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Aims Testicular sex cord‐stromal tumours (TSCSTs) are relatively rare, accounting for ~5% of all testicular neoplasms. They were historically classified into Leydig cell tumour, Sertoli cell tumour, granulosa cell tumour, and unclassified sex cord‐stromal tumour. More recently, classification was expanded to incorporate additional histologic types, including some associated with inherited cancer predisposition syndromes. However, the classification of TSCSTs still relies entirely on morphology, with some tumour types being defined based on their resemblance to ovarian counterparts. In recent years, molecular studies have identified drivers and genomic alterations associated with aggressive behaviour and progression; however, these findings have not yet impacted classification and management. Methods and results Under sponsorship of the International Society of Urological Pathology (ISUP) and the Genitourinary Pathology Society (GUPS), a group of genitourinary pathologists was assembled in 2023 with the aim of assessing how to use these new data to improve the classification and management of TSCSTs. Conclusions This paper summarizes the recommendations derived from the consensus activities and the first meeting of the te sticular s ex cord‐ s tromal t umour (TESST) group (held at Johns Hopkins Hospital, Baltimore, USA, 3/23/2024).

We assessed associations of pediatrician demographic characteristics with patient satisfaction (PS) scores. We performed a retrospective analysis of PS scores among pediatricians at a single academic institution and their associations with individual demographic features including gender, race, and geographic location of medical school education. We analyzed PS survey results for 153 pediatricians, 48.4% of whom were female. Males received higher scores in 4 out of 10 questions including “Likelihood of your recommending this care provider to others” ( P = .007). We observed similar findings for white pediatricians compared to Black, Indigenous, and People of Color (BIPOC) ( P = .033) and US medical school graduates compared to international school graduates ( P = .044). Overall, we observed that pediatricians who are female, BIPOC, or international medical school graduates receive lower PS scores than their counterparts. The impact of potential survey responder bias should be acknowledged when interpreting PS scores for pediatricians.

Background: The use of validated risk stratification tools for the workup of suspected pulmonary embolism (PE) is a recommendation of the American Society of Hematology and the American College of Emergency Physicians. Methods: We designed and implemented electronic clinical pretest probability (PTP) tools for use in emergency departments (ED). Overall, 38 EDs (tertiary and regional EDs) in the United States were involved across three health systems. PTP use was analyzed between September 12, 2022 and January 11, 2023 in 270,247 ED visits. PTP use was examined in terms of the percentage of visits for which patients underwent computed tomography pulmonary angiography (CTPA). Each site chose the 3-tier Wells’ score for implementation and Site 2 designed a combined Wells’, pulmonary embolism rule-out criteria (PERC), and YEARS score. Results: At Site 3, forced use resulted in documented PTP scores in 49–53% of ordered CTPAs. At Sites 1 and 2, where PTP scores were optional, documented PTP scores occurred in 2–3% and 1–3% of CTPA orders, respectively. At Site 1, the use of PTP increased slightly over the study period, with signs that PE yield on imaging was also increasing (3.4–5.9%). At Site 2, PE yield on imaging was 9–10%, and it remained similar, with similar use of PTP tools over the study period. PE yield (6–8%) on imaging also remained similar throughout the study at Site 3. Conclusions: Guideline-endorsed PTP scores for PE at three independent health systems in the United States did not increase PE yield on imaging. Novel implementation strategies involving interdisciplinary teams are urgently needed.

Abstract Background Despite 40 years of evidence supporting psychosocial interventions as a component of comprehensive cancer care, patients continue to report vast unmet psychosocial needs and distress. Cognitive behavioral therapies for cancer distress (CBT-C) are the most rigorously tested class of psychosocial interventions for cancer care. Purpose To report clinical effectiveness outcomes of cancer-related distress and self-efficacy following implementation of best-evidence CBT-C, adapted for a real-world, billable practice setting. Methods Patients who completed group-delivered, CBT-C (10 intervention hours, 5 sessions) in the practice setting were invited to enroll in a research study to document cancer distress across the year following CBT-C. Participants (n = 65) were primarily middle-aged (mean 50.5 years, 17% were young adults ≤40 years), female, and White. Analyses utilized mixed linear models with intent-to-treat procedures. Given group delivery and social skills training content within CBT-C, social self-efficacy was assessed as a potential treatment mechanism. Results Distress decreased across the year following CBT-C (mean score change of 20 points for YAs, 6 points for non-YAs), with statistically significant age x time effects. Within-person improvements in social self-efficacy scores were related to reductions in cancer distress, including distress subscales of intrusive thoughts, avoidant coping, and hyperarousal. The model explained 76.6% of the total variance in cancer distress. Conclusions This study demonstrates the effective translation of CBT-C from controlled research trials to the practice setting. CBT-C effectiveness within a mixed-cancer population and relatively rural region of the US is also supported. CBT-C can be effectively translated to the practice settings for which it is intended.

