Citations

Genotypic testing for mecA / mecC is heavily relied upon for rapid optimization of antimicrobial therapy in infections due to Staphylococcus aureus . Little is known regarding optimal reporting and/or therapy for patients demonstrating lack of genotypic evidence of mecA or mecC but phenotypic oxacillin resistance.

PURPOSE In response to the COVID-19 pandemic, many cancer practices rapidly adopted telehealth services. However, there is a paucity of data regarding ongoing telehealth visit utilization beyond this initial response. The purpose of this study was to assess changes in variables associated with telehealth visit utilization over time. METHODS This is a cross-sectional, year-over-year, retrospective analysis of telehealth visits conducted across a multisite, multiregional cancer practice in the United States. Multivariable models examined the association of patient- and provider-level variables with telehealth utilization across outpatient visits conducted over three 8-week periods from July to August in 2019 (n = 32,537), 2020 (n = 33,399), and 2021 (n = 35,820). RESULTS The rate of telehealth utilization increased from <0.01% (2019) to 11% (2020) to 14% (2021). The most significant patient-level factors associated with increased telehealth utilization included nonrural residence and age ≤65 years. Among patients residing in rural settings, video visit utilization rates were significantly lower and phone visit utilization rates were significantly higher compared with patients from nonrural residences. Regarding provider-level factors, widening differences in telehealth utilization were observed at tertiary versus community-based practice settings. Increased telehealth utilization was not associated with duplicative care as per-patient and per-physician visit volumes in 2021 remained consistent with prepandemic levels. CONCLUSION We observed continuous expansion in telehealth visit utilization from 2020 to 2021. Our experiences suggest that telehealth can be integrated into cancer practices without evidence of duplicative care. Future work should examine sustainable reimbursement structures and policies to ensure accessibility of telehealth as a means to facilitate equitable, patient-centered cancer care.

Introduction: Deep-learning artificial intelligence (AI) algorithms can identify hypertrophic cardiomyopathy (HCM) from the electrocardiogram (ECG). Preliminary data indicate that AI-ECG may also track treatment response in HCM patients (pts) receiving mavacamten (Mava). In this placebo-controlled analysis, we investigated the performance of AI-ECG in HCM detection and its changes during Mava treatment compared to placebo in the phase 3, EXPLORER-HCM trial. Methods: Pts with non-paced ECGs enrolled in EXPLORER-HCM, evaluating Mava over 30 weeks of treatment, were included. All pts had a 12-lead ECG pre-treatment, at each study visit, and 8 weeks after treatment end. Two independently developed AI-ECG convolutional neural network algorithms from the Mayo Clinic and the University of California, San Francisco (UCSF) were applied to all ECGs suitable for analysis. Serial AI-ECG-predicted scores, which correlate with HCM likelihood (range 0-1), were examined between Mava and placebo groups. Results: A total of 101 Mava and 110 placebo pts were included (mean age 58.6, female 40%). At baseline, the mean Mayo and UCSF AI-ECG scores for HCM were 0.82 and 0.65, with 94% and 88% of pts exceeding the respective diagnostic thresholds of 0.11 (Mayo) and 0.4 (UCSF). During 30 weeks of follow-up in the Mava group, the algorithms showed a mean AI-ECG score reduction of 0.32 (Mayo) and 0.17 (UCSF) in all pts between start and end of treatment. In comparison, AI-ECG scores decreased by 0.05 (Mayo) and increased by 0.02 (UCSF) in the placebo group (Mava vs placebo, t-test p-values <0.001 for both algorithms; Figure ) Conclusion: In the EXPLORER-HCM trial population, two independent deep-learning AI-ECG algorithms correctly identified most HCM pts and demonstrated significant reductions in predicted HCM scores after treatment with Mava when compared to placebo. This relative normalization of the ECG suggests disease-modifying properties of Mava, deserving further investigation.

