Objectives: Community voices highlight opportunities to improve understanding and access to prostate cancer genomic testing; however, uptake remains limited, particularly among racially and geographically diverse populations. This study explored community perceptions of prostate cancer genomic testing and identified barriers, facilitators, and communication priorities to inform culturally responsive, literacy-sensitive education strategies. In this study, we focus specifically on tissue-based genomic testing used to inform treatment decision-making, rather than cancer screening or inherited genetic risk assessment. Methods: We conducted a qualitative, phenomenological study using a community-based participatory research approach with multi-site Community Advisory Boards (CABs) in Florida, Arizona, and Minnesota (June 2023-March 2024). Across eight focus groups, 31 participants, including prostate cancer survivors, caregivers, clinicians, and community advocates, shared perspectives on genomic testing and preferences for educational materials. Discussions were conducted in English, audio-recorded, transcribed verbatim, and analyzed using reflexive thematic analysis guided by Braun and Clarke's six-phase approach. Results: Participants demonstrated limited awareness of genomic testing and frequently conflated it with ancestry or hereditary testing. Engagement was shaped by fear, stigma, masculine identity norms, and structural barriers, including cost and healthcare access. Caregivers were described as central to decision-making, while trust in information sources strongly influenced receptivity to genomic testing. Participants emphasized the need for clear, culturally relevant communication delivered by trusted community messengers and supported by family-inclusive approaches. Conclusions: Community perspectives suggest that improving access to prostate cancer genomic testing requires more than increasing availability; it requires addressing gaps in understanding, trust, and structural access. Community-informed, culturally grounded strategies may support more equitable implementation of precision oncology.

BACKGROUND:Sharing of family cancer history (FCH) in Black families has been documented as lower than in other populations. There has been limited exploration as to the factors and circumstances that facilitate or hinder FCH communication in these communities. OBJECTIVE:To explore intersecting factors influencing FCH discussion in Black families with a breast or ovarian cancer diagnosis. INTERVENTIONS/METHODS:We conducted qualitative interviews with socioeconomically diverse breast and ovarian cancer patients or family members. Interviews were thematically analyzed for iterative themes on FCH. RESULTS:A total of 107 participants completed an interview. Discussion of FCH was reported as being influenced by several factors, including relationship and family dynamics, personality of family members, involvement in caregiving and support, and perceived importance and responsibility of communicating FCH for cancer prevention. Participants also described how inequitable access to medical care influenced disclosure of a cancer diagnosis, and socioeconomic concerns can influence family communication and documentation of FCH in the medical record. CONCLUSION:Our analysis indicates that disclosure of FCH is improving over time as access to healthcare has increased for Black families. IMPLICATIONS FOR ONCOLOGY NURSING PRACTICE:Strategies to collect FCH outside of clinic settings, such as digital tools or chatbots, should be considered for increased capture of cancer pedigrees in families where discussion is limited. Patient education on options for preventative care and communications tools may assist patients with family discussions, although patients with adverse social determinants of health are likely to experience additional barriers to genetic screening based on FCH alone.

Objective: We aimed to analyze the current literature for IORT in gynecological cancers and summarized clinical outcomes regarding patient selection. Methods: A systematic search was conducted utilizing PUBMED, Embase, and CINAHL to identify studies following PRISMA-ScR guidelines. A PICOS structure was utilized: population: patients with epithelial gynecological cancers; intervention: IORT; C: a comparator was not required, as we aimed to analyze patient selection; outcome: clinical outcomes and overall survival; and S: experimental and quasi-experimental analytical observational studies and descriptive observational studies, excluding case series published in English and limited to the last 10 years. Data extraction was conducted for patient selection, IORT, oncological outcomes, and morbidity. Results: A total of 707 results were identified, and 509 studies were uploaded to Covidence for screening after removing duplications. Of the 21 eligible studies, 9 were included in the final review. The total number of patients included was 348. The studies were retrospective single-institution studies, except for one. There was significant heterogeneity in their design and protocols. IORT was exclusively used for recurrent and advanced stage gynecological cancers adjunct to pelvic exenteration or laterally extended endopelvic resections with variable indications across institutions. The mean number of IORT patients per study was 2.8 per year. Survival rates were variable and dependent on the surgical margin. Endometrial cancer had a favorable outcome compared to vulvar and cervical cancers. Conclusions: Current clinical practice, as demonstrated by the research, is consistent with NCCN guidelines that endorse the application of IORT in instances of recurrent cervical, vaginal, and vulvar malignancies; however, there are no established recommendations for primary tumors. The analysis shows that there are gaps in our knowledge, mainly regarding the status of the margins, the criteria used to choose patients, and the outcomes that are specific to each histology. The standardization of protocols and prospectively powered studies are needed to refine patient selection criteria.

