The mental health of Australians bereaved during the first two years of the COVID-19 pandemic: a latent class analysis

BACKGROUND

The COVID-19 pandemic disrupted many areas of life, including culturally accepted practices at end-of-life care, funeral rites, and access to social, community, and professional support. This survey investigated the mental health outcomes of Australians bereaved during this time to determine how these factors might have impacted bereavement outcomes.

METHODS

An online survey indexing pandemic and bereavement experiences, levels of grief, depression, anxiety, and health, work, and social impairment. Latent class analysis (LCA) was used to identify groups of individuals who shared similar symptom patterns. Multinomial regressions identified pandemic-related, loss-related, and sociodemographic correlates of class membership.

RESULTS

1911 Australian adults completed the survey. The LCA identified four classes: low symptoms (46.8%), grief (17.3%), depression/anxiety (17.7%), and grief/depression/anxiety (18.2%). The latter group reported the highest levels of health, work, and social impairment. The death of a child or partner and an inability to care for the deceased due to COVID-19 public health measures were correlated with grief symptoms (with or without depression and anxiety). Preparedness for the person's death and levels of pandemic-related loneliness and social isolation differentiated all four classes. Unemployment was associated with depression/anxiety (with or without grief).

CONCLUSIONS

COVID-19 had profound impacts for the way we lived and died, with effects that are likely to ricochet through society into the foreseeable future. These lessons learned must inform policymakers and healthcare professionals to improve bereavement care and ensure preparedness during and following future predicted pandemics to prevent negative impacts.

Artificial Intelligence-Assisted Cancer Status Detection in Radiology Reports

Cancer research is dependent on accurate and relevant information of patient's medical journey. Data in radiology reports are of extreme value but lack consistent structure for direct use in analytics. At Memorial Sloan Kettering Cancer Center (MSKCC), the radiology reports are curated using gold-standard approach of using human annotators. However, the manual process of curating large volume of retrospective data slows the pace of cancer research. Manual curation process is sensitive to volume of reports, number of data elements and nature of reports and demand appropriate skillset. In this work, we explore state of the art methods in artificial intelligence (AI) and implement end-to-end pipeline for fast and accurate annotation of radiology reports. Language models (LM) are trained using curated data by approaching curation as multiclass or multilabel classification problem. The classification tasks are to predict multiple imaging scan sites, presence of cancer and cancer status from the reports. The trained natural language processing (NLP) model classifiers achieve high weighted F1 score and accuracy. We propose and demonstrate the use of these models to assist in the manual curation process which results in higher accuracy and F1 score with lesser time and cost, thus improving efforts of cancer research.

SIGNIFICANCE

Extraction of structured data in radiology for cancer research with manual process is laborious. Using AI for extraction of data elements is achieved using NLP models' assistance is faster and more accurate.

Primary care usage at the end of life: a retrospective cohort study of cancer patients using linked primary and hospital care data

PURPOSE

Health service use is most intensive in the final year of a person's life, with 80% of this expenditure occurring in hospital. Close involvement of primary care services has been promoted to enhance quality end-of-life care that is appropriate to the needs of patients. However, the relationship between primary care involvement and patients' use of hospital care is not well described. This study aims to examine primary care use in the last year of life for cancer patients and its relationship to hospital usage.

METHODS

Retrospective cohort study in Victoria, Australia, using linked routine care data from primary care, hospital and death certificates. Patients were included who died related to cancer between 2008 and 2017.

RESULTS

A total of 758 patients were included, of whom 88% (n = 667) visited primary care during the last 6 months (median 9.1 consultations). In the last month of life, 45% of patients were prescribed opioids, and 3% had imaging requested. Patients who received home visits (13%) or anticipatory medications (15%) had less than half the median bed days in the last 3 months (4 vs 9 days, p < 0.001, 5 vs 10 days, p = 0.001) and 1 month of life (0 vs 2 days, p = 0.002, 0 vs 3 days, p < 0.001), and reduced emergency department presentations (32% vs 46%, p = 0.006, 31% vs 47% p < 0.001) in the final month.

CONCLUSION

This study identifies two important primary care processes-home visits and anticipatory medication-associated with reduced hospital usage and intervention at the end of life.

A comprehensive review on anticorrosive/antifouling superhydrophobic coatings: Fabrication, assessment, applications, challenges and future perspectives

Superhydrophobicity (SHP) is an incredible phenomenon of extreme water repellency of surfaces ubiquitous in nature (E.g. lotus leaves, butterfly wings, taro leaves, mosquito eyes, water-strider legs, etc). Historically, surface exhibiting water contact angle (WCA) > 150° and contact angle hysteresis <10° is considered as SHP. The SHP surfaces garnered considerable attention in recent years due to their applications in anti-corrosion, anti-fouling, self-cleaning, oil-water separation, viscous drag reduction, anti-icing, etc. As corrosion and marine biofouling are global problems, there has been focused efforts in combating these issues using innovative environmentally friendly coatings designs taking cues from natural SHP surfaces. Over the last two decades, though significant progress has been made on the fabrication of various SHP surfaces, the practical adaptation of these surfaces for various applications is hampered, mainly because of the high cost, non-scalability, lack of simplicity, non-adaptability for a wide range of substrates, poor mechanical robustness and chemical inertness. Despite the extensive research, the exact mechanism of corrosion/anti-fouling of such coatings also remains elusive. The current focus of research in recent years has been on the development of facile, eco-friendly, cost-effective, mechanically robust chemically inert, and scalable methods to prepare durable SHP coating on a variety of surfaces. Although there are some general reviews on SHP surfaces, there is no comprehensive review focusing on SHP on metallic and alloy surfaces with corrosion-resistant and antifouling properties. This review is aimed at filling this gap. This review provides a pedagogical description with the necessary background, key concepts, genesis, classical models of superhydrophobicity, rational design of SHP, coatings characterization, testing approaches, mechanisms, and novel fabrication approaches currently being explored for anticorrosion and antifouling, both from a fundamental and practical perspective. The review also provides a summary of important experimental studies with key findings, and detailed descriptions of the evaluation of surface morphologies, chemical properties, mechanical, chemical, corrosion, and antifouling properties. The recent developments in the fabrication of SHP -Cr-Mo steel, Ti, and Al are presented, along with the latest understanding of the mechanism of anticorrosion and antifouling properties of the coating also discussed. In addition, different promising applications of SHP surfaces in diverse disciplines are discussed. The last part of the review highlights the challenges and future directions. The review is an ideal material for researchers practicing in the field of coatings and also serves as an excellent reference for freshers who intend to begin research on this topic.

