bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract PO-194: A systematic review of testosterone status and ill health across African populations
Authors: Orozco Cristina , Rotimi Solomon
Published: December 2020

Introduction: Testosterone is not just a “male sex hormone” but a biomolecule with a broad spectrum of demonstrated physiological functions as well as a wide variety of physiological and pathophysiological associations about which we are just learning. The level of testosterone impacts the general well-being and outcomes of individuals and populations. Consequently, testosterone levels influence disparity in health outcomes and its variation is determined by gender, age, and racial differences. There is however, a dearth of empirical evidence regarding whether there are geographical variations in the level of testosterone and whether this variation is associated with ill health in different African populations. The current study therefore, elucidated the documented levels of testosterone in African populations. Methodology: A systematic search was conducted following the PRISMA guidelines, with a combination of terms including ‘testosterone’ and nationality/ancestry descriptors. The search included studies from the last 10 years using databases including Google Scholar, Web of Science, Scopus, PubMed, EBSCOHost, and ProQuest. Results: We identified 64 eligible peer-reviewed original research publications across Africa on the levels of testosterone in health and several diseases including erectile dysfunction, obesity, and drug use. Changes of plasma total testosterone (ng/dL) from control to case were evaluated; more often, regardless of region, testosterone levels for case groups were lowered, as was the case in patients with diabetes mellitus. Although, this did not hold true for every study like one for hepatitis and benign prostate hyperplasia in which levels rose for the case group. Variations across countries were evaluated. Studies from Morocco reported the least levels of testosterone, following South Africa and Tunisia with levels nearing 3.9 ng/ml. In the middle of the spectrum was Ghana, Nigeria, Cameroon, and Egypt, with levels nearing 6 ng/dl. Ethiopia had the highest levels of testosterone nearing 7.9 ng/ml. Further, the variation based on African region suggests there is no statistically significant difference between the reported levels of testosterone across North, South, West, and East Africa (p-value of 0.7804).

Nevertheless, the data suggests variation in the level of testosterone across African populations. Conclusion: It is hoped that our findings will provide biological evidence for the physiological dissimilarity among Black populations and the impact of such differences on disease risk.

Citation Format: Cristina Orozco, Solomon Rotimi. A systematic review of testosterone status and ill health across African populations [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-194.
Abstract PO-202: Cancer survival differences among Medicare beneficiaries and their younger uninsured counterparts
Authors: Sineshaw Helmneh M. , Yabroff K. Robin , Jemal Ahmedin , Silvestri Gerard A.
Published: December 2020

Purpose: To assess cancer survival differences between uninsured patients younger than age 65 years with their immediate older counterparts age 66-69 years with Medicare coverage. Methods: Data from the National Cancer Data Base were used for this study. The main outcomes were 1-, 2-, and 5-year survival for 16 cancer types in 1,206,821 newly diagnosed patients. We characterized patients by insurance and age categories and used Kaplan-Meier method with log-rank test for statistical significance to calculate all-cause 1-, 2-, and 5-year survival rates. The analysis assessed differences between uninsured and insured patients age 60-64 years with those aged 66-69 years with Medicare coverage. Cox proportional hazards models were used to generate hazard ratios (HR) of all-cause mortality. Results: Uninsured patients aged 60-64 years had higher proportion with late stage disease, and lower proportion with receipt of surgery, chemotherapy or radiotherapy than Medicare beneficiaries aged 66-69 years. Younger uninsured patients had significantly worse 1-, 2-, and 5-year survival overall and by race/ethnicity, comorbidity score, and cancer type compared with their older counterparts with Medicare coverage. In a stratified analysis by cancer type, uninsured younger patients had strikingly lower 1-, 2- and 5- year survival for nearly all 16 cancers compared with older Medicare patients. For instance, the 1-year and 2-year survival differences between younger uninsured and older Medicare +/- private insured patients showed the largest differences of about 20% for patients with lung cancer (adjusted HR (aHR) = 1.42; 95% CI, 1.38-1.47; and aHR = 1.37; 95% CI, 1.33-1.41; respectively). Similarly, 5-year survival rates in uninsured younger patients with colorectal and breast cancer were 8-15% lower compared with older Medicare patients (aHR = 1.34; 95% CI, 1.27-1.41 and aHR = 1.56; 95% CI, 1.44-1.69; respectively). Conclusions: Survival after a diagnosis of cancer is considerably lower in uninsured younger patients age 60-64 years than in older Medicare patients age 66-69 years. Our findings suggest that expanding uniform health insurance coverage to individuals approaching Medicare eligibility age down to the age of 60 could substantially improve cancer survival in the United States.

