 35 faculty (57%). Compared with faculty, residents more often reported that AAC improved their anatomic understanding (residents: 3.9 vs faculty: 2.1, p < .001) and overall education (4.2 vs 2.3, p < .001). Both groups agreed that AAC reduced time spent contouring (4.6 vs 4.4, p = .39) and improved the workflow from simulation to plan approval (4.5 vs 4.0, p = .08). Perceived AAC contour quality was neutral (3.33 vs 2.85, p = .11). AAC was viewed as improving familiarity with standardized OAR nomenclature (4.3 vs 3.3, p = .001) and as contributing positively to clinic (4.7 vs 3.7, p < .001) and resident well-being (4.6 vs 3.6, p < .001). Faculty comments highlighted inaccurate or incomplete contours and uncertainty about residents' systematic review or correction of AAC output, raising concerns about reduced practice with de novo delineation and computed tomography anatomy. Residents acknowledged AAC's imperfections but emphasized time savings and the ability to redirect effort toward other educational activities. CONCLUSIONS:Residents and faculty diverge on AAC's educational value, particularly its effect on anatomic learning. However, both recognize benefits for workflow and well-being. Improving the integration and understanding of AAC-derived OARs during contouring will be crucial to improving resident training and ensuring high-quality care delivery in the era of artificial intelligence.

BACKGROUND:Limbic white matter (WM) of the Papez circuit, including the fornix, dorsal cingulum, and parahippocampal cingulum (PHC), interplay with the hippocampus as key components of the memory network. We analyzed biomarkers of injury to these pathways to understand their impact on post-radiation therapy (RT) memory performance. METHODS:Primary brain tumor patients on a prospective trial receiving fractionated brain RT (n = 57) underwent volumetric MRI, diffusion tensor imaging, and memory assessments (Hopkins Verbal Learning Test-Revised [HVLT-R] Total and Delayed Recall and Brief Visuospatial Memory Test -Revised [BVMT-R] Total and Delayed Recall) at baseline and 3, 6, and 12 months post-RT. MRI biomarkers included volume, fractional anisotropy (FA), and mean diffusivity (MD). Linear mixed-effects models assessed associations between biomarkers and memory performance over time. RESULTS:Smaller volumes in the right fornix were associated with lower BVMT-R-Total scores (P = 0.019) and left PHC volume loss was associated with worse performance on BVMT-R-Delayed (P = 0.039). Lower FA in the left (P = 0.010) and right (P = 0.019) fornix was associated with lower BVMT-R-Total performance. Lower FA in the left dorsal cingulum (P = 0.038) and right PHC (P = 0.039) were associated with lower HVLT-R-Total and HVLT-R-Delayed scores, respectively. Higher MD in bilateral fornix (P = 0.01) and right PHC (P = 0.011) correlated with lower BVMT-R-Total scores; higher MD in the right PHC (P = 0.046) also correlated with lower HVLT-R-Total scores. Hippocampal volume was not associated with memory scores. CONCLUSION:Poorer microstructural integrity in limbic WM tracts of the Papez circuit predicted worse memory performance, while hippocampal injury did not. Dose avoidance in these tracts may preserve memory outcomes.