Enhancing microbiologically influenced corrosion protection of carbon steels with silanized epoxy-biocide hybrid coatings

Microbial biofilms and microbiologically influenced corrosion (MIC) pose serious problems in pipelines transporting freshwater from the reservoir to service water systems and fire water systems of power reactors. The present work aims to design a silane-based epoxy-biocide hybrid coating along with antibacterial compounds on carbon steels (CS) for controlling the MIC of pipeline materials. The optimal inhibitory concentrations of biocides are identified and a robust protocol has been developed to prepare epoxy-based coatings impregnated with three biocides (25 ppm each of benzalkonium chloride, bronopol, and isothiazoline). Microbiological and accelerated corrosion studies were carried out by exposing the coated CS specimens to the enriched freshwater bacterial culture (FWC). As compared to the impedance value of 102 Ohms for the polished CS, the values were 106 and 105 Ohms, respectively, for epoxy-coated specimens (CSE) and epoxy-coated specimens impregnated with biocides (CSEB). The corrosion protection efficiency of CSE and CSEB coated specimens exposed to FWC was 99.9% and 98.1%, respectively. Confocal microscopic analysis showed the average biomass thickness was 51.3 ± 0.6 µm and 24.4 ± 0.5 µm, respectively, for CSE and CSEB specimens in comparison to 94.1 ± 0.2 µm on CS specimens. The improved anticorrosion and antifouling behaviors observed in the CSEB specimens suggest that the new coating strategy has the potential for the development of multifunctional hybrid epoxy coatings for pipeline materials to mitigate MIC-related issues in water-transporting pipeline systems.

A nudge over the relaxation plateau: effect of pH, particle concentration, and medium viscosity on the AC induction heating efficiency of biocompatible chitosan-coated Fe3O4nanoparticles

The effects of pH, MNP concentration, and medium viscosity on the magnetic fluid hyperthermia (MFH) properties of chitosan-coated superparamagnetic Fe3O4nanoparticles (MNPs) are probed here. Due to the protonation of the amide groups, the MNPs are colloidally stable at lower pH (∼2), but form aggregates at higher pH (∼8). The increased aggregate size at higher pH causes the Brownian relaxation time (τB) to increase, leading to a decrease in specific absorption rate (SAR). For colloidal conditions ensuring Brownian-dominated relaxation dynamics, an increase in MNP concentrations or medium viscosity is found to increase theτB. SAR decreases with increasing MNP concentration, whereas it exhibits a non-monotonic variation with increasing medium viscosity. Dynamic hysteresis loop-based calculations are found to be in agreement with the experimental results. The findings provide a greater understanding of the variation of SAR with the colloidal properties and show the importance of relaxation dynamics on MFH efficiency, where variations in the frequency-relaxation time product across the relaxation plateau cause significant variations in SAR. Further, thein vitrocytotoxicity studies show good bio-compatibility of the chitosan-coated Fe3O4MNPs. Higher SAR at acidic pH for bio-medically acceptable field parameters makes the bio-compatible chitosan-coated Fe3O4MNPs suitable for MFH applications.

Microbiologically influenced corrosion of AISI 202 and 316L stainless steels under manganese-oxidizing biofilms

In this work, we study the microbiologically influenced corrosion (MIC) of AISI 316L (1-2% Mn) and AISI 202 (8-12% Mn) in the presence of manganese-oxidizing biofilms. Microbiological and 16S rRNA amplicon sequencing analysis on biofilms formed on the surfaces of both the SS materials after exposure to seawater for two months showed the presence of predominant Mn-oxidizing bacteria (MnOB) groups. The Mn contents in the biofilms formed on AISI 202 and 316L were 0.577 and 0.193 ppm, respectively. Mixed biofilms of 11 pure axenic cultures of MnOB isolated and identified from both the SS biofilms were used for MIC studies on SS. Electrochemical studies showed four orders of magnitude high icorr values (1.271 × 10-4 A.cm-2) and the onset of crevice corrosion potentials (502 mV) confirming the localized corrosion of AISI 202 and 316L, respectively, under MnOB biofilms. X-ray photoelectron spectroscopic (XPS) analysis on biotic surfaces showed a reduced Mn content from 10.1 to 7.9 atom.% confirming the Mn oxidation in AISI 202. This study confirms that MnOB biofilms on the SS surfaces can lead to MIC due to biogenic Mn oxidation, depletion of Fe and Mn content, and enrichment of Cr content.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13205-023-03845-z.

Analysis and Visualization of Longitudinal Genomic and Clinical Data from the AACR Project GENIE Biopharma Collaborative in cBioPortal

International cancer registries make real-world genomic and clinical data available, but their joint analysis remains a challenge. AACR Project GENIE, an international cancer registry collecting data from 19 cancer centers, makes data from >130,000 patients publicly available through the cBioPortal for Cancer Genomics (https://genie.cbioportal.org). For 25,000 patients, additional real-world longitudinal clinical data, including treatment and outcome data, are being collected by the AACR Project GENIE Biopharma Collaborative using the PRISSMM data curation model. Several thousand of these cases are now also available in cBioPortal. We have significantly enhanced the functionalities of cBioPortal to support the visualization and analysis of this rich clinico-genomic linked dataset, as well as datasets generated by other centers and consortia. Examples of these enhancements include (i) visualization of the longitudinal clinical and genomic data at the patient level, including timelines for diagnoses, treatments, and outcomes; (ii) the ability to select samples based on treatment status, facilitating a comparison of molecular and clinical attributes between samples before and after a specific treatment; and (iii) survival analysis estimates based on individual treatment regimens received. Together, these features provide cBioPortal users with a toolkit to interactively investigate complex clinico-genomic data to generate hypotheses and make discoveries about the impact of specific genomic variants on prognosis and therapeutic sensitivities in cancer.

SIGNIFICANCE

Enhanced cBioPortal features allow clinicians and researchers to effectively investigate longitudinal clinico-genomic data from patients with cancer, which will improve exploration of data from the AACR Project GENIE Biopharma Collaborative and similar datasets.

Automated full body tumor segmentation in DOTATATE PET/CT for neuroendocrine cancer patients

PURPOSE

Neuroendocrine tumors (NETs) are a rare form of cancer that can occur anywhere in the body and commonly metastasizes. The large variance in location and aggressiveness of the tumors makes it a difficult cancer to treat. Assessments of the whole-body tumor burden in a patient image allow for better tracking of disease progression and inform better treatment decisions. Currently, radiologists rely on qualitative assessments of this metric since manual segmentation is unfeasible within a typical busy clinical workflow.