Citation Format: Helmneh M. Sineshaw, K. Robin Yabroff, Ahmedin Jemal, Gerard A. Silvestri. Cancer survival differences among Medicare beneficiaries and their younger uninsured counterparts [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-202.
Abstract PO-204: Impact of the Affordable Care Act on timeliness to treatment for patients with multiple myeloma
Authors: Jayakrishnan Thejus , Bakalov Veli , Callander Natalie , Sadashiv Santhosh , Ailawadhi Sikander
Published: December 2020

Background Socioeconomic disparities impact access to treatment and outcomes for patients with cancer. Affordable Care Act (ACA) sought to mitigate some of these disparities In the present study, we examined the influence of socioeconomic factors on patients facing delay in treatment initiation and the impact of Affordable Care Act (ACA). Methods We queried the National Cancer Database (NCDB) for patients with MM (ICD-0-3 code 9732) diagnosed from 2004-2016 who received any therapy.

Active MM patients were defined as those treated within 120 days of diagnosis. Time to initiation (TTI) was defined as time in days (d) from diagnosis of cancer to initial myeloma therapy and divided into quartiles. Patients belonging to 4th quartile for TTI constituted the delayed treatment group (delayed-TTI). Study period was divided into pre-ACA and post-ACA using 2010 as cut-off. Multivariate logistic regression analysis was used and p-value 0.05 was used for statistical significance. Results We identified 65,723 patients meeting the eligibility criteria (28,814 pre-ACA and 36,909 post-ACA respectively). Median age was 68 (Interquartile Range IQR 59-76) years, included 55.1% males and majority insured patients (96.4%). Racial distribution was 66%(non hispanic whites-NHW), 20%(non hispanic blacks-NHB), 6%(Hispanics-H).

Median TTI were 13 (IQR 5-27) days overall and 42 (33-58) days for delayed-TTI group. NHB and H races were associated with delayed-TTI in the multivariate model - Odds Ratio OR 1.18 (IQR 1.09-1.27)p-value <0.005 pre-ACA vs. 1.17 (1.09-1.25) p-value<0.005 post-ACA for NHB and OR 1.22 (1.07-1.38) p-value0.003 pre-ACA that became non-significant post-ACA for H. Treatment at comprehensive community cancer center – OR 0.79 (0.74-0.84),p-value<0.005 or academic research center -0.92 (0.86-0.98) were associated with lower OR for delayed-TTI while insurance status was not significant in the overall analysis. Conclusion Contemparory results from the present study demonstrate that racial minority status may be a predisposing factor to delay in treatment initiation. While the ACA has been shown to help mitigate this in certain cancer categories, the effect is still limited among MM patients.

Citation Format: Thejus Jayakrishnan, Veli Bakalov, Natalie Callander, Santhosh Sadashiv, Sikander Ailawadhi. Impact of the Affordable Care Act on timeliness to treatment for patients with multiple myeloma [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-204.
Abstract PO-205: The impact of DSRIP and practice transformation on cancer screening outcomes for Medicaid, low income, and uninsured patients in Texas
Authors: Jones Rebecca , Ramirez Amelie , Cancino Ramon
Published: December 2020

Background In 2011, Texas received federal approval of the 1115 Healthcare Transformation waiver, which went to support the Texas Delivery System Reform Incentive Payment Program (DSRIP) pool, incentivizing the transformation of service delivery practices to improve quality, health status, patient experience, coordination, and cost-effectiveness. To date, no research has described the impact DSRIP has had on cancer screening outcomes on the Texas Medicaid, low income, and uninsured (MLIU) patient population. Objective To describe the impact of practice transformation at an academic medical center primary care practice towards a value- based care delivery model on breast, cervical, and colorectal cancer screening for its MLIU patient population as a result of 1115 Healthcare Transformation Texas waiver. Study Design Retrospective analysis of electronic health record data from 1/1/2017 through 12/31/2018. Participants MLIU patients who received care at an academic medical center primary care practice during the study time frame and met the criteria for colorectal, cervical, and/or breast cancer screenings. Main Measures The primary outcomes for these analyses were proportions of the patient population who received or did not receive the recommended cancer screenings. Key Results After controlling for relevant confounders, we found significantly improved rates of cervical and colorectal cancer screening among Medicaid, low income, and uninsured patients. Conclusions Practice transformation, specifically integrating primary care, quality, and health information technology, resulted in higher rates of cervical and colorectal cancer screening among a high-risk vulnerable group of patients in one year. Further research should be conducted to determine if the findings are reproducible and if the return on investment equals or surpasses the cost of upfront and sustaining costs of practice transformation.

Citation Format: Rebecca Jones, Amelie Ramirez, Ramon Cancino. The impact of DSRIP and practice transformation on cancer screening outcomes for Medicaid, low income, and uninsured patients in Texas [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-205.
Abstract PO-214: Delay time in the diagnosis and treatment of breast cancer in the California-Mexican Border
Authors: Galindo-Castañeda Antonio , Gonzalez-Corral Martín , Garcia-Armas Luis , Egurrola-Terán Oscar , Martínez-Gómez Luis , Guadarrama-Orozco Jorge Albert
Published: December 2020

Introduction The delay in the diagnosis and treatment of breast cancer has a direct correlation with more advanced stages of the disease and a lower survival rate.

