Patients’ characteristics (N = 827).

Forest plot for OS (A) and PFS (B) according to multivariate analysis. ATB, antibiotics.

Supplementary Figure from Long-Term Outcomes among Adolescent and Young Adult Survivors of Acute Leukemia: A Surveillance, Epidemiology, and End Results Analysis

Associations between antihistamine use and tumor responses. ABS, antibodies; AH, antihistamines; VAC, vaccines.

Response data according to therapy type.

Summary of variables related to survival.

Background Immune checkpoint inhibitors (ICIs) are increasingly used in adolescents and young adults (AYAs) with cancer; however, data on treatment response, the frequency and pattern of immune-related adverse events (irAEs), and the feasibility of ICI rechallenge after irAEs are limited.Methods This retrospective study included 136 AYAs (80 males and 56 females) who received ICI therapy for melanoma at our institution from 2013 to 2023. We documented the initial ICI treatment and ICI rechallenge, along with associated irAEs and treatment responses. Kaplan-Meier plots were used to analyze overall survival (OS) and progression-free survival.Results At ICI initiation, the median age was 33 (range, 15–39) years, and most patients had stage III or IV disease (93%) and BRAF mutations (63%). Treatment settings included adjuvant (n=70), palliative (n=50), and neoadjuvant (n=16). Compared with those receiving ICI monotherapy (n=77), patients receiving ICI combination therapy (n=59) had significantly higher rates of irAEs of any grade (53% vs 75%, p=0.011) and grade three or four irAEs (12% vs 32%, p=0.003) and higher rates of treatment delay (26% vs 51%, p=0.044), and hospitalization (8% vs 20%, p=0.032). ICI rechallenge was common (n=71), even after prior irAEs (n=48). Colitis and hepatitis were the most common irAEs following initial ICI therapy (26% and 23%, respectively) and ICI rechallenge (31% and 29%, respectively). The adjuvant, palliative, and neoadjuvant ICI therapy groups had 5-year OS rates of 86%, 77%, and 88%, respectively. In the palliative therapy group, the overall response rate and disease control rate were 38% and 42% during initial ICI therapy and 35% and 44% during ICI rechallenge. Elevated baseline lactate dehydrogenase levels were associated with worse OS (adjusted HR, 21.04, 95% CI, 1.35 to 328.29, p=0.030), and colitis and/or hepatitis were strongly associated with better OS (adjusted HR, 0.10, 95% CI 0.01 to 0.83, p=0.033).Conclusions AYA patients receiving ICI therapy for melanoma had high incidence of colitis and hepatitis and favorable survival. Initial and rechallenge ICI therapy had similar patterns of irAE severity and efficacy. Colitis and hepatitis were associated with improved OS.

Kaplan–Meier OS curves for patients with colorectal cancer receiving PPIs.

Supplemental Table 1 shows the univariate analysis of the association between patient and clinical factors and radiation therapy (RT) receipt in adolescents and young adults (AYAs) with Hodgkin Lymphoma

. Participant exclusions and the resulting numbers of included participants are shown in this consort diagram.

Abstract Prior studies have demonstrated that certain populations including older patients, racial/ethnic minority groups, and women are underrepresented in clinical trials. We performed a retrospective analysis of patients with non-Hodgkin lymphoma (NHL) seen at MD Anderson Cancer Center (MDACC) to investigate the association between trial participation, race/ethnicity, travel distance, and neighborhood socioeconomic status (nSES). Using patient addresses, we ascertained nSES variables on educational attainment, income, poverty, racial composition, and housing at the census tract (CT) level. We also performed geospatial analysis to determine the geographic distribution of clinical trial participants and distance from patient residence to MDACC. We examined 3146 consecutive adult patients with NHL seen between January 2017 and December 2020. The study cohort was predominantly male and non-Hispanic White (NHW). The most common insurance types were private insurance and Medicare; only 1.1% of patients had Medicaid. There was a high overall participation rate of 30.5%, with 20.9% enrolled in therapeutic trials. In univariate analyses, lower participation rates were associated with lower nSES including higher poverty rates and living in crowded households. Racial composition of CT was not associated with differences in trial participation. In multivariable analysis, trial participation varied significantly by histology, and participation declined nonlinearly with age in the overall, follicular lymphoma, and diffuse large B-cell lymphoma (DLBCL) models. In the DLBCL subset, Hispanic patients had lower odds of participation than White patients (odds ratio, 0.36; 95% confidence interval, 0.21-0.62; P = .001). In our large academic cohort, race, sex, insurance type, and nSES were not associated with trial participation, whereas age and diagnosis were.

