Citations

e18017 Background: Head and neck (H&N) cancers affect the oral cavity, pharynx, larynx, salivary glands, nasal cavity, and sinuses. In Sub-Saharan Africa (SSA), the true burden of H&N cancers remains unclear, with available estimates suggesting approximately 47,000 new cases and 26,000 deaths annually. Limited cancer datasets hinder understanding of disease patterns and outcomes. This study explores patient characteristics, treatments, and outcomes to guide regional cancer control efforts. Methods: A cancer dataset was created and implemented at 4 leading teaching hospitals in Ghana, Kenya, Ethiopia, and Rwanda to systematically collect data on patient demographics, disease characteristics, and treatment patterns. Established through competitive grant funding, the primary objective of the database was to assess the indirect impact of the COVID-19 pandemic on cancer care. The dataset includes all cancer patients seen in consultation and/or treated between 2016 and 2023. In this study, a subset of patients diagnosed with H&N cancers was analyzed using descriptive statistics to assess clinical characteristics, treatments modalities, and patients' outcomes. Results: A total of 1,023 patients with H&N cancer were included in the analysis. The median age at diagnosis was 54 yrs (IQR 41-66), with 37% (n= 374) of the cohort being female. A total of 55% (n= 549) had no health insurance coverage. Of those with staging data, majority presented with advanced disease (89%) on presentation. Regarding treatment modality, 16% (n= 157) underwent surgery, 27% (n=279) received radiotherapy (RT), 14% (n= 143) received chemotherapy (CT), and 56% (n= 572) received no cancer therapy. Of those who received CT the timing was neoadjuvant (12%), concurrent with RT (22%), adjuvant after surgery (8.9%) or as palliative treatment (57%). Platinum-based agents (94%) were the most common CT, followed by Taxol-based (31%), and 5FU-based agents (27%). Regarding RT, planning was performed using 2D (55%) and 3D (45%) techniques. The median delivered dose was 60 Gy in 30 fractions. At a median follow up of 43 months, 1.6% were disease free, 10% (n= 103) were alive, 5.9% (n= 60) were confirmed dead, and 84% (n= 848) were lost to follow up. Conclusions: This study identifies key challenges in managing H&N cancers in SSA, including late-stage presentation, limited access to advanced treatment modalities, and a high lost to follow-up rate (84%). The reliance on older RT techniques such as 2D planning and the limited use of surgery highlight gaps in infrastructure and resource availability. Limited health insurance coverage suggests potential financial barriers to care and disparities in treatment access. Addressing these challenges will require greater investment in cancer care, expansion of the oncology workforce, and improvements in healthcare infrastructure to support better patient outcomes in the region.

e17511 Background: Cervical cancer is a significant public health concern in Sub-Saharan Africa (SSA), where it remains the leading cause of cancer-related mortality among women. SSA has the highest global incidence and mortality rates, with an estimated 110,300 new cases and 76,700 deaths in 2020. Despite this burden, data on patient characteristics and treatment outcomes remain limited. This study aims to address these gaps by analyzing current treatment patterns and outcomes for cervical cancer in SSA. Methods: A cancer dataset was established at 4 major teaching hospitals in Ghana, Kenya, Ethiopia, and Rwanda to capture data on patient demographics, disease characteristics, and treatment modalities. The dataset encompasses all cancer patients seen between 2016-2023, with over 9,000 cases collected to date. The primary objective of the dataset was to assess impact of COVID-19 pandemic on cancer care in SSA. This study conducted a retrospective analysis of cervical cancer cases within the dataset utilizing descriptive metrics. Results: A total of 2,326 patients were analyzed, with a median age at diagnosis of 56 y (48–65) and 53% having health insurance. The majority had squamous cell carcinoma (87%) and presented with locally advanced disease (FIGO stages IIB–IVA, 88%). Treatment primarily consisted of concurrent chemoradiotherapy (CRT, 34%) or radiotherapy (RT) alone (30%), while smaller proportions received chemotherapy (CT) alone (1.2%) or surgery (1.3%). A total of 33% of patients received no cancer therapy. Among 1,524 patients treated with RT, 1,180 received external beam RT with a median dose of 46 Gy in 23 fractions, using 2D planning in 60% and 3D planning in 40% of cases. Additionally, 25 patients underwent brachytherapy, with 58% receiving low-dose-rate and 42% high-dose-rate treatments. Of 1,011 patients treated with CT, 85% (n=844) completed the intended course, with a median of 4 cycles, primarily delivered concurrently with RT (95%). Only a few received CT as adjuvant (4.8%), neoadjuvant (1.6%), or palliative (3.4%) therapy. Platinum-based regimens were most common, with 43% receiving platinum monotherapy and 5% receiving platinum-taxane combinations. By the end of treatment, 27% (n=633) achieved disease-free status. After a median follow-up of 47 months (range,37–55), 42% were alive, 7% had died, and 53% were lost to follow-up with unknown vital status. Conclusions: This study reveals significant challenges in management and follow-up of cervical cancer in SSA. Most patients were diagnosed at advanced stages, with 32% receiving no treatment and 53% of treated patients lost to follow-up. These findings highlight barriers to early diagnosis, treatment access, and continuity of care. Addressing these issues requires expanding early diagnostic services, increasing vaccination coverage, strengthening healthcare infrastructure, and improving patient retention.

