Zurob, A S

Abstract Background Despite the reported benefits, lung cancer screening (LCS) uptake remains alarmingly low in comparison to other cancer screening programs. Objective To develop and evaluate an automated, electronic health record (EHR)-embedded LCS outreach program designed to increase screening uptake while minimizing workload for referring providers and schedulers. Methods We developed an automated outreach and referral program at two Mayo Clinic campuses (Rochester [RST] and northwest Wisconsin [NWW]) coupled with a streamlined virtual care delivery process. Eligible patients were identified based on the information in the EHR regarding US Preventive Services Task Force guidelines for screening and were contacted through either a patient portal message, letter, or both. Outreach included LCS educational materials and self-scheduling instructions for a telephone or video shared decision-making (SDM) visit. During the visit, a licensed care team member discussed the risks and benefits of a low dose computed tomography (LDCT) scan with patients who could choose to enroll in the Lung Cancer Screening Program or decline. Results During the study period, 8,845 eligible patients (RST: 2201, NWW: 6644) were contacted using automated portal messages, letters, or both. Among the RST cohort, 2,156 portal messages and 1,060 letters were distributed in comparison to 7,642 portal messages, 6,441 letters, and 618 text messages in the NWWI cohort. The study showed increase in shared decision-making visits completion and screenings for eligible patients across both groups. Portal engagement was higher among the RST group 75.4% than 55.8% in the NWWI group, as was digital brochure access (14.1% vs 6.5%). Scheduling for share-decision-making visits was noted to be higher among the RST group (22% vs 13.6%), though visit completion rates were similar across sites (12.6 vs 13.6%). A lower opt-out rate was noted among the RST group (12.6% vs. 14.3%). Collectively, both campuses demonstrated meaningful patient engagement. Conclusion The automated outreach program effectively increased lung cancer screening engagement and uptake for eligible patients without adding significant administrative burden on primary care providers and clinical staff. Observed differences in engagement between sites, as well as relatively low completion rates highlight the need for further investigation into contextual and operational factors influencing program performance. This abstract is funded by: none

Abstract Introduction We report a case of an 87-year-old male presenting with debilitating fatigue and multifocal airspace opacities that improved with corticosteroid therapy, later diagnosed as VEXAS syndrome. Case Presentation An 87-year-old man with a history of atrial fibrillation (on Xarelto), diastolic heart failure, coronary artery disease, sick sinus syndrome status post pacemaker placement, hypertension, and chronic kidney disease presented with profound fatigue and failure to thrive over the last few months. A CT chest showed multifocal consolidative airspace opacities (Figure 1a) interpreted as “non-resolving pneumonia.” Despite multiple antibiotic courses, symptoms persisted. Notably, the patient had no respiratory complaints and maintained oxygen saturation of 98-99% on room air. Bronchoscopy revealed bronchoalveolar lavage (BAL) fluid with lymphocytic predominance, but cultures were negative and transbronchial biopsy was non-diagnostic and lymph node biopsies revealed normal lymphocytic tissue. Hematologic evaluation for plasma cell dyscrasia and amyloidosis was negative, though he was noted to have monoclonal gammopathy of undetermined significance. Additional workup revealed EBV positivity in BAL and serum (IgG+, IgM-), and weakly positive ANA and p-ANCA levels. Rheumatology consultation concluded that clinical features were not consistent with ANCA-associated vasculitis, additionally there was no evidence of diffuse alveolar hemorrhage on bronchoscopy. Empirical prednisone therapy led to a marked improvement in fatigue and interval resolution of the pulmonary opacities (Figure 1b). However, repeated steroid tapering attempts resulted in recurrent weakness, failure to thrive, and anemia, which normalized only during corticosteroid use. Given the relapsing course, bone marrow next-generation sequencing was pursued, identifying a pathogenic UBA1 mutation, confirming VEXAS syndrome. The patient has since been initiated on a JAK2 inhibitor and is tapering off steroids. Conclusion VEXAS syndrome is a late-onset, X-linked autoinflammatory disorder caused by somatic mutations in the UBA1 gene. It typically manifests with systemic inflammation, cytopenias, and multi-organ involvement, including pulmonary infiltrates, fevers, vasculitis, neutrophilic dermatoses, and bone marrow vacuolization of myeloid and erythroid precursors. The disease is often refractory to standard immunosuppressive therapy, with management focusing on corticosteroids and JAK inhibitors. This case underscores the importance of considering VEXAS syndrome in elderly men with unexplained systemic inflammation, autoimmune-like features and hematological abnormalities. This abstract is funded by: None