METHODS

We address these challenges by extending the application of the nnU-net pipeline to produce automatic NET segmentation models. We utilize the ideal imaging type of 68Ga-DOTATATE PET/CT to produce segmentation masks from which to calculate total tumor burden metrics. We provide a human-level baseline for the task and perform ablation experiments of model inputs, architectures, and loss functions.

RESULTS

Our dataset is comprised of 915 PET/CT scans and is divided into a held-out test set (87 cases) and 5 training subsets to perform cross-validation. The proposed models achieve test Dice scores of 0.644, on par with our inter-annotator Dice score on a subset 6 patients of 0.682. If we apply our modified Dice score to the predictions, the test performance reaches a score of 0.80.

CONCLUSION

In this paper, we demonstrate the ability to automatically generate accurate NET segmentation masks given PET images through supervised learning. We publish the model for extended use and to support the treatment planning of this rare cancer.

Digital pathology operations at a tertiary cancer center: Infrastructure requirements and operational cost

Whole slide imaging is revolutionizing the field of pathology and is currently being used for clinical, educational, and research initiatives by an increasing number of institutions. Pathology departments have distinct needs for digital pathology systems, yet the cost of digital workflows is cited as a major barrier for widespread adoption by many organizations. Memorial Sloan Kettering Cancer Center (MSK) is an early adopter of whole slide imaging with incremental investments in resources that started more than 15 years ago. This experience and the large-scale scan operations led to the identification of required framework components of digital pathology operations. The cost of these components for the 2021 digital pathology operations at MSK were studied and calculated to enable an understanding of the operation and benchmark the accompanying costs. This paper describes the unique infrastructure cost and the costs associated with the digital pathology clinical operation use cases in a large, tertiary cancer center. These calculations can serve as a blueprint for other institutions to provide the necessary concepts and offer insights towards the financial requirements for digital pathology adoption by other institutions.

The submental island flap - should we be worried about lymph node transfer? An anatomical and histological study

The submental island flap has been increasing in popularity for both oncological and non-oncological reconstruction of the head and neck. However, the original description of this flap left it with the unfortunate designation as a lymph node flap. There has thus been significant debate on the oncological safety of the flap. In this cadaveric study the perforator system suppling the skin island is delineated and the lymph node yield of the skeletonised flap is analysed histologically. A safe and consistent approach to raising the perforator flap modification is described and the pertinent anatomy, and an oncological discussion with regards to the submental island perforator flap histological lymph node yield discussed. Ethical approval was received from Hull York Medical School for the anatomical dissection of 15 sides of cadavers. 6 x 4cm submental island flaps were raised following a vascular infusion of a 50/50 mix of acrylic paint. The flap size mimics the T1/T2 tumour defects these flaps would usually be used to reconstruct.The submental vascular anatomy, including length, diameter, venous drainage patterns, and the skin perforator system was documented. The dissected submental flaps were then histologically examined for the presence of lymph nodes by a head and neck pathologist at Hull University Hospitals Trust department of histology. The total length of the submental island arterial system, the distance from where the facial artery branches off from the carotid to the submental artery perforator entering the anterior belly of digastric or skin, averaged 91.1mm with anaverage facial artery length of 33.1mm and submental artery of 58mm. Vessel diameter for microvascular reconstruction was 1.63mm for the submental artery and 3mm for the facial artery. The most common venous anatomy drainage pattern was the submental island venaecomitantes draining to the retromandibular system then to the internal jugular vein. Almost half the specimens had a dominant superficial submental perforator allowing the ability to raise this as a skin only system. There were generally 2-4 perforators passing through the anterior belly of digastric to supply the skin paddle.73.3% (11/15) of the skeletonised flaps contained no lymph nodes on histological examination. The perforator version of the submental island flap can be safely and consistently raised with inclusion of the anterior belly of digastric. In approximately half the cases a dominant superficial branch allows for a skin only paddle. Due to the vessel diameter, free tissue transfer is predictable.Venous anatomy is variable and care needs to be taken when raising this flap. The skeletonised version of the perforator flap is largely devoid of nodal yield and on oncological review a 16.3% recurrence rate is equivalent to current standard treatment.

Interplay of Immunosuppression and Immunotherapy Among Patients With Cancer and COVID-19

Importance

Cytokine storm due to COVID-19 can cause high morbidity and mortality and may be more common in patients with cancer treated with immunotherapy (IO) due to immune system activation.

Objective

To determine the association of baseline immunosuppression and/or IO-based therapies with COVID-19 severity and cytokine storm in patients with cancer.

Design, Setting, and Participants

This registry-based retrospective cohort study included 12 046 patients reported to the COVID-19 and Cancer Consortium (CCC19) registry from March 2020 to May 2022. The CCC19 registry is a centralized international multi-institutional registry of patients with COVID-19 with a current or past diagnosis of cancer. Records analyzed included patients with active or previous cancer who had a laboratory-confirmed infection with SARS-CoV-2 by polymerase chain reaction and/or serologic findings.

Exposures

Immunosuppression due to therapy; systemic anticancer therapy (IO or non-IO).

Main Outcomes and Measures

The primary outcome was a 5-level ordinal scale of COVID-19 severity: no complications; hospitalized without requiring oxygen; hospitalized and required oxygen; intensive care unit admission and/or mechanical ventilation; death. The secondary outcome was the occurrence of cytokine storm.

Results

The median age of the entire cohort was 65 years (interquartile range [IQR], 54-74) years and 6359 patients were female (52.8%) and 6598 (54.8%) were non-Hispanic White. A total of 599 (5.0%) patients received IO, whereas 4327 (35.9%) received non-IO systemic anticancer therapies, and 7120 (59.1%) did not receive any antineoplastic regimen within 3 months prior to COVID-19 diagnosis. Although no difference in COVID-19 severity and cytokine storm was found in the IO group compared with the untreated group in the total cohort (adjusted odds ratio [aOR], 0.80; 95% CI, 0.56-1.13, and aOR, 0.89; 95% CI, 0.41-1.93, respectively), patients with baseline immunosuppression treated with IO (vs untreated) had worse COVID-19 severity and cytokine storm (aOR, 3.33; 95% CI, 1.38-8.01, and aOR, 4.41; 95% CI, 1.71-11.38, respectively). Patients with immunosuppression receiving non-IO therapies (vs untreated) also had worse COVID-19 severity (aOR, 1.79; 95% CI, 1.36-2.35) and cytokine storm (aOR, 2.32; 95% CI, 1.42-3.79).

