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Introduction: Breast cancer patients with intracranial (IC) metastases including leptomeningeal metastasis (LM) confer poor prognosis. Upon disease progression with standard lines of therapy, high-dose intravenous methotrexate (HD IV MTX) is offered to patients given its effective CNS penetrance. HD IV MTX is commonly administered inpatient, requiring extended hospitalization, rigorous leucovorin rescue, IV hydration, and urine alkalinization. Currently, quality of life (QoL) aspects of inpatient v. outpatient regimens remain unknown. Methods: An outpatient MTX protocol with daily visits to outpatient infusion centers was institutionally developed. Study eligibility criteria included solid tumor diagnoses with IC±LM metastasis, disease progression on standard of care treatment, and transition from inpatient to outpatient regimen within the past 12 months. For eligible patients upon consent, qualitative semi-structured phone interviews were conducted with focus on physical functioning and symptom burden. Thematic analysis was utilized. Results: Of the 10 patients who were screened, three (breast=2, sarcoma=1) were eligible. Patient demographics included 2 Caucasians, 1 African American, mean age of 52 years, and s/p prior whole brain radiation. Among QoL measures, no differences in functional status were reported between the two regimens. Single sarcoma patient reported less nausea and emesis with the outpatient regimen. All patients agreed on convenience, autonomy, greater personal and family time, and stronger emotional support while undergoing the outpatient protocol. Despite honorable mentions of inpatient onsite staff and services, all patients reported higher QoL experienced with outpatient MTX protocol vs. inpatient. Conclusions: Interview analysis determined that patient autonomy and nonobligatory hospitalization are key outpatient MTX treatment hallmarks that greatly enhanced patient QoL. Despite the small preliminary patient pool, this study delineates the feasibility in development of an institutionalized patient-centered outpatient MTX protocol. Future clinical trials will additionally be dedicated in conducting a cost-effective analysis comparing both MTX regimens. Citation Format: Heun Min, Elizabeth Weil, Maggie Nelson, John Charlson, Meghan Conroy, Miracle Powell, Yee Chung Cheng, Lubna N. Chaudhary, John Burfeind, Janet Retseck, Deepika Sriram, Sailaja Kamaraju. Improving Health-Related Quality of Life with Outpatient High-Dose Methotrexate Regimen Among Solid Tumor Oncology Patients with Intracranial Metastases: A Qualitative Study [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P5-07-05.

Background Electronic medical record (EMR) systems and electronic messages are an increasingly common conduit between physicians and patients. Clear benefits of this type of communication have been established, especially among cancer patients. Studies suggest that patient portals and electronic messaging platforms can help with care coordination between oncology providers and facilitate asynchronous patient-provider communication. Despite the many benefits, there is little research regarding EMR and secure messaging use, particularly among patients with breast cancer. Objectives The objective of this systematic review was to examine the evidence supporting the use of EMR-based messaging systems in patients with breast cancer. Methods A systematic literature search of Ovid MEDLINE, PubMed, Scopus, Web of Science CINAHL, and Cochrane Library was conducted. Studies were required to be published between 2005 and 2022 and report data on demographic information and electronic messaging between patients and providers. Studies were excluded if they reported insufficient data, did not include breast cancer patients, or were not published in English. Results This study identified 10 articles that met inclusion criteria. The resulting studies investigated topics such as: patterns of messaging and medication adherence, cancer screening, messaging as a predictor of behavior or outcomes, and symptom management. The literature indicates that electronic messaging with providers was associated with clinical benefits for breast cancer patients and improved screening behaviors. Conclusion This review uncovered multiple areas to focus future research on, including ideal volume of electronic messages sent and their relation to prescription adherence, studies focusing solely on the breast cancer population, racial disparities in electronic messaging, and provider perceptions of electronic messaging. It is vital that more work be done to understand barriers and gaps in EMR usage to ensure that all individuals can access this increasingly essential medical service while minimizing physician workload and burnout.

Quality improvement (QI) techniques can help veterinary practices improve the care they give to their patients. There are numerous barriers that may prevent veterinary staff taking part in audits s...

This article investigates the motivations driving the production of ISIS’s distinctive 2015 video, No Respite, released in response to the UN Security Council’s condemnation of the terrorist organi...

