Durani, Urshila

10503 Background: Gender bias can be reinforced through the use of gender-subordinating language and differences in the forms of address. We examined how professional titles were used during speakers’ introductions at the American Society of Clinical Oncology (ASCO) Annual Meeting. Methods: A retrospective observational study of video-archived speaker introductions at the 2017 and 2018 ASCO annual meetings was conducted. Data were extracted by mixed-gender coders. Professional address was defined as professional title followed by full name or last name. Multivariable logistic regressions were used to identify factors associated with the form of address. Results: 2511 videos were reviewed and 812 met inclusion criteria. Regarding speakers’ characteristics, 530 (65%) were non-Hispanic white (NHW), 743 (92%) held a MD or MD-PhD degree, and 484 (60%) were an associate or full professor. Female speakers were less likely to receive a professional address compared to male speakers (61% vs. 81%, p < 0.001). Female speakers were more likely to be introduced by first name only (17% vs. 3%, p < 0.001). Males were less likely to use a professional address when introducing female speakers compared to male speakers (53% vs. 80%, p < 0.01). No gender differences in professional address were observed for female introducers (p = 0.13). Male introducers were more likely to address female speakers by first name only compared to female introducers (24% vs. 7%, p < 0.01). In a multivariable regression including gender, race, degree, and academic rank, male speakers were more likely to receive a professional address compared to female speakers (OR: 2.67, 95%CI: 1.81-3.94, p < 0.01). Black speakers of both genders were less likely to receive a professional address compared to NHW (OR: 0.10, 95%CI: 0.01-0.53, p < 0.01). Female gender was a predictor for a non-professional form of address (first name only) (OR: 9.50, 95%CI: 4.38-20.62, p < 0.01). Conclusions: When introduced by men, female speakers were less likely to receive a professional address and more likely to be introduced by first name only compared to male speakers. Selective use of forms of address may strengthen gender bias; more research is needed to explore the causes of this disparity and its influence.

e20077 Background: Small cell lung cancer (SCLC) accounts for about 10% to 15% of lung cancers among women and men. Though heavily associated with smoking, its incidence in women is rapidly increasing despite a decline in cigarette exposure. Given the changing demographics of SCLC and hormonal factors associated with other forms of lung cancer, we studied differences between sexes in SCLC. Methods: Utilizing the National Cancer Database, we identified all incident SCLC cases from 2004 to 2014. Patients were classified as limited stage (LS) or extensive stage (ES). Women were stratified by menopausal status (≥55 years = postmenopausal). Kaplan-Meier method and Cox regression were used for overall survival (OS) and multivariable analysis. Results: 161,978 patients were identified. No significant sociodemographic differences were observed between sexes. The majority of patients were non-Hispanic whites (89.1%), followed by non-Hispanic blacks (7.5%). Men were more likely to be diagnosed with ES disease than women (63% vs. 56%). Both sexes initiated treatment within a similar time frame from diagnosis (chemotherapy, median: 18 days, IQR 8-32). Women had better median OS compared to men in both LS (15.2 vs. 12.7 months, HR: 0.85, 95% CI 0.83-0.86, p < 0.0001) and ES (6.4 vs. 5.7 months, HR: 0.88, 95% CI 0.87-0.90, p < 0.0001). No racial or ethnic disparities in OS were observed, overall and when examined within sex and disease stage groups. Differences between sexes in OS were also observed when comparing patients within the same racial/ethnic group (women having better OS). When divided by menopausal status, postmenopausal women with LS and ES had worse OS than premenopausal women (14.7 vs. 22 months, HR: 1.50, 95% CI 1.44-1.56; 6.1 vs. 9.8 months, HR: 1.41, 95% CI: 1.37-1.46, respectively). We also observed worse OS in older men when divided by age ( < 55 years and ≥55 years). In multivariable analysis, older age, postmenopausal status, and Medicaid as primary insurance were associated with worse OS for both LS and ES. Conclusions: In this large cohort, women with SCLC had better OS compared to men. Post-menopausal women had worse OS compared to pre-menopausal women. Since older men had a similar trend of worse survival compared to younger men, age might exert a more significant influence on survival than hormonal status in SCLC. Further studies with data on sexual hormone levels are necessary to better understand their role in women with SCLC.

