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PURPOSE: Frailty predicts poor outcomes in older adults with cancer, but how it differs between different cancer types is unknown. We examined differences in pretreatment frailty between colorectal (CRC), pancreatic, and hepatobiliary cancers. METHODS: We included older adults age 60 years or older with the above cancer types enrolled in the Cancer and Aging Resilience Evaluation registry. Frailty was defined using a 44-item Cancer and Aging Resilience Evaluation frailty index constructed on the basis of the principles of deficit accumulation (including several geriatric assessment impairments encompassing malnutrition, functional status, comorbidities, anxiety, depression, cognitive complaints, health-related quality of life, falls, ability to walk one block, interference in social activities, and polypharmacy). Multivariable logistic regression models were used to examine the adjusted odds ratio (aOR) of frailty between cancer types. RESULTS: A total of 505 patients were included (mean age 70 years, 59% male): 211 (41.8%) CRC, 178 (35.2%)pancreatic cancer, and 116 (23.0%) hepatobiliary cancer. Patients with pancreatic cancer had the highest prevalence of frailty (23.3% CRC, 40.6% pancreatic, 34.3% hepatobiliary; P = .001). Both pancreatic (aOR, 2.18; 95% CI, 1.38 to 3.45), and hepatobiliary cancer (aOR, 1.73; 95% CI, 1.03 to 2.93) were independently associated with higher odds of frailty relative to CRC. Frailty was driven by higher rates of malnutrition and instrumental activities of daily living impairments in patients with pancreatic cancer and higher number of comorbidities in patients with hepatobiliary cancer. CONCLUSION: Older adults with pancreatic and hepatobiliary cancers are at high-risk of pretreatment frailty. Early interventions to improve nutritional and functional status and optimization of comorbidities may help improve outcomes.

Patients with limited health literacy (HL) have difficulty understanding written/verbal information. The quality of verbal communication is not well understood. Therefore, our aim was to characterize patient-surgeon conversations and identify opportunities for improvement.New colorectal patient-surgeon encounters were audio-recorded and transcribed. HL was measured. Primary outcomes were rates-of-speech, understandability of words, patient-reported understanding, and usage of medical jargon/statistics. Secondary outcomes included length-of-visit (LOV), conversation possession time, patient-surgeon exchanges, and speech interruptions.Significant variations existed between surgeons in rates-of-speech and understandability of words (p 0.05). Faster rates-of-speech were associated with significantly less understandable words (p 0.05). Patient-reported understanding varied by HL and by surgeon. Conversation possession time and usage of medical jargon/statistics varied significantly by surgeon (p 0.05) in addition to patient-surgeon exchanges and interruptions. Patients with limited HL had shorter LOV.Significant variations exist in how surgeons talk to patients. Opportunities to improve verbal communication include slowing speech and using more understandable words.

We determined the efficacy and safety of 0.1% RGN-259 ophthalmic solution (containing the regenerative protein thymosin ß4) in promoting the healing of persistent epithelial defects in patients with Stages 2 and 3 neurotrophic keratopathy. Complete healing occurred after 4 weeks in 6 of the 10 RGN-259-treated subjects and in 1 of the 8 placebo-treated subjects (p = 0.0656), indicating a strong efficacy trend. Additional efficacy was seen in the significant healing (p = 0.0359) with no recurrent defects observed at day 43, two weeks after cessation of treatment, while the one healed placebo-treated subject at day 28 suffered a recurrence at day 43. The Mackie classification disease stage improved in the RGN-259-treated group at Days 29, 36, and 43 (p = 0.0818, 0.0625, and 0.0467, respectively). Time to complete healing also showed a trend towards efficacy (p = 0.0829, Kaplan–Meier) with 0.1% RGN-259. RGN-259-treated subjects had significant improvements at multiple time points in ocular discomfort, foreign body sensation, and dryness which were not seen in the placebo group. No significant adverse effects were observed. In summary, the use of 0.1% RGN-259 promotes rapid healing of epithelial defects in neurotrophic keratopathy, improves ocular comfort, and is safe for treating this challenging population of patients.

