Citations

This study provided additional evidence to support the OR-Stretch Web- App as a potential ergonomic intervention in the operating room. Overall, the ORStretch Web-App was beneficial to surgeons’ physical performance, mental focus, and discomfort. However, improving the Web-App to be user-friendly, and developing strategies to align the microbreaks with appropriate time spots during surgeries to not interrupt surgical workflow are among the key factors that need attention. Additionally, no significant differences in the surgeons’ subjective evaluation of the Break-30 and Break-60 scheduling strategies were found. However, the data and surgeons’ feedback implied that taking microbreaks every 30 min (Break-30 condition) may not be ideal, especially during long or complicated surgical procedures.

LBA531 Background: Muscle-invasive urothelial carcinoma (MIUC) is an aggressive disease with high relapse rates. Neoadjuvant platinum-based chemotherapy (NAC) is the standard of care in patients (pts) who are cisplatin (Cis)-eligible. However, many pts are Cis-ineligible or have persistent muscle-invasive disease after NAC and surgery. We evaluated pembrolizumab (Pembro) as adjuvant therapy in pts with high-risk MIUC following surgical resection. Methods: The AMBASSADOR study is an open-label, randomized, phase III trial that enrolled pts with histologically confirmed MIUC of the bladder, upper tract, or urethra who (1) had ≥ pT2 and/or pN+ or margins+ at surgery (radical cystectomy, nephrectomy, nephroureterectomy, or ureterectomy) following NAC or (2) ≥ pT3 and/or pN+ or margins+ at surgery without NAC and were either Cis-ineligible or declined adjuvant Cis-based therapy. Pts were registered ≥4 to 16 weeks after surgery and randomized 1:1 to receive Pembro 200 mg every 3 weeks for 1 year or observation (Obs). Randomization was stratified by pathologic stage, centrally tested PD-L1 status, and prior NAC. The dual primary endpoints were disease-free survival (DFS) and overall survival (OS) with a target sample size of 739 pts and required 387 DFS and 320 OS events for final analysis. Secondary objectives included evaluation of DFS and OS in PD-L1-positive and -negative pts and assessing safety. Here we present the interim DFS and OS results. Results: Between 09/2017 and 08/2021 a total of 702 pts were randomized prior to early closure due to US FDA approval of nivolumab for MIUC pts: 354 pts to Pembro and 348 pts to Obs; 13.0% vs 21.6% withdrew from study without event in the Pembro vs Obs arms, respectively. 74 pts (21%) in the Obs arm received an immune checkpoint inhibitor. Median follow-up was 22.3 months (mos) for DFS and 36.9 mos for OS. The DFS endpoint (based on 319 events needed for interim analysis) crossed the efficacy boundary. Median DFS was 29.0 months (95% confidence interval (CI) 21.8‒not evaluable (NE)) with Pembro and 14.0 months (95% CI 9.7‒20.20) with Obs (hazard ratio (HR) 0.69 [95% CI 0.55–0.87]; p=0.0013). At the interim analysis (n = 257 events), median OS was 50.9 months (95% CI 43.9‒NE) with Pembro and 55.8 months (95% CI 53.3‒NE) with Obs (HR 0.98 [95% CI 0.76–1.26]; p=0.88). Grade 3+ adverse events occurred in 48.4% and 31.8% of pts in the Pembro and Obs arms, respectively. Conclusions: Adjuvant Pembro demonstrated a statistically significant and clinically meaningful improvement in DFS vs Obs for high-risk MIUC pts after radical surgery. The OS endpoint may have been impacted by pts on the Obs arm receiving a checkpoint inhibitor. Pembro was tolerable with no new safety signals. These results support adjuvant Pembro as a new therapeutic option for pts with MIUC with high risk for recurrence. Additional follow-up is ongoing for the final DFS/OS, PD-L1 subgroups, and ctDNA analyses. Clinical trial information: NCT03244384 .

Exoskeletons are ergonomic devices that can support workers to improve performance and worker safety. This study created an apparatus that simulated a head-and-neck exoskeleton designed for surgeons to test the effects of varying tension forces on muscle activation (splenius capitis, splenius cervices, and erector spinae), body part discomfort, dexterity, cognition, and overall usability of the device. Eight participants were involved in twelve trials over two days and held static postures (looking down at 45° or 90°) for 20 minutes with 10-minute breaks between trials. Six trials utilized tension forces, which were recorded every two minutes and then averaged for each trial. A bivariate regression analysis ( on each metric vs. average tension forces demonstrated that increasing tension forces led to decreased muscle activity of the left splenius capitis, change in general body pain, change in neck discomfort, and the rate of discomfort developing, and improved usability scores.

Despite advances in medical technology, intraoperative adverse events (IAE) continue to occur in hospital’s complex systems. Current approaches to understanding and mitigating IAEs rely on retrospective data analyses to recognize the series of events leading to an IAE. This paper discusses current challenges and highlights the potential of the Operating Room Blackbox (ORBB) system use to enhance patient safety.

