BACKGROUND:A growing population of older adult cancer survivors faces competing cancer and noncancer health risks. There are limited real-world data on recurrence patterns beyond 5 years post-treatment. METHODS:This was a SEER-Medicare retrospective cohort study of patients aged ≥66 with stage I-III breast, colon, or rectal cancer who received definitive surgery and survived ≥5 years from diagnosis without recurrence or second primary malignancy. Late recurrence (5-10 years postdiagnosis) was identified using a validated algorithm to detect treated recurrence in Medicare claims. Demographic and clinical characteristics collected at cancer diagnosis were assessed as predictors of late treated recurrence using restricted mean survival time (RMST) regression. RESULTS:The sample included 12 859 breast, 17 329 colon, and 4427 rectal cancer survivors. The cumulative incidence of late treated recurrence 5-10 years postdiagnosis was 5.0% in breast, 4.4% in colon, and 8.0% in rectal cancer survivors. In all cohorts, stage was associated with shorter RMST. The absolute risk difference between stage I and III was greatest in breast (2% vs 18.1%), followed by rectal (5.2% vs 10.3%) and colon (2.7% vs 6.7%) cancer survivors (P < .001 for all cohorts). Although their effect on RMST was modest (<5%), higher grade, node-positive, and ER-positive disease in breast, left-sided tumors in colon, and radiation in rectal cancer were associated with late treated recurrence. Across all cohorts, the incidence of other-cause mortality (24.1%-34.0%) exceeded cancer-specific mortality (2.9%-6.2%). CONCLUSIONS:Late treated recurrence in older long-term survivors is uncommon, but risk remains elevated 5 years postdiagnosis in those with more advanced stage.

Importance The prevalence of depression is higher in cancer survivors than in the general population. As the long-term cancer survivor population increases, it is increasingly important to understand risk factors for late-onset depression. Objective To identify risk factors associated with late-onset depression in long-term (5-year) survivors of breast, prostate, or colorectal cancer. Design, Setting, and Participants This retrospective cohort study used 2022 linkage of Surveillance, Epidemiology, and End Results (SEER) and Medicare data to identify 5-year survivors of breast, prostate, or colorectal cancer 66 years or older who were enrolled in fee-for-service Medicare and had no previous depression diagnosis. Long-term survivors were diagnosed with cancer between January 1, 2007, and December 31, 2012, and followed up between January 1, 2008, and December 31, 2020. Data analysis was performed from August 2024 to July 2025. Exposures Sociodemographic and cancer-specific characteristics, treatment within 1 year after diagnosis, comorbidities within 1 year before cancer diagnosis, and previous diagnosis of anxiety. Main Outcomes and Measures The primary outcome was late-onset depression 5 to 10 years after cancer diagnosis, identified using a validated claims-based algorithm. Analyses were conducted separately for each survivor cohort. Fine-Gray subdistribution hazard regression, accounting for the competing risk of mortality, was used to identify factors associated with late-onset depression. Results A total of 53 769 survivors were identified, including 13 265 breast, 26 979 prostate, and 13 525 colorectal cancer survivors (mean [SD] age, 74.1 [5.8] years; 31 279 [61.9%] male; 2375 [4.4%] Asian or Pacific Islander, 2691 [5.0%] Hispanic, 3906 [7.3%] non-Hispanic Black, 43 986 [81.8%] non-Hispanic White, and 811 [1.5%] other or unknown) were identified. The 5-year risk of late-onset depression was highest in breast cancer survivors (13.3% [1768 of 13 265]), compared with prostate (8.7% [2360 of 26 979]) and colorectal (11.8% [1591 of 13 525]) cancer survivors. Older age was associated with greater hazard of depression among some categories (eg, prostate cancer survivors aged ≥90 years vs 71-74 years: HR, 1.57; 95% CI, 1.10-2.24) but not among others (eg, colorectal cancer survivors aged ≥90 years vs 71-74 years: HR, 1.02; 95% CI, 0.84-1.24). Variables that were consistently associated with greater hazard of depression included Medicare-Medicaid dual eligibility (eg, dual eligible breast cancer survivors vs non-dual eligible: HR, 1.38; 95% CI, 1.22-1.57), anxiety (eg, prostate cancer survivors: HR, 2.82; 95% CI, 2.47-3.22), and comorbidity burden (eg, breast cancer survivors: HR, 1.33; 95% CI, 1.12-1.57). In prostate cancer survivors, receipt of radiotherapy with or without androgen deprivation therapy was also associated with higher risk (HR, 1.22; 95% CI, 1.10-1.36). The risk of depression among survivors in the high-risk tertile was twice as high compared with the low-risk tertile. Conclusions and Relevance In this cohort study of long-term cancer survivors, Medicare and Medicaid dual eligibility, higher comorbidity burden, and preexisting anxiety were independently associated with greater risk of late-onset depression. These findings suggest that these risk factors may be used to proactively inform survivorship care during the transition from cancer surveillance to preventive care, which could reduce the risk of inconsistent follow-up care for survivors that may drive socioeconomic and racial and ethnic disparities in depression screening and treatment.

