e12625 Background: Neoadjuvant Endocrine therapy (NET) is under-utilized for locally advanced hormone receptor + breast cancer (BC) despite literature to date concluding that chemotherapy and NET have comparable response rates but with lower toxicity for the latter. The COVID19 pandemic presented a unique occasion to extend the use of NET for localized BC. Many surgical procedures across the country, including at Dartmouth-Hitchcock Medical Center (DHMC) were postponed in order to redirect resources. The American Society of Breast Surgeons released guidelines to manage patients in which surgery was delayed. For Estrogen Receptor + (ER+), HER2- early-stage tumors, the guidelines recommended NET as first-line treatment. Herein we review the rate of adoption of NET and patient/tumor characteristics associated with NET adoption at DHMC during the lockdown. Methods: A Retrospective analysis of patients diagnosed with early-stage ER+, HER2- BC between December 2019 and June 2020. Inclusion criteria included patients with non-metastatic hormone receptor + BC. Data extracted from chart review included age, menopausal status, tumor stage/grade, body mass index (BMI). A delay in surgery was defined as days between surgical consult and surgery over 14 days. Descriptive statistics will be applied to data collected on patient/tumor characteristics, and the number of patients accepting or declining NET. Results: 109 cases were identified within the study period with 42 cases designated as experiencing delays in surgery. The median age of the group (n = 42) was 62 and the majority was post-menopausal. 36 patients received NET with most started on an aromatase inhibitor. Median BMI was 28.5. Median duration of treatment was 39.5 days. Tumor response to NET was not clearly described in the pathology reports. Three cases were noted to have some decrease in cellularity for pathologic partial response and four had no definite response. Imaging modalities were compared to pathology size and MRI was found to be a fair predictor of size obtained from pathology specimens with a correlation metric of 0.78 indicating that it may serve as the best proxy for pre-treatment size. Pre-surgical MRIs were obtained in 51.3% of cases. The majority of patients on NET had no change in the grade of their pathology. During the course of the pandemic long-term adherence of adjuvant endocrine therapy decreased from 78% for those diagnosed in early 2020 to 56% for those diagnosed in late 2020. Conclusions: The COVID19 crisis was an unprecedented challenge to healthcare systems. Delays in surgery resulted in increased use of NET in early-stage BC. We plan to integrate other data including impact of NET on long-term adherence to endocrine therapy. Change in clinical vs pathologic stage will be reported for those with or without NET. This experience may help guide care during healthcare crises or in resources limited settings.
11006 Background: Comprehensive patient care requires an understanding of medical guidelines and the intersectional context of the patient’s identity and experiences. Hematology/Oncology programs must explicitly teach topics addressing various disparities of care to prepare trainees for informed care. We have developed a Global Oncology and Disparities of Cancer Program to address this gap. Methods: The telementoring program was piloted in 2019 at Dartmouth and has evolved to include didactics, discussion, and evaluations. Participants from across the globe include medical students, residents, Hematology/Oncology Fellows, Faculty, Global Health Scholars, and cancer clinicians. US Hematology/Oncology trainees from Dartmouth and the University of Connecticut consistently participate in the international program. Monthly sessions from September 2021-June 2022 include: Esophageal and GI Cancers in Rwanda, HCC and Cholangiocarcinomas, Gastric Cancer, ASCO International, Global Med ED in Haiti, Breast Cancer in Kosovo, Breast Cancer Risk Factor Prediction Tools Research, Shared Decision Making in Breast Cancer, Hemoglobinopathies, and Health Disparities and Capacity-Building in Rwanda. A pre-course survey was sent to identify participant’s demographics, barriers, and expectations. We will administer a post-course survey. Results: We have preliminary data for our ongoing project. However, we anticipate complete data collection and analysis before the ASCO Meeting. 24 participants were enrolled. 12 (52%) of the participants were located outside of the US in locations such as Haiti, Kosovo, and France. Using a 5-point Likert scale, 11 (46%) participants were “not at all” or only “slightly” aware of obstacles faced by Oncology patients and caregivers in seeking access to healthcare in the US. 7 (29%) participants answered similarly regarding those in low- and middle-income countries. Meanwhile, participants rated ‘’gaining different perspectives’’ as their most important reason for attending with 19 (79%) rating this as “very important” or above. For anticipated improvement from the course, understanding risk factors and cancer biology internationally and recognizing disparities in healthcare between domestic and international settings were the highest rated with 18 (75%) expecting an improvement to a “large degree” or higher. Conclusions: We developed a virtual educational experience to enhance participants’ ability to address disparities of care through challenging Global Oncology topics. Our course is ongoing however initial surveys show a need and desire for this content from participants. We intend to analyze the course surveys to shape future courses. This program can serve as a model for Hematology-Oncology programs to address unmet needs in the curriculum and prepare trainees to provide more complete care to improve cancer outcomes.
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