e19523 Background: Previous studies have shown a disparity in outcomes of MM between clinical trials and real-world practice. This could be partly due to clinical trial exclusion of patients who need urgent treatment due to high burden of disease or significant illness. In this study, we aim to analyze the impact of time to initiation of systemic therapy for MM on overall survival (OS). Methods: We included MM patients reported to National Cancer Data Base (2004-2014). We excluded 2,860 patients with suspected smoldering MM due to initial treatment beyond 120 days. Relative risk of delayed time to systemic therapy was assessed by logistic regression model. Kaplan-Meier method and Cox multivariate analysis were used to evaluate the association between time to therapy and OS. Results: A total of 53, 519 MM patients were included. Median time to systemic therapy in our cohort was 18 days (range 0-120). Of the entire cohort, 24% patients received systemic therapy for MM < 7 days from diagnosis, and 32% received it after 30 days. Factors associated with time to systemic therapy > 30 days were Black race (OR 1.12, CI 1.07-1.16), female sex (OR 1.10, CI 1.06-1.14), lower Charlson comorbidity score (OR 1.36, CI 1.28-1.45), and academic facility (OR 1.18, CI 1.13-1.24). The median OS for patients who initiated therapy > 30 days after diagnosis was longer than those who received it within 7 days (37 vs. 29 month, p < 0.001). Similarly, on multivariate analysis, patients who received treatment > 30 days after diagnosis were found to have a lower mortality as compared to those who initiated treatment < 7 days (HR 0.81, CI 0.79-0.83; Table). Conclusions: In our study, time to initiation of systemic therapy was an independent prognostic factor in MM. This could be related to the high-risk nature of disease of patients treated within a short duration of diagnosis. These findings have implications for future clinical trial design, which should allow for a pragmatic approach toward enrollment of these high-risk patients to improve external validity. [Table: see text]

Background Women are currently under-represented in ‘C-suite’ leadership positions at academic medical centres, including medical school deans, department chairs and hospital chief executive officers (CEOs). There are many potential reasons for the low percentage of women in academic medical leadership, including lack of mentorship and sponsorship, increased non-work responsibilities compared with men, implicit bias, and others. Methods We collected data from 136 fully accredited US allopathic medical schools regarding sex of the medical school dean and sex of the CEO of the largest academic medical centre/teaching hospital affiliate. Schools where students rotate at non-academic centres were excluded from the final analysis, leaving 124 schools where we investigated the relationship between sex of US medical school dean and affiliated academic medical centre CEO. Results 16.9% of current medical school deans and 17.7% of affiliated academic medical centre CEOs were female. Systems with one female leader were significantly (6.25-fold, 95% CI 2.22 to 17.56, p=0.001) more likely to have a second female leader, regardless of geographical region or institution type (public vs private). Conclusions There is a significant positive association between medical school dean and affiliated academic hospital centre CEO sex. There are many potential factors that could contribute to this positive association, including mentorship, sponsorship and medical system consciousness about gender equity, among others. This relationship is important to recognise as we strive for more gender parity for women in positions of leadership in academic medicine.

PURPOSE: Gender disparity persists in academic medicine. Female faculty are underrepresented in leadership positions and have lower research output. We studied gender differences in faculty rank and departmental leadership and contributing factors among academic hematologists and oncologists in the United States. METHODS: For clinical faculty at 146 hematology or oncology fellowship programs listed in the Fellowship and Residency Electronic Interactive Database, we collected data on demographics, academic rank, and research output using the Doximity and Scopus databases. We compared unadjusted characteristics of men and women by using 2-sided t tests and χ2 tests where appropriate. To predict probability of full professorship or leadership position among men versus women, we performed multivariable logistic regression analysis adjusted for clinical experience in years, number of publications, h-index, clinical trial investigator status, National Institutes of Health funding, and workplace ranking (top 20 v not). RESULTS: Two thousand one hundred sixty academic hematologists and oncologists were included. Women composed 21.9% (n = 142) of full professors, 35.7% (n = 169) of associate professors, and 45.4% (n = 415) of assistant professors. Thirty percent (n = 70) of departmental leaders were women. Female faculty, compared with male faculty, had a lower mean h-index (12.1 v 20.9, respectively; P < .001) and fewer years of professional experience since fellowship (10 v 16 years, respectively; P < .001). After adjusting for duration of clinical experience, academic productivity, and workplace ranking, the odds of obtaining professorship (odds ratio [OR], 1.05; 95% CI, 0.71 to 1.57; P = .85) or divisional leadership (OR, 0.57; 95% CI, 0.20 to 1.58; P = .28) for female physicians were not different compared with male physicians. CONCLUSION: Gender disparity exists in senior ranks of academic hematology and oncology; however, gender is not a significant predictor in achieving professorship or department leadership position.