e21004 Background: Sacred moments – brief periods of deep interconnectedness between clinicians and patients – have been associated with enhanced well-being and therapeutic alliance. While these moments have been described in radiation oncology and general hospital patients, they have been unexplored in medical oncology, where relationship-centered care is particularly crucial. We thus assessed the frequency and themes around sacred moments experienced by clinicians caring for patients with cancer. Methods: We conducted an exploratory, mixed methods study at an NCI-designated Comprehensive Cancer Center through purposeful sampling of clinicians. Participants completed a semi-structured interview and a survey. Interviews were recorded, transcribed, and de-identified. Thematic analysis was performed on textual data of transcripts using an inductive coding approach. The survey assessed demographics, frequency of sacred moments, and their impact. Using a 5-point Likert scale, participants rated how these moments influenced career fulfillment, sense of meaning, and connection with patients. Results: We interviewed 24 clinicians: attendings (70%), fellows (20%), and advanced practice providers (10%). Of 23 survey respondents, specialties included medical oncology (65%), hematology (13%), surgical oncology (13%), and palliative medicine (9%). A majority of participants were female (65%), with a range of experience (56% 0-10 years, 43% >10 years’ in practice). All 24 clinicians reported having experienced a sacred moment during a patient encounter in their career, with 95% of participants reporting at least monthly occurrences. All agreed these moments enhanced their professional fulfillment, allowed for connection with their patients, and reminded them of why they went into their career. Three main themes emerged from the qualitative interviews: 1) Sacred moment catalysts: changes in patient clinical status, continuity of patient-clinician relationships 2) Cultivation strategies: intentional presence, partnership with the patient, recognizing shared humanity, and 3) Career fulfillment: sense of purpose, increased likelihood of goal aligned care with patients (Table 1). Conclusions: Sacred moments among oncology clinicians are common, professionally fulfilling, and serve as a reminder of why they pursued oncology. Future work will examine the patient perspective and developing interventions to increase the frequency of these meaningful interactions. Themes and illustrative quotes. Catalysts “I followed her for several years, and suddenly she very rapidly deteriorated. We stood together and sobbed.” Cultivation “ My principle if I go into the room is I’m going to spend as much time as that patient needs, and share some human interaction.” Fulfillment “It’s what's kept me enjoying the practice of medicine.” “Feels more like what medicine is supposed to be.”