Conclusions and Relevance

This cohort study found that in patients with cancer and COVID-19, administration of systemic anticancer therapies, especially IO, in the context of baseline immunosuppression was associated with severe clinical outcomes and the development of cytokine storm.

Trial Registration

ClinicalTrials.gov Identifier: NCT04354701.

Magnetic nanofluids (Ferrofluids): Recent advances, applications, challenges, and future directions

Impelled by the need to find solutions to new challenges of modern technologies new materials with unique properties are being explored. Among various new materials that emerged over the decades, magnetic fluids exhibiting interesting physiochemical properties (optical, thermal, magnetic, rheological, apparent density, etc.) under a magnetic stimulus have been at the forefront of research. In the initial phase, there has been a fervent scientific curiosity to understand the field-induced intriguing properties of such fluids but later a plethora of technological applications emerged. Magnetic nanofluid, popularly known as ferrofluid, is a colloidal suspension of fine magnetic nanoparticles, has been at the forefront of research because of its magnetically tunable physicochemical properties and applications. Due to their stimuli-responsive behaviour, they have been finding more applications in biology and other engineering disciplines in recent years. Therefore, a critical review of this topic highlighting the necessary background, the potential of this material for emerging technologies, and the latest developments is warranted. This review also provides a summary of various applications, along with the key challenges and future research directions. The first part of the review addresses the different types of magnetic fluids, the genesis of magnetic fluids, their synthesis methodologies, properties, and stabilization techniques are discussed in detail. The second part of the review highlights the applications of magnetic nanofluids and nanoemulsions (as model systems) in probing order-disorder transitions, scattering, diffraction, magnetically reconfigurable internal structures, molecular interaction, and weak forces between colloidal particles, conformational changes of macromolecules at interfaces and polymer-surfactant complexation at the oil-water interface. The last part of the review summarizes the interesting applications of magnetic fluids such as heat transfer, sensors (temperature, pH, urea detection, cations, defect detection sensors), tunable optical filters, removal of dyes, dynamic seals, magnetic hyperthermia-based cancer therapy and other biomedical applications. The applications of magnetic nanofluids in diverse disciplines are growing day by day, yet there are challenges in their practical adaptation as field-worthy or packaged products. This review provides a pedagogical description of magnetic fluids, with the necessary background, key concepts, physics, experimental protocols, design of experiments, challenges and future directions.

Genomic analysis of early-stage lung cancer reveals a role for TP53 mutations in distant metastasis

Patients with non-small cell lung cancer (NSCLC) who have distant metastases have a poor prognosis. To determine which genomic factors of the primary tumor are associated with metastasis, we analyzed data from 759 patients originally diagnosed with stage I-III NSCLC as part of the AACR Project GENIE Biopharma Collaborative consortium. We found that TP53 mutations were significantly associated with the development of new distant metastases. TP53 mutations were also more prevalent in patients with a history of smoking, suggesting that these patients may be at increased risk for distant metastasis. Our results suggest that additional investigation of the optimal management of patients with early-stage NSCLC harboring TP53 mutations at diagnosis is warranted in light of their higher likelihood of developing new distant metastases.

Thermal and rheological properties of magnetic nanofluids: Recent advances and future directions

Technological advancement and miniaturization of electronic gadgets fueled intense research on nanofluids as potential candidates for cooling applications as a substitute to conventional heat transfer fluids. Among nanofluids, magnetic nanofluids, traditionally known as ferrofluids have attracted a lot of attention owing to their magnetic field tunable thermal conductivity and rheological properties due to the aggregation of the magnetic nanoparticles into chains or columns in the presence of the magnetic field. The field-induced aggregates act as low resistance pathways thereby improving thermal transport substantially. Recent studies show that ferrofluids with smaller size and narrow size distribution display significant enhancement in thermal conductivity in the presence of a magnetic field with negligible viscosity enhancement, which is ideal for effective thermal management of electronic devices, especially in miniature electronic devices. On the contrary, highly polydisperse ferrofluids containing large aggregates, show modest enhancement in thermal conductivity in the presence of a magnetic field and a huge enhancement in viscosity. The most recent studies show that magnetic field ramp rate has a profound effect on aggregation kinetics and thermal and rheological properties. The viscosity enhancement under an external stimulus impedes their practical use in electronics cooling, which warrants the need to attain a high thermal conductivity to viscosity ratio, under a modest magnetic field. Though there are several reviews on heat transfer in nanofluids and hybrid nanofluids, a comprehensive review on fundamental understanding of field-induced thermal and rheological properties in magnetic fluids is missing in the literature. This review provides a pedagogical description of the fundamental understanding of field-induced thermal and rheological properties in magnetic fluids, with the necessary background, key concepts, definitions, mechanisms, theoretical models, experimental protocols, and design of experiments. Many important case studies are presented along with the experimental design aspects. The review also provides a summary of important experimental studies with key findings, along with the key challenges and future research directions. The review is an ideal material for experimentalists and theoreticians practicing in the field of magnetic fluids, and also serves as an excellent reference for freshers who indent to begin research on this topic.

Incidence and clinical outcomes of HER2-altered bladder cancer (BC) patients (pts)

