3664 Background: In addition to timely evaluation and screening in patients with colorectal cancer (CRC), routine primary care provider (PCP) engagement may improve CRC survival outcomes through earlier diagnosis and increased treatment adherence. We evaluated the association between pre-diagnostic PCP utilization and metastatic disease at diagnosis, cancer-specific mortality (CSM), and cancer treatment adherence. Methods: Using the Surveillance, Epidemiology, and End Results (SEER)-Medicare database, we conducted a retrospective cohort study of adults aged 68-75 diagnosed with CRC between 2010-2017. PCP visits in the three years preceding diagnosis were categorized as none (0 visits), occasional (1–2), or annual (3). Multivariable logistic regression models evaluated associations between PCP use and metastatic CRC at diagnosis, as well as treatment adherence. Locally advanced (Stage III) treatment adherence was defined as curative therapy ≤1 year from diagnosis, and metastatic treatment adherence was defined as systemic therapy ≤6 months from diagnosis. A competing risk Cox proportional hazards model evaluated cancer-specific mortality (CSM), with non-cancer death as a competing event. Results: Of 18,604 patients with CRC, 12.9% had no prior PCP visits, 48.6% had occasional visits, and 38.5% had annual visits. Compared to patients with no pre-diagnostic PCP use, occasional and annual PCP visits were respectively associated with 43% and 57% lower odds (p < 0.001) of metastatic disease at diagnosis and 48% and 57% lower odds (p < 0.001) of CSM (Table 1). Among patients with locally advanced CRC, occasional and annual PCP use were associated with 64% and 150% higher odds of receiving curative treatment, respectively (Table 1). Similarly, occasional and annual PCP use in patients with metastatic CRC were associated with 2-fold and 3-fold higher odds, respectively, of receiving systemic treatment (Table 1). Conclusions: Primary care utilization prior to CRC diagnosis is significantly associated with lower odds of metastatic disease, lower risk of CSM, and higher odds of treatment adherence, with the highest effects observed with annual PCP utilization. Increasing PCP engagement is an essential strategy to improving outcomes in patients with CRC. Multivariate estimates for the effect of pre-diagnostic primary care provider (PCP) utilization prior to cancer diagnosis. Metastatic Disease at DiagnosisOR, [95% CI], p-value Cancer-Specific MortalitysHR, [95% CI], p-value Received Treatment (Locally advanced CRC)OR, [95% CI], p-value Received Treatment (Metastatic CRC)OR, [95% CI], p-value 1-2 PCP visits (Occasional) 0.57 [0.51-0.64], p < 0.001 0.52 [0.48-0.56], p < 0.001 2.64 [2.10-3.30], p < 0.001 2.08 [1.70-2.56], p < 0.001 3+ PCP visits(Annual) 0.43 [0.40-0.47], p < 0.001 0.43 [0.40-0.47], p < 0.001 3.50 [2.76-4.24], p < 0.001 2.90 [2.31-3.64], p < 0.001

Background:Early cancer diagnosis improves survival and quality of life, yet disparities in stage at diagnosis persist. This study evaluates demographic, clinical, insurance, and neighborhood-level socioeconomic factors associated with late-stage cancer diagnosis within an academic health system. Methods:We conducted a retrospective cohort study of 27,064 adults diagnosed with breast, colorectal, or lung and bronchus cancer between 2015 and 2025 in the University of California Health System. Late-stage disease was defined as AJCC stage III/IV. Multivariable logistic regression examined associations between late-stage diagnosis and patient characteristics, insurance status, comorbidity burden, and neighborhood socioeconomic measures, including the Area Deprivation Index (ADI), Social Vulnerability Index (SVI), and Healthy Places Index (HPI). Results:17.6% of patients were diagnosed at a late stage. Cancer type was the strongest predictor, with lung (aOR ≈ 13-14) and colorectal cancer (aOR ≈ 8) associated with higher odds of late-stage diagnosis compared with breast cancer. Residence in medium and high ADI tertiles and Medicaid insurance (OR = 1.16; 95% CI: 1.06-1.28) were associated with higher odds of late-stage diagnosis, while Veterans Affairs coverage was associated with lower odds (OR = 0.76; 95% CI: 0.58-1.01). SVI was not associated with stage at diagnosis, whereas higher HPI scores were modestly protective. Conclusion:Late-stage cancer diagnosis is driven primarily by cancer type and insurance status, with additional contributions from neighborhood disadvantage.