BACKGROUND:Psychological safety is critical to early and continued engagement with healthcare providers, yet no studies have explored this concept in relationship to cancer care. Black/African American ("Black") individuals experience disparities in breast and ovarian cancer beyond what can be explained biologically. AIMS:We explored factors influencing psychological safety among Black breast and ovarian cancer patients and their family members. METHODS:Socioeconomically diverse patients with a personal diagnosis or family history of breast and/or ovarian cancer were invited to complete a semi-structured qualitative interview on their cancer and healthcare experiences between September 2020 and April 2021. Informed by principles of grounded theory, interview transcripts were qualitatively analyzed for thematic content related to psychological safety. RESULTS:Black breast and ovarian cancer patients and their family members described personal and community experiences and structural components of the healthcare system that suggested they may receive differential cancer care due to their race, placing them on guard. This posture was mediated by several self-identified factors that added to or detracted from their comfort, including provider racial and gender concordance in healthcare, personalized care, and effective communication. The priorities and perceptions of care in participants receiving care in safety net clinics were more focused on what was feasible given resource limitations rather than what was ideally desired. CONCLUSIONS:Implementation of strategies to promote psychological safety with Black cancer patients may foster improved patient experiences, as well as encourage early screening, patient engagement, and treatment continuation.

Abstract Black women experience significant disparities in morbidity and mortality related to hereditary breast and ovarian cancer (HBOC). Early identification of women with HBOC is essential for proactive screening and timely diagnosis. However, evidence suggests that Black women receive genetic testing for HBOC at lower rates than their White counterparts. We conducted in-depth qualitative interviews with 107 Black women with a personal or family history of breast or ovarian cancer, to understand their perceptions of their familial risk of HBOC and interest in genetic testing. In phase 1 of this study, participants were recruited from the networks of patient support organizations and historically Black sororities representing mostly highly educated and well insured patients. In phase 2, participants were recruited from a family medicine safety net clinic in Jacksonville, FL for socioeconomic diversity. Participants in both cohorts frequently expressed a lack of awareness about their family cancer history and identified many barriers to family disclosure of a cancer diagnosis. These include a culture of silence around medical issues and a belief that personal difficulties should be kept to oneself. Practical and cultural barriers to family history sharing were magnified among those with lower socioeconomic status. Many participants in both cohorts indicated a strong desire to understand their own risk of HBOC. They also expressed interested in genetic testing to proactively mitigate risk to themselves and future generations. Understanding of the potential relevance of HBOC testing to one’s personal health and post-test actionability was variable across both groups, although perceptions of genetic testing were generally favorable. These findings suggest that culturally tailored educational materials and alternative clinical modalities to collect family health history may be beneficial to improve timely identification of Black women who meet NCCN Guidelines for HBOC testing. Specifically, greater attention should be given to addressing barriers that led to underestimation of HBOC risk among patients experiencing disparities driven by adverse social determinants of health. Citation Format: Kirsten Riggan, Jane Yap, Ewan Cobran, Michele Halyard, Sarah James, Marion Kelly, Daphne Phillips, Megan Allyse. Perceptions and Experiences of Black Women on Family History Sharing and Genetic Testing for Hereditary Breast and Ovarian 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 PO4-09-08.

