The prevalence of cancer among patients accessing primary care in federally qualified health centers (FQHCs) is poorly characterized. A patient’s history of cancer in addition to common chronic conditions makes providing comprehensive primary care more complex, especially for patients accessing care at FQHCs who often face additional social and economic barriers to care. Trained auditors conducted a comprehensive electronic medical record audit using a standardized abstraction form to identify cancer history in patients aged ≥ 40 years with two common chronic conditions (diabetes and/or hypertension) and who had at least one visit to an FQHC between January 1 and December 31, 2019. Descriptive statistics were performed. Among 712 adult patients with diabetes and/or hypertension, 46 (6.46

Abstract Background: Metastatic triple negative breast cancer (TNBC) is a diverse disease with the propensity to spread to visceral organs and the central nervous system (CNS). While systemic chemotherapy is commonly used, there is a growing utilization of immune checkpoint inhibitors (ICI) and antibody drug conjugates (ADC). However, few studies have examined the impact of specific therapies on individual metastatic sites, limiting clinical guidance for solitary metastases. Objective: This study aimed to evaluate the efficacy of various systemic therapies in TNBC patients with lung, liver, and CNS metastases. Methods: We analyzed data from the Dallas Metastatic Breast Cancer Study, a retrospective cohort study that includes all patients with metastatic breast cancer treated at a single academic medical center and identified 52 TNBC patients with visceral and CNS metastases diagnosed between 2009 and 2021. We correlated the site of metastasis with and treatment response, which was assessed based on imaging findings using RECIST 1.1 criteria. Results and Discussion: The median age at diagnosis of visceral metastatic disease was 52 years. Of the patients, 60% presented with de novo metastatic disease, while 40% experienced disease recurrence. The most prevalent metastatic sites were the lung (n=28), CNS (n=28), and liver (n=9). Among patients with detectable circulating tumor DNA, the most prevalent gene mutations in lung metastases were TP53 (36%), PTEN (13%), and PIK3R1 (10%). In liver metastases, TP53 (53%) and BRCA1 (15%) mutations were the most frequently observed. Similarly, in CNS metastases, TP53 (40%) and BRCA1 (13%) mutations were again most frequently detected. The notable frequency of TP53 mutations indicates the necessity for further investigations to explore potential differences in treatment approaches for patients with these mutations. The median overall survival (OS) was 14.43 months ±15.53, with the longest survival observed in patients with lung metastases (15 months), followed by liver metastases (6 months) and CNS metastases (5 months). Patients with involvement of a single visceral or CNS site had a mean OS of 15.80±18.19 months, whereas those with two sites of involvement had a mean OS of 13.08±10.18 months. Patients with metastases in all three sites had a mean OS of 8.33±8.50 months. Treatment modalities varied among patients. For liver metastases, chemotherapy (n=6), ICI (n=2), ADC (n=1), radiation therapy (n=2), and surgery (n=1) were administered. Lung metastases were treated with chemotherapy (n=26), ICI (n=4), ADC (n=5), radiation therapy (n=4), and surgery (n=1). CNS metastases were managed with chemotherapy (n=14), ICI (n=2), ADC (n=1), radiation therapy (n=21), and surgery (n=4). Systemic therapy for liver metastases resulted in stable disease (75%) and progressive disease (25%). In lung metastases, it led to stable disease (56%), partial response (23%), complete response (13%), and progressive disease (8%). CNS metastases treated with systemic therapy demonstrated stable disease (86%) and progressive disease (14%). The most commonly used systemic therapy was paclitaxel. Immunotherapy achieved a partial response (60%), stable disease (20%), and progressive disease (20%) in metastatic lesions. Treatment with ADCs resulted in stable disease (43%), partial response (29%), and progressive disease (29%). Compared to lung metastases, liver and CNS metastases exhibited lower response rates and overall survival. CNS metastases were less likely to receive systemic therapies, indicating a need for improvement. These findings highlight the importance of personalized treatment strategies tailored to individual metastatic sites in TNBC. Citation Format: Hannah Chang, Pallavi Dev, Luise Froessl, Shao-Po Huang, Christine Hodgdon, Julia Maues, Isaac Chan. Impact of Therapy on Sites of Metastases in Triple Negative Breast Cancer [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-06-13.

There is a paucity of data regarding the use of non-pharmacologic therapies for pain in sickle cell disease. The purpose of this pilot study was to assess the acceptability and feasibility of video-guided mindfulness meditation, breathing exercises, and yoga, in addition to standard of care, during admission for painful vaso-occlusive crisis. Feasibility was demonstrated by the enrollment rate of > 90% and high level of participant engagement in the intervention. Acceptability was demonstrated by positive feedback obtained in post-intervention surveys and the majority of subjects who expressed interest in participating in future mindfulness and yoga therapy sessions.

