Garg, Chandi

e23252 Background: The UPMC-Kline Health Center (KHC) in Harrisburg, PA, shows a lower cervical cancer screening rate compared to the general population in the USA (57.08% vs 78%, respectively, based on the Medical Group Fiscal Year 2023 Internal Quality Measures). To understand this gap, we distributed a comprehensive questionnaire to patients, aiming to pinpoint factors contributing to the lower screening rate and plan targeted interventions for improvement. Methods: We randomly distributed questionnaires to female patients aged 21 to 61 during appointment check-in at the KHC, considering our linguistically diverse patient population with surveys available in Spanish, English, and Nepali. Given the diverse linguistic landscape of our patient population, we prepared questionnaires in Spanish, English, and Nepali. The survey aims to identify and address specific clinic-related problems, with a follow-up assessment after a few months to gauge improvements following interventions targeting the underlying causes of screening gaps. Results: Over a three-month span, 65 questionnaires were completed. Among the participants, 38% (25 patients - 7 white/Caucasian, 11 black/African American, 1 Asian, 7 others; 12 Hispanic, 13 non-Hispanic) revealed that they had not undergone screening within the past three years. The analysis of this subgroup unveiled significant issues: 84% (21/25) did not receive paperwork to schedule the test, 88% (22/25) were not contacted to schedule the test, 76% (19/25) did not receive reminder notifications before appointments, and 72%(18/25) expressed concerns about the lack of insurance coverage for costs. Furthermore, 76% (19/25) indicated the requirement to pay a co-pay, and an equal percentage reported difficulties in obtaining the screening test. Additionally, 72%(18/25) mentioned that their healthcare providers did not discuss the screening's importance, while 76%(19/25) noted their providers did not explain the purpose of the test. Conclusions: These findings underscore critical gaps in communication, accessibility, and cost-related barriers to cervical cancer screening at KHC. This ongoing quality improvement project, scheduled for data recollection in a few months, encompasses proposed interventions such as automated reminders, technology integration for communication, and distributing flyers in clinic and waiting areas to foster open communication and address inadequate discussions about the importance of screening. The aim is to improve patient awareness, engagement, and ultimately prevent delayed cancer diagnoses. KHC is committed to enhancing the cervical cancer screening rate to minimize the likelihood of delayed cancer diagnoses.

e23244 Background: The UPMC-Kline Health Center (KHC) located in Harrisburg, PA, has a lower colon cancer screening rate compared to the general patient population in the USA (26.03% vs 78%, respectively, according to the Medical Group Fiscal Year 2023 Internal Quality Measures). To understand the reasons behind this disparity, a comprehensive questionnaire was conducted aiming to identify factors contributing to the lower colonoscopy screening rate and to implement targeted interventions to improve the situation. Methods: Surveys were distributed to eligible patients aged 45 to 75 at the clinic, considering linguistic diversity by preparing questionnaires in Spanish, English, and Nepali. Distribution, randomized and conducted by medical assistants, aims to identify and address specific clinic-related issues. Subsequent assessment, after a few months, will determine improvements resulting from interventions targeting the underlying causes of screening gaps. Results: Over a three-month period, a total of 77 questionnaires were completed and collected. We analyzed responses from 33 patients (42%, 14 females, and 19 males; 16 white/Caucasian, 14 black/African American, 2 Asian, 1 other; 8 Hispanic/Latino, 25 non-Hispanic/Latino) who had not undergone a colonoscopy in the past 10 years. Findings revealed that 72% (24/33) of patients reported not receiving paperwork for scheduling, while 72% (24/33) were not contacted to schedule the test. Additionally, 78% (26/33) of patients did not receive a reminder call or message before their scheduled appointments. 51% (17/33) of patients highlighted a lack of insurance coverage for costs, with 63% (21/33) indicating the need for a co-pay. 57% (19/33) of patients reported difficulties in obtaining the screening test. 51% (17/33) of patients mentioned that their healthcare provider discussed the importance of the screening test, and 54% (18/33) of patients noted that their providers explained the purpose of the test. Conclusions: The survey identifies scheduling, communication, and cost-related barriers to colon cancer screening at KHC. Proposed interventions, including the implementation of automated reminders, integrating technology to facilitate communication, and incorporating flyers within the clinic and patient waiting areas. This quality improvement project is ongoing, with data scheduled for recollection in a few months. These measures are anticipated to foster improvements, aiding more patients in preventing delayed cancer diagnoses. KHC aims to create a patient-friendly environment by addressing scheduling inefficiencies, improving communication, and tackling financial concerns for timely and accessible colon cancer screenings.

Introduction Diffuse large B-cell lymphoma (DLBCL) is the most common subtype of non-Hodgkin lymphoma. The mainstay of frontline therapy remains R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) or R-CHOP-like immunochemotherapy. Patients' responses to R-CHOP therapy vary depending on the stage and/or molecular subtypes of DLBCL. Approximately 40% of advanced-stage DLBCL patients suffer from a refractory or relapsed disease[1]. The outcome for patients with early relapses after rituximab-containing first-line therapy remains poor[2]. DLBCL poses a marked degree of genetic heterogeneity. Here, we compare the expression of genes related to epigenetics and chromatin modifications in DLBCL patients resistant and non-resistant to R-CHOP therapy. Objective The aim of this study is to assess the differences in the expression of genes related to epigenetics and chromatin modification in DLBCL patients that could lead to chemoresistance and failure of R-CHOP treatment. Method The gene expression profile (GEP) was obtained from Gene Expression Omnibus (GEO) database (Accession number: GSE173263) submitted by Dlouhy et al[3]. The GEP was analyzed in DLBCL cases, including 10 early failure cases (defined as refractory to induction treatment or early relapsing (<12 months from diagnosis)) and 29 responding patients, to identify features associated to primary chemoresistance. The comparison was done using the list of genes proposed by Bakhshi, T. et. al[4] , where he selected the genes that were identified to potentially cause epigenetic and chromatin modifications in DLCBL. All the comparisons were done using a T-test. Results There were significant differences in the gene expression related to epigenetics and chromatin modifications between DLBCL patients in the early failure arm versus the remission arm. Patients who had early failure to R-CHOP tended to have higher expression of these genes: SMARCA4 (p=0.010), SETD1B (p=0.018), SETD2 (p=0.024), EP300 (p=0.012), MLL3 (p=0.049), INO80 (p=0.001), CHD8 (p=0.007), NCOR1 (p=0.020), ARID1B (p=0.034), and SETD5 (p=0.007). Compared to the patients who were in remission after R-CHOP therapy, these patients had significantly higher expression of HIST1H1E (p=0.007). Conclusion Gene expression related to epigenetics and chromatin modifications significantly impacts the prognosis of DLBCL patients treated with R-CHOP. Differences in gene expression may lead to chemoresistance, and higher expression levels are associated with a worse prognosis. This study sheds light on the importance of chromatin and epigenetic modifications in DLBCL progression, guiding the development of future therapies.