Background:Telehealth use expanded rapidly during the COVID-19 pandemic and has since become integrated into routine oncology care. However, clinician experiences and confidence with telehealth may vary across oncology subspecialties, and these differences remain incompletely characterized. Objective:This study aimed to evaluate telehealth perceptions, decision-making factors, and confidence across oncology clinicians from multiple specialties at a single academic cancer center. Methods:We conducted a cross-sectional survey of oncology clinicians at the University of California San Diego Moores Cancer Center. A 27-item Qualtrics questionnaire was distributed by email to attending physicians, fellows, and advanced practice providers across surgical, medical, radiation, and palliative oncology. Survey domains included telehealth coordination, technical quality, communication effectiveness, confidence in remote physical examination, and factors influencing visit modality selection. Quantitative responses were summarized descriptively, and open-ended responses underwent thematic analysis. Results:Among 114 invited clinicians, 57 (50%) complete responses were analyzed. Among 57 respondents, 86% (n=49) were physicians. Specialties included surgical oncology (n=21, 36.8%), medical oncology (n=18, 31.6%), radiation oncology (n=16, 28.1%), and palliative care (n=2, 3.5%). Telehealth coordination was rated easy or very easy by 78.9% (n=45) of clinicians. Audio and video quality were rated good or very good by 71.9% (n=41) and 57.9% (n=33), respectively. Technical issues prompted at least occasional conversion to audio-only visits for 86% (n=49) of respondents, and 17.5% (n=10) of clinicians reported frequent conversion. Communication satisfaction was high (n=48, 84.2%), yet only 50.9% (n=29) reported moderate or high confidence in performing a virtual physical examination. The need for physical examination (n=53, 93%) and patient travel distance (n=45, 78.9%) were the most influential factors in offering telehealth visits. Confidence varied by specialty and clinical phase: moderate or high confidence was reported by surgical oncology clinicians in 52.4% (11/21) of preoperative and 71.4% (15/21) of postoperative responses, by medical oncology clinicians in 77.8% (14/18) of prechemotherapy and 76.5% (13/17) of during chemotherapy responses, and by radiation oncology clinicians in 87.5% (14/16) of preradiation and 93.8% (15/16) of during radiation responses. Conclusions:Oncology clinicians reported generally positive experiences with telehealth, although confidence and use patterns varied across specialties and phases of care. Telehealth is viewed as a complementary modality when physical examination is not essential. Improvements in technical reliability and interpreter integration may enhance equitable access and support continued telehealth use in oncology care.

Training programs designed to increase participation of underrepresented students in cancer-related careers rarely include structured community engagement components. We describe the design and pilot of the Field Experience in Cancer Outreach and Engagement (FECOE), a program developed as part of the CREATE Partnership (Cancer Research and Education to Advance HealTh Excellence), a National Cancer Institute-funded grant to San Diego State University (SDSU) and University of California San Diego (UCSD). Scholars were situated within the UCSD Moores Cancer Center Community Outreach and Engagement (COE) component and completed 20 h of field and product-development activities from May-August 2025. A focus group was conducted at the conclusion of the program. Three SDSU Undergraduate Scholars and one UCSD Medical Student Scholar completed the pilot. Scholars reported gaining skills in health communication, community engagement, and cultural humility. Scholars described the experience as "connected" and "eye-opening," and reported gains in career clarity. Feedback included improving tracking of hours, event preparation, and networking. The pilot FECOE demonstrates the feasibility of embedding a community outreach field experience within a cancer research training program. The COE-embedded model offers a scalable, sustainable approach that benefits Scholars and the host institution's outreach mission. Lessons learned will inform refinements for future iterations.