556

Background: Bladder cancer has one of the highest rates of human epidermal growth factor receptor 2 (HER2) alteration. Novel HER2-directed agents are being investigated in metastatic BC. We sought to define the incidence and clinical characteristics of HER2-altered BC across disease states. Methods: We retrospectively analyzed our single-institution, clinically annotated cohort of urothelial BC pts with available genomic profiling data (MSK-IMPACT). We quantified the prevalence of HER2 alterations, defined as driver mutation (based on OncoKB), and/or amplification, across BC disease states. We examined the association between HER2 alteration and disease progression and survival. The Kaplan-Meier method was used for time-to-event analyses. Results: A total of 1073 BC pts underwent MSK IMPACT profiling of tumor tissue derived from the following disease states: 36% (n = 380) non-muscle invasive (NMI)BC, 41% (n = 443) muscle invasive (MI)BC, and 23% (n = 250) (met)BC. At initial diagnosis, the median age was 67 years, 77% (n = 822) were male, 86% (n = 928) were white, and 66% (n = 710) were smokers. Overall, 16% (n = 177) of pts had any oncogenic HER2 alteration (Table), including 11% with a HER2 driver mutation and 7% with HER2 amplification The most frequent mutations were S310F (40%, n = 53) and S310Y (14%, n = 19). The rate of HER2 amplification was different among the three groups (p = 0.002), 9% in MIBC and metBC compared to 3% in NMIBC. Among 514 pts with NMIBC, the median time to progression (TTP) to MIBC or metBC was 111.6 months (95% Cl: 85.7-NR). Among NMIBC pts, TTP was significantly shorter for HER2-amplified (n = 17) vs. non-amplified (n = 497) (HR = 1.99, 95%CI: 1.05-3.76, p = 0.034, median 26 vs. 114 months). Among pts with metBC receiving frontline platinum-based chemotherapy (n = 143), the median overall survival (OS) was 25.3 months (95%CI: 18.5-33.9). OS was numerically higher in pts with any oncogenic HER2 alteration (n = 26) compared to wild-type (n = 117) (HR = 0.59, 95% Cl: 0.33-1.07, p = 0.082), though this difference was not statistically significant. The median OS for platinum-refractory metBC pts receiving 2nd line immunotherapy (n = 63) was 10.3 months (95%CI: 7.2-31.6), and the association between OS and HER2 alteration was not significant (HR = 0.57, 95%CI: 0.24-1.37, p = 0.2). Conclusions: HER2 amplification is more frequent in MIBC and metBC than in NMIBC. In NMIBC, HER2 amplification is associated with shorter TTP to MIBC or metBC. HER2 alteration in metBC is associated with a non-significant trend towards improved OS in frontline platinum-treated pts, though this analysis is limited by small sample size.[Table: see text]

1153 “To FNA Or to Not FNA, That Is the Question.” A 5-Year Retrospective Epidemiological Study Of 238 Surgical Parotid Cases Treated at An East Yorkshire OMFS Unit

Introduction

Fine needle aspiration (FNA) is a surgical procedure used to aid with diagnosis and subsequent treatment planning. This study compares FNA histology with final histology (gold standard) for diagnostic accuracy in parotid surgery patients.

Method

A retrospective investigation of patient records from January 2014-January 2019 was performed to find eligible patients that underwent parotid surgery. Histology reports of the ultrasound (US) FNA and final parotid sample were compared for diagnostic accuracy and ability to differentiate between malignant & benign tumours.

Results

240 parotid surgeries on 238 patients were undertaken between 2014-2019 under OMFS and ENT specialities. 137 US FNA’s were performed, of these, there was an 85% diagnostic rate. Of the diagnostic FNA’s 79% reach gold standard, with the histology matching that of the final histology. Of the 24 without diagnostic accuracy, 2/3 were still able to differentiate between malignant and benign lesions. Overall, the US FNA’s were able to differentiate malignant and benign parotid lesions in 93% of cases.

Conclusions

The audit has proven US FNA to be an accurate diagnostic test, it gives extra data to aid in the decision making and planning for parotid surgeries. Although US FNA has shown to be more accurate in diagnosing benign parotid tumours; it is useful in detecting cellular change which could be indicative of malignancy.

1239 Postoperative Complication Rate of Facial Injury Repairs Treated by Maxillofacial On-Call Team: Surgical Audit

Introduction

A significant aspect of Oral and Maxillofacial Surgery workload relates to trauma, particularly soft-tissue injuries. Contingent on the aetiology of injury, facial wounds require debridement and rapid closure to reduce risk of infection and degree of scarring. The aim was to identify possible risks and frequency of postoperative complications, including problems identified by patients following treatment of facial injuries by the Maxillofacial on-call team.

Method

Data was retrospectively collected from patients who sustained soft-tissue facial injuries treated by the Maxillofacial team and provided with follow-up appointments from January to August 2020. Computerised clinical notes were accessed to determine patient demographics, mechanism and site of injury, location and time of repair, operator grade and postoperative complications (if any).

Results

153 patients required debridement and suturing of a facial injury under local or general anaesthetic. Among these, the male to female ratio was 65:35. 47% of facial injuries resulted from mechanical fall. Lips were found to be the most common site (31%) of injury. Postoperative complication rate was 8% within the 8-month period, with reports of infection, wound dehiscence and haematoma requiring further treatment. 58% of complications resulted from treatment carried out between 5pm-5am with a sole operator (DCT/SHO). 83% of complications followed treatment carried out within the Emergency Department rather than Maxillofacial clinical setting.

Conclusion

Following facial injury repair, just less than 8% of patients experienced complications, which required corrective treatment. Although facial injuries require immediate care, careful planning and performing treatment in a specialised setup may improve perioperative care, thus clinical outcomes.

1209 Effect Of COVID-19 On the Referral Base, Presentation, Treatment, And Immediate Outcome of Oral Cancer in An East Yorkshire Regional OMFS Head and Neck Unit. An Epidemiological Review Of 2019 vs 2020

Introduction

The COVID-19 pandemic has drastically altered healthcare provision in primary and secondary care settings in the UK due to significant resources being prioritised for coronavirus care. Services have been affected at all levels of the referral ladder due to reductions and in some cases complete cancellation of face-to-face care. Throughout the pandemic the OMFS unit observed increasing numbers of patients with later stage oral malignant disease, therefore significantly more invasive surgical intervention, and reconstruction, associated with increased morbidity and mortality.

Method

This retrospective review collated data of all OMFS patients with oral squamous cell carcinomas requiring surgical intervention between the 23rd March and the 31st December 2019 compared with the same time period in 2020. Data collected included age, sex, time from referral to both 1st appointment and treatment, TNM staging, types of neck dissection and reconstruction, length of stay in hospital and any adjunctive treatment required.

Results

On comparison of the data sets, the 2020 cohort of patients had an overall later TNM staging result, with an increasing requirement for radical neck dissections and postoperative adjunctive treatment such as chemo/radiotherapy. The study found that on average, patients experienced a shorter waiting time from referral to initial assessment and commencement of treatment during the pandemic when compared to the previous year.

Conclusions

Overall, less patients were referred into hospital during period of the pandemic, however patients seen were diagnosed with significantly more advanced disease, this is likely attributed to reduced primary care services and delayed presentation.

1435 A Review of Literature Reviews: What Is the Quality of Publications That Dictates Best Practice for Managing Plunging Ranulas?

Introduction

We present a case of an extensive plunging ranula in a 10-year-old boy with a review of literature reviews with a focus on pathophysiology, diagnosis, and the best treatment options.