ABSTRACTIntroduction and ObjectiveProcedural therapies for overactive bladder (OAB) most often include intradetrusor onabotulinumtoxinA (BTX) injections, sacral neuromodulation (SNM), and percutaneous tibial nerve stimulation (PTNS). Despite their proven efficacy, real‐world data on therapy continuation and crossover rates between these modalities remain limited. This study aimed to evaluate longitudinal patterns of treatment continuation and therapy crossover among women receiving procedural OAB treatments.MethodsWe conducted a multi‐institutional retrospective cohort study of women with idiopathic OAB who underwent index BTX, SNM, or PTNS between 2014 and 2022. Patients were identified using electronic medical records, and follow‐up data were collected through December 31, 2023. The primary outcomes included duration of maintenance treatments and crossover to another procedural therapy for OAB. Kaplan–Meier survival analysis estimated rates of continued treatment, and a log‐rank test assessed differences in crossover rates among treatment groups.ResultsA total of 506 women met inclusion criteria: 266 (52.6%) received BTX, 114 (22.5%) underwent SNM, and 126 (24.9%) received PTNS. Ongoing treatment rates were lowest for PTNS, with only 17.1% maintaining therapy between 3 and 5 years and 26.1% crossing over to another procedure within 3 years. Among BTX patients, 65.2% underwent repeat treatment within 3 years, and 9.5% of patients crossed over to another procedure within 3 years. Of those with 5 or more years of follow‐up, 39.1% of patients continued with BTX procedures in the 3–5‐year follow‐up timeframe. Among SNM patients, the cumulative revision rates were 7.6% at 1 year and 10.9% at 2 years. 13.1% of patients crossed over from SNM to another procedure within 3 years (the vast majority to BTX).ConclusionsPTNS had the lowest ongoing therapy rates and the highest crossover rates. BTX and SNM demonstrated similar crossover rates. These findings underscore the importance of individualized patient counseling and treatment selection based on expectations of therapy persistence. Future research should focus on optimizing patient selection, improving long‐term adherence strategies, and evaluating novel or combined therapeutic approaches for OAB management.

TPS1138 Background: The SV-BR-1-GM breast cancer cell line activates anti-tumor immunity by expressing tumor associated antigens and secreting GM-CSF which enhances dendritic cell activation and promotes adaptive (T-cell mediated) and innate (dendritic and NK cell) immune responses. The cells are also engineered to optimize immune recognition through pt specific HLA antigen matching. SV-BR-1-GM acts through direct antigen presentation and CD4+ T-cell activation and, when combined w/ checkpoint inhibitors (CPIs), has demonstrated clinical benefit in 54 heavily pretreated metastatic breast cancer (MBC) pts. In pts w/ disease progression following CPI therapy, similar or improved progression free survival (PFS) compared to their prior treatment regimen. Disease control following antibody drug conjugates was observed in 40%of pts. Clinical benefit was seen in 5 out of 8 pts w/ untreated intracranial metastases. CD8+ Immuno-PET imaging suggests systemic activation, w/ increased CD8+ tumor infiltrating lymphocytes at both primary and metastatic tumor sites, as well as lymphoid organs. Optimized sequencing of CPI w/ SV-BR-1-GM and its latest phase 3 formulation have shown enhanced clinical outcomes, including improved overall survival (OS) (median 13.4 mos), PFS (3.6 mos), and clinical benefit rate (CBR; 61%).These findings have informed refinements to the ongoing pivotal, registration enabling Phase 3 trial, designed to optimize pt selection and treatment sequencing strategies. Methods: This ongoing multicenter, randomized, open label Phase 3 trial evaluates Bria-IMT + CPI vs. Treatment of Physician’s Choice (TPC) in MBC pts lacking approved curative therapies. Pts are randomized 1:1:1 to Bria-IMT + CPI, TPC, or Bria-IMT monotherapy (discontinued after 150 enrollments to prioritize combination arms). The Bria-IMT regimen consists of: Day -2: Cyclophosphamide 300 mg/m², Day 0: 20M irradiated SV-BR-1-GM cells, Day 2/3: 0.1 mcg pegylated α interferon at each inoculation site. CPI infusion is administered Day -3 to 3. Cycles q3w. TPC regimens follow site specific SOC. Imaging q6w (first 2 cycles), then q8w. Eligibility includes all MBC subtypes, including CNS mets, and permits prior CPI therapy ( >21 days pre-treatment). There will be 100 sites across the U.S., Canada, and ex-North America w/ an enrollment target of 404. The trial is currently active at 59 sites with 217 sub investigators. To date, 67 pts screened: 46 randomized (median age 56 yrs [34–83], median 6 [2–13] prior lines of therapy. The primary endpoint is OS, with an interim analysis at 144 events targeting a hazard ratio of 0.6. Secondary endpoints: PFS, overall response rate, CBR, CNS event free survival, and TWiST. Safety analyses ongoing; pt reported outcomes assess subjective treatment impact. Clinical trial information: NCT03328026 .