Objectives: The incidence of renal cell carcinoma (RCC) has been rising, largely due to increased incidental detection from widespread imaging. Although synchronous distant metastasis (SM) with a primary renal tumor measuring <4 cm (cT1a) is uncommon, its presence may influence survival outcomes and the utility of cytoreductive nephrectomy. We sought to investigate clinical characteristics, metastatic patterns, treatments, and survival outcomes of patients with T1a RCC. Methods: All patients aged ≥18 years diagnosed with RCC between 2004 and 2019 were extracted from the National Cancer Database. The Cochran–Armitage test was used for trend analysis, while multivariable analyses were conducted to identify variables associated with SM and to assess the impact of cytoreductive surgery on mortality across isolated metastatic sites. Kaplan–Meier analysis was performed to compare survival outcomes. Results: A total of 263,911 individuals diagnosed with T1a RCC were analyzed in the study. Among them, 114,661 patients (43.4%) were classified as having cT1a tumor stage, and of these patients with cT1a RCC, 2275 (2.0%) exhibited SM. The proportion of SM cT1a was 3.39% in 2004 and 2.08% in 2019, with an Average Annual Percent Change (AAPC) of −0.037% (p = 0.830). The most common sites of metastasis were bone (59%), followed by lung (35%), liver (16%), and brain (12%). Resection of the primary tumor and receipt of systemic therapy were significantly associated with reduced mortality among all metastatic sites, especially in individuals with lung-only metastases (HR = 0.02, p = 0.013). Metastasectomy was associated with improved survival in patients with brain-only metastases (HR = 0.26, p = 0.006) but did not demonstrate the same benefit in patients with bone-, lung- or liver-only metastases. The worst 5-year OS rate was observed in cases with metastasis to multiple sites, whereas isolated metastases had similar survival rates (p < 0.0001). Our findings are limited by retrospective study design. Conclusions: This comprehensive analysis of T1a RCC patients reveals that while synchronous metastasis is relatively uncommon (2.0%), it presents significant clinical challenges, with bone as the most common metastatic site, contrasting with the typical lung predominance in larger tumors. Primary tumor resection showed survival benefit in patients with isolated metastases, especially for lung-only metastasis. These findings highlight the heterogeneous nature of tumor biology in small renal masses and underscore the importance of tailored, multimodal treatment strategies for the effective management of SM T1a RCC.

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.

Improving accuracy, time spent, and ubiquity of delineation has been a long-standing design aim, yet many HCI works have overlooked high-stakes and complex healthcare annotation. We explore contouring, a critical workflow aimed at identifying and segmenting tumors, usually performed on immobile desktop computers in clinics, in which limited support for mobile access leads to prolonged and subpar treatment planning. Following interviews and think-aloud studies (N = 10 physicians), we report key contouring behaviors, and later design a novel cross-device prototype that enables contouring on everyday touch devices. We compared contouring via desktop and touch in a lab study (N = 8 residents) and found that mobile phones not only yielded similar accuracy, but also took significantly less time. Our results point to three broad design guidelines for cross-device solutions deployed within standalone healthcare workflows, and highlight how incorporating different device and input modalities can improve treatment delivery in today’s distributed healthcare environments.

BACKGROUND:Opioid tapering in the general population is linked to increases in hospitalizations or emergency department visits related to psychiatric or drug-related diagnoses. Cancer survivors represent a unique population with different opioid indications, prescription patterns, and more frequent follow-up care. This study sought to describe patterns of opioid tapering among older cancer survivors and to test the hypothesis of whether older cancer survivors face increased risks of adverse events with opioid tapering. METHODS:Using the Surveillance, Epidemiology and End Results Medicare-linked database, we identified 15 002 Medicare-beneficiary cancer survivors diagnosed between 2010 and 2017 prescribed opioids consistently for at least 6 months after their cancer diagnosis. Tapering was defined as a binary time-varying event occurring with any monthly oral morphine equivalent reduction of 15% or more from the previous month. Primary diagnostic billing codes associated with emergency room or hospital admissions were used for the composite endpoint of psychiatric- or drug-related event(s). RESULTS:There were 3.86 events per 100 patient-months, with 97.8% events being mental health emergencies, 1.91% events being overdose emergencies, and 0.25% involving both. Using a generalized estimating equation for repeated measure time-based analysis, opioid tapering was not statistically associated with acute events in the 3-month posttaper period (odds ratio [OR] = 1.02; P = .62) or at any point in the future (OR = 0.96; P = .46). CONCLUSIONS:Opioid tapering in older cancer survivors does not appear to be linked to a higher risk of acute psychiatric- or drug-related events, in contrast to prior research in the general population.