ImportanceRates of early-onset (before 50 years of age) colorectal cancer (EOCRC) are increasing, with notable differences across racial and ethnic groups. Limited data are available on EOCRC-related mortality differences when disaggregating racial and ethnic groups.ObjectiveTo investigate racial and ethnic differences in EOCRC mortality, including disaggregation of Asian American populations separately, including Native Hawaiian or Other Pacific Islander populations and specific Asian American groups, and to quantify the contribution of clinical and sociodemographic factors accounting for these differences.Design, Setting, and ParticipantsThis population-based cohort study included California Cancer Registry data for individuals aged 18 to 49 years with EOCRC between January 1, 2000, to December 31, 2019. Median follow-up was 4.2 (IQR, 1.6-10.0) years. The data analysis was conducted between July 1, 2021, and September 30, 2024.ExposureRace and ethnicity defined as Asian American (and 7 disaggregated subgroups), Hispanic, Native Hawaiian or Other Pacific Islander, non-Hispanic American Indian or Alaska Native, non-Hispanic Black, and non-Hispanic White.Main Outcomes and MeasuresCox proportional hazards regression models were used to measure association between race and ethnicity and CRC mortality risk, yielding adjusted hazard ratios (AHRs) and 95% CIs. Associations of sociodemographic, health system, and clinical factors with differences in mortality by racial and ethnic minority group were assessed using sequential modeling.ResultsThere were 22 834 individuals diagnosed with EOCRC between 2000 and 2019 (12 215 [53.5%] male; median age, 44 [IQR, 39-47] years). Racial and ethnic identity included 3544 (15.5%) Asian American, 6889 (30.2%) Hispanic, 135 (0.6%) Native Hawaiian or Other Pacific Islander, 125 (0.5%) non-Hispanic American Indian or Alaska Native, 1668 (7.3%) non-Hispanic Black, and 10 473 (45.9%) non-Hispanic White individuals. Compared with non-Hispanic White individuals, higher EOCRC mortality was found for Native Hawaiian or Other Pacific Islander (AHR, 1.34; 95% CI, 1.01-1.76) and non-Hispanic Black (AHR, 1.18; 95% CI, 1.07-1.29) individuals. Disaggregation of Asian American ethnic groups revealed notable heterogeneity, but no single group had increased EOCRC mortality risk after full adjustment for covariates. For Hispanic individuals, there was higher EOCRC mortality (AHR, 1.15 [95% CI, 1.08-1.22]) with the base model (adjustment for age, sex, and tumor characteristics), but the association disappeared once neighborhood socioeconomic status was added to the base model (AHR, 1.00 [95% CI, 0.94-1.06]). Similarly, there was higher EOCRC mortality among Southeast Asian individuals with the base model (AHR, 1.17 [95% CI, 1.03-1.34], but that association disappeared with the addition of insurance status to the model (AHR, 1.10 [95% CI, 0.96-1.25]).Conclusions and RelevanceIn this cohort study, racial and ethnic disparities in EOCRC mortality were evident, with the highest burden among Native Hawaiian or Other Pacific Islander and non-Hispanic Black individuals. These results provide evidence of the role of social determinants of health in explaining these differences.

BackgroundThe integration of artificial intelligence (AI) auto contouring (AAC) in radiation oncology has streamlined the delineation of organs at risk (OARs). Assessing OAR contours is a vital skill in radiation oncology. This study set out to elucidate how AAC usage impacts resident education and development of this skill and the impact of AAC implementation on adjusting educational programming.MethodsA survey was sent to all residents and resident-facing faculty at a single tertiary academic institution that has recently implemented AAC in the past year. Respondents were anonymized, indicated whether they were resident or faculty, and answered questions in free text or scaled form 1-5 (strongly disagree (1) to strongly agree (5)). Statistical analysis with t-test were performed, with p values less than or equal to 0.05 considered as significant.Results13/13 residents and 14/21 faculty responded. Residents and faculty disagreed on whether AAC's improved understanding of anatomy (4.2 vs 2.1, p<0.01) respectively, or had a positive impact on general resident education (4.2 vs 2.4, p<0.01). However, both agreed that AAC allows residents to spend less time contouring (4.6 vs 4.3, p=0.22), improved workflow from simulation to plan approval (4.4 vs 3.9, p=0.13), and were relatively neutral on the quality of AAC contours (3.4 vs 2.6, p=0.06). Residents and faculty also agreed that AAC improves understanding of standardized OAR nomenclature (4.1 vs 3.2, p=0.02) and has had a positive contribution to clinic (4.8 vs 3.6, p<0.01) and resident wellbeing (4.6 vs 3.4, p<0.01), though at varying levels. Free text from faculty generally highlighted how OARs were sometimes incorrect and it was unclear whether residents reviewed or corrected the OARs, commenting that the lack of repetition of OAR contouring meant not building the experience needed to review CT anatomy. Residents highlighted that although AACs were not perfect and still needed review, the time saved improved quality of life and could be better spent on other educational endeavors.DiscussionResidents and faculty disagree on whether AAC affects understanding of OARs, specifically highlighting the imprecision of AI contours. However, almost all agree that there has been a positive impact on clinic and overall education. Improving the integration and understanding of AAC-derived OARs during contouring will be crucial for improving resident training and ensuring high-quality care delivery in the AI era.