INTRODUCTION:Due to the growth of the cancer survivor population, strategies to facilitate efficient delivery of survivorship care are critical to reduce the risk of adverse events associated with frailty. The objective of this study was to develop a risk stratification tool to identify long-term survivors at the highest risk of becoming frail 5-10 years after cancer diagnosis. MATERIALS AND METHODS:We used the Surveillance, Epidemiology, and End Results (SEER) dataset linked with Medicare data to identify patients with stage I-III breast, prostate, colon, or rectal cancers who lived at least five years from diagnosis and were not severely frail at year five post-diagnosis. Frailty was assessed using the claims-based Kim Frailty Index (FI) categorized by recommended thresholds. Restricted mean survival time (RMST) regression was used to identify clinical and demographic characteristics associated with frailty progression, defined as an increased category of the FI. Significant predictors were used to create clinical prediction rules and stratify survivors into low, intermediate, and high-risk groups. RESULTS:A total of 87,229 five-year survivors were included. At five years from diagnosis (time zero), 22 % of patients not frail at cancer diagnosis had new onset frailty and were mildly or moderately frail; at 10 years from diagnosis, 61 % had developed new or worsening frailty. Advanced age, comorbidities (RMST ratios ranging from 0.67 [95 % CI 0.65-0.70] to 0.80 [95 % CI 0.77-0.84], baseline moderate frailty at cancer diagnosis (RMST ratios ranging from 0.79 [95 % CI 0.76-0.83] to 0.86 [95 % CI 0.83-0.90]) and at five years post-diagnosis (RMST ratios ranging from 0.63 [95 % CI 0.62-0.64] to 0.71 [95 % CI 0.69-0.73]), living in a high poverty area (RMST ratios ranging from 0.91 [95 % CI 0.87-0.94] to 0.96, [95 % CI 0.93-0.99], and systemic treatments four to five years post-diagnosis (RMST ratios ranging from 0.77 [95 % CI: 0.70-0.84] to 0.86, [95 % CI: 0.84-0.89] were associated with less average time without frailty. DISCUSSION:Age, comorbidities, prior frailty, and late treatment were associated with frailty in older breast, prostate, colon, and rectal cancer survivors. This risk stratification model can be used by clinicians to assess cancer and age-related risk of frailty and facilitate timely intervention.

Importance In May 2021, the US Preventive Services Task Force (USPSTF) issued a grade B recommendation encouraging colorectal cancer (CRC) screening among average-risk individuals aged 45 to 49 years. The patterns of screening uptake and possible socioeconomic disparities in screening in this age group remain unknown. Objective To evaluate changes in CRC screening uptake among average-risk individuals aged 45 to 49 years after the USPSTF recommendation was issued in 2021. Design, Setting, and Participants This retrospective cohort study used deidentified claims data from commercially insured Blue Cross Blue Shield beneficiaries aged 45 to 49 years across the US between January 1, 2017, and December 31, 2022. Exposure Publication of the May 2021 USPSTF CRC screening recommendation for adults aged 45 to 49 years. Main Outcomes and Measures Absolute and relative changes in screening uptake were compared between a 20-month period preceding (May 1, 2018, to December 31, 2019) and a 20-month period following (May 1, 2021, to December, 31, 2022) the USPSTF recommendation. Interrupted time-series analysis and autoregressive integrated moving average models were used to evaluate changes in screening rates, adjusting for temporal autocorrelation and seasonality. Results In this cohort study of 10 221 114 distinct beneficiaries aged 45 to 49 years (mean [SD] age, 47.04 [1.41] years; 51.04% female), bimonthly mean (SD) numbers of average-risk beneficiaries were 3 213 935 (31 508) and 2 923 327 (105 716) in the prerecommendation and postrecommendation periods, respectively. Mean (SD) screening uptake increased from 0.50% (0.02%) to 1.51% (0.59%) between the 2 periods (P < .001), representing an absolute change of 1.01 percentage points (95% CI, 0.62-1.40 percentage points) but no significant relative change (202.51%; 95% CI, -30.59% to 436.87%). Compared with average-risk beneficiaries residing in areas with the lowest socioeconomic status (SES), those residing in areas with the highest SES experienced the largest absolute change in screening (1.25 [95% CI, 0.77-1.74] percentage points vs 0.75 [95% CI, 0.47-1.02] percentage points), but relative changes were not significant (214.01% [95% CI, -30.91% to 461.15%] vs 167.73% [95% CI, -16.30% to 352.62%]). After the recommendation was issued, the screening uptake rate also increased fastest among average-risk beneficiaries residing in the areas with highest SES (0.24 [95% CI, 0.23-0.25] percentage points every 2 months) and metropolitan areas (0.20 [95% CI, 0.19-0.21] percentage points every 2 months). Conclusions and Relevance This study found that among privately insured beneficiaries aged 45 to 49 years, CRC screening uptake increased after the USPSTF recommendation, with potential disparities based on SES and locality.

The authors have no conflict of interest to disclose. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.