Our primary analysis assumed that projected incidence and survival trends would continue based on historical trends. Supplemental Table S2 demonstrates the number of radiation-treated cancer survivors when assuming constant cancer incidence, constant relative survival, and both constant incidence and constant relative survival.

Context. There is no current standard-of-care follow-up strategy for patients who receive palliative radiotherapy (PRT) for bone metastases. Within our institution there is currently a heterogenous practice in which some providers schedule routine follow up 1-3 months after initial PRT while others do follow up only as needed (PRN).Objectives. Our study aims to compare rates of retreatment based on follow-up strategies (planned vs. PRN), explore factors that potentially affect retreatment, and evaluate whether provider follow-up strategy correlates with measurable differences in quality of care. Methods. In a retrospective chart review, PRT courses for bone metastases at our single institution were divided by follow-up strategies (planned vs. PRN). Demographic, clinical, and PRT data were collected and analyzed via descriptive statistics. The relationship between planned follow-up appointment and subsequent retreatment was studied.Results. More patients received retreatment within one year of initial PRT in the planned follow-up group than in the PRN follow-up group (40.4% vs. 14.4%, p<0.001). Retreatment was achieved sooner in the planned follow-up group than in the PRN follow-up group (137 days vs. 156 days). When accounting for other variables, having a planned follow-up appointment remains the most important factor in establishing retreatment (OR = 3.32, 2.11-5.29, p<0.001).Conclusion. Having a planned follow-up appointment after the initial course of PRT improves identification of patients who would benefit from additional treatment, thus improving patient experience and quality of care.

Our primary analysis focused on radiation-treated cancer survivors alive at least 5 years from diagnosis. Supplemental Table S1 demonstrates the primary analysis where we vary the required length of survivorship from 1 to 10 years, focusing on the nine most common cancers.

INTRODUCTION:Older adults living with Alzheimer's disease and related dementias (ADRD) who are then diagnosed with cancer are an understudied population. While the role of cognitive impairment during and after cancer treatment have been well-studied, less is understood about patients who are living with ADRD and then develop cancer. The purpose of this study is to contribute evidence about our understanding of this vulnerable population. MATERIALS AND METHODS:This was a retrospective cohort study of a linked, representative family of databases of cancer registries and Medicare administrative claims that make up the SEER-Medicare database. Older adults ages 68 and older with a first primary cancer type: breast, cervical, colorectal, lung, oral, or prostate were eligible for inclusion (N = 337,932). Prevalence estimates of ADRD across cancer types and a 5% non-cancer comparison sample were compared by patient factors. RESULTS:The overall prevalence of patients who had an ADRD diagnosis anytime in the three years prior to their cancer diagnosis was 5.6%. Patients with ADRD were more likely to be female, older (over age 75), a racial/ethnic minority, single, with multiple chronic conditions, and a tumor diagnosed early (stage I) or were unstaged. Black patients with colorectal and oral cancer had the highest and second highest prevalence of ADRD compared to White patients (13.46% vs 7.95% and 12.64% vs 7.82% respectively, p < .0001). We observed the highest prevalence of ADRD among Black patients for breast (11.85%), cervical (11.98%), lung (8.41%), prostate (4.83), and the 5% sample (9.50%, p > .0001). DISCUSSION:The higher prevalence of ADRD among Black and Latine older adults with cancer not only aligns with the trend observed in our non-cancer comparison sample, but also, these findings demonstrate the compounded risk experienced by minoritized older adults over the life course. The greater than expected prevalence of patients with ADRD who go on to develop cancer demonstrates better assessment of cognition is urgently needed. Accurate identification of these vulnerable populations is critical to improve assessment, care coordination, and address inequities in screening and treatment planning.