Purpose/Objective(s) The integration of AI auto contouring (AAC) in radiation oncology has streamlined the delineation of organs at risk (OARs). Assessing OAR contours is a vital skill in radiation oncology. This study aimed to elucidate the impact of AAC implementation on resident education, contouring skill development, and longitudinal educational programming. Materials/Methods An anonymized survey was administered to all residents and resident-interfacing faculty at a single tertiary academic institution that implemented AAC in the past year. Respondents indicated whether they were resident or faculty and answered questions in free text or on a Likert scale from 1-5 (strongly disagree (1) to strongly agree (5)). Free text responses were analyzed qualitatively. Statistical analyses with t-tests were performed, with p values ≤ 0.05 considered as significant. AAC contours that residents worked on were analyzed to determine the percentage of OARs edited by residents. Contours were considered edited if an entire axial slice was added or removed, or an axial slice was edited to a Hausdorff distance of ≥ 2mm. Results 13/13 residents (100% response rate) and 14/21 faculty (67% response rate) completed the survey. Residents and faculty disagreed on whether AAC improved understanding of anatomy (4.2 vs 2.1, p<0.01) respectively, or had a positive impact on general resident education (4.2 vs 2.4, p<0.01). However, both agreed that AAC allowed residents to spend less time contouring (4.6 vs 4.3, p=0.22) and improved workflow from simulation to plan approval (4.4 vs 3.9, p=0.13). Both were relatively neutral on the quality of AAC contours (3.4 vs 2.6, p=0.06). Residents and faculty also agreed that AAC improved understanding of standardized OAR nomenclature (4.1 vs 3.2, p=0.02) and positively contributed to clinic (4.8 vs 3.6, p< 0.01) and resident wellbeing (4.6 vs 3.4, p< 0.01), though at varying levels. On objective analysis of 113 imaging studies with AAC, there were 1526 edited OARs, of which 1479 (96.9%) were first edited by residents. Thematic analysis of faculty responses highlighted inaccuracies of AAC OARs, with concern that the lack of OAR contouring repetition may translate into inadequate experience with and knowledge of CT anatomy. Residents highlighted that although AACs were imperfect and require review and revision, the time saved improved quality of life and could be better channeled into other educational endeavors. Conclusion Residents and faculty disagree on whether AAC affects understanding of OARs, specifically highlighting the imprecision of AI auto contours. However, most agree that there has been a positive impact on clinic and overall education. Improving the integration and understanding of AAC-derived OARs during contouring will be crucial for improving resident training and ensuring high-quality care delivery in the AI era.

Objective Giant cell arteritis (GCA) has a relapsing–remitting course and is associated with a high burden of comorbidities, leading to repeated hospitalizations. This study was undertaken to investigate the burden, risk factors, causes, and outcomes of hospitalization and readmission in GCA patients in a US national cohort. Methods Using the 2017 US National Readmission Database, we identified adults ≥50 years of age hospitalized with GCA between January and June 2017, with at least 6 months of follow‐up. We estimated the burden of hospitalization including 6‐month risk of readmission, total days spent in hospital, and costs, annually. We examined patient‐, hospital‐, and index hospitalization–related factors for 6‐month readmission and total days of hospitalization using binomial logistic regression. Results Our study included 1,206 patients hospitalized with GCA (70% women, median age 77 years), with 13% of patients experiencing GCA‐related ophthalmologic complications at index hospital admission. On follow‐up, 3% died, and 34% of patients were readmitted within 6 months, primarily for infections (23%) and cardiovascular diseases (CVDs) (15%). Charlson comorbidity index (CCI) of ≥1, smoking, and obesity were associated with readmission. GCA patients spent a median of 5 days/year in hospital (interquartile range [IQR] 3–11), with those in the top quartile spending 19 days/year in hospital (IQR 14–26). Conclusion GCA patients frequently experience unplanned health care utilization, with 1 in 3 patients experiencing readmission within 6 months, and 3% dying within the follow‐up period. Infection and CVDs are common causes of readmission and may be related to glucocorticoid exposure. Population health management strategies are required in these vulnerable GCA patients.

The 30-day readmission rate is a nationally recognized quality measure with nearly one-fifth of patients being readmitted. This study aims to evaluate frailty, as measured by the hospital frailty risk score (HFRS), as a prognostic indicator for 30-day readmission after inpatient ERCP. We analyzed weighted discharge records from the 2017 Nationwide Readmissions Database (NRD) to identify patients undergoing ERCP between 01/01/2017 and 11/30/2017. Our primary outcome was the 30-day unplanned readmission rate in frail (defined as HFRS > 5) against non-frail (HFRS < 5) patients. A mixed effects multivariable logistic regression method was employed. Among 68,206 weighted hospitalized patients undergoing ERCP, 31.3