Purpose/Objective(s) To assess the per-fraction target coverage and organ-at-risk (OAR) sparing effects with application of three distinct planning target volume (PTV) margins for cone beam computed tomography (CBCT)-based dose calculation and evaluation of intact prostate radiotherapy. Materials/Methods A retrospective evaluation was performed on daily CBCT data of intact prostate cancer patients with four implanted fiducials who underwent either stereotactic body radiotherapy (SBRT – 35Gy in 5 fractions, n = 15) or conventional fractionation radiotherapy (CFRT – 60 or 70Gy in 20 or 28 fractions, n = 16). Clinical target volume (CTV) and relevant OAR contours (bladder and rectum) were generated using an in-house deep learning-based CBCT auto-segmentation model and validated by physician assessment. A trained and clinically validated knowledge-based planning model was utilized to generate treatment plans on the planning CT data for each patient with uniform PTV margins of 0, 2, and 3 mm (expanded from the CTV), and these plans were then applied to CBCT images corresponding to select fractions based on the treatment type (SBRT vs. CRFT). Relative dose metrics for the CTV and the bladder and rectum OAR volumes were assessed for plans generated with each PTV margin. Statistical analysis was performed via an ANOVA single factor test (with an alpha value of 0.05). Results CTV D90% > 90% was achieved 97.67% of patients treated with SBRT and 99.36% with CFRT when utilizing 2 mm and 3 mm margins, and coverage was lower on 0 mm PTV margins (93.02% SBRT, 96.15% CFRT). Maximum bladder dose in SBRT patients remained under the recommended limit of 105% for 88.75% of fractions with 0 mm, 79.38% for 2 mm, and 66.87% for 3 mm (p = NS). Whereas maximum rectum dose in SBRT patients remained under 105% in 90.63% of fractions for 0 mm, 85.63% for 2 mm, and 83.13% for 3 mm, with a difference that was statistically significant between patients with 0 versus 3 mm PTV margins (p < 0.01). Bladder and rectum V65% were under the recommended threshold (< 50%) in all CFRT cases irrespective of the PTV margins utilized. Rectum V65% among CFRT cases was lower when utilizing 0 mm PTV margins compared to 2 or 3 mm (p < 0.01). For SBRT, bladder V90% was lower than 10% in 97.78% with 0 mm PTV, 96.67% with 2 mm, and 94.44% with 3 mm PTV margins. Whereas the V50% was lower than 50% in 100% of cases using 0 mm or 2 mm PTV, and in 98.89% when using 3 mm PTV margins (p = NS). Among SBRT patients, rectum V90% < 10% and V50% < 50% were achieved in 100% of cases irrespective of PTV margins, with a difference that was significant between 0 and 3 mm (p < 0.01). Conclusion A 2.0 mm PTV margin demonstrated optimal balance, ensuring CTV coverage while minimizing OAR dose which helps to reduce radiation-related GU toxicity risks.

Background The strong Black woman (SBW) stereotype can be seen as a positive view of Black women and even a standard to uphold. SBW internalization is a coping mechanism for dealing with racism and sexism. However, multiple recent studies have indicated that Black women in the modern era experience the paradox of SBW internalization having negative generational health effects. We interviewed Black women with a personal or relation diagnosis of breast or ovarian cancer to understand their views and experiences, including how the perception of the SBW stereotype influenced their care. Methods Qualitative semi-structured interviews were conducted via telephone or video conference and transcribed verbatim. Transcripts were qualitatively analyzed for iterative themes related to cancer care and psychosocial support. Results Sixty-one Black women completed an interview. Responses in multiple transcripts expressed experiences and sentiments consistent with the SBW stereotype, including the importance of maintaining the appearance of strength during their cancer journey. This resulted in some patients declining assistance during their cancer journeys. Participants shared a hope that there would be more willingness to show vulnerability so that future generations of cancer patients receive adequate support. Key aspects of the SBW stereotype were also cited as potential contributors to ongoing racial disparities in breast and ovarian cancer outcomes. Conclusion(s) Participants described a paradox of the SBW stereotype that is ultimately detrimental to health and wellbeing. Healthcare professionals and cancer researchers should be aware of this phenomenon to address cancer care more appropriately in Black women.

