Ariel E Hirsch’s research while affiliated with Boston University and other places

The field of radiation oncology (RO) has experienced large fluctuations in the number of applicants to residency programs. It is essential to understand the modifiable factors which influence entry. The objective of this project is to identify factors (i.e., “enablers”) that motivate prospective medical students to apply to RO. A survey was developed to characterize RO enablers and barriers as perceived by current RO residents. An existing conceptual framework of why medical students choose primary care was used as the foundation of the survey and was modified for relevance towards RO. The final mixed-methods survey was administered to Canadian RO residents (2015–2019 match years) via Program Directors and the Canadian Association of Radiation Oncologists resident member database. Medical students are most likely to select a career in RO during or after a clerkship experience. Extrinsic factors strongly motivating interest in RO were (% rating as very important or extremely important on a 5-point scale) as follows: positive feedback from radiation oncologists (86%) and RO residents (66%), clinical rotations in RO (84%) and mentorship (77%). Intrinsic factors include perceived fulfillment (95.2%), commitment to patient care (85.3%), and intellectual challenge (67.7%). Qualitative data highlighted the importance of mentorship, the “hand-heart” connection, career variability/flexibility, career satisfaction/lifestyle, and personal connections with cancer/cancer care in motivating students to pursue RO. Increased preclinical exposure such as mentorship may encourage students to seek clerkship opportunities in RO. These findings inform strategies to recruit medical students to a career in RO.

Introduction Typically, oncology is not a structured part of the curriculum in Brazilian medical schools. Furthermore, sarcomas, which are uncommon tumors, are seldom covered in depth. A lack of comprehensive education on sarcomas might result in medical professionals being ill-equipped to care for patients with this condition. Objectives To assess medical students' understanding and awareness of sarcomas and the specific principles related to these tumors. Materials and methods A quantitative, cross-sectional study was conducted using a questionnaire, applied to medical students, focusing on the epidemiology, pathophysiology, and treatments of bone and soft tissue sarcomas. In all tests, the significance level adopted was 5%. The SPSS version 25.0 software was used. Results Of the 825 questionnaires distributed, 325 were returned. Educational sessions on sarcomas did not appear to significantly improve the student's knowledge. Only 29.5% of students identified the lack of pain as an indicator of potential malignancy in soft tissue sarcomas, while 73.8% correctly recognized pain as a symptom of bone sarcomas. Limb amputation as the optimal surgical method for patient recovery was incorrectly reported by 39.1% of the sample. Conclusion A great part of the surveyed population does not have adequate knowledge about the basic concepts associated with limb sarcomas. The minority of them are satisfied with the knowledge gained during their medical education about these tumors. Inadequate medical academic training may initially lead to the wrong clinical management of patients with bone and soft tissue tumor lesions. An educational effort is needed to enhance oncology education for medical students, especially concerning sarcomas.

e12537 Background: The landmark trials, TAILORx and RxPONDER have established Oncotype DX (ODX) as a prognostic and predictive tool in the management of estrogen receptor positive (ER+), early-stage breast cancer. However, recent studies have revealed existing racial disparities in the ODX test. These findings call into question whether ODX is generalizable to diverse populations. We evaluated the prognostic value of ODX RS at an urban, academic safety net hospital. Methods: We conducted a single-institution retrospective study of patients diagnosed with invasive breast cancer and had an ODX test performed between January 1, 2010 to December 31, 2021. Demographic, tumor and treatment characteristics were obtained. Chi-square and ANOVA were used to examine associated factors among recurrences and non-recurrences. Results: We identified 315 patients diagnosed with ER+ breast cancer with an ODX test obtained. Racial breakdown was 47% White, 35% Black and 18% Other. 69% of the patients had public or no insurance. 20% of the patients had a low RS (0-10), 62% had intermediate (11-25) and 18% were high (26-100). 264 patients had no evidence of recurrence, 15 patients had a local or distant recurrence and 36 were unknown. Recurrence was significantly associated with younger age (p = 0.04), higher histologic grade (P < 0.001, < 0.001), intermediate oncotype score (p = 0.002) and no receipt of chemotherapy (p = 0.014). Focused analysis of the recurrence cohort demonstrates a significant proportion with an Intermediate ODX RS classification (93.3%, P = 0.001). 53% had distant recurrence, 20% had received adjuvant chemotherapy and 93.3% were adherent to hormonal therapy. Conclusions: In a diverse patient population, recurrences were significantly more likely among younger patients with high grade tumors, intermediate RS and those who did not receive chemotherapy. Further investigation and understanding whether Oncotype DX is generalizable to diverse breast cancer patient populations is needed.

