Discovering disparities in diffuse large B-cell lymphoma (DLBCL): A hispanic population comparison between Florida and Texas

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Background: DLBCL is the most common type of non-Hodgkin lymphoma worldwide. Hispanics (H) in Texas (TX) and Florida (FL) represent 39.7% and 26.4% of the population of each state, respectively. This is the first population-based two statewide study looking at demographics, treatment patterns, and survival outcomes, in years (y), comparing those two Hispanic enriched states. We hope that identifying differences among state populations and provide interventions for the future. Methods: A retrospective cohort study of patients diagnosed with DLBCL between 2006-2017 using the Texas Cancer Registry and the Florida Cancer Data System. Standard demographic, socioeconomic, clinical, survival variables were reviewed. The Fisher's Exact tests and Chi-Square tests were assessed for categorical outcomes by ethnicity; Survival distributions were depicted using Kaplan-Meier curves. Results: From 2006 to 2017, 16,529 patients from TX and 18,641 patients from FL were diagnosed with DLBCL. At 20-100% poverty index, H in FL and TX had higher poverty percentages than non-Hispanic (NH), with TX H having the higher percentage (55%) compared to FL H (33%). Median survival time in FL was 5.4y for H compared to TX 3.7y H. Overall survival probability at 10y did show a statistically significant difference for H vs. NH when comparing FL (p < 0.001) and TX (p = 0.95). Conclusions: In patients with DLBCL, two statistically significant differences were survival probability at 10y and median survival time comparing H populations in FL and TX. While most demographic variables were homogenous, one difference was observed; poverty index at 20-100% was higher for H in TX than FL. Higher poverty rates in TX to FL among the H population may explain why the median survival time and probability are higher and can provide further opportunities for structured interventions.[Table: see text] [Table: see text]

1402. NTM Infections; A Rising Global Health Problem/Clinical Characteristics and Outcomes of Patients with Non-Tuberculous Mycobacterial Infections at Two Tertiary Academic Medical Centers

Background

Non-Tuberculous Mycobacteria (NTM) cause infections in immunocompetent as well as immunocompromised individuals affecting pulmonary and extra pulmonary sites. These pathogens are widely distributed globally and recent reports have shown their rise in many developed countries. Our study aimed to assess the disease magnitude, describe patient characteristics and risk factors, assess diagnostic and therapeutic measures and review outcomes furthering our understanding of the overall disease process.

Methods

We conducted a retrospective, multicenter review of patients with positive NTM cultures treated at University Hospital System and South Texas Veterans Health Care System (STVHCS) from 2011 to 2018. Infections were classified as pulmonary or extrapulmonary, and we recorded demographics, microbiological data, treatment regimens, duration, complications, follow-up and mortality. All categorical variables were described using percentages and compared between groups using the chi-square test.

Results

A total of 176 patients were included for analysis, of which 111 (63.1%) met criteria for NTM disease (2020 ATS/IDSA). The most common cultured mycobacterium was M. Avium Complex (MAC). M. abscessus-chelonae was more commonly associated with clinical disease and isolated from an extra pulmonary site whereas M. simiae complex had similar distribution between the infected and un-infected groups. Over 50% of patients received treatment (80% in the infected group). Cure was seen in 47.2%, all-cause mortality was 27% at last follow-up. Median duration of therapy was 10 months. 47% of patients experienced adverse effects which led to treatment discontinuation in one third of patients. Patients who were able to achieve a cure received a longer duration of therapy (12 vs 7 months; not statistically significant) and treatment was halted more commonly in the group that did not achieve eventual cure (42.6% vs. 16.7%, p=0.007).

Conclusion

NTM infections represent a therapeutic challenge with low cure rates and high mortality. An understanding of the risk factors, treatment options and outcomes is essential to guide appropriate management. Our study highlights high rates of adverse effects and discontinuation which precludes prolonged courses of therapy required to achieve cure.

Disclosures

All Authors: No reported disclosures

Delayed genital necrosis after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy with Mitomycin-C

INTRODUCTION

Genital necrosis (GN) is a rare complication of cytoreductive surgery with hyperthermic intraoperative chemotherapy (CRS/HIPEC) which can be confused with necrotizing fasciitis. We present an analysis of GN after CRS/HIPEC to define its natural history.

METHODS

We identified patients with GN after CRS/HIPEC at two peritoneal surface malignancy institutions. Patient demographic, surgical, and postoperative data were extracted from prospective databases.

RESULTS

Of 1597 CRS/HIPECs performed, 13 patients (0.8%) had GN. The median age was 57 years (IQR: 49-64) and 77% (n = 10) were male. Mitomycin-C was the perfusion agent in all cases of GN (100%). The median time to GN onset after CRS/HIPEC was 64 days (IQR: 60-108) and 2 (15%) patients were receiving systemic chemotherapy at the time of GN onset. Symptoms included severe pain (100%), edema (100%), labial or scrotal skin ulceration (92%), signs of infection (39%), and fever (15%). Seven (54%) patients had thrombocytosis >400 ∗10⁹/L, whereas coagulation tests were within normal reference range in 100% cases. All patients initially underwent conservative treatment, with antibiotic therapy administered in 62% (n = 8). Surgical debridement was performed in 9 (70%) cases with median time after GN onset of 57 (IQR: 8-180).

CONCLUSION

GN is a debilitating complication after CRS/HIPEC with delayed onset and a protracted clinical course. Optimal treatment results could be achieved with initial conservative management until complete lesion demarcation followed by surgical debridement. The pathophysiology of GN is unclear, and we call for other researchers attention to better understand the complication and prevention.