Method

PubMed was used as the search engine and the phrase “plunging ranula” was used. The search dates were between 2000-2020. 124 articles were found by the search. Systematic review and review articles in English were then selected and duplicates removed, which narrowed the search down to 10. The abstracts were then reviewed by two data extractors as per PRISMA review guidelines and full articles were then scrutinised for quality control as per AMSTAR2 tool.

Results

Using the AMSTAR2 tool the overall quality of the reviews was low as most did not fulfil multiple sections in the evaluation tool. Based on case series and meta-analysis of observational studies, opinions varied on the use of diagnostic tools with 80% of the literature reviewed using CT over Ultrasound (60%) and MRI (60%) scans. In all review articles, expert opinion suggested surgery as the best treatment and 50% discussed the benefits of Sclerotherapy as an alternative. 60% discussed the use of aspiration as an intermediate tool in diagnosis and treatment.

Conclusion

For plunging ranulas, CT scan was most commonly used in the reviews. However, the best evidence for diagnosis and treatment was MRI, US scans and surgery. Temporary symptomatic relief has been achieved with aspiration and enabled the fluid to be analysed for amylase content to aid diagnosis. Evidence is mainly from retrospective observational studies.

Inter-droplet force between magnetically polarizable Pickering oil-in-water nanoemulsions stabilized with γ-Al2O3 nanoparticles: Role of electrostatic and electric dipolar interactions

HYPOTHESIS

The presence of nanoparticles at oil-water interface influences the interaction forces between Pickering emulsions. When charged nanoparticles are at the oil-water interface of an electrostatically stabilized emulsion, in addition to the screened Coulombic interaction, electric dipolar force also influences the total inter-droplet force profiles. An in-depth understanding of the effects of such electric dipolar forces is essential for designing colloidally stable Pickering nanoemulsions for various applications.

EXPERIMENTS

Inter-droplet forces between γ-Al₂O₃ nanoparticle stabilized oil-in-water nanoemulsion, containing superparamagnetic nanoparticles (magnetically polarizable) in the oil phase, are measured using the magnetic-chaining technique at different pH and salt concentrations. The role of mono-, di- and tri-valent salts on the inter-droplet force profiles are assessed.

FINDINGS

Force measurement studies reveal a lowering of inter-droplet spacing, within the linear chains, for higher salt concentrations due to an increased screening. Strong interfacial attachment of the charged nanoparticles results in the formation of an asymmetric charge cloud leading to an electric dipolar interaction. Incorporating the contributions of electric dipolar and screened Coulombic interactions, the theoretically estimated total repulsive force magnitudes are in good agreement with the experimental data. The obtained results offer better insights into the nature of colloidal force between charged particle stabilized nanoemulsions.

Integrated digital pathology at scale: A solution for clinical diagnostics and cancer research at a large academic medical center

OBJECTIVE

Broad adoption of digital pathology (DP) is still lacking, and examples for DP connecting diagnostic, research, and educational use cases are missing. We blueprint a holistic DP solution at a large academic medical center ubiquitously integrated into clinical workflows; researchapplications including molecular, genetic, and tissue databases; and educational processes.

MATERIALS AND METHODS

We built a vendor-agnostic, integrated viewer for reviewing, annotating, sharing, and quality assurance of digital slides in a clinical or research context. It is the first homegrown viewer cleared by New York State provisional approval in 2020 for primary diagnosis and remote sign-out during the COVID-19 (coronavirus disease 2019) pandemic. We further introduce an interconnected Honest Broker for BioInformatics Technology (HoBBIT) to systematically compile and share large-scale DP research datasets including anonymized images, redacted pathology reports, and clinical data of patients with consent.

RESULTS

The solution has been operationally used over 3 years by 926 pathologists and researchers evaluating 288 903 digital slides. A total of 51% of these were reviewed within 1 month after scanning. Seamless integration of the viewer into 4 hospital systems clearly increases the adoption of DP. HoBBIT directly impacts the translation of knowledge in pathology into effective new health measures, including artificial intelligence-driven detection models for prostate cancer, basal cell carcinoma, and breast cancer metastases, developed and validated on thousands of cases.

CONCLUSIONS

We highlight major challenges and lessons learned when going digital to provide orientation for other pathologists. Building interconnected solutions will not only increase adoption of DP, but also facilitate next-generation computational pathology at scale for enhanced cancer research.

Influence of size polydispersity on magnetic field tunable structures in magnetic nanofluids containing superparamagnetic nanoparticles

We probe the influence of particle size polydispersity on field-induced structures and structural transitions in magnetic fluids (ferrofluids) using phase contrast optical microscopy, light scattering and Brownian dynamics simulations. Three different ferrofluids containing superparamagnetic nanoparticles of different polydispersity indices (PDIs) are used. In a ferrofluid with a high PDI (∼0.79), thin chains, thick chains, and sheets are formed on increasing the in-plane magnetic field, whereas isotropic bubbles, and hexagonal and lamellar/stripe structures are formed on increasing the out-of-plane magnetic field over the same range. In contrast, no field-induced aggregates are seen in the sample with low polydispersity under the above conditions. In a polydisperse sample, bubbles are formed at a very low magnetic field strength of 30 G. Insights into the structural evolution with increasing magnetic field strength are obtained by carrying out Brownian dynamics simulations. The crossovers from isotropic, through hexagonal columnar, to lamellar/stripe structures observed with increasing field strength in the high-polydispersity sample indicate the prominent roles of large, more strongly interacting particles in structural transitions in ferrofluids. Based on the observed microstructures, a phase diagram is constructed. Our work opens up new opportunities to develop optical devices and access diverse structures by tuning size polydispersity.