157 Background: Health literacy (HL) is a patient’s ability to obtain, process, and understand health information. Limited HL can act as a barrier to communication and access to medical treatment and lead to poor identification and management of comorbid conditions, resulting in frailty and impaired HRQoL; these issues remain unstudied in the geriatric oncology populations. We aimed to (1) describe the prevalence of limited HL; (2) examine the association between limited HL and frailty, HRQoL and healthcare utilization in older adults with cancer. Methods: The CARE registry prospectively enrolls older adults (≥60y) with cancer seen at UAB. Patients complete a patient-reported geriatric assessment. A single-item screening measure of HL (Stagliano et al. JABFM 2013) was also completed by the participants. Frailty was defined using the 44-item CARE frailty index (based on deficit accumulation). Multivariable analysis examined association of limited HL with CARE frailty index, HRQoL, and health care utilization, adjusting for age, race, sex, education, cancer type/stage and treatment phase. Results: The cohort included 475 participants with a mean age at enrollment of 69.4y; 61.9% were male; 18.9% were non-Hispanic Black. The most prevalent cancer types included colorectal (34.9%), pancreatic (17.5%) and hepatobiliary (11.4%) cancers. The prevalence of limited HL was 33.3%. Participants with limited HL were less educated (< HS: 23.4% vs. 4.7%, p= 0.01), older (71 vs. 68.5 years, p< 0.001), more likely to self-report as Black (26.6% vs. 15.1%, p= 0.009), and disabled (19.6% vs. 11.7%, p< 0.001). Patients with limited HL had a higher prevalence of frailty (57.6% vs 22.1%, p< 0.001) and hospitalizations (57.0% vs 45.4%, p= 0.036), as well as lower physical (39.5 vs. 46.4 p< 0.001) and mental (42.9 vs. 49.2 p< 0.001) HRQoL. In multivariable analysis, older patients with limited HL had 3.9 higher adjusted odds (aOR) of frailty (95% CI 2.4-6.3), worse physical (aOR 2.2, 95%CI 1.4-3.6) and mental (aOR 3.2 95%CI 2.0-5.2) HRQoL, and increased hospitalizations (aOR 1.8 95% CI 1.2-2.8), compared to those with adequate health literacy. Conclusions: Older cancer patients with limited HL had higher adjusted odds of frailty, lower physical and mental HRQoL scores, and higher odds of a recent hospitalization. Interventions to address limited HL should be explored in this vulnerable and growing cancer population.

542 Background: Frailty is an independent predictor of mortality in older adults and has been used to predict surgical complications and chemotherapy toxicities in GI cancers. How frailty differs between GI cancer types is unknown and could explain disparities in cancer outcomes. Our goal was to examine differences in pre-treatment frailty and geriatric assessment (GA) domain impairments between pancreatic, hepatobiliary, and colorectal cancers (CRC). We hypothesized that patients with more aggressive cancers (such as pancreatic cancer) would have increased frailty and more GA impairments, even prior to initiation of treatment. Methods: Our study included older adults age ≥60 years with cancer enrolled in the CARE Registry at the University of Alabama at Birmingham (UAB) who underwent a patient-reported GA during their initial visit with a GI medical oncologist. The GA was performed prior to any cancer-directed therapy. Frailty was defined using the 44-item CARE frailty index constructed based on principles of deficit accumulation described by Rockwood et al. We evaluated differences in frailty and GA domains between patients with CRC, pancreatic, and hepatobiliary cancers. Lastly, using a multivariable model we examined the adjusted odds ratio (aOR) of frailty by GI cancer type (reference CRC), adjusted for age, sex, race, cancer stage, and comorbidities. Results: Our study included 505 patients; 211 (41.8%) with CRC, 178 (35.2%) with pancreatic, and 116 (23.0%) with hepatobiliary cancers. Mean age of 70 years (standard deviation of 7) and 59% male. Cancer types did not differ by age, race, or sex. Patients with pancreatic and hepatobiliary cancers had more advanced cancer stage at time of assessment (stage IV 36.2% for CRC, 44.9% for pancreatic, and 45.2 for hepatobiliary; p=0.007). Older adults with pancreatic cancer had the highest prevalence of frailty (23.3% for CRC, 40.6% for pancreatic, and 34.3% for hepatobiliary; p=0.001), instrumental activities of daily living limitations (50.2% for CRC, 64.3% for pancreatic, and 52.7% for hepatobiliary; p=0.018), and malnutrition (40.8% for CRC, 70.3% for pancreatic, and 45.4% for hepatobiliary; p< 0.001). In multivariable analyses, older patients with pancreatic cancer had a 2.0 times higher odds of frailty in comparison to patients with CRC (aOR 2.0 95% CI 1.2-3.3, p=0.007). Conclusions: Older adults with pancreatic cancer had a higher prevalence of pre-treatment frailty, malnutrition, and functional impairments compared to CRC and hepatobiliary cancers. A focus on early intervention in these patients with optimization of nutrition and targeted physical/occupational therapy prior to and during treatment may help mitigate these factors and potentially improve outcomes.