These delays represent an urgent situation in developing countries due to their high prevalence. Objective This study aims to determine the time intervals in the diagnosis and treatment of patients with breast cancer in the main public hospital in the city of Tijuana, to identify the mechanisms through which the different population aspects and Hospitals affect the treatment of patients. Methods A descriptive, observational, and retrospective study was conducted, including patients with breast cancer diagnoses treated at the General Hospital Tijuana in the period from January 2019 to December 2019. We used data from the medical record, including dates, demographics, histopathological, and clinical data from each visit.

Descriptive statistics were calculated in SPSS V27. Results A total of 154 patients with breast cancer were treated at the TGH during 2019. Of these, 97 patients included in the study, with an average age of 52.34 ± 9.14 years. The patient delay time was higher than three months in 61% of cases. The diagnosis delay time was between 5 and 13 weeks. Conclusion Mexican breast cancer patients, as Latinas in California, are more likely to exhibit late-stage breast cancers at the time of diagnosis and have lower survival rates. Mexico counts an opportunistic or non-organized mammography screening program, leading to considerable delays in the diagnosis of breast cancer, even in border cities near to the US (where some people use multiple healthcare systems). With this context, it is necessary to recommend the creation of an organized screening program based on a more exceptional ability to cover the target population and, therefore, greater effectiveness at the community, as well as more equitable access.

Citation Format: Antonio Galindo-Castañeda, Martín Gonzalez-Corral, Luis Garcia-Armas, Oscar Egurrola-Terán, Luis Martínez-Gómez, Jorge Albert Guadarrama-Orozco. Delay time in the diagnosis and treatment of breast cancer in the California-Mexican Border [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-214.
Abstract PO-261: Barriers to Pap smear screening among medical students in Yemen: A qualitative study
Authors: Al-Naggar Redhwan
Published: December 2020

Objective: The objective of this study is to explore the barriers to Pap smear screening among medical students in Yemen. Methodology: This study was conducted among forty one medical students. Ten female and 31 male. Four focus groups discussions participated in this study, one female group discussion and 3 male group’s discussions. The obtained data were sorted into categories based on content analysis and data were analyzed manually. Results: Total number of 41 medical students participated in this qualitative study. The majority of the participants were male and in their 22 years of age. All groups reported that the lack of awareness is the main barrier to Pap smear screening. The conservative culture and traditions of the people, shameful of the doing pap testing despite the gender of healthcare workers, not trusting the health care workers, man has the final decision for his wife to do the Pap smear screening, fear of the disease, fear of the complications of the test were considered the main barriers of Pap smear testing. All groups were willing to suggest this test to their families and friends to prevent and treat the disease as early as possible. All groups agreed that the gender of the healthcare workers is matter and definitely will affect the women decision to do the Pap smear screening. All girls preferred to be examined by female. All the groups mentioned that the advantages of Pap smear screening is to diagnose and treat the disease early. All groups mentioned that personal hygiene of the private parts is the most important prevention measures for cervical cancer. Conclusion: Lack of awareness is the main barrier to Pap smear screening. Gender of the healthcare workers greatly affect the women decision to do the Pap smear screening and all female medical students preferred to be examined by female. Therefore raising awareness among the general population is urgently needed considering the culture of the Yemeni people.

Citation Format: Redhwan Al-Naggar. Barriers to Pap smear screening among medical students in Yemen: A qualitative study [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-261.
Abstract PO-266: Factors affecting Appalachian Kentuckians' beliefs related to colorectal cancer and colorectal cancer screening
Authors: Aleshire Mollie E. , Adegboyega Adebola , Sha Shuying , Hatcher Jennifer
Published: December 2020

Background: Rural Appalachian Kentucky has much higher colorectal cancer (CRC) morbidity (50.6 per 100,00) and mortality (19.8 per 100,000) than the U.S. Appalachian Kentucky CRC screening rates are 36% compared with 27% statewide and 53% nationally. This study assessed factors affecting Appalachian Kentuckians’ beliefs related to CRC and CRC screening. Methods: Appalachian Kentuckians 50 years of age and older who were not up-to-date on CRC screening (N = 190) completed a survey including subscales measuring perceived CRC susceptibility and perceived benefits of CRC screening. Mann-Whitney U and Kruskal-Wallis tests compared differences in beliefs and Spearman’s Rho examined the correlation between variables. Results: Sixty-two percent were concerned about developing CRC, and 94.7% had completed CRC screening previously. Participants felt more susceptible to CRC if they had a family history of CRC (p < .01) and if their healthcare provider recommended CRC screening (13.03 versus 12.19, p < .01). Perceived benefits of CRC screening were not significantly associated with demographic or healthcare access variables. Conclusions: Although many participants were concerned about developing CRC, very few had completed CRC screening. These findings and those of previous research provide information to guide tailored interventions to promote CRC screening in Appalachian Kentuckians. Individuals with a family history of cancer may perceive a higher CRC susceptibility and be more likely to complete CRC screening. Healthcare providers’ recommendations for CRC screening can influence perceived CRC susceptibility and potentially influence completion of CRC screening in this population.