PURPOSE:Brain radiation therapy can impair fine motor skills (FMS). Fine motor skills are essential for activities of daily living, enabling hand-eye coordination for manipulative movements. We developed normal tissue complication probability (NTCP) models for the decline in FMS after fractionated brain radiation therapy (RT).METHODS AND MATERIALS:On a prospective trial, 44 patients with primary brain tumors received fractioned RT; underwent high-resolution volumetric magnetic resonance imaging, diffusion tensor imaging, and comprehensive FMS assessments (Delis-Kaplan Executive Function System Trail Making Test Motor Speed [DKEFS-MS]; and Grooved Pegboard dominant/nondominant hands) at baseline and 6 months postRT. Regions of interest subserving motor function (including cortex, superficial white matter, thalamus, basal ganglia, cerebellum, and white matter tracts) were autosegmented using validated methods and manually verified. Dosimetric and clinical variables were included in multivariate NTCP models using automated bootstrapped logistic regression, least absolute shrinkage and selection operator logistic regression, and random forests with nested cross-validation.RESULTS:Half of the patients showed a decline on grooved pegboard test of nondominant hands, 17 of 42 (40.4%) on grooved pegboard test of -dominant hands, and 11 of 44 (25%) on DKEFS-MS. Automated bootstrapped logistic regression selected a 1-term model including maximum dose to dominant postcentral white matter. The least absolute shrinkage and selection operator logistic regression selected this term and steroid use. The top 5 variables in the random forest were all dosimetric: maximum dose to dominant thalamus, mean dose to dominant caudate, mean and maximum dose to the dominant corticospinal tract, and maximum dose to dominant postcentral white matter. This technique performed best with an area under the curve of 0.69 (95% CI, 0.68-0.70) on nested cross-validation.CONCLUSIONS:We present the first NTCP models for FMS impairment after brain RT. Dose to several supratentorial motor-associated regions of interest correlated with a decline in dominant-hand fine motor dexterity in patients with primary brain tumors in multivariate models, outperforming clinical variables. These data can guide prospective fine motor-sparing strategies for brain RT.

PURPOSE:Amygdalae are bilateral, almond-shaped structures located anterior to the hippocampi, critical to limbic system functions of emotional processing and memory consolidation. The amygdalae are heterogeneous, composed of multiple nuclei with distinct structural and functional properties. We prospectively assessed associations between longitudinal changes in amygdala morphometry, including component nuclei, and functional outcomes in patients with primary brain tumors receiving radiation therapy (RT). METHODS AND MATERIALS:On a prospective longitudinal trial, 63 patients underwent high-resolution volumetric brain magnetic resonance imaging and testing for mood (Beck Depression Inventory and Beck Anxiety Inventory), memory (Brief Visuospatial Memory Test-Revised [BVMT] Total Recall and Delayed Recall; Hopkins Verbal Learning Test-Revised [HVLT] Total Recall and Delayed Recall), and health-related quality-of-life outcomes (Functional Assessment of Cancer Therapy-Brain Social/Family Well-Being and Emotional Well-Being) at baseline and 3, 6, and 12 months after RT. Amygdalae, including 8 nuclei, were autosegmented bilaterally using validated techniques. Linear mixed-effects models assessed longitudinal change in amygdalae and nuclei volumes and associations with dose and outcomes. Wilcoxon rank sum tests compared amygdala volume change between patient groups with worse and more stable outcomes at each time point. RESULTS:Atrophy was found in the right amygdala at 6 months (P = .001) and the left amygdala at 12 months (P = .046). A higher dose was associated with atrophy of the left amygdala (P = .013) at 12 months. The right amygdala showed dose-dependent atrophy at 6 months (P = .016) and 12 months (P = .001). Worse BVMT-Total, HVLT-Total, and HVLT-Delayed performance was associated with smaller left lateral (P = .014, P = .004, and P = .007, respectively) and left basal (P = .034, P = .016, and P = .026, respectively) nuclei volumes. Increased anxiety at 6 months was associated with greater combined (P = .031) and right (P = .007) amygdala atrophy. Greater left amygdala atrophy (P = .038) was noted in patients with decreased emotional well-being at 12 months. CONCLUSIONS:Bilateral amygdalae and nuclei undergo time- and dose-dependent atrophy after brain RT. Atrophy in amygdalae and specific nuclei was associated with poorer memory, mood, and emotional well-being. Amygdalae-sparing treatment planning may preserve neurocognitive and neuropsychiatric outcomes in this population.

