National estimates project COVID-19 negatively influenced cancer screening, leading to an estimated deficit of 3.9 million breast cancer (BC) screenings among US adults. 1,2 In San Francisco, California, low-income neighborhoods disproportionately affected by COVID-19 bear the burden of higher BC stage at diagnosis. 3,4 We sought to evaluate the association of COVID-19 and BC screening in a safety-net hospital in San Francisco. MethodsThis cross-sectional study evaluated trends in BC screening at an urban integrated health system's safety-net hospital. We obtained the number of screening mammograms per month during 2019 from electronic health record (EHR) data, and aggregate numbers between September 1, 2019, and January 31, 2021, after the implementation of a new EHR. The number of screening mammograms per month was plotted against the 2019 baseline. Proportions of completed tests by phase of the pandemic (pre-COVID-19, first stay-at-home order, reopening, and second stay-at-home order) were compared by race/ethnicity and age with 2-sided, 2-sample proportion tests. Race/ethnicity was used as a proxy for the disproportionate burden of COVID-19 and experiences of individual and systemic racism experienced by minority communities. Analyses were conducted with Stata, version 16 (StataCorp LLC). P < .05 was used to determine significance. We followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline for cross-sectional studies. 5 Deidentified data collected for quality improvement activities does not require approval from The University of California, San Francisco institutional review board; this study was therefore exempted from review.

Background Chemotherapy-induced peripheral neuropathy (CIPN) is a common toxicity secondary to chemotherapy. Genetic factors may be important in predisposing patients to this adverse effect. Patients and Methods We studied 950 primary lung cancer patients, who received platinum or platinum-combination drug chemotherapy and who had DNA available for study. We analyzed epidemiological risk factors in 279 CIPN patients and 456 non-CIPN patients and genetic risk factors in 141 CIPN patients and 259 non-CIPN patients. The risk factors studied included demographic, diagnostic, and treatment data, as well as 174 tag SNPs (single nucleotide polymorphisms) across 43 candidate genes in the glutathione, cell cycle, DNA repair, cell signaling, and apoptosis pathways. Results Patients who had diabetes mellitus were more likely to have CIPN (p=0.0002). Other epidemiologic risk factors associated with CIPN included number of cycles (p=0.0004) and type of concurrent chemotherapy (p<0.001) . SNPs most associated with CIPN were in glutathione peroxidase 7 (GPX7) gene (p values 0.0015 and 0.0028, unadjusted and adjusted) and in ATP-binding cassette sub-family C member 4 (ABCC4) gene (p values 0.037 and 0.006, unadjusted and adjusted). We also found other suggestive associations in methyl-o-guanine-methyl-transferase (MGMT) and glutathione-S-transferase (GST) isoforms. Conclusions Epidemiological and genetic risk factors associated with CIPN in this cohort, included the type of chemotherapy drug, intensity of chemotherapy treatment, and genes known to be associated with chemotherapy resistance. These findings suggest that differentiating between cytotoxic and neurotoxic mechanisms of chemotherapy drugs is challenging but represents an important step toward individualized therapy and improving quality of life for patients.

Objective To identify changes in incidence of cutaneous melanoma over time in the fastest-growing segment of the US population, middle-aged adults. Patients and Methods Using the Rochester Epidemiology Project resource, we identified patients aged 40 to 60 years who had a first lifetime diagnosis of melanoma between January 1, 1970, and December 31, 2009, in Olmsted County, Minnesota. Incidence of melanoma and overall and disease-specific survival rates were compared by age, sex, year of diagnosis, and stage of disease. Results From 1970 through 2009, age- and sex-adjusted incidence increased significantly over time (P<.001) from 7.9 to 60.0 per 100,000 person-years, with a 24-fold increase in women and a 4.5-fold increase in men. Although not significant (P=.06), incidence of melanoma increased with age. Overall and disease-specific survival improved over time, with hazard ratios of 0.94 (P<.001) and 0.93 (P<.001) for each 1-year increase in year of diagnosis, respectively. Each 1-year increase in age at diagnosis was associated with increased risk of death from any cause (hazard ratio, 1.07; P=.01) but was not significantly associated with disease-specific death. Sex was not significantly associated with death from any cause or death from disease. No patient with malignant melanoma in situ died from disease. Patients with stage II, III, and IV disease were over 14 times more likely to die from disease compared with patients with stage 0 or I disease (P<.001). Conclusion The incidence of cutaneous melanoma among middle-aged adults increased over the past 4 decades, especially in middle-aged women, while mortality decreased.