Binary blended fly ash concrete with improved chemical resistance in natural and industrial environments

This study reports the enhanced chemical resistance of a blended concrete mix (CFNI) made with 40 wt.% fly ash, 2 wt.% nanoparticles, and 2 wt.% sodium nitrite inhibitor as partial replacement of cement against calcium leaching, acid and sulfate attacks. The concrete test specimens of four different compositions were fabricated and immersed in natural seawater, 3% sulfuric acid solution, and 10% magnesium sulfate solution for 120 days. Long-term chemical deterioration of the concrete systems is evaluated by assessing visual changes of the specimens and solutions along with the changes in percentage mass loss, compressive strength of the concrete, pH of the solution, and dimensions. The results indicate that CFNI concrete exhibits a superior resistance against chemical attack under all the three aggressive environments. Detailed chemical characterization of the specimens, carried out using XRD, FTIR, and thermogravimetric analysis, reveal a reduced CaO content, absence of deterioration phases like ettringite, brucite, and enhanced C-S-H content in the CFNI concrete. The addition of nanoparticles and inhibitors into fly ash concrete has lowered w/c ratio, increased surface pH, enabled conversion of soluble calcium hydroxide into insoluble calcium silicate hydrate, filled pores/voids, and reduced shrinkage and cracking. The compact microstructure of the CFNI prevented leaching and reduced the ingress of aggressive chemical ions into the concrete. Our results demonstrate that incorporation of nanoparticles and inhibitor into the fly ash concrete composition is ideally suited for the design of high-quality, low-permeable concrete structures that is the key for enhanced chemical resistance in natural and industrial environments.

Anti-tumor effects of an ID antagonist with no observed acquired resistance

ID proteins are helix-loop-helix (HLH) transcriptional regulators frequently overexpressed in cancer. ID proteins inhibit basic-HLH transcription factors often blocking differentiation and sustaining proliferation. A small-molecule, AGX51, targets ID proteins for degradation and impairs ocular neovascularization in mouse models. Here we show that AGX51 treatment of cancer cell lines impairs cell growth and viability that results from an increase in reactive oxygen species (ROS) production upon ID degradation. In mouse models, AGX51 treatment suppresses breast cancer colonization in the lung, regresses the growth of paclitaxel-resistant breast tumors when combined with paclitaxel and reduces tumor burden in sporadic colorectal neoplasia. Furthermore, in cells and mice, we fail to observe acquired resistance to AGX51 likely the result of the inability to mutate the binding pocket without loss of ID function and efficient degradation of the ID proteins. Thus, AGX51 is a first-in-class compound that antagonizes ID proteins, shows strong anti-tumor effects and may be further developed for the management of multiple cancers.

Real-time data quality assurance analysis for real-world, pan-cancer data

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Background: The production of high-quality real-world data requires comprehensive and meticulous data quality assurance (QA) methods to guarantee that adequate standards of accuracy, completeness, and consistency are met. Memorial Sloan Kettering Cancer Center (MSKCC) synthesizes manually curated Electronic Health Record (EHR) data to collect and harmonize the fundamental data elements across all cancer types. Centralized real-time analysis of curated data quality can allow for rigorous review to identify areas of strength and opportunities for improvement in the curation process. Methods: MSKCC built the Core Clinical Data Element (CCDE) data model, which encompasses aspects of PRISSMM, ASCO’s mCODE, and NAACCR tumor registry frameworks, to capture standardized real-world, pan-cancer, pan-specialty data across 11 modules, including cancer genomics, imaging, pathology, surgery, and radiation. A key component within the QA process is source data verification (SDV), the comparison of curated data against source documents to identify inconsistencies. Any discrepancies detected are classified into major and minor violations. Major violations are errors or omissions on core data elements that would impact time interval calculations, such as an incorrect procedure date. Minor violations are errors or omissions on less critical data elements, such as a missing radiation therapy dose. Identifying these inconsistences allows the QA team to recognize patterns in curation errors and distinguish areas for curator retraining. Results: With limited functionality in basic standard data quality checks that exist across various data storage platforms, an interactive application was developed using the R Shiny package to access data as cases are recorded and summarize findings from SDV in real time. The app has two panels, each stratified by CCDE module. The first panel details the total number of forms curated and percentage of forms that underwent SDV, with each form representing one of the 11 modules. The other panel consists of a set of tables that summarize specific major and minor violations based on user selection of a denominator of either patients (e.g. how many patients had a violation on at least one imaging report) or forms (e.g. how many imaging reports had a violation). We will demonstrate the utility of the app and discuss benefits of real time evaluation in large-scale, real-world EHR curation efforts. Conclusions: We recommend automated, user-friendly tools to assess data quality of such efforts. With real-time analysis, the tool allows for ongoing and regular data checks, enabling clarification of directives and retraining of curators as necessary early in the curation process. As the data curation efforts expand to more cancer cohorts, the app examines data quality of each cohort to ensure consistent evaluation. This offers transparency of data quality to ensure usability in real-world data for rigorous research.

A comprehensive Memorial Sloan Kettering Cancer Center real-world data model: Core clinical data elements

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Background: The 2016 21st Century Cures Act supports the use of Real-World Data (RWD) for regulatory decision/approval. Due to technological advances, a vast amount of health-related data are now available, but most are not standardized nor readily useable for research. Also, currently available standardized RWD models are not applicable across cancer types or oncology specialties (surgery, medical oncology, radiation oncology, pathology, radiology, etc.). To address these deficiencies Memorial Sloan Kettering Cancer Center (MSKCC) built a comprehensive, pan-cancer, pan-specialty RWD model. Methods: The Core Clinical Data Element (CCDE) data model incorporates aspects of existing academic and biopharma data models, including PRISSMM framework, ASCO’s mCODE, and NAACCR tumor registry model. The data model encompasses 11 domains that are critical to the understanding of the patient’s cancer journey, including: demographic, comorbidities, diagnosis, pathology, imaging, genomics, cancer surgeries, radiation oncology treatments, medical oncology treatments, cancer status/progression, and additional health information. To align with current standards, we are using ICD-10, ICDO3, CTACE V5.0, HL7, SNOMED and LOINC code sets. Further, this adaptable model allows for 5-10 disease specific elements to accommodate for disease heterogenicity and capture the differences among cancer types. Results: The CCDE database includes 1,126 of total data elements. MSKCC has 52,704 patients with MSK-IMPACT (Next-Generation sequencing platform with 505 genes panel) testing of which, we have identified 1,132 bladder cancer patients with at-least one year of cancer care follow-up for the initial curation cohort. Patients were identified as having an OncoTree bladder tumor type code that is assigned by a pathologist who attests the diagnosis by reviewing results from clinical tests on tumor specimens. To the date, 641 patients including 46,415 curated forms have been curated (Table). Conclusions: The comprehensive MSKCC’s CCDE data model standardizes the common and critical pan-cancer and pan-specialty elements for RWD. The dataset resulting from this curation efforts will provide robust structured and unified genomic and phenomic data across tumor types for future research enabling greater collaboration across various cancer types as well as oncology specialties.[Table: see text]

Polydimethylsiloxane-graphene oxide nanocomposite coatings with improved anti-corrosion and anti-biofouling properties

