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Background: The combination of cyclin dependent 4/6 kinase inhibitors (CDK4/6i) with endocrine therapy (ET) has resulted in clinically significant improvements in progression-free survival (PFS) and overall survival (OS) in hormone-receptor (HR)-positive metastatic breast cancer (MBC). However, most patients’ disease ultimately progresses on CDK4/6i and ET. Therefore, further research is necessary to understand the mechanisms driving primary and secondary resistance. PROMISE is a multicenter prospective cohort study enrolling women with HR-positive MBC commencing treatment with palbociclib + letrozole (1st line) or palbociclib + fulvestrant (2nd Line). The study provides a comprehensive “omic” assessment of blood, tumor, urine and the fecal microbiome to identify molecular or cellular features associated with primary endocrine resistance (e.g. disease progression ≤ 12 months on treatment) and acquired resistance to CDK 4/6i. Additionally, patient derived xenografts and organoids are created to test new drug strategies designed to overcome resistance to CDK 4/6i and ET. Here, we present initial sequencing results from pretreatment biospecimens collected from PROMISE study participants. Methods: On-study tumor biopsies and blood samples were collected for DNA/RNA sequencing (TempusTM). The analyzed biospecimens were all obtained prior to initiation of palbociclib and ET. We correlated patient clinical characteristics (phenotypes) with molecular data and responses to protocol treatment. The data were analyzed using a series of cutting-edge bioinformatics pipelines for somatic and germline mutations in addition to copy number alterations (CNAs). The study database was locked for analysis on 06/20/2019. Results: We analyzed the somatic single nucleotide variants/INDELs (sSNV/INDEL) profiles across the tumor samples to determine the genes that were least likely to occur as a result of background mutation processes. Twenty-six patients had somatic copy number alterations (sCNA) and/or sSNV/INDEL in at least one of 18 genes with the most significant sSNV/INDEL profiles (p < 0.03) which included clinically and biologically relevant genes. The genes with the most statistically significant sSNV/INDEL mutation profiles were GATA3, PIK3CA, CDH1, and ESR1 (p < 0.0009). We observed a high percentage of tumors with somatic alterations in GATA3 (23% sSNV/INDEL, 15% sCNA), PIK3CA (38%, 12%), CDH1 (19%, 50%) and ESR1 (19%, 58%). ESR1 mutations were more frequent in patients receiving 2nd line treatment. Other frequently altered genes included TP53 (15%, 46%), MAP2K4 (8%, 50%), DNAAF1 (8%, 50%), and CDKN1B (8%, 35%). Further, ZNF317 and F3 were altered in 9 and 7 patients, respectively. Twenty-four samples had alterations in at least one of the CDK4/6 pathway genes (RB1, CCNE2, CCND1, CDK6, ESR1, CDKN2A, CCND3, CDK4, CDK2 and CCNE1). Four patients progressed on therapy; three of the four patients had mutations in PIK3CA, and one had a mutation in ESR1. Results of the RNA sequencing data (N=26) will be presented at the SABCS meeting. Conclusions: This is the first report of a prospective study designed to characterize the genomic landscape of ER+/HER2- MBC prior to palbociclib treatment. We observed high frequencies of known targetable alterations in PIK3CA and ESR1, including in patients that progress, which is consistent with previous reports. RNA sequencing data will be presented at the meeting. Citation Format: Ciara C O Sullivan, Krishna R Kalari, Vera J Suman, Peter T Vedell, Ann Moyer, Erin Carlson, Jason Sinnwell, Tejaswi Alaparthi, Xiaojia Tang, Kevin Thompson, Jaeyun Sung, Alvaro Moreno-Aspitia, Donald Northfelt, Minetta C Liu, Tufia C Haddad, Prema Peethambaram, Saranya Chumsri, Kathryn J Ruddy, Karthik V Giridhar, Roberto A Leon-Ferre, Paula Gill, Mohammad Ranginwala, Asad Javed, Sameer Batoo, Brendan P. McMenomy, Richard Weinshilboum, Liewei Wang, Matthew P Goetz. Comprehensive tumor sequencing to identify biomarkers of palbociclib response: First report of the PROMISE study [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-11-07.