Abstract Introduction: Advances in treatment have significantly improved the survival rates of adolescent and young adult (AYA) cancer patients, with a five-year survival rate reaching 86%. However, these survivors remain at increased risk for developing secondary cancers later in life. Racial and ethnic minority groups, such as Hispanics, often experience significant healthcare disparities, including lower cancer screening rates. Cancer survivors, particularly those who are Hispanic and diagnosed as AYAs, may face unique barriers in adhering to recommended cancer screening guidelines. This study examines the uptake rates of colon, breast, and cervical cancer screenings among Hispanic survivors of AYA cancer compared to their age- and sex-matched Hispanic non-cancer controls. Methods: The National Health Interview Survey data (years 2000 - 2021) [R1] were analyzed to identify Hispanic survivors of AYA cancer and Hispanic age- and sex-matched non-cancer controls. Data on cancer screening, including whether patients were up- to-date and ever screened for colon, breast, and cervical cancers, were assessed. The US Preventive Services Task Force recommendations were used to determine whether survivors were up-to-date for the cancer screening tests. The sample included 92 colon cancer survivors, 113 breast cancer survivors, and 313 cervical cancer survivors, matched with 920, 1130, and 3130 controls, respectively. Weighted percentages and odds ratios (OR) were calculated, adjusting for age at survey, sex, marital status, education, poverty status, and insurance. Results: Colon cancer screening uptake was significantly higher among survivors, with 26.1% up-to-date versus 11.5% of controls (OR=2.49, 95% CI=1.17-5.30, p=0.019). For breast cancer, 14.6% of survivors were up-to-date compared to 5.1% of controls [R2] (OR=2.51, 95% CI=1.33-4.72, p=0.005), and 82.6% of survivors were ever screened versus 38.7% of controls (OR=7.41, 95% CI=4.43-12.41, p<0.001). Cervical cancer screening showed the most pronounced difference, with 40.6% of survivors up-to-date compared to 19.0% of controls (OR=3.36, 95% CI=2.43- 4.65, p<0.001), and 71.2% of survivors ever screened compared to 28.6% of controls (OR=14.16, 95% CI=8.56-23.40, p<0.001). Conclusion: Hispanic AYA cancer survivors exhibit significantly higher cancer screening rates compared to matched controls. Despite these positive findings, the overall low screening rates highlight the need for targeted interventions to ensure that all survivors adhere to recommended screening guidelines. Enhancing access to healthcare and ensuring continuity of care are critical steps toward reducing disparities and improving health outcomes for this vulnerable population. Citation Format: Eunju Choi, Amy M. Berkman, Clark R Andersen, Michael E. Roth. Cancer screening uptake among Hispanic survivors of adolescent and young adult cancer [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A120.

6565 Background: Unplanned readmissions are associated with substantial distress for patients and their families. We hypothesized that goals-of-care (GOC) discussions, by improving goal-concordant care, may reduce unplanned readmissions. However, only a handful of studies have specifically examined this question. We assessed the implementation of a system-wide multicomponent interdisciplinary GOC (myGOC) program on the 30-day unplanned readmission rate and other hospital outcomes for medical patients at our comprehensive cancer center. Methods: In this retrospective cohort study, we compared the 30-day unplanned readmission rates in consecutive medical patients during the pre-implementation period from May 1, 2019 to December 31, 2019 and the post-implementation period from May 1, 2020 to December 31, 2020. The primary outcome was the 30-day unplanned readmission rate as defined by Vizient. Secondary outcomes included 7-day unplanned readmission rates, inpatient do-not-resuscitate (DNR) orders and supportive care consults. A multi-variate analysis model was used to examine the association between 30-day unplanned readmission rates and the implementation of the myGOC program adjusting for age, sex, race, index hospitalization type, and Sequential Organ Failure Assessment (SOFA) score. Results: This study included 7028 and 5982 unique medical patients during the pre- and post-implementation period, respectively. The 30-day unplanned readmission rates decreased from 13.7% before to 12.0% after implementation of the myGOC program. After adjusting for covariates, the myGOC implementation remained significantly associated with a reduction in 30-day unplanned readmission rates (OR [95% CI] 0.85 [0.77, 0.95], p=0.003). Other factors significantly associated with a decreased likelihood of a 30-day unplanned readmission were hematologic malignancies (vs. solid: 0.71 [0.64, 0.79]), White race (vs. Hispanic: 0.86 [0.75, 0.98]), an inpatient DNR order (0.30 [0.25, 0.37], an ICU admission (0.58 [0.48, 0.71], and an emergent admission (vs. elective: 0.86 [0.76, 0.99]). We also observed a significant decrease in 7-day unplanned readmission rates (0.75 [0.64, 0.89], p=0.0009), an increase in inpatient DNR orders (1.48 [1.35, 1.63], p<0.0001) and an increase in supportive care consults (1.22 [1.13, 1.31], p<0.0001) post-implementation. Conclusions: Implementation of a system-wide multicomponent GOC intervention was associated with a significant reduction in 30-day unplanned readmission rates after accounting for other key clinical factors.