It is important to consider medication interactions and overlapping medication toxicities in persons living with HIV (PLWH) who are on combination antiretroviral therapy (cART), in addition to disease-specific cancer therapy, medications to alleviate cytotoxic effects of chemotherapy, prophylaxis to prevent infection or medications for palliation. Protease inhibitors, integrase inhibitors, nucleoside reverse transcriptase inhibitors (NRTIs) and non-NRTIs are the major components of commonly used cART regimens, and are metabolised via the cytochrome P450 (CYP450) system of the liver. Many antineoplastic agents, and supportive therapies, including those medications required for management of opportunistic infections (anti-infective medications including antifungal agents and antibiotics), nausea/vomiting (antiemetics and steroids), cancer-related pain (opioid analgesics) and comorbid psychiatric disorders (selective-serotonin …

Background: HIV/AIDS remains one of the world’s most significant public health challenges; sub-Saharan Africa accounts for 71% of the global burden of HIV. Testing for HIV is pivotal to achieving UNAIDS 95-95-95 target towards bringing an end to the epidemic. Objective: The study assessed five-year HIV testing data from the largest tertiary hospital in Monrovia, Liberia and highlights risk groups that would benefit from targeted testing and prevention interventions. Methods: This was a single-center academic hospital-based retrospective analysis of HIV testing data from January 2014 to December 2018 obtained from all testing sites at John F. Kennedy Medical Center in Monrovia, Liberia. Pooled HIV testing data during the study period were analyzed using descriptive statistics and stratified by age, gender and pregnancy status. Annual diagnoses rates were reported as proportion of individuals tested within a specified category (age [<15 years, age 15–24 years and >=25 years], gender, and pregnancy status) that had a positive HIV test. Five-year trends were analyzed. Results: Over the study period, 41,343 non-pregnant individuals were screened for HIV. In addition, the antenatal clinic performed 24,913 tests. Of non-pregnant individuals tested, 4,066 (10%) were diagnosed with HIV ranging from 7% (909/12821) in 2018 to 13% (678/5079) in 2014. Case detection rates for individuals aged 15–24 were 7%, 5%, 4%, 6% and 3% for years 2014, 2015, 2016, 2017 and 2018 respectively. Annually, 2–3% of all pregnant women tested were diagnosed with HIV. While HIV detection rates decreased over time overall, children less than 15 years of age showed an annual increase from 6.7% in 2014 to 12.3% in 2018. Conclusion: A large five-year dataset from the largest tertiary facility in Liberia shows broad HIV detection rates that are much higher than national prevalence estimates. Ramping up HIV testing and prevention interventions including pre-exposure prophylaxis are sorely needed.

Background Late diagnosis of human immunodeficiency virus (HIV) is associated with increased morbidity and mortality, and represents a serious public health concern. Methods A retrospective medical record review was conducted on 188 patients with newly diagnosed HIV at a large academic center’s HIV clinic from 1/2010 to 12/2019. Patient demographic data, HIV staging, and response to combination antiretroviral therapy (cART) as measured by HIV viral suppression at 12 weeks (HIV RNA < 50 copies) were collected. Bivariate analyses were applied to compare patients ≥50 years old to those < 50 years old. Results Over two-thirds of the older patients with a new diagnosis of HIV presented with a CD4 count < 200, or an AIDS-defining illness. Though not statistically significant, this same group also had a delay to viral suppression with only 59% achieving viral suppression after 12-weeks of cART initiation. Conclusions This study suggests that older patients are presenting to care with advanced stages of HIV, and may also have a delay in achieving viral suppression after cART initiation. Future studies should aim to target HIV testing and treatment strategies for this at-risk older adult group.

Individuals in US Immigration and Customs Enforcement (ICE) detention are at risk from serious consequences resulting from the rapid spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and inadequate access to appropriate medical care. This situation represents a moral and public health imperative for rapid action by the US Department of Homeland Security (DHS) to mitigate the human toll of the pandemic.