PURPOSE: We report 5-year oncologic outcomes of a prospective series of patients with prostate cancer treated with spot-scanning proton therapy (SSPT).METHODS AND MATERIALS: A prospective registry identified patients with prostate cancer treated with SSPT between January 2016 and December 2018. Five-year overall survival (OS), local control (LC), biochemical failure (BF), regional and distant failures, and adverse events (AEs) were assessed. Biochemical failure was defined as rise in PSA ≥ 2.0 ng/mL above nadir PSA. Baseline-adjusted toxicities were assigned using CTCAE v5.0.RESULTS: With a median follow up of 4.4 years, 284 prostate cancer patients were treated with SSPT. Median total radiation dose was 79.2 Gy over 44 fractions, 70 Gy over 28 fractions, and 38 Gy over 5 fractions for conventional fractionation (CF), hypofractionation (HF), and stereotactic body radiation therapy (SBRT), respectively. Biochemical failure rate for all patients was 6.7%. Five-year LC rates for CF, HF, and SBRT were 100%, 100%, and 97.3%, respectively (p = 0.07). Regional recurrences occurred in 12 (4.2%) patients: 8 treated with CF, 2 with HF, and 2 with SBRT (p = 0.62). Distant failures occurred in 12 patients (4.2%): 5 treated with CF, 7 with HF, and none with SBRT (p = 0.05). Five-year OS for patients treated with CF, HF, and SBRT SSPT were 88.1%, 86.1%, and 97.2%, respectively (p = 0.1). Acute and chronic grade 2+ GI AEs occurred in 8 (2.8%) and 51 (18.0%) patients, respectively. Acute and chronic grade 3+ GI AEs occurred in 3 (1.1%) and 4 (1.4%) patients, respectively. Acute and chronic grade 2+ GU-related AEs were observed in 71 (25%) and 63 (22.2%) patients, respectively. Acute and chronic grade 3+ GU toxicity were observed in 3 (1.1%) and 6 (2.1%) patients, respectively.CONCLUSIONS: SSPT provides high local control rates and excellent oncologic outcomes across different fractionation schedules with low long-term AE rates.

Abstract Black women experience significant disparities in morbidity and mortality related to hereditary breast and ovarian cancer (HBOC). Early identification of women with HBOC is essential for proactive screening and timely diagnosis but evidence suggests that Black women receive genetic testing for HBOC at lower rates than their White counterparts. To understand Black women’s perspectives on HBOC genetic testing and potential factors influencing this decision, we conducted in-depth qualitative interviews with 107 Black women with a personal or family history of breast or ovarian cancer. Participants were recruited via the networks of patient support organizations and sororities as well as at a family medicine safety net clinic in Jacksonville, FL. Participants frequently expressed a lack of awareness about their family cancer history; many cancer patients stated that they only became aware of extensive family history upon their own diagnosis. Lack of family history sharing was attributed to a culture of silence around medical issues and a desire to protect family members from difficult information. However, most participants indicated a strong desire to understand their own risk of HBOC and were interested in genetic testing. Participants with a personal diagnosis were motivated to undergo HBOC genetic testing to reduce the risk for future generations. Clinical experiences with the offer of HBOC genetic testing were variable, with a few expressing that they had to make repeated inquiries from a provider to understand the relevance of the test to their own health. These findings suggest that investigation into alternative clinical modalities to collect family health history may be beneficial to identify Black women who meet NCCN Guidelines for HBOC testing. In contrast to the literature suggesting hesitancy for HBOC genetic testing, many participants perceived genetic results as having a positive impact for their medical decision-making and family's health. The development of patient materials and provider education on cultural and social factors that influence the uptake of HBOC genetic testing is also needed. Citation Format: Kirsten A. Riggan, Michele Halyard, Sarah E. James, Marion Kelly, Daphne Phillips, Megan A. Allyse. Perceptions and experiences of Black women on hereditary breast and ovarian cancer genetic testing [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A067.