We demonstrate enhanced anti-corrosion and anti-biofouling properties of graphene oxide-silica-polydimethylsiloxane (GSP) coating on carbon steel (CS). Electrochemical analyses of GSP-coated carbon steel exposed to Gram-positive Bacillus sp., Gram-negative Pseudomonas sp., and freshwater bacterial cultures for 72 h showed a 3-5 orders of magnitude reduction in i_corr values and high impedance values (10⁷ Ω) as compared with polished specimens. The corrosion protection efficiency of GSP-coated specimens was 99.9% against Bacillus sp. and freshwater culture and it was 89.6% against Pseudomonas sp. Evaluation of anti-biofouling property of GSP coating using microbiological and epifluorescence microscopic techniques showed three order reductions in total viable cells on GSP-coated specimens exposed to bacterial cultures. Confocal laser scanning microscopic analysis of biofilm architecture confirmed a significant reduction of biomass and biofilm thickness on GSP-coated CS demonstrating an excellent anti-biofouling activity of GSP.

Interplay between chromosomal alterations and gene mutations shapes the evolutionary trajectory of clonal hematopoiesis

Stably acquired mutations in hematopoietic cells represent substrates of selection that may lead to clonal hematopoiesis (CH), a common state in cancer patients that is associated with a heightened risk of leukemia development. Owing to technical and sample size limitations, most CH studies have characterized gene mutations or mosaic chromosomal alterations (mCAs) individually. Here we leverage peripheral blood sequencing data from 32,442 cancer patients to jointly characterize gene mutations (n = 14,789) and mCAs (n = 383) in CH. Recurrent composite genotypes resembling known genetic interactions in leukemia genomes underlie 23% of all detected autosomal alterations, indicating that these selection mechanisms are operative early in clonal evolution. CH with composite genotypes defines a patient group at high risk of leukemia progression (3-year cumulative incidence 14.6%, CI: 7-22%). Multivariable analysis identifies mCA as an independent risk factor for leukemia development (HR = 14, 95% CI: 6-33, P < 0.001). Our results suggest that mCA should be considered in conjunction with gene mutations in the surveillance of patients at risk of hematologic neoplasms.

Surviving glioblastoma and a sense of disconnection

Given the poor prognosis of glioblastoma, little focus has been placed on the needs of long-term survivors (those alive at least two years following diagnosis). The aim of this project was to explore the lived experience of long-term survivors of glioblastoma using a qualitative approach. Long-term survivors of glioblastoma diagnosed between 1/1/2006-31/12/2016 were identified at the tertiary centre involved. Participants underwent a semi-structured qualitative interview and caregiver dyads were collected if available. Thematic analysis was undertaken where themes were gradually generated from the data alongside data collection and confirmed or contrasted as data collection proceeded. Participants were selected and interviewed until data saturation was reached at 10 interviews. The overarching theme explaining the data was a sense of disconnection, beginning with the shock of diagnosis, and evolving over time, leading survivors to feel disconnected from (1) 'who I was', redefining their work, independence and social self; (2) 'who I am', contributing to social isolation, disavowal, and anxiety and depression; and (3) 'who I could be', reassessing their future. This unique study highlights the acute emotional distress and disconnection that begins with diagnosis and its evolving impact on the lived experience. Clinicians need to consider the emotional impact of survival when managing these patients and adopt a holistic approach, including the early introduction of psychosocial support to patients and their caregivers. Further validation of these findings in a larger cohort is desirable.

Cancer therapy shapes the fitness landscape of clonal hematopoiesis

Acquired mutations are pervasive across normal tissues. However, understanding of the processes that drive transformation of certain clones to cancer is limited. Here we study this phenomenon in the context of clonal hematopoiesis (CH) and the development of therapy-related myeloid neoplasms (tMNs). We find that mutations are selected differentially based on exposures. Mutations in ASXL1 are enriched in current or former smokers, whereas cancer therapy with radiation, platinum and topoisomerase II inhibitors preferentially selects for mutations in DNA damage response genes (TP53, PPM1D, CHEK2). Sequential sampling provides definitive evidence that DNA damage response clones outcompete other clones when exposed to certain therapies. Among cases in which CH was previously detected, the CH mutation was present at tMN diagnosis. We identify the molecular characteristics of CH that increase risk of tMN. The increasing implementation of clinical sequencing at diagnosis provides an opportunity to identify patients at risk of tMN for prevention strategies.

Chemotherapy and COVID-19 Outcomes in Patients With Cancer

PURPOSE

Coronavirus-2019 (COVID-19) mortality is higher in patients with cancer than in the general population, yet the cancer-associated risk factors for COVID-19 adverse outcomes are not fully characterized.

PATIENTS AND METHODS

We reviewed clinical characteristics and outcomes from patients with cancer and concurrent COVID-19 at Memorial Sloan Kettering Cancer Center until March 31, 2020 (n = 309), and observed clinical end points until April 13, 2020. We hypothesized that cytotoxic chemotherapy administered within 35 days of a COVID-19 diagnosis is associated with an increased hazard ratio (HR) of severe or critical COVID-19. In secondary analyses, we estimated associations between specific clinical and laboratory variables and the incidence of a severe or critical COVID-19 event.

RESULTS

Cytotoxic chemotherapy administration was not significantly associated with a severe or critical COVID-19 event (HR, 1.10; 95% CI, 0.73 to 1.60). Hematologic malignancy was associated with increased COVID-19 severity (HR, 1.90; 95% CI, 1.30 to 2.80). Patients with lung cancer also demonstrated higher rates of severe or critical COVID-19 events (HR, 2.0; 95% CI, 1.20 to 3.30). Lymphopenia at COVID-19 diagnosis was associated with higher rates of severe or critical illness (HR, 2.10; 95% CI, 1.50 to 3.10). Patients with baseline neutropenia 14-90 days before COVID-19 diagnosis had worse outcomes (HR, 4.20; 95% CI, 1.70 to 11.00). Findings from these analyses remained consistent in a multivariable model and in multiple sensitivity analyses. The rate of adverse events was lower in a time-matched population of patients with cancer without COVID-19.

CONCLUSION

Recent cytotoxic chemotherapy treatment was not associated with adverse COVID-19 outcomes. Patients with active hematologic or lung malignancies, peri-COVID-19 lymphopenia, or baseline neutropenia had worse COVID-19 outcomes. Interactions among antineoplastic therapy, cancer type, and COVID-19 are complex and warrant further investigation.