Citation Format: Mollie E. Aleshire, Adebola Adegboyega, Shuying Sha, Jennifer Hatcher. Factors affecting Appalachian Kentuckians' beliefs related to colorectal cancer and colorectal cancer screening [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-266.
Abstract PR08: African-centric p53 hypomorphs play significant roles in cancer risk and efficacy of therapy
Authors: Barnoud Tim , Leung Jessica , Gnanapradeepan Keerthana , Ke Lei , Karanicolas John , Murphy Maureen E.
Published: December 2020

The p53 tumor suppressor gene plays a central role in human cancer. In addition to mutation, there are genetic coding region variants of p53 that exist in different ethnic groups. In some cases, these variants have incomplete or impaired function and confer increased cancer risk. We call such variants ‘hypomorphs’. Two p53 hypomorphs exist in populations of African descent: P47S and Y107H. Our research on the P47S hypomorph of p53 revealed that this variant confers increased risk for cancer in humans and in mouse models (Jennis, Genes Dev 2016; Murphy, NPJ Breast Cancer 2017). We find that P47S protein is selectively impaired for the ability to confer sensitivity to ferroptosis (Leu, PNAS 2019); consequently, we find that human and mouse cells with this variant accumulate iron in certain tissues, and that the P47S variant is associated with iron overload in African Americans (Singh, Nat Comm 2020). We find that tumor cells containing the P47S variant are resistant to most genotoxic chemotherapies, but we have discovered that P47S tumor cells are markedly more sensitive to other therapies, including cisplatin and BRD2/4 inhibitors (Barnoud, Can Res 2018). Our current focus is on another African-centric p53 hypomorph, Y107H. We show that this variant is impaired for p53-mediated apoptosis, and is associated with cancer risk in a mouse model. We also show that Y107H is impaired for the transactivation of only a dozen p53 target genes. Notably, half of these genes are known tumor suppressor genes. Our biophysical and NMR structure of the Y107H protein explains the mechanistic basis for the impaired function of this hypomorph. Our analysis of the P47S and Y107H hypomorphs of p53 has significant potential to understand cancer risk and improve cancer therapy in populations of African descent.

Citation Format: Tim Barnoud, Jessica Leung, Keerthana Gnanapradeepan, Lei Ke, John Karanicolas, Maureen E. Murphy. African-centric p53 hypomorphs play significant roles in cancer risk and efficacy of therapy [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PR08.
Abstract IA24: Navigating the new normal: Trends shaping post-COVID-19 cancer care delivery
Authors: Richardson Lisa
Published: December 2020

In just a few short weeks, COVID-19 transformed cancer care around the world. The crisis has dismantled how care is delivered and forced providers to make difficult decisions about what types of care are essential and can be sustained with the resources and staff available. This presentation will provide an overview of the emerging trends that are shaping cancer care and how providers are adapting to these new challenges to continue to safely provide necessary care to those who need it most.

Citation Format: Lisa Richardson. Navigating the new normal: Trends shaping post-COVID-19 cancer care delivery [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr IA24.
Abstract PO-009: Cancer-related distress among multiple myeloma patients during the COVID-19 pandemic
Authors: Sweeney Nathan W. , Ahlstrom Jenny
Published: December 2020

Background: The rapid outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to the delay of non-urgent or routine medical appointments, placing tremendous burden on cancer patients. Meanwhile, the emotional effect of the novel coronavirus (COVID-19) on high-risk groups, such as multiple myeloma (MM) patients, remains unclear. The purpose of this project was to understand psychosocial distress and unmet needs among patients with active MM during the acute phase of social distancing and COVID-19 impact in the United States.

Methods: We utilized HealthTree (healthtree.org) and invited patients with active MM cancer or precursor conditions to participate in an online survey curated through a partnership with the Cancer Support Community (CSC). Participants were asked to rate their level of concern (Not at All to Very Seriously) on 12 items assessing psychosocial, practical, and physical needs (selected from CSC’s CancerSupportSource® distress screening tool) during the COVID-19 pandemic. De-identified responses were aggregated and reviewed. The survey was determined to be exempt by the Western Institutional Review Board.