Introduction: Despite evidence that utilization of Electronic Medical Record (EMR) messaging positively impacts patients with cancer, there is little research on who uses EMR messaging and for what purpose. Methods: Sociodemographic and MyChart usage data was collected from Epic to identify patterns of EMR messaging by patients at an academic breast center. Study eligibility included breast cancer patients who completed a visit and sent at least one message to a provider during the study period (May 2021- May 2022). Chi-square and t-tests were used to describe differences between users and non-users of EMR messaging. ANOVA and chi-square were used to describe differences between race/ethnicity. Analyses were performed in R version 4.2 and p< 0.05 was considered statistically significant. Results: A total of 4069 patients who had MyChart account activated were included in the analysis sample. Of those, 3575 (87.9%) were messaging users and 494 (12.1%) were non-users. The mean age of users was significantly lower compared to the non-users (57.7 vs 61.2, p< .001). There were statistically significant racial/ethnic differences (p< 0.001) by user status with 83.9% and 9.5% of users being non-Hispanic White (NHW) and non-Hispanic Black (NHB) respectively. Among non-users 69.6% were NHW and 21.1% were NHB. There were also significant differences in preferred language (p< 0.001) and payor (p< 0.001) by user status. 99.2% of users were English speaking and 96.8% of non-users were non-English speaking. 54% and 38%, and 6.5% of users had Managed care, Medicare, and Medicaid respectively as their payor. Whereas 36.9%, 51%, and 10.5% of non-users had Managed care, Medicare, and Medicaid respectively. Lastly, there were statistically significant racial/ethnic differences in the types of messages sent among EMR users. Conclusions: There are significant differences in race/ethnicity among EMR users and non-users, and racial/ethnic differences in the types of messages sent among EMR messaging users. We believe that these differences may be in part due to disparities in access or comfort in using EMR. Future directions include conducting interviews with minority patients who are users and non-users of EMR messaging to identify barriers and gaps in use. Table 1. Patient Characteristics. Characteristics of users and non-users of EMR messaging. Chi-square and T-test for significance were performed to assess the difference between groups. P< .05 was considered significant. Table 2. Message Type by Race/Ethnicity. Types of message sent by race/ethnicity. ANOVA and chi-square were used to describe differences between race/ethnicity and type of message sent. P< .05 was considered significant. Citation Format: Meghan Conroy, Miracle Powell, Sneha Nagavally, Aprill Dawson, Anna Beckius, Heun Min, Maressa Sweeney, Elizabeth Weil, Angela Hallbach, Lubna N. Chaudhary, Yee Chung Cheng, Jutta Deiinger, John Burfeind, Janet Retseck, Tamiah Wright, John Charlson, Sailaja Kamaraju. Addressing Healthcare Gaps and Disparities in Electronic Medical Record Messages: A Quality Improvement Project Among Breast Cancer Patients [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-52.

The objective of this study was to determine the associations between heart disease, obesity, and demographic factors and increased COVID-19 mortality.We extracted deidentified patient-level data from the Froedtert Health System and Children's Hospital of Wisconsin and used descriptive statistics and multivariable logistic regression to characterize relationships between heart disease, obesity, age group, sex, race and ethnicity and mortality following COVID-19 diagnosis.We found heart disease (adjusted odds ratio [AOR] 2.85; 95% CI, 2.11-8.83) and other demographic factors are significant predictors of increased mortality in COVID-19 patients. However, obesity was not a significant predictor of mortality (AOR 1.04; 95% CI, 0.53- 3.10).These unique results indicate some comorbid conditions and patient demographics contribute more strongly to mortality in COVID-19 patients.

The majority of women with ovarian cancer are diagnosed with metastatic disease, therefore elucidating molecular events that contribute to successful metastatic dissemination may identify additional targets for therapeutic intervention and thereby positively impact survival. Using two human high grade serous ovarian cancer cell lines with inactive TP53 and multiple rounds of serial in vivo passaging, we generated sublines with significantly accelerated intra-peritoneal (IP) growth. Comparative analysis of the parental and IP sublines identified a common panel of differentially expressed genes. The most highly differentially expressed gene, upregulated by 60-65-fold in IP-selected sublines, was the type I transmembrane protein AMIGO2. As the role of AMIGO2 in ovarian cancer metastasis remains unexplored, CRISPR/Cas9 was used to reduce AMIGO2 expression, followed by in vitro and in vivo functional analyses. Knockdown of AMIGO2 modified the sphere-forming potential of ovarian cancer cells, reduced adhesion and invasion in vitro, and significantly attenuated IP metastasis. These data highlight AMIGO2 as a new target for a novel anti-metastatic therapeutic approach aimed at blocking cohesion, survival, and adhesion of metastatic tumorspheres.

Post-transplant lymphoproliferative disorders (PTLDs) represent a serious complication of both solid organ and bone marrow transplant, with mortality rates that exceed 50% [1–3]. The incidence rang...