Summary Tumour lysis syndrome (TLS) is a significant complication of haematologic malignancies and their management. The syndrome consists of laboratory abnormalities either alone (laboratory TLS) or with clinical sequelae including renal failure, seizures, and arrhythmias (clinical TLS). Clinical TLS is a predictor for worse overall morbidity and mortality in cancer patients, but can be prevented. Thus, accurate prognostication is critical to appropriate management of patients at risk for TLS, and incorporates both disease factors (tumour type and burden) and patient factors (baseline renal insufficiency or hyperuricaemia). Strategies to prevent TLS include hydration and allopurinol in low‐ and intermediate‐risk patients and rasburicase in high‐risk patients.

Abstract Background: Venous thromboembolism (VTE) contributes to significant morbidity, mortality, and socioeconomic burden. Though male sex is a known risk factor for recurrent VTE, there is a paucity of literature regarding sex-based sociodemographic differences as well as differences in VTE outcomes including hospital length of stay and mortality rates. Methods: We conducted a retrospective analysis from the National Inpatient Sample (NIS) database from 2012-2013. Inclusion criteria were age 18 years and older and primary discharge diagnosis of VTE Sociodemographic features and medical comorbidities were analyzed, as were hospital length of stay and in-hospital mortality rates. Results: 107,896 patients in the NIS, representing a national estimate of 539,480 patients hospitalized for VTE between 2012 and 2013, met inclusion criteria. 53% were female and 47% were male. Mean age was 63 years and on average women were older than men (65 years versus 62 years, p<0.001). There were significant differences between men and women with respect to race, primary insurance payor, and VTE location as well as medical comorbidities (Table 1). Median overall length of stay (LOS) was 4 days and in-hospital mortality rates were 2.1%. Female sex was associated with a small but significantly longer hospital LOS (RR 1.04, CI 1.03-1.05, p<0.001) which was also seen in subgroup analyses of lower extremity DVT (RR 1.05, CI 1.03-1.06, p<0.001) and pulmonary embolism (RR 1.03, CI 1.02-1.05, p<0.001) but not upper extremity (RR 1.04, CI 0.96-1.12, p=0.36). There were no significant sex-based differences in in-hospital mortality (2.2% in women versus 2.1% in men, p=0.15). In a multivariate model correcting for sociodemographic differences and medical comorbidities, there were no significant differences between women and men with respect to hospital LOS or in-hospital mortality (Table 2). Conclusion: We used data from the NIS to study a large number of patients hospitalized for VTE, and identified several sex-based disparities in sociodemographic factors and location of VTE. However, in a multivariable analysis correcting for these factors, sex was not associated with significant differences in hospital LOS or inpatient mortality rates. Disclosures Kapoor: Celgene: Research Funding; Takeda: Research Funding; Amgen: Research Funding.