Background: We analyzed post-radiation (RT) neurocognitive outcomes in an ethnically diverse pediatric brain tumor population undergoing photon radiotherapy (XRT) and proton radiotherapy (PRT). Procedure: Post-RT neurocognitive outcomes from 49 pediatric patients (37% Hispanic/Latino) with primary brain tumors were analyzed. Tests included cognitive outcomes, behavioral outcomes, and overall intelligence. For each outcome, proportion of patients with cognitive impairment (scores <1.5 SD) was calculated. The Fisher exact tests compared proportion of patients with impairment and t tests compared T-scores between XRT (n=32) and PRT (n=17) groups. Linear regression assessed associations between radiation modality and outcomes. Results: Median follow-up was 3.2 and 1.8 years in the XRT and PRT groups, respectively. The median RT dose was 54.0 Gy. We found impairment in 16% to 42% of patients across most neurocognitive domains except executive function. There was no difference in scores between XRT and PRT groups. Regression analyses revealed no association of neurocognitive outcomes with radiation modality. Non-Hispanic patients had better Verbal Comprehension Index and General Ability Index scores than Hispanic patients ( P <0.05). Conclusions: Among pediatric patients with brain tumors receiving RT, all cognitive domains were affected except executive function. Radiation modality was not associated with neurocognitive outcomes. Hispanic patients may be more vulnerable to posttreatment cognitive effects that warrant further study.

Objectives: We investigated racial and ethnic differences in colorectal cancer (CRC) mortality in adults with early onset colorectal cancer (ages <50; EO-CRC) in California and quantified the contribution of sociodemographic, health system, and clinical factors to racial and ethnic disparities in mortality. Methods: California Cancer Registry data were used to estimate CRC-specific mortality for adults ages 18-49 with EO-CRC between 2000-2019 for each racial/ethnic group (non-Hispanic Black [NHB], Hispanic, Asian American, American Indian/Alaska Native [AIAN], Native Hawaiian/Pacific Islander [NHPI]) compared with non-Hispanic White (NHW) adults. Additional disaggregated comparisons were conducted in Asian American ethnic groups: Chinese, Filipino, Japanese, Korean, South Asian, Southeast Asian, Other Asian and NHPI, compared to NHW individuals and separately using Chinese adults as a referent group. Cox proportional hazards models were used to measure association between race/ethnicity and CRC mortality risk, yielding unadjusted hazard ratios (HR) and adjusted hazard ratios (aHR) accounting for sociodemographic, clinical and health system factors, with corresponding 95% confidence intervals (95% CI). Mediation analyses were conducted to measure the percentage of contribution of factors to overall racial/ethnic CRC mortality rates using a sequence of multivariable Cox models. Results: There were 22,997 adults ages 18-49 with an EO-CRC diagnosis between 2000-2019, with 3,544 Asian (1,039 deaths), 6,889 Hispanic (1,998 deaths), 125 AIAN (36 deaths), 1,668 NHB (670 deaths), 10,473 NHW (3,089 deaths), 135 NHPI (51 deaths) and 163 (<5 deaths) unknown race/ethnicity adults. Compared to NHW adults, higher CRC mortality was shown for NHPI adults (HR=1.69; 95% CI: 1.27-2.23; aHR=1.36; 95% CI: 1.03-1.79) and NHB adults (HR=1.53; 95% CI: 1.41-1.66; aHR=1.17; 95% CI: 1.07-1.29). Hispanic adults had an increased risk of CRC mortality in the unadjusted model (HR=1.15, 95% CI: 1.09-1.22) that was attenuated in the adjusted model (aHR=0.99, 95% CI: 0.92-1.04), compared to NHW adults. After disaggregating the Asian American group, Southeast Asian adults had increased CRC mortality risk in the unadjusted (HR=1.29, 95% CI: 1.13-1.46) but not adjusted model (aHR=1.10; 95% CI: 0.97-1.26), compared to NHW adults. In mediation analyses that examined contributors to the association between race/ethnicity and CRC mortality risk, neighborhood socioeconomic status and insurance status were among the top five most influential factors for Hispanic, NHB, and NHPI adults. However, the magnitude of influence differed by racial and ethnic group. Conclusions: Compared to NHWs, NHPI and NHB adults with EO-CRC had increased CRC mortality risk, even after adjusting for clinical and sociodemographic factors. Mediation analyses highlighted variation in the importance of various sociodemographic, clinical, health system and neighborhood factors, underscoring the need to better disentangle factors within racial and ethnic groups that contribute to disparities in CRC-related mortality. Citation Format: Joshua Demb, Scarlett Gomez, Alison Canchola, Alexander Qian, James D. Murphy, Samir Gupta, Maria Elena Martinez. Contribution of neighborhood and clinical factors to differences in early-onset colorectal cancer mortality across different racial and ethnic groups [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A074.