12005 Background: Young adults (YAs) diagnosed with cancer between the ages of 18 and 39 face unique psychosocial challenges and are at risk of experiencing significant emotional distress and poor health-related quality of life (HRQOL). This randomized trial evaluated the efficacy of Bright IDEAS-YA, a problem-solving skills training intervention, on reducing distress and improving HRQOL of YAs newly diagnosed with cancer. A secondary aim examined change in problem-solving ability as a potential mediator of treatment effects. Methods: A three-site randomized trial of Bright IDEAS-YA compared with enhanced usual care (EUC) enrolled YA survivors within four months of a first diagnosis of cancer. Participants were randomized 1:1 to Bright IDEAS-YA or EUC (NCT04585269). Bright IDEAS-YA is a 6-session, one-on-one intervention that teaches a systematic approach to overcome personal challenges across any life domain. EUC involved usual psychosocial care plus AYA resources. Participants completed surveys at 0 (baseline), 3, 6, 12, and 24 months, with 6 months as the primary endpoint. Validated measures included the PROMIS Depression Short Form and Anxiety Short Form (primary outcomes), the Functional Assessment of Cancer Therapy – General (FACT-G; primary outcome), and Social Problem-Solving Inventory-Revised Short Form (SPSI-R; mediator). Efficacy was tested using linear mixed effects models, run in R, examining the group x time interaction effects. Mediation was tested using the R multiple mediation analysis. Results: 344 YA (34.2% acceptance rate, M age = 30.3 years, SD = 6.3; 63% female, 37% male, < 1% non-binary) participated (100% planned enrollment), with 86% and 81% completing surveys at 3 and 6 months, respectively. Compared to baseline, the intervention arm showed statistically significant improvements in depression, anxiety, and HRQOL relative to the control group at 6 months. The intervention arm demonstrated an average reduction of 3.2 T-score points reduction in depression (95% CI [-4.9, -1.5], p < 0.001), 2.4 T-score points in anxiety (95% CI [-4.0, -0.81], p = 0.003), and 3.4 points improvement in total FACT-G (95% CI [0.34, 6.5], p = 0.029) relative to the control. These differences reflect clinically meaningful changes per published reports. Across all three models, change in total problem-solving ability (SPSI-R) was shown to mediate treatment effects, primarily due to change in the negative problem-orientation subscale. Conclusions: Bright IDEAS-YA was efficacious in reducing symptoms of depression and anxiety and improving HRQOL compared with enhanced usual care among YAs with cancer. Improvements are attributable to increased problem-solving ability, particularly by reducing the tendency to view problems as significant threats and doubt one’s ability to successfully solve problems. Clinical trial information: NCT04585269 .