There have been remarkable advances in drug development for the treatment of HIV-1 infection. From the co-formulation of combination antiretroviral therapy (cART) into single-tablet regimens to the development of long-acting antiretroviral (ARV) drug formulations, the treatment of HIV has and will become much more tolerable and less complicated for patients. In addition, and appropriately, there is a focus on reducing short- and long-term toxicities of treatment while maintaining robust efficacy. One of such approaches includes 2-drug regimen constructs that contain and retain effective ARV compounds while excluding components that have relatively unfavorable toxicity profiles. The first-ever 2-drug regimen approved for the treatment of HIV-1 infection for treatment-naive people living with HIV (PLWH), consisting of the integrase inhibitor dolutegravir (DTG) and the nucleoside reverse transcriptase inhibitor (NRTI) lamivudine (3TC), is reviewed in this paper. The chemical composition and properties, pharmacokinetic and pharmacodynamics profile, and clinical trial data on efficacy and safety of DTG/3TC are presented. An expert opinion aims to highlight important considerations for the use of DTG/3TC in the context of existing and emerging ARV options.

Francis J Zamora 1,2 Ellen Dowers 2 Faiza Yasin Onyema Ogbuagu 3 1Department of Pharmacy Services, Broward Health Medical Center, Fort Lauderdale, FL, USA; 2Department of Pharmacy Services, Yale-New Haven Hospital, New Haven, CT, USA; 3Section of Infectious Diseases, Yale AIDS Program, Yale University School of Medicine, New Haven, CT, USA Abstract: There have been remarkable advances in drug development for the treatment of HIV-1 infection. From the co-formulation of combination antiretroviral therapy (cART) into single-tablet regimens to the development of long-acting antiretroviral (ARV) drug formulations, the treatment of HIV has and will become much more tolerable and less complicated for patients. In addition, and appropriately, there is a focus on reducing shortand long-term toxicities of treatment while maintaining robust efficacy. One of such approaches includes 2drug regimen constructs that contain and retain effective ARV compounds while excluding components that have relatively unfavorable toxicity profiles. The first-ever 2-drug regimen approved for the treatment of HIV-1 infection for treatment-naive people living with HIV (PLWH), consisting of the integrase inhibitor dolutegravir (DTG) and the nucleoside reverse transcriptase inhibitor (NRTI) lamivudine (3TC), is reviewed in this paper. The chemical composition and properties, pharmacokinetic and pharmacodynamics profile, and clinical trial data on efficacy and safety of DTG/3TC are presented. An expert opinion aims to highlight important considerations for the use of DTG/3TC in the context of existing and emerging ARV options.

There are 36.7 million persons living with HIV globally and 1.1 million in the United States with additional ~45,000 new diagnosis annually. One in six newly diagnosed HIV-infected persons is older than 50 years of age. It is estimated that 45% of the US HIV population is over 50 years old and more than 10% are older than 60 years. HIV is more likely to be diagnosed at an advanced stage in older adults. Therefore there is a need to better understand the characteristics, staging of the disease, and response to treatment in older HIV-infected adults, in order to provide an effective treatment and prevention approach. A retrospective medical record review of all newly diagnosed HIV-infected patients was conducted at a single academic center HIV ambulatory clinic from January 1, 2010 to December 31, 2015. Patients demographics, age group, HIV staging, and response to antiretroviral treatment (ART) measured by HIV viral suppression at 12 weeks (HIV RNA <50 copies), and change in CD4 count were collected. Bivariate analysis was conducted comparing two groups of HIV-infected patients: younger group (age <50 years) and older group (age 50 years and older). From 2010 to 2015, 130 newly diagnosed HIV patients were enrolled in the clinic. Thirty-one (23.8%) were 50 years or older and of those 12 (38.7%) were 60 years and older. Older patients group were more likely to have AIDS defining illness at the time of diagnosis, compared with the younger group [19 (61.3%) vs. 29 (29.3%), respectively]. Of those eight (42%) were older than 60 years. Compared with the younger group, the majority of the HIV-infected patients in the older group who were on ART (61.5%) did not achieve HIV viral suppression at 12 weeks. However, both groups accomplished immune reconstitution with an increase in CD4 cell count in older and younger groups (mean CD4 count = 132 and 200 cell/dl, respectively). More than 80% of patients in both groups were on an integrase inhibitor ART-based regimen. HIV-infected patients 50 years and older are more likely to present late to care, and to have a delay in HIV viral suppression compared with younger patient group. These findings are alarming and require emphasize on early HIV diagnosis. More data are required to understand the immune response to cART. All authors: No reported disclosures.