Women with estrogen deficiencies can suffer from vaginal symptoms that negatively impact sexual health. This study evaluated vaginal dehydroepiandrosterone (DHEA) for alleviation of vaginal symptoms. This three-arm randomized, controlled trial evaluated DHEA 3.25 mg and DHEA 6.5 mg, each compared to a plain moisturizer (PM) over 12 weeks, to improve the severity of vaginal dryness or dyspareunia, measured with an ordinal scale, and overall sexual health using the Female Sexual Function Index (FSFI). Postmenopausal women with a history of breast or gynecologic cancer who had completed primary treatment, had no evidence of disease, and reported at least moderate vaginal symptoms were eligible. The mean change from baseline to week 12 in the severity of vaginal dryness or dyspareunia for each DHEA dose was compared to PM and analyzed by two independent t tests using a Bonferroni correction. Four hundred sixty-four women were randomized. All arms reported improvement in either dryness or dyspareunia. Neither DHEA dose was statistically significantly different from PM at 12 weeks (6.25 mg, p = .08; 3.25 mg, p = 0.48), although a significant difference at 8 weeks for 6.5 mg DHEA was observed (p = 0.005). Women on the 6.5 mg arm of DHEA reported significantly better sexual health on the FSFI (p

Recent catastrophic school shootings have drawn worldwide attention to issues of gun control and mental health. In the wake of these tragedies, more and more schools have begun to adopt school-wide social and emotional learning (SEL) programs. However, we have few examples of what it looks like to integrate SEL skills into content curricula. What's more, teachers and support professionals are ill-equipped to engage in the collaborative work necessary to effectively integrate the teaching of SEL into academic content. The collaboration described herein highlights an interdisciplinary collaboration among university faculty and graduate students from school psychology and English education to collaboratively design and evaluate standards-based secondary English curricula that foreground SEL and themes of care. Language: en

In higher education, faculty work is typically enacted—and rewarded—on an individual basis. Efforts to promote collaboration run counter to the individual and competitive reward systems that characterize higher education. Mentoring initiatives that promote faculty collaboration and support also defy the structural and cultural norms of higher education. Collaborative mentoring initiatives, however, support all faculty to be lifelong learners. We analyze a reciprocal model of mentoring—a community of practice for mentoring—that integrates collaborative mentoring into faculty's daily work. Additionally, we examine the dilemmas, benefits, and costs of institutionalizing a community of practice model for mentoring in higher education. Our analyses indicate that communities of practice can be fruitful sites of mentoring for all faculty when members mutually engage in shared practices required by the institution. Additionally, such communities nurture relationships and emotional support that sustain engagement in practice and reduce isolation. Given these benefits, we argue that communities of practice should be publically recognized at the institutional level as viable mechanisms for faculty mentoring and learning. Institutions of higher education must explicitly support a campus culture of collaboration and lifelong learning. Findings offer guidance for faculty and center for teaching and learning (CTL) interested in starting or participating in communities of practice.

Despite the growing knowledge base on mentoring in academia, providing effective mentoring for faculty presents several complex dilemmas for academic units charged with facilitating mentoring. How do we institutionalize voluntary and spontaneous mentoring interaction? How do we support a collaborative climate in an inherently individual and competitive reward system? How do we design for trust? This study proposes a community of practice (CoP) model for faculty mentoring that emerged from the practical and conceptual dilemmas we faced as a professional graduate school trying to facilitate mentoring for its faculty. We share our rationale and process in moving toward a CoP model for mentoring and propose a structural–functional model for what it might look like in academia.