Results: 1,079 MM pts participated in the survey between April 15, 2020 and June 8, 2020. The percentages of patients responding moderately to very seriously concerned are reported here. Eating and nutrition (71%), sleep problems (49%), pain and/or physical discomfort (46%), and feeling too tired to do the things you need or want to do (44%) made up the physical/health concerns. Psychosocial/emotional concerns included worrying about the future and what lies ahead (46%), worry about family, children, and/or friends (44%), feeling irritable (37%), feeling sad or depressed (30%), feeling nervous or afraid (25%), feeling lonely or isolated (20%), and relationship problems with your spouse/partner (11%). Finally, 32% reported insurance or money concerns.

Conclusions: Respondents to our survey were most concerned with eating and nutrition, sleep problems, pain and/or physical discomfort, and worrying about the future. Informing patients and medical professionals of physical and psychosocial distress experienced by patients could create a unified approach to decreasing distress levels and increase patient overall health, even during a pandemic or when care is delayed. Patient-reported surveys via an online portal, like HealthTree, can help investigators assess the patient community and result in hypothesis-generating research questions to enhance patient outcomes.

Citation Format: Nathan W. Sweeney, Jenny Ahlstrom. Cancer-related distress among multiple myeloma patients during the COVID-19 pandemic [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr PO-009.
Abstract PO-011: CiRCL: A psychosocial program facilitating communication and care to patients, families, and frontline health care teams during COVID-19
Authors: Ahmed Kauser , Phung Peter , Goldstein Noah , Glaspy John
Published: December 2020

The need for strict social distancing measures preventing visitors on inpatient oncology, ICU, and COVID units during the COVID-19 pandemic has had the unintended consequence of leading to significant psychological and spiritual distress for patients and families and “moral distress” for frontline health care teams tasked with supporting patients who are suffering or dying alone without the support of their loved ones. The trauma of these deaths is sometimes further compounded for families by their inability to provide the final rituals of patients’ faith communities in their last moments, leading to complicated and ongoing grief after the loss. To address these complex psychosocial needs among COVID-19 and advanced cancer oncology patients, and the health care teams caring for them, the Simms/Mann UCLA Center for Integrative Oncology, in collaboration with colleagues at the UCLA Anderson School of Business and a team of diverse faith leaders, developed an innovative digitally mediated program for connection, communication, and care. This program, CiRCL (Caring in Remote Communities of Love), leveraged ZOOM and smartphone recording technology to accomplish the following goals: 1) provide psychological support to family members and friends to facilitate the recording of meaningful personal messages to the patient, including curated playlists of evocative songs from the patient’s life to be played at the bedside; 2) facilitate more meaningful communication between loved ones and frontline workers, including messages of gratitude and support to reduce feelings of isolation and moral distress for frontline workers; and 3) create a liturgical library of recorded ecumenical and faith-based blessings from various traditions, available during illness and at time of dying. Blessings include and encompass the health care teams as well as patients. This program, recently developed and being piloted at UCLA, is intended to extend compassion to all within the health care system during the unique challenges of COVID-19 and, by facilitating connection and support among patients, families, and frontline teams, extend the definition of healing and mitigate the impact of loss and grief for all during the many phases of this pandemic.

Citation Format: Kauser Ahmed, Peter Phung, Noah Goldstein, John Glaspy. CiRCL: A psychosocial program facilitating communication and care to patients, families, and frontline health care teams during COVID-19 [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr PO-011.
Abstract PO-032: Patient-centered communication: Collaborative learning and communication strategies for patients and health care providers in the new normal of COVID-19
Authors: Raymond Martha , Simonetta Margaret-Ann
Published: December 2020

Background: Data from the National Cancer Institute’s Surveillance, Epidemiology & End Results (SEER) program estimate that in 2020 over 1.8 million new cancer diagnoses will occur. SEER data also indicate that over 15.5 million patients/survivors are currently living with a cancer diagnosis in the United States. Amid COVID-19, transitioning care beyond the clinic to minimize exposure for patients and health care providers is essential. Now more than ever, new and evolving ways to communicate openly and effectively are crucial for patients and their health care team.

Methods: In March-May, 2020, the Raymond Foundation hosted nationwide virtual focus groups and town halls for cancer patients, survivors, and caregivers to gain a better understanding of how COVID-19 is affecting their cancer care, communication with their health care team, and shared decision-making. Primary goals included reaching patients in rural, urban, and community oncology settings to gain perspective from diverse populations.

Results: 489 patients, survivors, and caregivers (54% female, 46% male) provided the following insights: 89% reported communication with their health care team had deteriorated since the pandemic; 94% indicated the need for increased communication with their health care team; 42% had a general knowledge of telehealth while 58% had little to no knowledge; 98% indicated they would like to learn more about telehealth options and would try this advanced class of service if offered by their health care team; 64% reported they were not able to accurately communicate treatment adverse effects leading to increased suffering; and 96% reported increased isolation and fear of the unknown care landscape.