Abstract Background Treatment options for penile squamous cell carcinoma are limited. We sought to investigate clinical outcomes and safety profiles of patients with penile squamous cell carcinoma receiving immune checkpoint inhibitors. Methods This retrospective study included patients with locally advanced or metastatic penile squamous cell carcinoma receiving immune checkpoint inhibitors between 2015 and 2022 across 24 centers in the United States, Europe, and Asia. Overall survival and progression-free survival were estimated using the Kaplan-Meier method. Objective response rates were determined per Response Evaluation Criteria in Solid Tumours 1.1 criteria. Treatment-related adverse events were graded per the Common Terminology Criteria for Adverse Events, version 5.0. Two-sided statistical tests were used for comparisons. Results Among 92 patients, 8 (8.7%) were Asian, 6 (6.5%) were Black, and 24 (29%) were Hispanic and/or Latinx. Median (interquartile range) age was 62 (53-70) years. In all, 83 (90%) had metastatic penile squamous cell carcinoma, and 74 (80%) had received at least second-line treatment. Most patients received pembrolizumab monotherapy (n = 26 [28%]), combination nivolumab-ipilimumab with or without multitargeted tyrosine kinase inhibitors (n = 23 [25%]), or nivolumab (n = 16 [17%]) or cemiplimab (n = 15 [16%]) monotherapies. Median overall and progression-free survival were 9.8 months (95% confidence interval = 7.7 to 12.8 months) and 3.2 months (95% confidence interval = 2.5 to 4.2 months), respectively. The objective response rate was 13% (n = 11/85) in the overall cohort and 35% (n = 7/20) in patients with lymph node–only metastases. Visceral metastases, Eastern Cooperative Oncology Group (ECOG) performance status of 1 or higher, and a higher neutrophil/lymphocyte ratio were associated with worse overall survival. Treatment-related adverse events occurred in 27 (29%) patients, and 9.8% (n = 9) of the events were grade 3 or higher. Conclusions Immune checkpoint inhibitors are active in a subset of patients with penile squamous cell carcinoma. Future translational studies are warranted to identify patients more likely to derive clinical benefit from immune checkpoint inhibitors.

e24104 Background: There is a high rate of anemia present in cancer patients and anemia is also a common referral to a hematologist. Symptomatic anemia can significantly impair an individual’s functional status so identifying its cause is essential for improving quality of life. Correction of nutritional deficiencies, like iron, B12, and folate deficiency can improve hemoglobin counts, prevent recurrent PRBC transfusions, and can often resolve the anemia. In a busy academic hematology oncology practice, we hypothesize that it is easy to overlook performing a basic nutritional evaluation especially in the setting of other causes for anemia such as chemotherapy, hemolysis, blood loss, chronic kidney disease, and other disorders. We aim to evaluate the frequency of anemia workup in the hematology and oncology division at our academic institution. Methods: We conducted a retrospective study of all hematology oncology patients seen in our clinic who received a blood transfusion in 2021. All patients were 18 years old or order and received at least one-unit PRBC transfusion as an outpatient. One “transfusion event” was defined as any number of PRBC transfusions on a single day and any subsequent transfusions within a 90-day periods. A single patient, therefore, can have multiple distinct transfusion events. We analyzed whether patients received a “basic” anemia evaluation, defined as checking ferritin, iron saturation, B12, and folate levels within 3 months before or after the first transfusion, and whether a discrepancy in practice patterns exists between different hematology oncology subspecialties. Results: At the interim analysis, we identified 368 transfusion events for 275 patients. Those events were ordered by providers (physician, nurse practitioner, or physician assistant) in the following subspecialties: oncology (n = 20), malignant hematology (n = 18), classical hematology (n = 3), and fellow-in-training (n = 5). A basic anemia workup was missing in 58% (84 of 146), 27% (49 of 183), 23% (8 of 35), 40% (2 of 5) in the above groups respectively. For patients with macrocytic anemia defined as mean corpuscular volume (MCV) > 100 fL, 48% (38 of 79) did not have B12 or folate levels checked within 3 months before or after a transfusion event. For patients with MCV < 80 fL, 47% (14 of 30) did not have ferritin or iron saturation checked within 3 months before or after a transfusion event. Conclusions: We observed a high percentage of cancer and non-malignant hematology patients who did not receive a basic anemia evaluation within three months before or three months after a blood transfusion. A higher percentage of patients with solid tumors patients who required PRBC transfusions did not receive a basic anemia evaluation in a timely manner. Our study identified an area of quality improvement and need for intervention that can easily be overlooked in a busy academic hematology oncology practice.