PURPOSE:The cerebellum's role in posttreatment neurocognitive decline is unexplored. This study investigated associations between cerebellar microstructural integrity using quantitative neuroimaging biomarkers and neurocognition among patients with primary brain tumors receiving partial-brain radiation therapy (RT). METHODS AND MATERIALS:In a prospective trial, 65 patients underwent volumetric brain magnetic resonance imaging, diffusion tensor imaging, and memory, executive function, language, attention, and processing speed (PS) assessment before RT and at 3, 6, and 12 months after RT. Delis-Kaplan Executive Function System-Trail Making (D-KEFS-TM) visual scanning and number and letter sequencing and Wechsler Adult Intelligence Scale, Fourth Edition, coding were used to evaluate PS. The cerebellar cortex and white matter (WM) and supratentorial structures subserving the previously mentioned cognitive domains were autosegmented. Volume was measured within each structure at each time point along with diffusion biomarkers (fractional anisotropy and mean diffusivity) in WM structures. Linear mixed-effects models assessed cerebellar biomarkers as predictors of neurocognitive scores. If associated, cerebellar biomarkers were evaluated as independent predictors of cognitive scores controlling for domain-specific supratentorial biomarkers. RESULTS:Left (P = .04) and right (P < .001) cerebellar WM volume declined significantly over time. Cerebellar biomarkers were not associated with memory, executive function, or language. Smaller left cerebellar cortex volume was associated with worse D-KEFS-TM number (P = .01) and letter (P = .01) sequencing scores. A smaller right cerebellar cortex volume correlated with worse D-KEFS-TM visual scanning (P = .02) and number (P = .03) and letter (P = .02) sequencing scores. Greater right cerebellar WM mean diffusivity, indicating WM injury, was associated with worse D-KEFS-TM visual scanning performance (P = .03). Associations remained significant after controlling for corpus callosum and intrahemispheric WM injury biomarkers. CONCLUSIONS:Injury to the cerebellum as measured with quantitative biomarkers correlates with worse post-RT PS, independent of corpus callosum and intrahemispheric WM damage. Efforts to preserve cerebellar integrity may preserve PS.

Admitted and non-admitted ED patients with cancer seen in the ED during radiotherapy are documented to experience similar symptoms, but certain symptoms are associated with a higher risk of hospital admission. NLP may offer a mechanism for early, automated identification to facilitate supportive interventions for patients at high risk for admission during radiotherapy.

Purpose/Objective(s) Memory deficits after brain RT are common. Critical white matter tracts including the fornix, cingulum, and parahippocampal cingulum (PHC) connect with the hippocampus, comprising the memory network. We analyzed quantitative neuroimaging biomarkers of microstructural injury to these white matter regions of interest (ROI) and hippocampus, to understand the impact these changes have on post-RT verbal and visuospatial memory performance in brain tumor patients. Materials/Methods Primary brain tumor patients on a prospective trial receiving fractionated brain RT (n=56) underwent volumetric brain MRI, diffusion tensor imaging, and prospective memory assessments (Hopkins Verbal Learning Test-Revised [HVLT-R] Total and Delayed Recall and Brief Visuospatial Memory Test [BVMT] Total and Delayed Recall) at baseline and 3, 6, and 12 months post-RT. Bilateral hippocampi, fornix, cingulum, and parahippocampal cingulum (PHC) were autosegmented; tumor, surgical bed, and edema were censored to avoid confounding. Volume was measured in each ROI, and diffusion biomarkers also analyzed in white matter ROIs (fractional anisotropy, FA; mean diffusivity, MD). Increase in MD and decrease in FA indicate WM injury. Multivariable linear mixed-effects models assessed associations of biomarkers with time and RT dose, and as longitudinal predictors of memory scores, controlling for time and subject-specific effects. P-values were corrected for multiple comparisons. Results Volumes of all ROIs significantly decreased after 6 months (p<0.05). Over time, FA decreased in right and left fornix and cingulum (p<0.05) and MD increased in left fornix (p=0.005). Higher RT dose was associated with: atrophy in left and right hippocampi (p<0.001) and right fornix (p=0.024), decreased FA in right fornix (p=0.046) and right PHC (p=0.042), and increased MD in right PHC (p=0.03). Atrophy of right fornix was associated with worse performance on BVMT Total (p=0.019) and decreased volume of left PHC with worse performance on BVMT Delayed (p=0.039). Volume of either hippocampus was not associated with memory scores. Reduced FA in the left (p=0.010) and right (p=0.019) fornix was associated with worse performance on BVMT Total. Lower FA in the left cingulum (p=0.038) was associated with worse performance on HVLT Total while lower FA in the right PHC was associated with worse performance on HVLT Delayed. Higher MD in the left (p=0.010) and right (p=0.007) fornix and the right PHC (p=0.011) correlated with poorer BVMT Total scores, while higher MD in the right PHC (p=0.046) was correlated with poorer HVLT Total scores. Conclusion Microstructural injury in the fornix, cingulum, and PHC predicted for worse verbal and visuospatial memory post-RT, while injury to the hippocampus did not. RT dose avoidance to these white matter regions should be explored to better preserve memory in brain tumor patients.