12083 Background: Fatigue and sleep disturbance are prevalent during and after cancer treatment; sleep-related symptoms affect 30-50% of patients with cancer, and sleep-wake disruptions persist beyond the immediate post-surgical period in breast cancer (BC) survivors. Identifying demographic- and treatment-related factors associated with sleep-related symptoms during survivorship is critical to inform interventions for those at highest risk of sleep disturbance. Methods: Patients who were seen at least once at Mayo Clinic Rochester following an initial diagnosis of BC at age 18 or older and provided informed consent were prospectively enrolled in the Mayo Clinic Breast Disease Registry. Surveys mailed to this cohort included two 11-point numeric rating scale questions regarding difficulty falling asleep and staying asleep in the past week, with values for each ranging from 0 (no problem) to 10 (as severe as you can imagine). Participants who provided sleep-related information on the Year 1 survey (answered approximately one year after cancer diagnosis) were included. Participants were excluded if they had clinical or pathologic metastatic disease and/or recurrence prior to the Year 1 survey. Associations of sleep-related symptoms with demographic and clinical characteristics were assessed using multivariate linear regression models, fitting the sleep difficulty rating scale as the outcome and clinical and demographic factors as exposures. Results: In total, 3,354 participants met inclusion criteria. The average age at BC diagnosis was 59, and most participants were female (99.3%), White (95.4%), non-Hispanic (96.2%), married (78.1%), had at least some college education (80.4%), did not report financial insecurity (76.2%), did not consume alcohol (60.6%) or smoke tobacco (93.2%), and reported at least some weekly exercise (76,6%). Sixty-two percent of participants had clinical stage 0 or I disease; 50.3% underwent lumpectomy (not mastectomy), 59.2% received radiotherapy, 34.1% received chemotherapy, and 67.2% received endocrine therapy. Overall, sleep-related symptoms were relatively low (mean rating for falling asleep = 2.1, mean rating for staying asleep = 3.1). In multivariate analyses, more difficulty falling asleep was associated with higher clinical stage (p < 0.001), more cigarettes smoked per day (p = 0.012), less moderate and/or strenuous exercise (p = 0.001), and more financial hardship (p < 0.001). More difficulty staying asleep was associated with higher clinical stage (0.003), older age (p < 0.001), more education (p = 0.011), and more financial hardship (p < 0.001). Conclusions: In our cohort of BC survivors, factors associated with both increased difficulty with falling and staying asleep at one year after diagnosis are higher clinical stage and more financial hardship. Future research should explore the course of these symptoms over time and across varied treatment trajectories.

Abstract Background Hospital‐at‐home programs (HaH) in the United States have evolved to include a virtual‐hybrid delivery model, where all physician encounters are virtual and partnered with a home care team. Objective To examine whether a virtual hybrid HaH program enabled by technology has similar clinical outcomes to traditional brick‐and‐mortar (B&M) hospital care. Methods We conducted a pragmatic trial at three hospitals, randomizing 1150 acutely ill patients requiring hospital care between July 10, 2023, and October 31, 2023 one‐to‐one into two groups: intervention (HaH) and control (B&M). The primary analysis was an intention‐to‐treat non‐inferiority analysis of the primary outcome, which was a composite of 30‐day all‐cause mortality and unplanned readmissions. Secondary outcomes included 30‐day readmission, all‐cause mortality, and patient experience. Results The mean age was 67.8 (standard deviation [SD] 16.3) years, and 52.2% were female. The primary outcome occurred in 99 (17.3%) HaH patients and 114 (19.8%) B&M patients (odds ratio [OR] 0.85, 95% confidence interval [CI] 0.63–1.14, p = .28), meeting the non‐inferiority criterion. Thirty‐day unplanned readmission occurred in 84 (14.7%) HaH patients and 101 (17.5%) B&M patients (OR 0.81, 95% CI 0.59–1.11, p = .19). Thirty‐day all‐cause mortality occurred in 25 (4.4%) HaH patients and 19 (3.3%) B&M patients (OR 1.34, 95% CI 0.73–2.46, p = .35). No HaH patients died while receiving their hospital care at home. HaH program was associated with a higher likelihood of patients reporting feeling extremely comfortable or very comfortable (84.4% HaH; 60.9% B&M, p = .001). Conclusion A hybrid HaH model is a safe and comfortable alternative to traditional B&M hospital care.