To examine factors associated with the use of radiation therapy (RT) at the end of life in patients with breast, prostate, or colorectal cancer. Using data from the Surveillance, Epidemiology, and End Results (SEER) – Medicare database, patients were over age 65 and diagnosed between January 1, 2004 and December 31, 2011 with any stage of cancer when the cause of death, as defined by SEER, was cancer; or with stage 4 cancer, who died of any cause. We employed multiple logistic regression models to identify patient and health systems factors associated with palliative radiation use. 50% of patients received RT in the last 6 months of life. RT was used less frequently in older patients and in non-Hispanic white patients. Similar patterns were observed in the last 14 days of life. Chemotherapy use in the last 6 months of life was strongly correlated with receiving RT in the last 6 months (OR 2.72, 95% CI: 2.59-2.88) and last 14 days of life (OR 1.55, 95% CI: 1.40-1.66). Patients receiving RT accrued more emergency department visits, radiographic exams and physician visits (all comparisons p < 0.0001). Among patients with breast, colorectal, and prostate cancer, palliative RT use was common. End-of-life RT correlated with end-of-life chemotherapy use, including in the last 14 days of life, when treatment may cause increased treatment burden without improved quality of life. Research is needed optimize the role and timing of RT in palliative care.

As part of the NCI’s Cancer Center Cessation (C3i) initiative, we initiated, expanded, and maintained an evidence-based tobacco treatment program at the Georgetown Lombardi Comprehensive Cancer Center. We present a quality improvement (QI) assessment of the implementation process and patient-level outcomes. At two hematology/oncology outpatient clinical sites, five oncology-based teams (clinical administrators, clinical staff, pharmacy, information technology, and tobacco treatment staff) developed implementation strategies for opt-out patient assessment and enrollment, centralized tobacco treatment, audit, feedback, and staff training. Among eligible patients (tobacco use in ≤30 days), we assessed demographic, clinical, and tobacco-related characteristics to examine predictors of enrollment (baseline completed), treatment engagement (≥one sessions completed), and self-reported 7-day abstinence (6 months post-enrollment). Across both sites, medical assistants screened 19,344 (82.4%) patients for tobacco use, which identified 1345 (7.0%) current tobacco users, in addition to 213 clinician referrals. Of the 687/1256 (54.7%) eligible patients reached, 301 (43.8%) enrolled, and 199 (29.0%) engaged in treatment, of whom 74.5% were African American and 68% were female. At the larger site, significant multivariate predictors of enrollment included African American race (vs. white/other) and clinician referral (vs. MA assessment). Treatment engagement was predicted by greater nicotine dependence, and abstinence (27.4%) was predicted by greater treatment engagement. In summary, the systematic utilization of multiple oncology-based teams and implementation strategies resulted in the development and maintenance of a high-quality, population-based approach to tobacco treatment. Importantly, these strategies addressed inequities in tobacco treatment, as the program reached and engaged a majority-African-American patient population. Finally, the opt-out patient assessment strategy has been implemented in multiple oncology settings at MedStar Health through the Commission on Cancer’s Just Ask program.

Background. Patients with cancer and health care workers (HCW) are at higher risk for SARS-CoV-2 infection. There are limited data regarding the rate of symptomatic versus asymptomatic infection and subsequent seropositivity in both populations. Methods. We performed a prospective study of patients and HCW across two institutions during the first wave of the pandemic to analyze the prevalence of SARS-CoV-2 antibodies, the extent of associated symptoms, and durability of serologic response. Results. In 1,953 persons (733 patients and 1,220 HCW), overall seropositivity rates for 3.1% patients (95% CI 2.0–4.7) and 3.7% HCW (95% CI 2.7–4.9, ), were similar. Each institutions’ seropositivity rates were numerically higher in HCW than patients. Non-Hispanic Whites and Asians had lower antibody rates (2.8%, 95% CI 2.0–3.8 and 3.3%, 95% CI 1.2–7.0) compared to Hispanics (6.9%, 95% CI 3.4–12.4) and non-Hispanic Blacks (5.9%, 95% CI 3.3–9.7), . Among persons with a positive SARS-CoV-2 antibody, 87% of patients and 56% of HCW did not recall having had a fever. Among HCW, administrative and technical personnel were most likely to be seropositive. The rate of persistent seropositivity at 3 months was similar between patients and HCW and was not influenced by the reporting of fever, cancer type, or therapy. Conclusion. These data suggest that patients are not at higher risk for febrile SARS-CoV-2 infections or more transient immunity than HCWs. Furthermore, racial differences and lack of association with the extent of HCW contact with COVID-19 patients suggest that community rather than hospital virus exposure was a source of many infections.