Introduction: The COVID-19 pandemic imposed significant constraints to delivery of cardiac rehabilitation (CR) with many programs relying on delivery of home-based cardiac rehabilitation (HBCR). We sought to compare the effects of HBCR vs conventional center-based CR (CBCR) on clinical metrics, health-related quality of life, and modifiable risk factors in CR patients. Methods: Retrospective cohort study comparing 511 HBCR patients (March 2020-April 2021; COVID-19 pandemic) and 765 age and sex matched CBCR patients (Jan 2018-Jan2020; immediately pre-pandemic) from the Mayo Clinic Health System. We assessed changes in clinical outcomes before and after CR. HBCR included 12 sessions (one in-person assessment + weekly education and exercise monitoring phone/video calls). Conventional CBCR included 36 sessions (3 sessions per week for 12 weeks). Continuous data were described as mean±SD, and comparisons of change between groups were assessed with linear regression adjusting for baseline value, in complete cases. Results: HBCR and CBCR patients were 65±14 yrs old (68% male) and 65±14 yrs old (67% male) respectively. HBCR patients demonstrated greater improvement in exercise days/week whereas CBCR patients had greater improvement in exercise min/day. HBCR patients had greater improvement in blood glucose with a trend towards greater improvement in non-HDL cholesterol. Both groups demonstrated similar improvement on nutrition, depression, health-related quality of life surveys and total, LDL and HDL cholesterol, as well as HbA1c between the groups. Conclusions: Collecting clinical metrics during the COVID-19 pandemic proved challenging due to the initial closure of out-patient services. For patients in whom data was captured, HBCR appears to be similarly effective at improving several intermediate outcomes compared to CBCR. HBCR may be an effective alternative for improving clinical outcomes in patients who are unable to participate in CBCR.

Abstract BACKGROUND TTFields are electric fields that exert physical forces to disrupt cellular processes critical for cancer cell viability and tumor progression. TTFields therapy is approved for adults with recurrent (r) and newly diagnosed (nd) glioblastoma (GBM), based on the phase 3 EF-11 (TTFields 200 kHz) and EF-14 studies (TTFields therapy 200 kHz + temozolomide), respectively, which showed clinical benefit without increase in systemic adverse events (AEs). Pediatric patients were not included in the EF-11 and EF-14 studies. Here, we present pediatric safety data from an updated global post-marketing surveillance (PMS) analysis of patients with brain tumors treated with TTFields therapy, over an 11-year timeframe. METHODS Unsolicited PMS data from patients with brain tumors who received TTFields therapy from October 2011-March 2022 in North America, Europe, Middle East, Africa, and Japan were included. AEs were categorized using MedDRA version 25.1. RESULTS Overall, 25,898 patients were included. Diagnoses were ndGBM (68%), rGBM (26%), anaplastic astrocytoma/oligodendroglioma (4%) and other (2%). Two-thirds of patients were male. The analysis included 93 (0.4%) pediatric/adolescent patients (&lt;18 years). In pediatric patients, 62% experienced ≥1 AE, with 53% related to TTFields therapy; these values were comparable with the overall population (73% and 56%, respectively). The most common treatment-related AEs in pediatric patients were: skin reaction (39%), heat sensation (14%), and headache (12%); and in the overall population were: skin reaction (43%), electric sensation (14%), and heat sensation (12%). CONCLUSIONS This long-term, global, real-world data analysis, including pediatric patients with brain tumors, demonstrates a tolerable safety profile of TTFields therapy, consistent with pivotal clinical studies. There were no major differences in AEs between pediatric and adult patients and no new safety signals identified in the pediatric population. Consistent with the overall dataset, most AEs in pediatric patients were localized mild–moderate skin events, which are typically easily managed.