Abstract Multiple guidelines exist for the diagnosis and management of heart failure with preserved ejection fraction (HFpEF). We systematically reviewed current guidelines and recommendations, developed by national and international medical organizations, on the management of HFpEF in adults to aid clinical decision-making. We searched MEDLINE and EMBASE on 28 February 2024 for publications over the last 10 years as well as websites of organizations relevant to guideline development. Of the 10 guidelines and recommendations retrieved, 7 showed considerable rigour of development and were subsequently retained for analysis. There was consensus on the definition of HFpEF and the diagnostic role of serum natriuretic peptides and resting transthoracic echocardiography. Discrepancies were identified in the thresholds of serum natriuretic peptides and transthoracic echocardiography parameters used to diagnose HFpEF. There was agreement on the general pharmacological and supportive management of acute and chronic HFpEF. However, differences exist in strategies to identify and address specific phenotypes. Contemporary guidelines for HFpEF management agree on measures to avoid its development and the consideration of cardiac transplantation in advanced diseases. There were discrepancies in recommended frequency of surveillance for patients with HFpEF and sparse recommendations on screening for HFpEF in the general population, use of diagnostic scoring systems, and the role of newly emerging therapies.

17 Background: Rectal cancer is among the top ten cancers in Kenya with most patients presenting with locally advanced rectal cancer (LARC). Management requires multimodality treatment including neo-adjuvant therapy and surgery. There is limited data on the outcome for patients with LARC from Kenya and the broader region. The aim of our study was to evaluate outcomes of LARC from a tertiary hospital in Nairobi, Kenya, to identify barriers to care and methods to improve cancer outcomes. Methods: We conducted a retrospective study of patients with LARC treated at the Kenyatta National Hospital between January 2016 and January 2020. Patients with histologic confirmation of rectal cancer, received neo-adjuvant treatment, and had available survival data in the electronic medical record were included in the analysis. A data abstraction tool was used to collect patient demographics and cancer outcomes including age, gender, tumor stage, cancer and vital status. Overall and progression-free survival were estimated using the Kaplan-Meier method. Results: A total of 182 patients were identified that met inclusion on the study. The median age of 53 years (range, 21 - 82) years, 52.5% were female and 94.5% had cT3 (57.5%) or cT4 (37%) disease and 75% of patients had N+ disease. The time from symptoms onset to diagnosis and diagnosis date to treatment was 14 and 3.6 months, respectively. months76% of patients were from rural regions of Kenya. Most patients (95%) received long-course chemoradiation (50.4 Gy/28 fractions) with concurrent Capecitabine 825 mg/m2 chemotherapy. Only 5% (n=9) of patients had resection after neoadjuvant therapy. The median progression free and overall survival after neo-adjuvant treatment respectively was 24 months (IQR: 23 – 25 months) and 36 months (IQR: 24 – 36 months), respectively. Presence of comorbidities (OR =7.87, 95% CI: 3.46 – 17.89, p<0.001), tumor staging cT3 (OR = 2.34, 95% CI: 1.13 – 7.49, p =0.013), tumor staging cT4 (OR =4.02, 95% CI: 2.12 – 10.34, p =0.004) and increase in duration of symptoms by one month (OR =1.04, 95% CI: 1.01 – 2.14, p =0.003) were significantly associated with lower overall survival. Conclusions: Our results represent one of the largest series of outcomes for rectal cancer from Sub-Saharan Africa and serves as a baseline for clinical improvement. The long interval from symptom onset to diagnosis represents an area for patient intervention and development of screening protocols. Further exploration into the barriers that limit access to surgery is warranted and development of a non-operative protocol may serve the patient population due to the limited capacity of surgery.

Effective communication of medical information by doctors to patients has been found to be positively related to patient satisfaction. In the United States ACGME requires doctors in training to meet the competency of effective communication across many socioeconomic and cultural backgrounds. One of the main contributors to ineffective patient communication is inaccurate perception by the doctor about the extent of a patient's medical knowledge. This study seeks to elucidate medical student perceptions of patients’ knowledge of anatomy based on patient age, sex, occupation, education level and race. It also seeks to understand which of these matter most in guiding students’ assumptions. Patients were asked to complete a questionnaire, created in collaboration with the Mayo Clinic Patient Education Center, which included a multiple choice anatomy quiz and demographic information. First year medical students who had just completed their gross anatomy course were given the same anatomy quiz and a survey that included the demographic profiles of the patients. They were then asked to predict how well the patients scored. Student perceptions of patient knowledge were compared to the actual scores. Pending the results of this study, we anticipate that medical students will over‐estimate patients’ anatomical knowledge. This project was funded by the Department of Anatomy, Mayo Clinic, Rochester, MN.

Scientific societies aiming to foster inclusion of scientists from underrepresented (UR) backgrounds among their membership often delegate primary responsibility for this goal to a diversity-focused committee. The National Science Foundation has funded the creation of the Alliance to Catalyze Change for Equity in STEM Success (ACCESS), a meta-organization bringing together representatives from several such STEM society committees to serve as a hub for a growing community of practice. Our goal is to coordinate efforts to advance inclusive practices by sharing experiences and making synergistic discoveries about what works. ACCESS has analyzed the approaches by which member societies have sought to ensure inclusivity through selection of annual meeting speakers. Here we discuss how inclusive speaker selection fosters better scientific environments for all and identify challenges and promising practices for societies striving to maximize inclusivity of speakers in their scientific programming.

This essay compares the approaches that scientific societies in the ACCESS meta-organization use to implement and assess travel award programs for URM trainees and presents a set of recommendations, including both short- and long-term outcomes assessment in populations of interest and specialized programmatic activities coupled to travel award programs.