Mobile Applications: Breaking Barriers to Early Breast and Cervical Cancer Detection in Underserved Communities

BACKGROUND

Although potentially curable with early detection and timely treatment, breast cancer (BC) and cervical cancer (CC) remain leading causes of death for Colombian women. Lack of education, complicated administrative processes, and geographic limitations hinder early cancer detection. Today, technological tools permeate the society and could assess user risk, deliver customized information, and provide care coordination. We evaluated the effectiveness of a free mobile application (mApp) to reach women, understand misconceptions, identify users at risk for BC and/or CC, and coordinate screening tests in Cali, Colombia.

METHODS

The mApp was developed and advertised in four healthcare facility waiting rooms. It used educational, evaluative, and risk factor questions followed by brief explanations to assess the population's knowledge, educate on BC and/or CC, and identify users in need of screening test(s). Women who required screening were navigated and enrolled in the national cancer program.

RESULTS

From August 2017 to August 2019, 1,043 women downloaded the mApp. BC misconceptions included beliefs that BC can be prevented (87%), obesity does not increase the risk of BC (49%), and deodorant causes BC (17%). CC misconceptions included that pap smears should not be performed while sexually active (64%), vaginal pain is an early sign of CC (44%), and only women contract human papilloma virus (33%). Overall, 29% (303) were identified as at risk and needed a screening test, with 32% (98) successfully screened.

DISCUSSION

mApps can identify women at risk for BC and/or CC, detect barriers to early cancer detection, and help coordinate screening test(s). This technology has widespread applications and may be useful in other underserved communities.

Overcoming Barriers in the Implementation of Programs for Breast and Cervical Cancers in Cali, Colombia: A Pilot Model

Breast and cervical cancers are leading causes of mortality among women in Latin America. Colombia has universal health care and a government-sponsored 10-year cancer control plan focused on prevention, early detection, and treatment. However, many administrative and social barriers have hindered its success, and a majority of patients are diagnosed at a late stage. Established in 2012, Partners for Cancer Care and Prevention (PFCCAP) works to decrease the burden of these cancers by mitigating the obstacles women face during their cancer diagnosis and treatment. Through community outreach meetings with medical personnel, hospital directors, and government officials, PFCCAP identified major barriers, including lack of trained health care personnel, few centers with adequate screening equipment, and a fragmented health system with significant administrative delays and poor continuity of care. Its solution included monthly teleconferences, biannual on-site training, quality control programs, and improved access to screening equipment. PFCCAP also initiated a patient navigation project. After implementation of the PFCCAP plan of action, from 2012 to 2018, the average time from initial consult to biopsy decreased from 65 to 20 days; from biopsy to diagnosis, 33 to 4 days; and from diagnosis to surgery, 121 to 60 days. To date, more than 1,500 women have benefited from this initiative, which has expanded to other regions. Overall, PFCCAP is creating centers of excellence in strategically located hospitals and promoting the implementation of national guidelines. Although several barriers still exist, PFCCAP is helping to implement an efficient health care model that can be replicated in other underserved populations.

Overcoming Barriers in the Implementation of Programs for Breast and Cervical Cancer: A Pilot Model

Purpose

Breast and cervical cancers are leading causes of mortality in Latin America. Although Colombia has an integrated health system that provides universal coverage, approximately 70% of patients with cancer are diagnosed in a late stage. The government has a 10-year cancer control plan that is focused on prevention, early detection, and treatment; however, many barriers have hindered its implementation. Since 2012, Partners for Cancer Care and Prevention has worked to decrease the burden of breast and cervical cancer by mitigating the obstacles women face during their cancer journeys.

Methods

Through community outreach and meetings with medical personnel, hospital directors, and government officers, we identified some of the barriers—a deficit of trained personnel and physicians, limited centers and scarcity of equipment for early diagnosis, and a fragmented health system with poor continuity of care. Our proposal included monthly teleconferences, a twice-a-year on-site training and quality control program, improving the equipment for early diagnosis in easily accessible centers for patients, creating a patient navigation program and a mobile application (Amate), and unifying the system by directing patients for diagnosis to level 1 and 2 hospitals with rapid referral for treatment in level 3.

Results

From 2012 to 2016, we have trained 462 health professionals in the screening, diagnosis, and treatment of breast and cervical cancers and equipped level 1 and 2 hospitals for cancer diagnosis by donating a mammography machine and two video colposcopes, all of which has yielded 3,036 mammograms and 1,500 uterocervical cytologies annually. In addition, Amate is able to provide basic teaching and rapid referral for screening. Thus far, 2,583 women have benefited from the program. This has integrated the health system and shortened wait times. After 4 years, the time from initial consult to biopsy has decreased from 65 days to 20 days (70%), from biopsy to surgery for 154 days to 64 days, and from biopsy to chemotherapy from 148 days to 72 days.

Conclusion

A system of early diagnosis in level 1 and 2 hospitals—now centers of excellence—with rapid referral to a tertiary care institution has facilitated the implementation of the cancer program in Colombia. Although several barriers are still to be addressed, we are establishing an efficient health care model that could be replicated in other underserved countries.

AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . Armando Sardi Stock or Other Ownership: Celgene, Johnson & Johnson Mavalynne Orozco-Urdaneta Employment: Partners For Cancer Care And Prevention Foundation, Stamina-in-Action Stock or Other Ownership: Celgene, Johnson & Johnson Luis Gabriel Parra-Lara Research Funding: Merk & Co

Prototheca: A Danger Underwater

Prototheca wickerhamii rarely causes systemic infection in humans but when it occurs, there are coexisting comorbidities. This case illustrated shows the manifestation of this opportunistic microorganism in an immunosuppressed patient. The patient was successfully treated with Liposomal amphotericin B with complete resolution of the lesions.