Background: Male breast cancer (MBC) is rare, and management is extrapolated from trials that enroll only women. It is unclear whether contemporary axillary management based on data from landmark trials in women may also apply to men with breast cancer. This study aimed to compare survival in men with positive sentinel lymph nodes after sentinel lymph node biopsy (SLNB) alone versus complete axillary dissection (ALND). Patients and methods: Using the National Cancer Database, men with clinically node-negative, T1 and T2 breast cancer and 1-2 positive sentinel nodes who underwent SLNB or ALND were identified from 2010 to 2020. Both 1:1 propensity score matching and multivariate regression were used to identify patient and disease variables associated with ALND versus SLNB. Survival between ALND and SLNB were compared using Kaplan-Meier methods. Results: A total of 1203 patients were identified: 61.1% underwent SLNB alone and 38.9% underwent ALND. Treatment in academic centers (36.1 vs. 27.7%; p < 0.0001), 2 positive lymph nodes on SLNB (32.9 vs. 17.3%, p < 0.0001) and receipt or recommendation of chemotherapy (66.5 vs. 52.2%, p < 0.0001) were associated with higher likelihood of ALND. After propensity score matching, ALND was associated with superior survival compared with SLNB (5-year overall survival of 83.8 vs. 76.0%; log-rank p = 0.0104). Discussion: The results of this study suggest that among patients with early-stage MBC with limited sentinel lymph node metastasis, ALND is associated with superior survival compared with SLNB alone. These findings indicate that it may be inappropriate to extrapolate the results of the ACOSOG Z0011 and EORTC AMAROS trials to MBC.

An estimated 32.2% and 41.9% of breast cancer patients experience depression and anxiety, respectively. However, due to differences in the understanding of radiotherapy and variability in the severity of side effects, responses of patients with breast cancer receiving radiation therapy may vary at different time points and differ in comparison to other patients with breast cancer. This study sought to describe the changes in levels of depression and anxiety experienced by English and Spanish-speaking patients throughout a course of radiation therapy for breast cancer along with the impact of different variables on these levels to better understand and quantify potential gaps. Eligibility criteria included English and Spanish-speaking females, ages 18 or older, undergoing radiation therapy treatment for breast cancer at Boston Medical Center. Pre- and post-treatment surveys were completed before and after delivery of radiation therapy. Survey included sociodemographic questions along with the standardized PHQ-4 questionnaire, which uses a maximum total score of 12, to assess anxiety and depression. Results were analyzed using a least means square procedure. A total of 60 participants completed pre- and post- treatment surveys. Total baseline distress mean (BDM) was 3.32 (SD= 3.55) and final distress mean (FDM) was 3.22 (SD= 3.78). English-speaking patients comprised 70% (n=42) of the sample and had a BDM of 3.40 with an adjusted change mean (ACM) decrease of 0.48. Spanish-speaking patients comprised 30% (n=18) of the sample, with a BDM of 3.11 and an ACM increase of 0.79, differences in ACM trended toward significance with a p-value of 0.083. Sociodemographic characteristics included: race, ethnicity, marital status, education level and longest residency. Additional variables surrounding social determinants of health included housing and food insecurity, which showed statistically significant increasing distress with increased insecurity at baseline. While our study showed a higher BDM among English-speaking patients in comparison to Spanish-speaking patients, results showed that Spanish-speakers’ distress increased throughout treatment as opposed to English-speakers. Most of our patient population was English-speaking, though approximately one third Spanish-speaking and our participants were also primarily Black, non-Hispanic, never married, had a high school or associate level education, and had their longest residence in the US. Although the majority did not report housing or food insecurity, both had increasing DM with increased insecurity, with statistically significant results. As the number of Spanish-speakers in the US continues to increase, it will be important to continue assessing potential differences in cancer care. In addition, an understanding of the changes of distress throughout radiation treatment could help inform future interventions that address these disparities. Baseline distress values and adjusted change in overall score by sociodemographic factors Citation Format: Corina Beiner, Jenny Zhao, Muhammad Mustafa, Ariel Hirsch. Comparing Changes in Depression and Anxiety Levels of Breast Cancer Patients throughout a Course of Radiation Therapy [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-37.