Abstract Prostate cancer (CaP) significantly affects black men causing highermortality rates especially within African and Caribbean countries. The Prostate Cancer Transatlantic Consortium (CaPTC) is a 10 year longitudinal study aimed at studying environmental, epidemiological and prostate cancer associated risk factors within black men of West African descent living in the United States (US), Cameroon, and Nigeria. Methods: Men ages 35- 70 years old, who identified as a US Black male or West African Black male immigrant in the US, were recruited from community-based organizations. Community- based organizations include local churches, health fairs and socialorganizations. Anthropometric, environmental, and epidemiological variables measures were collected via survey questions. Saliva samples were collected using Salimetrics. Mean and range from the survey questions were categorized and a logistical regression model was used to determine associations between variables. Results: Logistical analysis output for analysis of pesticide exposure and cancer diagnosis within the three countries, found participants in Nigeria who were exposed to pesticide use, to be a significant predictor of cancer diagnosis (p 0.013). The age of exposure was another variable analyzed to see whether there was a correlation between age of exposure in pesticide use and cancer diagnosis. No significant predictors were determined yet a reasoning to why a significance is not yet found could be due to many participants needing a closer examination into the consequences of early exposure to known carcinogens. Conclusion: Significant data was found between pesticide exposure and cancer diagnosis between the US, Cameroon, and Nigeria in West African Black men. Regarding age of pesticide exposure and the relation between cancer diagnosis, more data needs to be collected regarding these variables. Significance in determining pesticide use as a predictor for cancer diagnosis in black males, can lead to increased efforts in pesticide exposure education in addition to possible government reformation on laws regarding pesticide use. Citation Format: Emelina Asto-Flores, Iweala Emeka, Popoola Ademola, Paul Jibrin, Mohammed Faruk, Anthonia Sowumi, Omolara Fatiregun, Nkegoum Blaise, Catherine Oladoyinbo, Ifeoma Okoye, Abdulkadir Ayo Salako, Abidemi Omonisi, Iya Eze Bassey, Kayode Adeniji, Nggada Haruna Asura, Ernest Kaninjing, Oluwole Kukoyi, Parisa Fathi, Ruth Enuka, Oluwaseyi Toye, Jennifer Crook, CaPTC Investigators, Folakemi Odedina. Impact of pesticide exposure in West African Black men within the United States, Cameroon, and Nigeria [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 1213.

The theme of the 2023 American Society of Clinical Oncology Annual Meeting is Partnering With Patients: The Cornerstone of Cancer Care and Research. As we aim to partner with patients to improve their health care, digital tools have the potential to enhance patient-centered cancer care and make clinical research more accessible and generalizable. Using electronic patient-reported outcomes (ePROs) to collect patients' reports of symptoms, functioning, and well-being facilitates patient-clinician communication and improves care and outcomes. Early studies suggest that racial and ethnic minority populations, older patients, and patients with less education may benefit even more from ePRO implementation. Clinical practices looking to implement ePROs can refer to the resources of the PROTEUS Consortium (Patient-Reported Outcomes Tools: Engaging Users & Stakeholders). Beyond ePROs, in response to the COVID-19 pandemic, cancer practices have rapidly adopted other digital tools (eg, telemedicine, remote patient monitoring). As implementation grows, we must be aware of the limitations of these tools and implement them in ways to promote optimal function, access, and ease of use. Infrastructure, patient, provider, and system-level barriers need to be addressed. Partnerships across all levels can inform development and implementation of digital tools to meet the needs of diverse groups. In this article, we describe how we use ePROs and other digital health tools in cancer care, how digital tools can expand access to and generalizability of oncology care and research, and prospects for broader implementation and use.

e22500 Background: Oncologists are change agents to improve tobacco cessation among patients. As part of the National Cancer Institute Cancer Center Cessation Initiative, we established an electronic health record (EHR, Epic)-based "opt-out" approach to refer patients to tobacco treatment specialist without active involvement by oncologists. However, the role of oncologists in contributing to the “opt-out” approach to patients has not been explored. We tested the hypothesis that a multi-component educational program for oncologists would increase the proportion of patients who completed tobacco treatment appointments. Methods: As a quality improvement initiative, oncology providers at the Rochester Mayo Clinic Cancer Center were educated using a multimodal academic detailing approach with group and individual educational sessions. Its effectiveness was tested using a modified step-wedge implementation design. The primary outcomes were patient behaviors that could plausibly be changed by conversations with their provider: the rate at which cancer patients identified as current tobacco users scheduled an appointment in the Nicotine Dependence Center (NDC) (which required active patient involvement), and the rate at which patients scheduled for a NDC appointment completed their appointment. Comparisons were made before, during, and after the education period (from July through Dec 2019) and with a separate group of providers who did not complete education (results examined over a similar time period). Results: Education did not improve outcomes in providers who received education; indeed, the rate of appointment scheduling decreased, although this may reflect other concurrent changes in the referral process (Table). Outcomes were similar between providers who did and did not receive education. Conclusions: Tobacco cessation efforts should be routinely integrated into cancer care to improve outcomes. The “opt-out” program resulted in approximately 1 in 5 cancer patients being seen for tobacco use, but an academic detailing approach designed to equip oncology providers to encourage their patients to complete appointments was not effective. Other approaches are needed to increase the uptake of tobacco treatment in these patients. [Table: see text]