Background: Patients with sickle cell disease (SCD) suffer from both acute and chronic pain that severely affects their quality of life. Pain is largely managed with opioids, which have significant side effects including dependence, adverse mood effects, and potential for opioid-induced hyperalgesia. The 2020 American Society of Hematology guidelines for SCD suggests cognitive and behavioral pain management strategies (including mind-body interventions). However, there remains low certainty in the evidence of these modalities. We chose to pursue mindfulness-based interventions given their proven efficacy in other chronic pain syndromes and associated mental health disorders. Objective: The purpose of our pilot study was to assess the feasibility and acceptability of weekly group yoga therapy sessions conducted virtually via videoconferencing software in patients with sickle cell disease and chronic pain, defined as pain on more than 15 days per month for the last 6 months. Design: Twenty patients with SCD were recruited for weekly virtual group yoga therapy sessions, which incorporated aspects of mindfulness meditation and low impact movements synchronized with breathing exercises (see Table 1). Results: Twenty out of 22 patients (92%) approached for the study agreed to participate. The median age of participants was 35 (IQR 26-43), with the majority being female (n=13 out of 19, 68%). The baseline survey revealed participants had frequent Emergency Department visits (median 3, IQR 1.25-4) and hospitalizations (median 2, IQR 0-2) in the 6 months prior to the intervention. The study population exhibited high levels of pain catastrophizing (median PCS 40.5, IQR 27.25-52.5, 93%tile), anxiety (median GAD-7 18.5, IQR 10.25-21.5), and depression (median PHQ-9 17, IQR 13.25-22.5). On average, 15% of participants (range 2-32%) attended each session. Barriers to participation included technologic difficulties, time conflicts, and inability to contact participants. The participants who consistently attended the sessions had positive feedback. One participant stated, "It went well for me. Meditation was helpful...[and] the yoga helped with my knee." Another participant commented, "I liked having a community with the other patients." Conclusions and Future Directions: This pilot study was among the first of its kind to examine mindfulness practices for chronic pain in adults with SCD. While there was a high rate of agreement to participate in the study, indicating a willingness and receptiveness to the study intervention, the overall participation per session was low. The study population had high rates of health care utilization despite most participants being on chronic opioid therapy and disease modifying medications, which illustrates the need for additional therapeutic strategies. A striking aspect of the baseline survey was the high rates of pain catastrophizing, anxiety, and depression, which directly impact chronic pain and thus require a holistic approach that includes mindfulness-based interventions. Our future research will draw upon lessons learned from the pilot study to address barriers to participation. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Direct oral anticoagulants (DOACs) are increasingly used for stroke prevention in atrial fibrillation and treatment and prevention of venous thromboembolism. They are also associated with bleeding risk. Existing literature suggests that prothrombin complex concentrate (PCC) administration may help control bleeding due to factor Xa inhibitors (FXaI). To determine the hemostatic efficacy of PCC in patients with major bleeding due to FXaI, we performed a retrospective chart review of 50 patients who presented with FXaI associated major bleeding that required urgent hemostatic management. Hemostatic assessment was performed using ISTH and ANNEXA-4 criteria. Twenty patients presented with intracranial hemorrhage (ICH), 20 had gastrointestinal bleeding, 3 had visceral bleeding, 3 had genitourinary bleeding, and 4 had miscellaneous types of bleeding. Fifty-six percent (28/50) had effective hemostasis using ISTH criteria and 84% (42/50) achieved effective hemostasis by ANNEXA-4 criteria. Hemostatic efficacy was similar by both tools for ICH (75% each). However, there was a major difference between ISTH and ANNEXA-4 hemostatic efficacy assessments for GI bleeding (45% and 95%, respectively). When comparing rivaroxaban and apixaban, there was no significant difference in effective hemostasis using either criteria, time to hemostasis, thromboembolic events, or patient mortality. Five (10%) patients had thromboembolic events within seven days of PCC administration, and the 30-day mortality rate was 14% (7/50). Our study shows similar efficacy, thromboembolic events, and mortality associated with PCC compared to andexanet alfa using ANNEXA-4 criteria, suggesting that PCC may be a viable alternative.

Key Points Vitamin D deficiency is a predictor for poor overall survival in patients with multiple myeloma, even after adjusting for age and stage. This difference is only observed in white patients, not African Americans, even under a lower threshold for deficiency.