Purpose/Objective(s) African American (AA) men with prostate cancer (PCa) are at higher risk of aggressive and metastatic disease when compared with non-Hispanic White (NHW) men. Palliative radiation offers effective pain alleviation from symptomatic lesions, though little is known about the patterns of palliative radiation usage for AA vs. NHW men. We evaluated whether receipt of palliative radiation differs between AA and NHW men and investigated whether AA men receive different palliative radiation treatment courses. Materials/Methods We identified men 65 and older, diagnosed with metastatic PCa from 2004-2013 within the Surveillance, Epidemiology, and End Results (SEER) – Medicare database. Palliative radiation usage, including number of fractions, courses, and use of intensity-modulated radiation therapy (IMRT), was delineated through Medicare reimbursement claims. Short-course was defined as ≤5 fractions. Multivariable logistic regression assessed the influence of AA race on receiving palliative radiation. AA men are often diagnosed at younger age than NHW men, so we included the interaction between age and AA race in another multivariable model. For patients who received palliative radiation, we used separate multivariable logistic regressions to evaluate the impact of AA race on receiving short-course radiation, >1 course of radiation, and IMRT. Results The cohort included 7,954 men (6,552 NHW and 1,402 AA). Median age was 77 with median follow-up of 32 months. Median age for AA men: 74; NHW men: 78. A total of 1,926 patients received palliative radiation (1,628 NHW and 298 AA). On multivariable analysis, AA men had 25% reduced odds of receiving palliative radiation (odds ratio (OR), 95% confidence interval (CI): 0.75, [0.65-0.87], P<0.01). For each year above age 65, AA men had 2% reduced odds of receiving palliative radiation when compared to NHW men (OR, 95% CI: 0.98, [0.96-0.99], Pinteraction: 0.04). For those undergoing palliative radiation, multivariable analysis revealed no significant difference between AA and NHW men for receiving >1 course, short-course vs long-course radiation, and IMRT. Conclusion In this large national cohort of Medicare patients, AA race was associated with reduced odds of receiving palliative radiation, a disparity most pronounced for older AA men. Our results suggest that the racial disparity in palliative radiation exists predominantly prior to initiation of therapy. AA men who received palliative radiation displayed similar fractionation, number of courses, and usage of IMRT when compared to NHW men. Increased counseling for AA men with metastatic PCa must be emphasized to ensure AA men have equal opportunity to the benefits of palliative radiation.

Importance:Black men have higher prostate cancer incidence and mortality than non-Hispanic White men. However, Black men have been underrepresented in clinical trials of prostate-specific antigen (PSA) screening; thus, there is a lack of data to guide screening recommendations for this population.Objective:To assess whether PSA screening is associated with reduced risk of prostate cancer-specific mortality (PCSM) among non-Hispanic Black men.Design, Setting, and Participants:This retrospective cohort study used data from the US Veterans Health Administration Informatics and Computing Infrastructure for men aged 55 to 69 years who self-identified as non-Hispanic Black or non-Hispanic White and were diagnosed with intermediate-, high-, or very high-risk prostate cancer from January 1, 2004, to December 31, 2017. Data were analyzed from August 2021 to March 2022.Exposures:Prostate-specific antigen screening rate, defined as the percentage of years in which PSA screening was conducted during the 5 years before diagnosis of prostate cancer.Main Outcomes and Measures:The primary outcome was risk of PCSM among Black men and White men. The association between PSA screening and risk of PCSM was assessed using Fine-Gray regression analysis. Risk of PCSM was also assessed categorically among patients classified as having no prior PSA screening, some screening (less than annual), or annual screening in the 5 years before diagnosis.Results:The study included 45 834 veterans (mean [SD] age, 62.7 [3.8] years), of whom 14 310 (31%) were non-Hispanic Black men and 31 524 (69%) were non-Hispanic White men. The PSA screening rate was associated with a lower risk of PCSM among Black men (subdistribution hazard ratio [sHR], 0.56; 95% CI, 0.41-0.76; P = .001) and White men (sHR, 0.58; 95% CI, 0.46-0.75; P = .001). On subset analysis, annual screening (vs some screening) was associated with a significant reduction in risk of PCSM among Black men (sHR, 0.65; 95% CI, 0.46-0.92; P = .02) but not among White men (sHR, 0.91; 95% CI, 0.74-1.11; P = .35).Conclusions and Relevance:In this cohort study, PSA screening was associated with reduced risk of PCSM among non-Hispanic Black men and non-Hispanic White men. Annual screening was associated with reduced risk of PCSM among Black men but not among White men, suggesting that annual screening may be particularly important for Black men. Further research is needed to identify appropriate populations and protocols to maximize the benefits of PSA screening.