Conclusion: Cancer patients realize the importance of patient-centered communication to facilitate a personalized dialogue to actively participate in their care. Empowering patients with the skills they require to comprehensively perceive telemedicine, virtual care, and remote monitoring will help minimize patient risk and provide an opportunity for patients to engage with their health care team throughout the care continuum. Implementing strategies to skillfully serve patients via telemedicine and teleconferencing may be the new normal as we virtually revive the classic house call.

Citation Format: Martha Raymond, Margaret-Ann Simonetta. Patient-centered communication: Collaborative learning and communication strategies for patients and health care providers in the new normal of COVID-19 [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr PO-032.
Abstract PO-033: Professional and psychological impact of COVID-19 pandemic on medical and radiation oncology residents: Results of a national survey
Authors: Hilmi Marc , Boilève Alice , Ducousso Anabelle , Michalet Morgan , Turpin Anthony , Neuzillet Cindy , Naoun Natacha
Published: December 2020

Background: The COVID-19 pandemic deeply impacted clinical practices in oncology leading to organizational, ethical, and medical issues. It has raised challenges in a context of competing care priorities between COVID-19 and cancer treatment. Residents and fellows were in the front line and had to face difficulties related to increasing care needs and urgent reorganization of the health care system while managing stress and uncertainty.

Methods: We conducted a national survey (39 questions) in France among all oncology and radiation therapy residents to describe psychological impact and difficulties encountered by residents (i.e., reassignment, training/research time, supervision, teleworking, management of patients) during the COVID-19 pandemic.

Results: Overall, 222 residents (oncologists: 61% and radiation therapists: 39%) participated in our survey (representing around one third of all residents and fellows in France). Reassignment in COVID-19 wards involved 32% of respondents. Training and research activity were decreased for 89% and 41% of respondents, respectively. 70% have been confronted with ethical issues, 35% felt worried about their health, and 23% experienced psychological distress. According to the Hospital Anxiety and Depression Scale, 32% were anxious and 17% depressive. Consumption of tobacco, psychostimulants, and alcohol was increased in 45%, 40%, and 24%, respectively.

Conclusion: French oncology residents were highly impacted by the COVID-19 pandemic in terms of training and emotions. This national survey can be used as a basis for improved management, medical reorganization, and training of residents during the COVID-19 pandemic, especially when further waves are not excluded.

Citation Format: Marc Hilmi, Alice Boilève, Anabelle Ducousso, Morgan Michalet, Anthony Turpin, Cindy Neuzillet, Natacha Naoun. Professional and psychological impact of COVID-19 pandemic on medical and radiation oncology residents: Results of a national survey [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr PO-033.
Abstract PO-040: The Effects of the COVID-19 pandemic on cancer patient encounters
Authors: London Jack W. , Fazio-Eynullayeva Elnara , Palchuk Matvey , Mossop Corinna , Sankey Peter , McNair Christopher
Published: December 2020

The outbreak of COVID-19 has upended the health care industry and the world as a whole, with the full effects unlikely to be realized for years to come. Unfortunately, cancer patients are likely to be disproportionately impacted by the pandemic, and there are a number of key efforts under way to explore this, including the COVID-19 and Cancer Consortium (CCC19) and the ASCO Survey on COVID-19 in Oncology registries. However, there have been few studies to quantify the immediate impact COVID-19 has had on deviation from normal cancer care, as well as declines in screening efforts. Less screening may lead to delayed diagnoses and poorer future outcomes. We were able to leverage an existing health research network platform (TriNetX) to create a cohort of 20 different institutions across the US representing over 29 million patients. We initially focused on all patients with ICD-10 diagnostic codes for neoplasms (C00-D49). Key findings include a marked decrease in the number of patients having neoplasm-related encounters for March and April of 2020 when compared to the same months in 2019, with January and February remaining largely unchanged. Specifically, comparing April 2020 to April 2019, we observed roughly a -56.9% drop in the number of patients with a neoplasm-related encounter and a -74.0% drop in the number of patients seen for the first time (e.g., screening, initial diagnosis, second opinion, treatment initiation). Similar trends were observed when querying for patients with encounters related exclusively to malignant neoplasms (ICD-10 C00-C96). Site-specific malignancies were also analyzed, with melanoma, breast cancer, and prostate cancer displaying the largest decline in patients seen, and lung cancer, colorectal cancer, and hematologic cancers the smallest drop. Finally, changes in screening were investigated, with breast cancer screening falling by -89.2% and colorectal cancer screening by -84.5% in April of 2020 compared to 2019. Ultimately, these analyses validate the vital need to study and monitor the effect of COVID-19 on cancer patients moving forward, and provide the largest study to quantify the changes in cancer encounters due to the pandemic to date.