BACKGROUND Embryonal central nervous system (CNS) tumors (medulloblastoma, cerebral neuroblastoma, pineoblastoma, and primitive neuroectodermal tumors) are rare in adults. Recurrent disease has an extremely poor outcome. The use of high-dose chemotherapy (HDC) with autologous stem cell transplantation (ASCT) has demonstrated promising results in children with recurrent disease, but there are only limited data regarding its role in adults. The purpose of the current study was to evaluate adult patients with embryonal CNS tumors who were treated with HDC with ASCT and compare their outcomes with those of patients who received conventional-dose chemotherapy. METHODS The authors reviewed the medical records of 23 adult patients (age ≥18 years) who were treated at the Mayo Clinic for recurrent embryonal CNS tumors between 1976 and 2004. The authors compared treatment with HDC with ASCT (10 patients) with an historic control of patients treated with conventional-dose chemotherapy (nitrosourea based, cisplatin based, or both) (13 patients). RESULTS HDC with ASCT was associated with increased survival (P = .044) and a longer time to disease progression (TTP) (P = .028). The conventional-dose chemotherapy group had a median TTP of 0.58 years and a median survival of 2.00 years. The HDC with ASCT group had a median TTP of 1.25 years and a median survival of 3.47 years. When restricted to patients receiving ASCT after first disease recurrence, the median TTP was 2.5 years and the median survival was 4.16 years. Toxicities were similar in both groups. CONCLUSIONS Improvements in the median TTP and survival noted with the administration of HDC with ASCT, as well as the acceptable toxicity of this regimen, supports consideration of its use in adults with recurrent embryonal CNS tumors. Cancer 2008. © 2008 American Cancer Society.

Objectives The purpose of this study was to (1) assess the quality of life (QOL) of the primary caregivers of hospice patients and (2) to analyze the ability of the hospice staff to accurately judge caregiver QOL. Methods A longitudinal pilot study of QOL of caregivers of patients entering hospice was undertaken. Caregivers and hospice personnel completed numerous questionnaires every 2 weeks until patient death. Global QOL and component constructs, as well as the demands of illness on the caregiver and profile of moods, were assessed. Simple descriptive statistics at each time point and summary measures (area under the curve) were calculated to describe the QOL profile of caregivers and staff perceptions of the caregivers. Cronbach's alpha coefficient was applied to verify tool internal consistency in a hospice population. Correlation coefficients were supplemented by Bland–Altman procedures for comparing scales measuring the same construct to compare the scores given by caregivers about themselves and staff ratings of the caregivers. The study had 80% power to detect an intracase difference between caregiver and staff ratings of the caregiver of 0.4 times the standard deviation using a two-sided paired t test with a 5% type I error rate. Results Caregiver QOL was relatively high and stable over time. Caregiver's QOL was correlated with the patient's overall QOL/hospice staff accurately evaluated caregiver QOL. Conclusions By drawing attention to issues that affect the caregiver, we can improve delivery of hospice care and positively impact QOL for both caregiver and patient. Linear analog self-assessment scales are valuable tools for hospice staff to assess caregivers.

Mental health care delivery has undergone massive changes. In this regard managed care has profoundly altered system delivery models in mental health. Further, organizational downsizing and mergers are occuring throughout health care, reshaping professional practice opportunities both inside and outside public schools. Many school-based mental health professionals may lack information on the breadth of these changes. This article examines the confluence between managed care and school-based services, with particular attention to school psychology and related special services and provides a reorientation framework.

Psychiatric rehabilitation programs that continue to ‘make job placements” need to assess the impact that such a caretaker approach has on the long term abilities of people with psychiatric disabilities to find their own jobs and then communicate independently with employers. Following a national survey of job coaches and job developers, the authors suggest a teaching approach to providing employment support services: job developers and job coaches should teach the ADA and workplace communication skills, so that individuals can develop the ability to negotiate with employers on their own behalf. Practitioners can also enhance this teaching approach to provision of employment support services through the development of employment peer support groups.