Coating nanoparticles with stealth epilayers increases circulation time by evading opsonization, macrophage phagocytosis, and reticuloendothelial sequestration. However, this also reduces internalization by cancer cells upon reaching the tumor. We designed gold nanorods (GNRs) with an epilayer that retains stealth properties in circulation but transforms spontaneously in the acidotic tumor microenvironment to a cell-penetrating particle. We used a customized stoichiometric ratio of l -glutamic acid and l -lysine within an amphiphilic polymer of poly( l -glutamic acid-co- l -lysine), or P(Glu-co-Lys), to effect this transformation in acidotic environments. P(Glu-co-Lys)-GNRs were internalized by cancer cells to facilitate potent in vitro radiosensitization. When administered intravenously in mice, they accumulate in the periphery and core of tumors without any signs of serum biochemical or hematological alterations, normal organ histopathological abnormalities, or overt deterioration in animal health. Furthermore, P(Glu-co-Lys)-GNRs penetrated the tumor microenvironment to accumulate in the hypoxic cores of tumors to potently radiosensitize heterotopic and orthotopic pancreatic cancers in vivo.

Ames, IA Cardiac sonographers suffer from high prevalence of work-related upper extremity musculoskeletal pain due to awkward postures and fatigue accumulation. Sonographers can choose either left- or right-hand scanning, or alternate between both, however, the impact of each scanning technique on the upper extremity muscles remains unknown. Four ambidextrous cardiac sonographers performed between four to six cardiac scans using left- and right-hand while postural and muscle activity were collected from specific muscles on the upper extremities. A comparison of the posture showed that apart from forearm pitch and 90 th percentile upper arm deviation, upper extremity postures between the two scanning techniques did not differ significantly. Furthermore, while right-hand scanning (RHS) appeared to induce slightly higher muscle activity in the deltoids compared to left-hand scanning (LHS), the difference between the two techniques was not significant. We recommend alternating between these two techniques to distribute muscle stress evenly to prevent muscle overuse.

52 Background: When combination medical therapy incorporates both IV and oral anti-cancer agents, patients may experience compound side effects and face challenges with treatment adherence. To assess how community cancer programs may improve care coordination for patients receiving combination IV/oral systemic therapy, the Association of Community Cancer Centers (ACCC) conducted a mixed-methods study that involved healthcare professionals (HCPs), patients and caregivers. Methods: The study followed a sequential quantitative-qualitative design to answer questions around the barriers or challenges associated with combination IV/oral systemic therapy. The quantitative phase included an online survey of HCPs (by ACCC) and a survey of patients and caregivers (by Edge Research, in collaboration with several patient advocacy organizations). In the quantitative phase, the survey results were contextualized through two HCP focus groups and individual HCP interviews. Results: Comparing and contrasting the patient survey (n = 113) and HCP survey (n = 157) results revealed insights around the following themes: Top Challenges: Patients felt their top challenges were side effects (57.5%); inconvenience going to medical appointments (37.2%); and financial burden (36.3%). HCPs perceived top challenges as cost of care to the patient (24.0%); coordination and delivery of oral agents (22.1%); and health insurance coverage (21.9%). In focus groups, HCPs explained how they were investing significant staffing resources to prevent and mitigate financial toxicity, especially for patients receiving oral therapies. Methods of Communication: 35.4% of patients “highly preferred” using email to communicate with HCPs about their combination regimens. However, HCPs felt that email was one of the least effective methods of communicating with patients. In focus groups, HCPs agreed that email is convenient when communicating about non-urgent matters. However, they were concerned that some patients may use email to communicate about urgent issues. Treatment-related AEs: When patients experienced treatment-related AEs, 30.1% said their clinicians tried a dose modification or hold. HCPs had mixed perceptions regarding the effectiveness of dose holidays. Those who felt this was highly effective included: advanced practice providers (42.9%), nurses (28.1%); oncologists (16.7%); and pharmacists (16.7%). Conclusions: This study identifies opportunities to improve care coordination for patients receiving combination IV/oral systemic anti-cancer regimens. These findings may inform the creation and dissemination of effective practices and quality improvement projects. These results may also help cancer programs tailor resources and incorporate proactive steps to address some of the key challenges patients may face.

AbstractObjectivesStudies on the association between metformin use and the risk of oesophageal cancer (OC) have generated controversial findings. This updated meta-analysis was conducted to reassess the effects of metformin on OC.MethodsA comprehensive search strategy was conducted to select relevant studies from origination to February 2021. Heterogeneity was evaluated through the Q test and I2 statistics. HRs and 95% CIs were pooled through either random-effect or fixed-effect models. Meta-regression, subgroup analyses, sensitivity analysis and publication bias diagnosis were also performed.ResultsSeven studies with 5 426 343 subjects were included. Metformin use was associated with reduced risk of OC (HR=0.69, 95% CI 0.54 to 0.87, p&lt;0.001). Sensitivity analysis suggested that the results were relatively stable.ConclusionMetformin is associated with a reduced risk of OC. More well-designed studies are still needed to further elaborate on these associations.PROSPERO registration numberCRD42021237127.