Citation Format: Jack W. London, Elnara Fazio-Eynullayeva, Matvey Palchuk, Corinna Mossop, Peter Sankey, Christopher McNair. The Effects of the COVID-19 pandemic on cancer patient encounters [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr PO-040.
Abstract PO-045: Multiplex analysis of coronavirus and influenza antibodies using the ZIVA multiplex platform
Authors: Schmuke Jon , Miller Ben , Meeh Linda , Witherbee Byran
Published: December 2020

Detection of antibodies to upper respiratory pathogens is critical to surveillance, assessment of the immune status of individuals, vaccine development, and basic biology. The urgent need for antibody detection tools has proven particularly acute in the COVID-19 era. We have used Arrayed Imaging Reflectometry (AIR™), a label-free protein microarray technology that relies on the target binding-induced perturbation of an antireflective coating on the surface of a silicon chip, to create a multiplex antibody detection array. ZIVA is a new multiplex protein detection platform that leverages AIR™ technology. We have used ZIVA technology to develop an acute respiratory virus panel capable of detecting the presence of antibodies specific for coronavirus and influenza including, but not limited to, detection of antibodies to SARS-CoV-2, SARS-CoV-1, MERS, three circulating coronavirus strains (HKU1, 229E, OC43), and multiple strains of influenza. We find that the array is readily able to distinguish uninfected from convalescent COVID-19 subjects and provides quantitative information about total IgG, as well as IgG- and IgM-specific responses. Samples may also be evaluated with ZIVA cytokine assays to monitor the cytokine storm in conjunction with viral antibody response.

Citation Format: Jon Schmuke, Ben Miller, Linda Meeh, Byran Witherbee. Multiplex analysis of coronavirus and influenza antibodies using the ZIVA multiplex platform [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr PO-045.
Abstract S02-02: Covid-19 treatment candidate hydroxychloroquine impairs tumor response to anti-PD1
Authors: Wabitsch Simon , McVey Jack C , Ma Chi , Ruf Benjamin , Diggs Laurence , Heinrich Bernd , Greten Tim F
Published: December 2020

Background and Aims: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has caused a worldwide health crisis. As of now, only one treatment has been established for the coronavirus infection disease 2019 (Covid-19), which has disproportionally affected patients with comorbidities such as cancer. Hydroxychloroquine (HCQ) has been studied as a potential treatment for Covid-19. Here we studied whether HCQ treatment could influence the effect of immunotherapy against colorectal and liver cancer.

Methods: In vitro studies were conducted to assess the effect of HCQ on lymphocyte activation and proliferation as well as cell growth and antigen presentation. Mouse cell lines used included MC38, CT26, RIL-175, SB1, and LD1 while human tumor cell lines used were TFK-1 and EGI-1. Mice bearing subcutaneous MC38, CT26, and RIL-175 tumors were treated with HCQ, anti-PD1, or both. Tumor volume was measured over 19 days. Systemic and tumor-infiltrating immune cells were analyzed by flow cytometry.

Results: HCQ treatment impairs T-cell production of TNF-α and IFNγ in vitro and in vivo. Whereas cell growth was decreased in all tumor cell lines, in vitro treatment of tumor cells with HCQ revealed an upregulation of MHC-1 in CT26, SB1, LD1, TFK-1, and EGI-1 but not in MC38 and RIL-175. HCQ treatment impaired response to anti-PD1 treatment in all subcutaneous models. Compared to control, HCQ treatment led to increased tumor growth in MC38 tumors. Flow cytometry analysis revealed an impaired activation of CD4+ T cells as well as tumor-infiltrating cytotoxic antigen-specific CD8+ T cells.

Conclusion: This study shows that HCQ treatment can result in immunotherapy failure due to a systematic immunosuppressive effect that overcomes the increased MHC expression on tumor cells.

Citation Format: Simon Wabitsch, Jack C McVey, Chi Ma, Benjamin Ruf, Laurence Diggs, Bernd Heinrich, Tim F Greten. Covid-19 treatment candidate hydroxychloroquine impairs tumor response to anti-PD1 [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr S02-02.
Abstract S04-01: Famotidine use and quantitative symptom tracking for COVID-19 in nonhospitalized patients: A case series
Authors: Janowitz Tobias , Gablenz Eva C. , Pattinson David J. , Wang Timothy C. , Conigliaro Joseph , Tracey Kevin J. , Tuveson David A.
Published: December 2020

Objective: Treatment options for nonhospitalized patients with coronavirus disease 2019 (COVID-19) to reduce morbidity, mortality, and spread of the disease are an urgent global need. The over-the-counter histamine-2 receptor antagonist famotidine is a putative therapy for COVID-19. We quantitively assessed longitudinal changes in patient-reported outcome measures in nonhospitalized patients with COVID-19 who self-administered high-dose famotidine orally.