Background Setup reproducibility of the tissue in the proton beam path is critical in maintaining the planned clinical target volume (CTV) dose coverage and sparing the organs at risk (OAR). In this study, we retrospectively evaluated radiation therapy dose reproducibility for proton pencil beam scanning (PBS) treatment of breast cancer patients with and without mask immobilization. Methods Ninety-four patients treated between January 2019 and September 2022 with at least one verification CT scan (V-CT) in treatment position were included for this study. All patients were set up with arms up using the Orfit AIO patient positioning system, with (69 patients) or without (25 patients) mask immobilization in chin, neck, shoulder, upper arm, and chest areas. Two to three enface or near enface single field uniform dose PBS beams were optimized using a commercial treatment planning system. Prescription doses were 25 to 60 Gy RBE in 5 to 45 fractions. Treatment plan doses re-calculated on V-CTs were compared to the corresponding planned doses. Cumulative doses were also calculated for patients with at least 3 V-CTs by deform and weighted sum doses from V-CTs to corresponding P-CTs. CTV D95%, ipsilateral-lung V40%, esophagus D0.01cc, and heart mean dose were evaluated and reported as percentages of prescription doses. Differences were large dose deteriorations (LDD) if: (1) CTV (V-CT/cumulative D95%) – (Planned D95%) < − 5%; or (2) Ipsilateral-lung (V-CT/cumulative V40%) – (Planned V40%) > 5%; or (3) Esophagus (V-CT/cumulative D0.01cc) – (Planned D0.01cc) > 10%; or (4) Heart (V-CT/cumulative mean) – (Planned mean) > 1.5%. Results On average, V-CT/cumulative and planned CTV/OAR dose parameter differences were less than 2.2%/1.7% and 3.4%/3.7% for masked and maskless patients, respectively. The percentages of patients with at least one CTV or OAR V-CT/cumulative dose LDD were 20.3%/25.0% and 72.0%/54.0% for masked and maskless patients, respectively. Conclusions On average, masked/maskless setups achieved delivered and planned CTV/OAR dose parameters agreed within 2.2%/3.7% for PBS treatment of breast cancer patients in this study. Maskless patients had higher rate of CTV/OAR LDDs compared to masked patients. Dosimetric differences large enough to raise clinical concerns in either group were able to be addressed with replannings.

Background: Black breast and ovarian cancer patients are underrepresented in clinical cancer trials disproportionate to the prevalence of these cancers in Black females. Historically, lower enrollment has been attributed to individualized factors, including medical mistrust, but more recently structural factors, including systemic racism, have received additional scrutiny. We interviewed Black women with a personal or family history of breast and ovarian cancer to understand their views and experiences related to research participation.Methods: Qualitative interviews were conducted via telephone or video conference and transcribed verbatim. Transcripts were qualitatively analyzed for iterative themes related to the offer and participation in cancer clinical trials and research studies, impact on cancer care, and recommendations to increase enrollment of Black patients.Results: Sixty-one Black women completed an interview. Participants expressed that Black women are underrepresented in cancer research, and that this negatively impacted their own care. Many cited past historical abuses, including the Tuskegee syphilis trial, as a potential factor for lower enrollment but suggested that lower enrollment was better understood in the context of the entirety of their healthcare experiences, including present-day examples of patient mistreatment or dismissal. Participants suggested that proactive community engagement, transparency, and increased representation of Black research team members were strategies likely to foster trust and bolster research participation.Conclusion(s): Medical mistrust is only a partial factor in the lower participation of Black patients in cancer research. Researchers should implement the strategies identified by our participants to promote diverse enrollment and ensure that Black patients are included in future therapeutic advances.

Black women experience disproportionate rates of advanced breast cancer diagnoses and mortality. Mammography is a proven and effective tool in early breast cancer detection and impacts patient outcomes. We interviewed Black women with a personal or family history of breast and/or ovarian cancer to understand their screening experiences and views. N = 61 individuals completed an interview. Interview transcripts were qualitatively analyzed for themes regarding clinical experiences, guideline adherence, and family sharing specific to Black women and their families. Most participants were college educated with active health insurance. Women in this cohort were knowledgeable about the benefits of mammography and described few barriers to adhering to annual mammogram guidelines. Some with first-degree family history were frustrated at insurance barriers to mammography before the age of 40. Participants were generally comfortable encouraging family and friends to receive mammograms and expressed a desire for a similar screening tool for ovarian cancer. However, they expressed concern that factors such as screening awareness and education, lack of insurance coverage, and other systematic barriers might prevent other Black women from receiving regular screening. Black women in this cohort reported high adherence to mammography guidelines, but expressed concern about cultural and financial barriers that may impact cancer screening access in the population more generally and contribute to disparities. Participants noted the importance of frank and open discussions of breast cancer screening in their families and community as a means of improving awareness.

