Midthun, D E

Abstract A 71-year-old male with a history of progressive pulmonary fibrosis underwent bilateral lung transplantation via clamshell incision seven months prior to presenting with dyspnea and recurrent bilateral pleural effusions. His post-transplant course was complicated by lymphocytic myocarditis, leading to acute hypoxic respiratory failure and heart failure. Outpatient management with torsemide improved fluid status but was discontinued due to worsening renal function, resulting in effusion recurrence. Upon readmission, a right-sided 12 Fr pigtail thoracostomy tube was placed and left thoracentesis was done. Pleural fluid analysis revealed a serosanguineous, lymphocytic, exudative effusion on the right and a neutrophilic, transudative effusion on the left. Both had negative cytology and infectious studies. The left effusion initially seemed to be controlled. Persistent right-sided drainage prompted placement of a right indwelling tunneled pleural catheter (IPC). Pre-procedure imaging showed bilateral effusions, and ultrasound revealed a diminishing right effusion during setup, supporting interpleural communication. To aid IPC placement, one liter of lactated Ringer’s (LR) solution was infused into the right pleural space. Post-procedure imaging showed a large left-sided effusion and a small right effusion (Figure 1.), confirming buffalo chest physiology—fluid migration between pleural cavities due to the clamshell incision. Despite suction drainage and positional maneuvers, the left effusion persisted. Intrapleural administration of lytics via the right IPC failed to evacuate the left effusion. A subsequent left thoracentesis removed one liter of fluid, but recurrence necessitated placement of a left IPC one week later. Three weeks post-placement, the right IPC was removed, and continued drainage from the left IPC prevented recurrence of the right effusion. This case highlights the anatomical alterations following bilateral lung transplantation via clamshell incision, which can lead to atypical pleural fluid dynamics, including interpleural communication and buffalo chest physiology. Awareness of these changes is critical for effective management of pleural effusions in post-transplant patients. This abstract is funded by: None

Abstract Rationale Rural populations in the US experience a higher lung cancer burden compared to urban residents, potentially due to differences in risk factors and access to preventative care and early detection. We sought to characterize tobacco use, smoking cessation, and lung cancer screening patterns by rurality to identify modifiable gaps in the lung cancer care continuum. Methods We analyzed data from current and former smoking adults in the Southern Community Cohort Study, a large prospective cohort recruited from community health centers across 12 southeastern states. Participants aged 65-80 years with at least 9 months of Medicare Part A/B and less than 3 months of Part C coverage between 2014 and 2020 were included. Data were linked with the National Death Index and Medicare claims for outcome ascertainment. Rurality was defined using Rural-Urban Commuting Area (RUCA) codes. We compared demographic characteristics, smoking patterns, use of smoking cessation interventions, and receipt of low-dose computed tomography (LDCT) screening between rural and urban participants over time. Results Among 10,114 adults included (56% urban; 46% rural), 54% were female, 55% identified as Black/African American, about a third reported less than a high school education, and 45% lived in areas in the highest quartile of deprivation. Urban residents were of similar age (66 vs 67 years), and more likely to currently smoke (42% vs 35%), but had fewer baseline smoking pack-years (27 vs 30 pack-years) than rural residents. Approximately 2% died of lung cancer during follow-up. Using the USPSTF 2013 lung cancer screening criteria, 27% of urban and 26% of rural residents were eligible. This increased unevenly to 38% urban and 35% rural under the USPSTF 2021 criteria. LDCT uptake was low, increasing from 0% in 2014 to 6% in 2020 among screening-eligible participants. Use of cessation interventions was similarly low. Among current smoking participants, 7% received smoking cessation counseling, and 3% had a varenicline prescription. These patterns remained relatively stable over time, with no significant rural-urban differences in LDCT and cessation intervention use. Conclusion Despite modest differences in smoking prevalence and screening eligibility, we found comparable lung cancer mortality and similarly low utilization of LDCT and cessation interventions among rural and urban residents. Our findings suggest that, among people in lower socioeconomic groups, shared socioeconomic constraints may extend beyond the rural-urban divide. Further research is needed to understand how social determinants of health may be addressed to improve lung cancer outcomes across the screening continuum. This abstract is funded by: NIH

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