Objectives: To evaluate risks of preterm birth and severe maternal morbidity (SMM) in female adolescent and young adult cancer survivors; assess maternal comorbidity as a potential mechanism; determine whether associations differ by use of assisted reproductive technology (ART). Design: Retrospective cohort Setting: Privately insured females in the U.S. Sample: Female with live births from 2000 to 2019 within OptumLabs®, a U.S. administrative health claims dataset Methods: Log-binomial regression models estimated relative risks of preterm birth and SMM by cancer status and tested for effect modification. Causal mediation analysis based on a counterfactual approach evaluated the proportions explained by maternal comorbidity. Main Outcome Measures: SMM, preterm birth Results: Among 46,064 cancer survivors, 2,440 singleton births, 214 multiple births, and 2,590 linked newborns occurred after cancer. In singleton births, preterm birth incidence was 14.8% in cancer survivors versus 12.4% in females without cancer (aRR 1.19, 95%CI 1.06-1.34); SMM incidence was 3.9% in cancer survivors versus 2.4% in females without cancer (aRR 1.44, 95%CI 1.13-1.83). Cancer survivors had more maternal comorbidities before and during pregnancy; 26% of the association between cancer and preterm birth and 30% of the association between cancer and SMM was mediated by maternal comorbidities. Associations between cancer and outcomes did not differ between ART and non-ART births. Conclusion: Preterm birth and SMM risks were modestly increased after cancer. Significant proportions of elevated risks may be due to increased comorbidities. Prevention and treatment of comorbidities provides an opportunity to improve perinatal outcomes among cancer survivors.

OBJECTIVEThe authors sought to determine the impact of selected social determinants of health (SDoH) on psychological health and well-being (defined as depression, cognition, and self-rated health) among Black and Hispanic/Latinx adults relative to White adults 51-89 years of age.METHODSDisparities in depressive symptomatology, cognition, and self-rated health were measured among 2,306 non-Hispanic/Latinx Black, 1,593 Hispanic/Latinx, and 7,244 non-Hispanic/Latinx White adults who participated in the Health and Retirement Study (N=11,143). Blinder-Oaxaca decomposition was used to examine whether differences in selected SDoH explained a larger share of the disparities than age, sex, measures of health, health behaviors, and health care utilization. Selected SDoH included education, parental education, number of years worked, marital status, veteran status, geographic residence, nativity status, income, and insurance coverage.RESULTSBlack and Hispanic/Latinx adults reported worse depressive symptomatology, cognition, and self-rated health than White adults. Selected SDoH were associated with a larger proportion of the Black-White disparities in depressive symptomatology (51%), cognition (39%), and self-rated health (37%) than were age, sex, measures of health, health behaviors, and health care utilization. SDoH were associated with a larger proportion of the Hispanic/Latinx-White disparity in cognition (76%) and self-rated health (75%), but age and physical health correlated with the disparity in depressive symptomatology (28%). Education, parental education, years worked, income, and insurance parity were SDoH associated with these disparities.CONCLUSIONSDifferences in SDoH underlie racial/ethnic disparities in depression, cognition, and self-rated health among older adults. Education, income, number of years worked, and insurance parity are key SDoH.

PURPOSE:To analyze the cost-effectiveness of the Light Adjustable Lens (LAL; RxSight) in comparison to a monofocal intraocular lens (IOL) for individuals undergoing cataract surgery in both eyes.METHODS:A cost-effectiveness analysis was performed using a Markov model that simulated the patient outcomes and costs associated with undergoing cataract surgery with the LAL or monofocal IOL. Cost-effectiveness was determined using the incremental cost-effectiveness ratio (ICER), a measure that quantifies the incremental cost in dollars per quality-adjusted life year (QALY) gained. Treatments with the ICER below the willingness-to-pay threshold (WTP) of $50,000/QALY were considered cost-effective. The model was also evaluated for the impact of uncertainties in parameters using one-way sensitivity and probabilistic sensitivity analyses.RESULTS:The cost-effectiveness analysis showed that the LAL is cost-effective compared to monofocal IOLs in patients undergoing cataract surgery, with ICERs of $9,792/QALY (health care perspective) and $10,072/QALY (societal perspective) both significantly below the WTP. The model was most sensitive to patient age, market cost of the LAL, and proportion of patients with residual astigmatism following cataract surgery. The probabilistic sensitivity analysis showed that cataract surgeries in patients starting at age 65 years were cost-effective in 94% of the simulations at a WTP of $50,000/QALY.CONCLUSIONS:From both health care and societal perspectives, the study shows cataract surgeries performed with the LAL are cost-effective when compared to those performed with a monofocal IOL. More studies are needed to compare the LAL to other premium lenses that also provide patients with excellent visual outcomes at a higher cost. [J Refract Surg. 2023;39(11):777-782.].