Spot-scanned proton radiation therapy provides high local control rates and excellent oncologic outcomes across different fractionation schedules with low long-term AE rates.

Abstract Background Phonetic transcription is recognized in regulatory standards as an essential skill for Speech and Language Therapists (SLTs) in the assessment, diagnosis and management of clients with speech difficulties. Previous research has identified that approaches to phonetic transcription vary, and that SLTs often lack confidence in transcribing. However, SLTs’ views and working practices have not been investigated in detail, particularly in terms of whole service approaches and following the recent increase in telehealth. Aims To investigate SLTs’ views about phonetic transcription, their working practices at both individual and service levels, and the factors that influence these. Methods & Procedures A total of 19 SLTs from the UK were recruited to online focus groups via social media and local networks. Participants discussed their views of, and practices in, phonetic transcription. Themes were identified using reflexive thematic analysis. Outcomes & Results Three broad themes were generated division and unity; one small part of a big job; and fit for purpose. SLTs were uniformly proud of their ability to phonetically transcribe and viewed this as a unique skill, but clear differences existed between different groups of SLTs in their views and practices. Investing in phonetic transcription was not always a priority for SLTs or services, and although many felt under‐confident in their skills they considered these to be adequate for the populations they usually encounter. SLTs make an early judgement about possible therapy targets, which influences the level of detail used in their phonetic transcription. Practical barriers are often not addressed at service level, and assessment via telehealth poses some specific challenges. Conclusions & Implications SLTs and services would benefit from increased investment in phonetic transcription in terms of time, opportunities for continuing professional development (CPD) and initiatives such as electronic patient records (EPRs) which support the use of phonetic symbols. Identifying target sounds at an early stage raises questions about the implications of disregarding other features of speech, and the selection of appropriate intervention approaches. Further research is needed to analyse actual rather than reported practices, and to consider the relationship between phonetic transcription and intervention approaches. Future studies could also identify precise CPD requirements and evaluate the effectiveness of CPD. What this paper adds What is already known on the subject Previous research has demonstrated that SLTs often lack confidence in phonetic transcription and that practices are varied, with relatively little use of narrow transcription. SLTs are interested in opportunities to maintain and develop transcription skills but do not often undertake CPD for transcription. What this paper adds to existing knowledge By using focus groups as a forum for discussions, this study provides a rich and detailed insight into SLTs’ views about clinical transcription and their working practices, with previously unreported details about the reasons for these practices in a clinical context and at a service‐wide level. What are the potential or actual clinical implications of this work? Transcription is often de‐prioritized in non‐specialist contexts, with practical barriers and a lack of clear and consistent protocols at a whole‐service level. There is an opportunity for service managers to address the systemic difficulties in using transcription effectively by raising the profile and value of transcription amongst clinicians, and promoting CPD opportunities, using the findings of this study as a rationale for funding this. Together, these recommendations have the potential to improve client outcomes through more accurate assessment and diagnosis, and hence more appropriate intervention.

Treatment-related pneumonitis is a significant concern in locally advanced non-small cell lung cancer (NSCLC) patients undergoing definitive chemoradiation (CRT). The incidence and predictors of pneumonitis in the era of consolidative durvalumab have yet to be fully elucidated. In this large, single institution, retrospective analysis, we analyze factors associated with grade 2+ pneumonitis in NSCLC patients treated on the Pacific regimen.

These data confirm the efficacy and safety of ablative RT for LM in well-selected patients. 5-year OS and LP were 43% and 6%, respectively. AEs were infrequent, even in the setting of 24% of courses delivered concurrently with systemic therapy and 40% of courses delivered subsequent to other local therapies for LM. Given the excellent OS, these data are suggestive of improved local control as a factor for improved OS.