Introduction: We have previously reported underrepresentation of female faculty at senior academic ranks in hematology/oncology (H/O). In this analysis we aimed to investigate the influence of sex in attaining leadership positions amongst academic hematologists/oncologists in United States. Methods: Faculty members were identified at 146 H/O fellowship programs listed on fellowship and residency electronic interactive database (FREIDA.) Data was collected on demographics, academic rank and research output using Doximity and Scopus databases. We compared the unadjusted characteristics of men and women by using two-sided t-tests and χ2 tests where appropriate. In primary analysis, logistic regression models were used to evaluate sex differences on probability of having full professorship (versus assistant and associate professorship) and of achieving leadership positions including division chief, Program Director (PD) and Associate Program Director (APD). Adjusted models included the following variables: clinical experience in years, number of publications, h-index, appointment at top 20 hospital, clinical trial investigator status and National Institutes of Health funding. Stratified analysis was performed adjusting for duration of clinical experience (≤15 vs >15 years) Results: Fewer women were full Professors (21.9% vs 78.1%), division chiefs (16.7% vs 83.3%), and PDs (30.5% vs 69.5) but the number was similar for Associate Program Directors (47.1% vs 52.9%). In a univariate unadjusted model, women were less likely to be full professors compared to men (OR 0.39; 95% confidence interval [CI], 0.31-0.48; P<.001). However, in the multivariable adjusted model no statistically significant sex difference in full professorship was found (OR 1.05; 95% CI 0.71, 1.57; P=.85; Table). The likelihood of full professorship was positively associated with clinical experience in years, number of first/last author publications, h-index, and being a primary investigator on at least one clinical trial.In a univariate unadjusted model, women were less likely to be division chiefs as compared to males (OR 0.35; 95% CI, 0.16, 0.80; P=.01). However, in the multivariable adjusted model, there was no statistically significant sex difference in achieving the position of division chief (OR 0.57; 95% CI 0.20, 1.58; P=.28; Table). No significant difference was found between females and males for being program directors or associate program directors in both univariate and multivariate analysis. Similarly, a stratified analysis adjusting for duration of clinical experience (≤15 vs >15 years) found no significant sex differences in attaining leadership position (Table) Conclusion: We found that women are underrepresented at higher academic ranks and in leadership positions in hematology/oncology, but that sex is not a significant negative predictor to women obtaining leadership positions after correcting for traditional predictors of academic success. However, "non-traditional" and therefore less measurable and analyzable factors such as networking, mentorship, sponsorship, gender bias, balancing work and home responsibilities and many others may contribute and should be further investigated. Disclosures No relevant conflicts of interest to declare.

Introduction: Several recent studies have shown a gender disparity in professional doctoral introductions at major medical conferences, with female speakers being less likely to be introduced with a professional title. We sought to examine whether a similar disparity existed at the American Society of Hematology (ASH) Annual Meeting. Methods: In this retrospective observational study, 8 investigators reviewed available presentations from video archives of the 2018 ASH Annual Meeting. Presentations were excluded if gender could not be identified and/or speaker did not have a doctoral degree. We collected data on speaker gender, speaker academic/non-academic rank, speaker geographic location, speaker training status, speaker session type and introducer gender were all collected. A "professional address" was defined as either "Dr. [First and Last Name]" or "Dr. [Last Name]." Descriptive statistics and regression modelling were used to analyze the data. Results:Of the videos reviewed, 645 presentations were eligible for analysis; 380 (59%) speakers were men and 264 (41%) were women. A comparison of male and female speaker cohorts is seen in Table 1. Forty-eight percent of both men and women held a Medical Doctor degree (MD), and the rest were MD/PhD or PhD graduates. Substantially more men (28%) were full professors compared to women (13%). Almost half (47%) of session types for both men and women speakers were designated as "basic science." In an adjusted analysis, more women (N=174, 66%) compared to men (N=225, 59%) received a professional address (P&lt;.01). 43% of women were introduced by a female introducer and 42% of men were introduced by a female introducer (P=.79). In addition, 48 of the introducers (19%) for women and 68 of the introducers (18%) for men had a PhD or MD/PhD. In a logistic regression model adjusting for session type, academic rank, degree, geographic location, trainee status, and gender of introducer, there were no significant gender-based differences in professional introduction [Table 1; Odds Ratio (OR) 0.71, P=.06]. In addition, speakers with MD introducers were more likely to have a professional introduction compared to PhD introducers (OR 2.15, P=.03) regardless of sex. Conclusions: Our study demonstrates that women were at least as likely as men to receive a professional address at the 2018 ASH Annual Meeting. These results differ from previous studies of other professional medical conferences. These findings may reflect the strong presence of PhD graduates as both speakers and introducers. Both forms of bias (gender and degree-based) merit further study and interventions including speaker training to ensure combatting unconscious bias. Disclosures Velazquez: Midatech: Other: Husband owns stock in this company; Portola Pharmaceuticals: Other: Husband owns stock in this company; Corbus Pharmaceuticals: Other: Husband owns stock in this company; Johnson & Johnson: Other: Husband is employed by this company.