Clinical supervision for practicum and internship students is a hallmark of professional training. Unfortunately, despite the importance of site supervision for students, little has actually been written regarding clinical supervision issues impacting school-based school psychology supervisors. Although largely unexplored, clinical supervision in school psychology offers a critical opportunity to shape professional education and training. Within this context, four dimensions of field supervision are examined: practicum and internship objectives, supervisor qualifications, training responsibilities, and supervisory evaluation.

This article is intended to provide the internship supervisor and advanced graduate student in school psychology with a resource and guide for preparing for professional employment. While the preparation for employment occurs throughout graduate education, final preparatory steps are critical to employment: (1) preparing a portfolio, (2) developing a resume, (3) providing sample psychological reports, (4) interviewing, (5) securing references, and (6) making application for certification. Information is provided on each area, with a sample cover letter and resume included for the emerging school psychologist.

Nausea and vomiting are two of the most feared cancer treatment-related side effects for cancer patients and their families. In 1983, Coates et al. found that patients receiving chemotherapy ranked nausea and vomiting as the first and second most severe side effects, respectively. Up to 20% of patients receiving highly emetogenic agents in this era postponed, or even refused, potentially curable treatments. Despite the availability of more than 20 different antiemetics, nausea and vomiting in cancer patients remain problematic and continue to pose tremendous challenges to practicing oncologists.

Primary bone lymphoma is rare. The majority of cases are diffuse large B-cell non-Hodgkin's lymphomas. Classification, staging, and treatment are controversial. The relatively small number of cases has led to many case reports and series describing institutional experiences but precludes the use of randomized clinical trials to address the question of optimal management. This article will review clinical and radiologic presentations, diagnostic techniques, and histologic characteristics. Most important, it will present what limited information we do have regarding effective treatment options for this unusual type of lymphoma.

Malignant bowel obstruction is the cause of death in the majority of women who die of ovarian cancer. Some patients are considered acceptable surgical candidates for relief of the obstruction. For many patients, however, lack of such surgical options has spawned a broad range of medical interventions, including palliative strategies to target pain and nausea and vomiting. This review discusses the general approach to patients with ovarian cancer and inoperable malignant bowel obstruction, with an emphasis on such palliative strategies.

The purpose of this study was to (1) assess the quality of life (QOL) of the primary caregivers of hospice patients and (2) to analyze the ability of the hospice staff to accurately judge caregiver QOL.A longitudinal pilot study of QOL of caregivers of patients entering hospice was undertaken. Caregivers and hospice personnel completed numerous questionnaires every 2 weeks until patient death. Global QOL and component constructs, as well as the demands of illness on the caregiver and profile of moods, were assessed. Simple descriptive statistics at each time point and summary measures (area under the curve) were calculated to describe the QOL profile of caregivers and staff perceptions of the caregivers. Cronbach's alpha coefficient was applied to verify tool internal consistency in a hospice population. Correlation coefficients were supplemented by Bland-Altman procedures for comparing scales measuring the same construct to compare the scores given by caregivers about themselves and staff ratings of the caregivers. The study had 80% power to detect an intracase difference between caregiver and staff ratings of the caregiver of 0.4 times the standard deviation using a two-sided paired t test with a 5% type I error rate.Caregiver QOL was relatively high and stable over time. Caregiver's QOL was correlated with the patient's overall QOL/hospice staff accurately evaluated caregiver QOL.By drawing attention to issues that affect the caregiver, we can improve delivery of hospice care and positively impact QOL for both caregiver and patient. Linear analog self-assessment scales are valuable tools for hospice staff to assess caregivers.

2043 Background: Recurrent embryonal tumors of the central nervous system (CNS) in adults are rare and have a poor prognosis. High-dose chemotherapy followed by autologous stem cell transplant (HDC...

1068 Background: Doxorubicin is a standard treatment for breast cancer, lymphoma, and leukemia. The benefits of doxorubicin are limited by its potential for cardiotoxicity. In this study we investi...

9507 Background: Impaired sexual satisfaction is a prevalent and distressing issue for female cancer survivors. The aim of this study was to evaluate the impact of vaginal DHEA on vaginal atrophy s...