Background:High levels of empathy among resident physicians are associated with improved patient outcomes. Empathy may be learned and practiced when reading nonmedical writing through narrative transportation, a process by which readers identify with characters and become emotionally involved in the plot. We hypothesized that residents and fellows who reported more nonmedical reading would have higher empathy levels and that empathy would decrease during training.Methods:An emailed survey was sent to program directors of Accreditation Council on Graduate Medical Education-accredited anesthesiology residency and fellowship programs, with a request to distribute the survey to trainees. The Toronto Empathy Questionnaire, reading volume, and demographics were included in the survey. Response data were analyzed using a multiple variable regression model.Results:Of 136 responses, 119 were included for data analysis. Seventeen partially completed surveys were excluded. Higher empathy scores were reported among women (P < .0001) and residents who worked 60 to 80 hours per week (P = .039). Age, postgraduate year of training, relationship status, time spent with family, and avid reading were not significantly associated with increased empathy.Conclusion:In this study, we examined whether nonmedical fiction reading would increase empathy in medical trainees. Our study was not able to find any significant association with time spent reading and increased empathy; however, we found that trainees who worked more hours, specifically 60 to 80 hours, had higher empathy scores. Limitations for this study included a smaller sample size. Further research should be done in this field to determine if there are other intangible factors that affect empathy in trainees.

Introduction: Treatment of ARDS caused by smoke inhalation is challenging with no specific therapies available. The aim of this study was to test the efficacy of nebulized adipose-derived mesenchymal stem cells (ASCs) in a well-characterized, clinically relevant ovine model of smoke inhalation injury. Material and Methods: Fourteen female Merino sheep were surgically instrumented 5-7 days prior to study. After induction of acute lung injury (ALI) by cooled cotton smoke insufflation into the lungs (under anesthesia and analgesia), sheep were placed on a mechanical ventilator for 48 hrs and monitored for cardiopulmonary hemodynamics in a conscious state. ASCs were isolated from ovine adipose tissue. Sheep were randomly allocated to two groups after smoke injury: 1) ASCs group (n = 6): 10 million ASCs were nebulized into the airway at 1 hr post-injury; and 2) Control group (n = 8): Nebulized with saline into the airways at 1 hr post-injury. ASCs were labeled with green fluorescent protein (GFP) to trace cells within the lung. ASCs viability was determined in bronchoalveolar lavage fluid (BALF). Results: PaO2/FiO2 in the ASCs group was significantly higher than in the control group (p = 0.001) at 24 hrs. Oxygenation index: (mean airway pressure x FiO2/PaO2) was significantly lower in the ASCs group at 36 hr (p = 0.003). Pulmonary shunt fraction tended to be lower in the ASCs group as compared to the control group. GFPlabelled ASCs were found on the surface of trachea epithelium 48 hrs after injury. The viability of ASCs in BALF was significantly lower than those exposed to the control vehicle solution. Conclusion: Nebulized ASCs moderately improved pulmonary function and delayed the onset of ARDS.

Isokinetic dynamometry is used during exercise testing and rehabilitation to obtain a quantitative strength measurement on which progressive strength training programs can be based. This study assesses the test-retest reliability of isokinetic leg function in the knee flexors and extensors at 150 degrees/s in children and young adults with severe burns to be used for rehabilitation exercise program prescription. In 39 severely burned patients (49 +/- 14% total body surface area burn [TBSA], mean +/- SD; 34 +/- 21% TBSA 3rd degree; 14 +/- 5 years, 153.3 +/- 16.5 cm height; 53.8 +/- 17.9 kg) knee flexion/extension isokinetic dynamometry at 150 degrees/s was performed on each patient's dominant leg in two sessions. The patient was acquainted with the test and performed 1 set of 10 repetitions at 150 degrees/s. A second session of 1 set of 10 repetitions at 150 degrees/ was performed within 24 h of the first. Muscle function outcomes were knee flexion/extension peak torque, average peak torque, and average power. One-sample paired t tests were performed for all muscle function outcomes; intraclass correlation coefficients and r(2) values with session two as a function of session one were calculated. Sessions did not differ significantly in knee extension or flexion for any muscle function outcome or the hamstrings to quadriceps ratio. All intraclass correlation coefficients were >0.89 and r(2) > 0.79. Test-retest isokinetic dynamometry functional measurements in the knee flexors and extensors at 150 degrees/s are reliable in the burn population and may aid resistance rehabilitation program prescriptions.

S442diffuse large B-cell lymphoma (DLBCL).The benefit of ibrutinib in relapsed/refractory PCNSL was weighed against the MTX toxicity profile in elderly patients.We initiated ibrutinib+rituximab while inpatient and continued oral ibrutinib therapy upon discharge.He demonstrated clinical improvement, shrinkage of brain lesions on MRI, and PET negativity.Conclusions: Our approach can be replicated at other institutions with repeat occurrences of drug shortages to ensure equitable distribution to avoid delays and lack of treatment.Weekly or more frequent pharmacy-led communications and open dialogue amongst specialists provide a sound approach to triaging chemotherapies during shortages.Specifically for CNS lymphoma/leukemia, reasonable regimens to consider are rituximab-Ara-C for younger, fit patients, and ibrutinib±rituximab for older, less fit patients.