Background. The proportion of women in the field of hematology and oncology (H&O) has increased over recent decades, but the representation of women in leadership positions remains poor. In an effort to close the gender gap in academia, it is important to report on such inequities in hopes to close these gaps and improve career development. Materials and Methods. We conducted a retrospective, observational study of published award recipients from 1994 to 2019 from the seven major H&O societies in the world. Gender was determined based on publicly available data. Chi-square and Cochran-Armitage tests were utilized for data analysis. Results. Of the 1,642 awardees over the past 26 years, 915 met inclusion criteria. Award recipients were overwhelmingly men (77.9%) and non-Hispanic white (84.7%).

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PURPOSE: Graduate medical and research training has drastically changed during the COVID-19 pandemic, with widespread implementation of virtual learning, redeployment from core rotations to the care of patients with COVID-19, and significant emotional and physical stressors. The specific experience of hematology-oncology (HO) fellows during the COVID-19 pandemic is not known. METHODS: We conducted a mixed-methods study using a survey of Likert-style and open-ended questions to assess the training experience and well-being of HO fellows, including both clinical and postdoctoral trainee members of the American Society of Hematology and ASCO. RESULTS: A total of 2,306 surveys were distributed by e-mail; 548 (23.8%) fellows completed the survey. Nearly 40% of fellows felt that they had not received adequate mental health support during the pandemic, and 22% reported new symptoms of burnout. Pre-existing burnout before the pandemic, COVID-19–related clinical work, and working in a primary research or nonclinical setting were associated with increased burnout on multivariable logistic regression. Qualitative thematic analysis of open-ended responses revealed significant concerns about employment after training completion, perceived variable quality of virtual education and board preparation, loss of clinical opportunities to prepare for independent clinical practice, inadequate grant funding opportunities in part because of shifting research priorities, variable productivity, and mental health or stress during the pandemic. CONCLUSION: HO fellows have been profoundly affected by the pandemic, and our data illustrate multiple avenues for fellowship programs and national organizations to support both clinical and postdoctoral trainees.

PURPOSE: The COVID-19 pandemic led to unprecedented challenges in medical training, and we sought to assess the specific impact of COVID-19 on hematology-oncology (HO) fellowship programs. METHODS: We conducted a cross-sectional anonymous online survey of 103 HO program directors (PDs) in conjunction with the American Society of Hematology (ASH) and ASCO. We sought to assess the specific impact of COVID-19 on HO fellowship programs' clinical, educational, and research activities, evaluate perceptions regarding PD and trainee emotional and mental health, and identify ways to support programs. Data were analyzed using descriptive statistics, parametric and nonparametric tests, and multivariable logistic regression models. Responses to open-ended questions were analyzed with thematic analysis. RESULTS: Significant changes to fellowship activities included transitioning fellow training from outpatient clinics to telehealth (77.7%), shifting to virtual education (94.2%), and moving to remote research work (63.1%). A minority (21.4%) of PDs reported that their fellows were redeployed to cover non-HO services. Most PDs (54.4%) believed COVID-19 had a slight negative impact on fellowship training. PD self-reported burnout increased significantly from 15.5% prepandemic to 44.7% during the pandemic, and most PDs witnessed minor signs of fellow burnout (52.4%). Common PD concerns included inadequate supervision for telehealth activities, reduced opportunities for fellow advancement and promotion, lack of professional development activities, limited research operations and funding, program financial constraints, and virtual recruitment. CONCLUSION: We encourage institutions and national societies to allocate resources and develop programs that can support fellowships and mitigate the potential negative effects of COVID-19 on trainee and PD career development.

A diverse workforce is critical to providing high-quality, equitable neurologic care. Many neurologic conditions disproportionately affect Black and Latinx people, but these populations have limited access to neurologic care.1,2 Although healthcare disparities can be reduced with a diverse workforce,3-7 just 2.8% of neurologists are Black and 7.2% are Latinx, compared with the most recent US census with 12.8% of individuals identifying as Black and 18.4% as Latinx.8,9 The gap also exists at the trainee level; 4.4% of neurology residents are Black and 7.2% are Latinx.10 Recruitment of an inclusive residency class is paramount to addressing these inequities.3,5,7,11 A record of 42,508 medical students and physicians applied for residency positions in the United States in 2020–2021, as the application season moved to a virtual format because of the COVID-1912 pandemic. Future residency application seasons will likely be a hybrid of in-person and virtual recruitment. This change presents both unique opportunities and challenges for the recruitment of a diverse and inclusive residency class.13