Introduction: Approximately 25% of women in the United States experience a symptomatic pelvic floor disorder such as urinary incontinence, pelvic organ prolapse, anal incontinence, and sexual dysfunction. Aspects associated with breast cancer treatment such a chemotherapy, oophorectomy/ovarian suppression, and endocrine therapy may predispose women to pelvic floor disorders. The prevalence of pelvic floor disorders among breast cancer survivors has been cited at 18%, but unpublished cross-sectional data suggests the prevalence may be much higher. In this study, 8.5% - 11.5% of participants experienced prolapse symptoms, 56.2% experienced anal incontinence symptoms, and 43.3% - 51.2% experience urinary incontinence symptoms. While pelvic floor dysfunction is associated with lower quality of life, it is unknown if breast cancer survivors with pelvic floor disorders experience decreased quality of life. The primary aim of this study was to assess if breast cancer survivors with pelvic floor disorders experience lower quality of life. Methods: Women 18 years or older who were previously treated for breast cancer and who were enrolled in a cancer research registry were invited to complete the Pelvic Floor Distress Inventory 20 (PFDI-20), the Female Sexual Function Index (FSFI), and the Short Form 12. Demographic and clinical data were abstracted from the research registry. A participant was considered eligible for the study if she had enrolled in the cancer registry and completed all core questions (i.e. demographics, cancer diagnosis, cancer treatment, endocrine therapy, medical/surgical history, and risk factors). As per standard PFDI-20 reporting, presence of a symptom was defined as answering a 1, 2, 3, or 4 to a question, while presence of a bothersome symptom was defined as answering a 2, 3, or 4. A score of 26 or less on the FSFI was considered indicative of sexual dysfunction. Results: A total of 634 women were considered eligible for enrollment in the study. 445 were able to be contacted, and 410 women agreed to participate in the study. Of those, 303 returned the PFDI-20 questionnaire and FSFI questionnaire, and 264 returned the SF-12 for response rates of 74% and 64%, respectively. Overall, higher scores on the PFDI-20 was associated with lower scores on both the physical and mental components of the SF-12 (Rho = -0.298, p = <.0001; Rho = -0.202, p = .0009, respectively). When the PFDI-20 was broken into subscores, higher POPDI scores (prolapse) was associated with lower physical component scores but not lower mental component scores. Higher CRADI scores (anal incontinence) and UDI-6 scores (urinary incontinence) were associated with lower physical and mental scores. Neither overall FSFI scores or subset domain scores were associated with lower physical or mental component scores of the SF-12. In linear regression analysis, PFDI summary score remained statistically significantly related to both mental and physical component subscores after controlling for age, race, stage of breast cancer, time since diagnosis, and use of adjuvant endocrine therapy. FSFI scores were related to age and endocrine therapy use, but were not related to SF-12 scores. Conclusion: Among a subset of breast cancer survivors, pelvic disorders including pelvic organ prolapse, urinary incontinence, and anal incontinence exist, and these disorders are associated with decreased mental wellbeing. All pelvic floor disorders except pelvic organ prolapse were associated with decreased physical wellbeing. None of the domains of female sexual dysfunction were associated with decreased physical or mental wellbeing among breast cancer survivors. A subset of breast cancer survivors experiences bothersome pelvic floor disorders and thus screening for these disorders can increase referrals to appropriate treatment and complement survivorship care to enhance overall quality of life. Citation Format: Jon F Pennycuff, Felice Yang, Tania Lobo, Caroline Jackman, Colleen McGuire, Ami Chitalia, Kristi Graves. Pelvic floor disorders and quality of life among breast cancer survivors [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS9-26.