Design: Patients were enrolled consecutively after signing written informed consent. Data on demographics, COVID-19 diagnosis, famotidine use, drug related side-effects, temperature measurements, oxygen saturations, and symptom scores were obtained using questionnaires and telephone interviews. Based on an NIH-endorsed Protocol to research Patient Experience of COVID-19, we collected longitudinal severity scores of five symptoms (cough, shortness of breath, fatigue, headaches, and anosmia) and general unwellness on a 4-point ordinal scale modeled on performance status scoring. All data are reported at the patient level. Longitudinal combined normalized symptom scores were statistically compared.

Results: Ten consecutive patients with COVID-19 who self-administered high-dose oral famotidine were identified. The most frequently used famotidine regimen was 80mg three times daily (n=6) for a median of 11 days (range: 5 to 21 days). Famotidine was well tolerated. All patients reported marked improvements of disease-related symptoms after starting famotidine. The combined symptom score improved significantly within 24 hours of starting famotidine and peripheral oxygen saturation (n=2), and device recorded activity (n=1) increased.

Conclusions: The results of this case series suggest that high-dose oral famotidine is well tolerated and associated with improved patient reported outcomes in nonhospitalized patients with COVID-19. A blinded outpatient trial is planned. The findings may be transferable and relevant to the treatment of patients with cancer and COVID-19.

Citation Format: Tobias Janowitz, Eva C. Gablenz, David J. Pattinson, Timothy C. Wang, Joseph Conigliaro, Kevin J. Tracey, David A. Tuveson. Famotidine use and quantitative symptom tracking for COVID-19 in nonhospitalized patients: A case series [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr S04-01.
Abstract S05-01: Profound CD8 T-cell responses towards SARS-CoV-2 OFR1ab in COVID-19 patients
Authors: Gangaev Anastasia , Ketelaars Steven L. , Patiwael Sanne , Dopler Anna , Isaeva Olga I. , Hoefakker Kelly , De Biasi Sara , Mussini Cristina , Guaraldi Giovanni , Girardis Massimo , Ormeno Cami M.P. Talavera , Hekking Paul J.M. , Lardy Neubury M. , Toebes Mireille , Balderas Robert , Schumacher Ton N. , Ovaa Huib , Cossarizza Andrea , Kvistborg Pia
Published: December 2020

While there is accumulating evidence on the antibody response against SARS-CoV-2, we are only beginning to acquire knowledge regarding the SARS-CoV-2 specific CD8 T-cell response. Therefore, it is an urgent matter to gain a deeper insight into the virus specific CD8 T-cell response to both assist vaccine design and provide tools to evaluate the vaccine-induced T-cell responses. To address this issue, we have analyzed samples from 20 COVID-19 patients for CD8 T-cell recognition of 500 predicted SARS-CoV-2-derived epitopes restricted to 10 of the most common HLA-A and HLA-B alleles. For each HLA allele, the top 50 epitopes were selected based on predicted binding affinity and likelihood of successful proteasomal processing. In addition, SARS-CoV-2 epitope predictions shared by the science community were considered. To probe for CD8 T-cell recognition of the selected epitopes, we made use of our in-house technology based on multiplexing of peptide HLA (pHLA) multimers conjugated to fluorescent dyes. Our data demonstrated that CD8 T-cell reactivity against SARS-CoV-2 was common. Remarkably, a substantial fraction of the observed CD8 T-cell responses were directed towards the ORF1ab polyprotein 1ab. These CD8 T-cell responses were frequently of a profound magnitude. In particular, a CD8 T-cell response towards a potentially immunodominant epitope (TTDPSFLGRY) restricted to the HLA-A*01:01 allele was found in all patients positive for this allele. Interestingly, the fraction of SARS-CoV-2 specific CD8 T cells expressing the inhibitory receptor NKG2A was higher as compared to bulk CD8 T cells. In conclusion, the fact that a major part of the identified SARS-CoV-2 specific CD8 T-cell response is directed against a part of the viral genome that is not included in the majority of vaccine candidates currently in development may potentially influence their clinical activity and toxicity profile.

Citation Format: Anastasia Gangaev, Steven L. Ketelaars, Sanne Patiwael, Anna Dopler, Olga I. Isaeva, Kelly Hoefakker, Sara De Biasi, Cristina Mussini, Giovanni Guaraldi, Massimo Girardis, Cami M.P. Talavera Ormeno, Paul J.M. Hekking, Neubury M. Lardy, Mireille Toebes, Robert Balderas, Ton N. Schumacher, Huib Ovaa, Andrea Cossarizza, Pia Kvistborg. Profound CD8 T-cell responses towards SARS-CoV-2 OFR1ab in COVID-19 patients [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr S05-01.