10534 Background: With the growing indications for germline testing in prostate cancer (PCa), there is accumulating evidence that African American and Hispanic men with PCa are significantly under-tested compared to non-Hispanic white (NHW) men. Given this, little is known about the pathogenic germline variant landscape in Hispanic men with PCa. Methods: This was a retrospective cohort analysis of 17,256 men with PCa who underwent diagnostic germline testing through a commercial laboratory (Invitae) from 2015-2020. Self-identified Hispanic and NHW men were selected for comparative analysis. The primary endpoint was the rate of pathogenic/likely pathogenic (PLP) germline alterations in Hispanic men among 25 genes associated with PCa. Secondary endpoints included comparison of PLP rates in Hispanic vs NHW men, the rate of specific PLP alterations, and the rate of variants of uncertain significance (VUS). Fisher’s exact test was used to compare germline alteration rates for significance. Results: We identified 508 Hispanic and 12,542 NHW men with PCa who underwent testing during the study period. Median age at the time of testing was 69 vs 67 years in Hispanic vs NHW cohorts. A family history of PCa was reported in 21.1% (N=108) vs 27.3% (N=3428) in the Hispanic vs NHW cohorts, respectively (p=0.002). The PLP alteration rate was 7.1% in the Hispanic cohort and this rate was numerically lower but not significantly different when compared to the NHW cohort (9.7%) (p=0.058). A significantly higher rate of VUS was seen in the Hispanic cohort (Table). The four most frequently detected genes with PLP alterations in both cohorts were ATM, BRCA1, BRCA2, and CHEK2. Only the rate of CHEK2 alterations was significantly different between cohorts among all 25 genes analyzed (Table). Conclusions: In this analysis, the PLP alteration rate among Hispanic men was 7.1%, a much higher rate than has been previously reported, and the germline genomic landscape was similar to that of NHW men. The VUS rate was significantly higher among Hispanic men, a known consequence of under-testing among minority populations.These data support germline testing in Hispanic men with prostate cancer and emphasize the importance of improving testing rates.[Table: see text]

Purpose: To assess the fiducial motion in abdominal stereotactic body radiotherapy (SBRT) using the cone-beam computed tomography (CBCT) projections acquired for pre-treatment patient set-up. Materials and Methods: Pre-treatment CBCT projections and anterior-posterior (AP) and lateral (LAT) pair of fluoroscopic sequences of 7 pancreatic and 6 liver SBRT patients with implanted fiducials were analyzed for 49 treatment fractions retrospectively. A tracking algorithm based on template matching and sequential stereo triangulation algorithms was used to track the fiducials in the CBCT projections and the fluoro sequence pairs. We predicted the clinical couch adjustment from CBCT tracking and compared it with the clinical couch decision made during the patient's treatment. Results: In 3D coordinate, the fiducial motion ranges for pancreas cases were 9.90+/-3.52 mm, 10.65+/-5.91 mm, and 10.74+/-6.24 mm for CBCT, AP, and LAT fluoro, respectively, while in the liver, they were 13.93+/-3.39 mm, 11.17+/-3.75 mm, and 11.52+/-4.33 mm, respectively. Prediction of couch adjustment in LAT, SI, and AP coordinates from CBCT tracking agrees with the actual clinical couch correction within 0.92+/-0.74 mm, 1.37+/-1.26 mm, and 0.68+/-0.56 mm for pancreas cases and within 1.12+/-0.96 mm, 1.15+/-0.92 mm and 0.90+/-0.86 mm for liver cases, respectively. Conclusion: Tracking pre-treatment CBCT projections using template matching and sequential stereo triangulation is suitable for assessing fiducial motion and adjusting the patient setup for abdominal SBRT. CBCT can be used for motion modeling, potentially eliminating the need for additional fluoroscopic pair acquisition and thus reducing the imaging dose to the patient and the total treatment time.