225 Background: African American (AA) men are known to develop more aggressive forms of prostate cancer at a younger age compared to their Non-Hispanic White (NHW) counterparts. However, few AA men were included in the major randomized trials assessing the efficacy of Prostate-Specific Antigen (PSA) screening. It is thus unknown whether PSA screening may be more beneficial in the AA population. Methods: We conducted a retrospective analysis of men diagnosed with prostate cancer in the United States (US) Veterans Affairs Health System (VA) using the VA Informatics and Computing Infrastructure. Inclusion criteria were AA or NHW men aged 55-69 diagnosed with intermediate or high-risk prostate cancer between 2004 and 2017. Patients were classified as never screened with PSA prior to diagnosis, screened at least once prior to diagnosis (some screening), or screened in 5 consecutive years prior to diagnosis (annual screening). A lead-time bias adjusted multivariate regression model was implemented to assess the effect of screening on prostate cancer specific mortality (PCSM), with covariates including age, comorbidities, BMI, smoking history, marital status and primary care utilization. Results: A total of 45,825 men met the inclusion criteria and were included in the analysis, including 14,294 (31.1%) AA men and 31,151 (68.9%) NHW men. When compared to no screening, any prior PSA screening was associated with improved PCSM for both AA (subdistribution hazard ratio (SHR) 0.64, p < 0.001) and NHW (SHR 0.62, p < 0.001) patients. Annual PSA screening (vs no or some screening) was associated with improved PCSM for AA men (SHR 0.68, p = 0.013) but not NHW men (SHR 0.90, p = 0.240). Other significant predictors of worse PCSM in both AA and NHW men included older age, earlier year of diagnosis, greater comorbidity burden, and cigarette smoking. Conclusions: In a diverse population of US veterans, at least one prior screening PSA was associated with improved PCSM in both AA and NHW patients. Annual PSA screening was associated with reduced PCSM in AA but not NHW men, suggesting that more intensive screening protocols may be beneficial for AA patients.

BACKGROUND:Despite higher risks associated with prostate cancer, young African American men are poorly represented in prostate-specific antigen (PSA) trials, which limits proper evidence-based guidance. We evaluated the impact of PSA screening, alongside primary care provider utilization, on prostate cancer outcomes for these patients. METHODS:We identified African American men aged 40-55 years, diagnosed with prostate cancer between 2004 and 2017 within the Veterans Health Administration. Inverse probability of treatment-weighted propensity scores were used in multivariable models to assess PSA screening on PSA levels higher than 20, Gleason score of 8 or higher, and metastatic disease at diagnosis. Lead-time adjusted Fine-Gray regression evaluated PSA screening on prostate cancer-specific mortality (PCSM), with noncancer death as competing events. All statistical tests were 2-sided. RESULTS:The cohort included 4726 patients. Mean age was 51.8 years, with 84-month median follow-up. There were 1057 (22.4%) with no PSA screening prior to diagnosis. Compared with no screening, PSA screening was associated with statistically significantly reduced odds of PSA levels higher than 20 (odds ratio [OR] = 0.56, 95% confidence interval [CI] = 0.49 to 0.63; P < .001), Gleason score of 8 or higher (OR = 0.78, 95% CI = 0.69 to 0.88; P < .001), and metastatic disease at diagnosis (OR = 0.50, 95% CI = 0.39 to 0.64; P < .001), and decreased PCSM (subdistribution hazard ratio = 0.52, 95% CI = 0.36 to 0.76; P  < .001). Primary care provider visits displayed similar effects. CONCLUSIONS:Among young African American men diagnosed with prostate cancer, PSA screening was associated with statistically significantly lower risk of PSA levels higher than 20, Gleason score of 8 or higher, and metastatic disease at diagnosis and statistically significantly reduced risk of PCSM. However, the retrospective design limits precise estimation of screening effects. Prospective studies are needed to validate these findings.