The CAVEX dense medium cyclone (DMC) was developed in the later part of the 1990s as a result of the expertise developed by Weir engineers in slurry pumping. The inlet area of the cyclone is designed to minimize turbulence and to reduce wear at the feed entry point, which provides more energy for particle separation at a given feed pressure. A parametric study was performed on a 150 mm diameter unit to quantify separation efficiency as a function of feed pressure, apex diameter, medium density, and cone angle. The added energy in the cyclone was confirmed by comparing the stability of the medium in the CAVEX unit with that provided by a common commercial unit having the same dimensions. A 500 mm unit was installed in parallel with an identically sized industrial unit in an operating preparation plant treating 12 × 1 mm coal. The separation efficiency values achieved by the CAVEX DMC were found to be higher than those obtained by the standard industrial unit and the amount of improvement increased with a d...

✓ Tumor cells are characterized by abnormalities in growth and metabolism, including the autocrine secretion of certain growth factors. The authors have previously shown the presence of insulin-like growth factor receptors in tumors of the central nervous system (CNS) and in this study examine whether CNS tumors are capable of autocrine secretion of insulin-like growth factors in situ. To investigate the production of insulin-like growth factors I and II by CNS tumors, the authors have developed specific radioimmunoassays for these growth factors. In situ production of insulin-like growth factors was studied by immunoassay of CNS tumor cyst fluid aspirated at the time of surgery from 12 cystic tumors: seven primary brain tumors, four metastatic tumors, and one spinal schwannoma. For immunoassay, cyst fluid was treated overnight with acetic acid, then insulin-like growth factors were separated from binding proteins by a refined solid-phase technique, then dried and reconstituted in immunoassay buffer. Normal human serum and cerebrospinal fluid served as controls. Insulin-like growth factor I was detected in all 12 tumors studied. In contrast, insulin-like growth factor II was detected only in three low-grade astrocytomas, the spinal schwannoma (which had the highest insulin-like growth factor II level of all tumors studied), and three metastatic lung cancers. These results suggest that CNS tumors may be capable of autocrine production of insulin-like growth factors in situ. Furthermore, there appears to be a difference in the type of insulin-like growth factors produced by different types of CNS tumors. Preferential production of insulin-like growth factors may be an important marker of tumor differentiation and useful as a diagnostic tool.

Insulin-like growth factors (IGFs) appear to play arole in the development of tumors in generaland brain tumors in particular. Specific receptors forIGFs have been identified in normal human andrat brain, and evidence suggests that components ofthe IGF signal transduction system may play arole in the transformation process. Secretion of IGFsby a variety of human brain tumors hasbeen confirmed, and these growth factors appear tohave an autocrine stimulatory effect on these tumors.IGFs circulate in the blood stream bound toat least six distinct binding proteins which maymodulate the effects of these growth factors ontarget tissues. Sex steroids may also regulate thebehavior of certain brain tumors such as meningiomasat least in part through their effects onthe expression of IGFs and their binding proteins.Recently, antisense gene technology against certain IGFs ortheir receptors have resulted in potent antitumor effectsin the case of several gliomas, although themechanism for this remains unclear.

To the Editor. —We write to alert surgeons of a possible danger from using disposable, battery-powered, hand-held thermocautery units near dry gauze sponges in the operative field. A patient presented to the ambulatory surgery operative suite for excision of a keloid on the right ear. Once the patient was prepared, draped, and given local anesthetic, and the keloid was excised, a hand-held, disposable, battery-operated thermocautery unit was used to provide hemostasis around the skin edge of the operative site. When the cautery was at full temperature, it inadvertently touched a thread of a dry, 4×4 surgical gauze pad that was used to hold back the skin edges. The gauze rapidly was engulfed in flame. It was grasped and thrown to the floor, where the fire was extinguished by stepping on the flame. No injury was sustained by the patient or surgeons. This incident highlights the convenience of and the caution