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Community health workers (CHWs) provide vital support to underserved communities in the promotion of health equity by addressing barriers related to the social determinants of health that often prevent people living with diabetes from achieving optimal health outcomes. Peer support programs in diabetes can also offer people living with diabetes invaluable support through a shared understanding of the disease and by offsetting diabetes-related stigma. As part of a Project Extension for Community Healthcare Outcomes (ECHO) Diabetes program, participating federally qualified healthcare centers were provided diabetes support coaches (DSCs) to facilitate patient engagement. DSCs hold invaluable expert knowledge, as they live with diabetes themselves and reside in areas they serve, thus combining the CHW role with peer support models. The use of DSCs and CHWs during the coronavirus disease 2019 pandemic and beyond is highly effective at reaching underserved communities with diabetes and promoting health equity.

Azacitidine (AZA) maintenance following allogeneic hematopoietic cell transplantation (HCT) for acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) may reduce relapse risk and improve survival. Given logistic and toxicity-related challenges, identifying subgroups appropriate for this approach is an unmet need. Using data from two centers, we retrospectively compared event-free survival (EFS) and overall survival (OS) of AML and MDS patients who received AZA maintenance (

Microbiome dysbiosis has been associated with adverse outcomes of hematopoietic cell transplantation (HCT). We hypothesized that exposure to high-dose melphalan and antimicrobials in patients undergoing autologous HCT for plasma cell disorders results in oral and gastrointestinal microbial dysbiosis, which in turn is associated with regimen-related toxicities. We conducted a prospective study describing the longitudinal changes in oral and gastrointestinal bacteriome and mycobiome in this patient population. Our findings show that microbiome composition present at baseline is associated with the incidence and severity of post-transplantation nausea, vomiting, and culture-negative neutropenic fever, as well as with the rate of neutrophil engraftment. We also have evidence of an association between the microbial communities at count nadir and the development of regimen-related gastrointestinal toxicities commonly observed after exposure to high-dose melphalan. Although bacteriome diversity largely recovers within 1 month after transplantation, we observed a continuous decrease in oral and gastrointestinal mycobiome diversity, suggesting that the mycobiome requires a longer time to recover compared with the bacteriome.

Introduction Relapse after allogeneic hematopoietic stem cell transplantation (HSCT) for acute myeloid leukemia (AML) and myelodysplastic syndrome (MDS) remains a major cause of treatment failure with associated poor prognosis. Low-dose post-HSCT maintenance azacitidine (AZA) has proved to be beneficial in preventing relapses (de Lima et al. Cancer 2010). Herein, we retrospectively evaluated outcomes of patients (pts) treated with low-dose AZA post-HSCT. Methods Pts with AML and MDS who underwent allogeneic HSCT between 2012-2018 at two centers were evaluated and categorized into AZA group (with low-dose AZA maintenance) and control group (without AZA maintenance). In control group, pts who died or relapsed prior to day +100, had grade III-IV aGVHD or received maintenance therapy other than AZA (e.g. FLT3 inhibitors) were excluded. Using Kaplan-Meier method, event (defined as relapse or death) free survival (EFS) and overall survival (OS) were computed and compared using log-rank test. Results A total of 107 patients were included; 53 (49.5%) in AZA and 54 (50.5%) in control groups. Disease and transplant-related characteristics are shown in table 1. Both groups were comparable with respect to age, diagnosis, disease risk stratification, disease status at HSCT, and MRD status at day +30 and day +100 (table 1). More pts received reduced intensity conditioning (RIC) in the AZA group (71.6% vs 37%, p= Conclusions In our cohort, low-dose AZA maintenance was generally well tolerated. The results of this study indicate that AZA maintenance is feasible and associated with improved EFS and OS. In addition, AZA has the potential of improving relapse rates even in pts who are unable to receive myeloablative conditioning as a significant number of pts in AZA group in this study received RIC. The optimal timing, duration of treatment and selection of pts most suitable for AZA for maximum benefit, however, requires further studies.

Incorporating palliative care (PC) is becoming the standard of care for patients with advanced solid tumors but stem cell transplant (SCT) patients infrequently receive early referral to PC. This may be due to a variety of reasons, including persistence of the belief that treatment aimed at cure contradicts the indication for palliative care. The purpose of this pilot project was to assess physical and psychological symptom burden in a baseline group of 30 patients undergoing autologous or allogeneic SCT. This was a prospective quality improvement project designed to obtain baseline data for use in developing a PC intervention of SCT patients. A simple modified 16-question Edmonton Symptom Assessment Survey (ESAS) was self-administered using an iPAD by 15 autologous and 15 allogeneic SCT patients just prior to admission (Time 1), and at time points T+10 (Time 2), and T+30 (Time 3). Tiredness was the most severe of all symptoms at all time points. Patients undergoing allogeneic SCT compared to autologous SCT reported higher levels of all symptoms at all time points. The differences between allogeneic vs autologous SCT approached significance for depression (p=.079) and anxiety (p=.063) at T1, tiredness (p=.064) at T2, and depression (p=.072) and tiredness (p=.056) at T3. The influences of type of SCT, age, gender, marital status on overall wellbeing, tiredness, pain, anxiety and depression were examined through linear regressions. The model for tiredness at T3 was the only significant model (adj.R2 = .376, p=.013), with gender and type of transplant making significant contributions. Palliative care integration offers the opportunity to add an additional layer of support to meet short term needs of SCT patients as well as symptoms arising in post-transplant survivorship. If PC resources are limited, this baseline assessment suggests allogeneic SCT patients are at higher risk for physical and psychological symptoms than autologous SCT patients.

Patients with early relapse of acute myelogenous leukemia (AML) or myelodysplastic syndrome (MDS) after hematopoietic cell transplantation (HCT) have a poor prognosis, and no standard treatment. Twenty-nine patients with early disease recurrence post-transplantation were treated with azacitidine (AZA; median dose, 40 mg/m2/day for 5 to 7 days). At a median follow-up of 6.3 months (range, 1.3 to 41.1 months), 7 patients (27%) had a response to AZA, defined as complete remission, hematologic improvement, or improved donor chimerism. Response occurred after a median of 3 cycles, and the median duration of response was 70 days (range, 26 to 464 days). Median survival was 6.8 months (95% confidence interval, 3.8 to 11.1 months). Survival was similar in the patients receiving an AZA dose ≤40 mg/m2 and those receiving an AZA dose >40 mg/m2. Six patients receiving donor lymphocyte infusion with AZA had a response or stable disease without worsening graft-versus-host-disease. We retrospectively used a flow cytometry assay to explore DNA-methyltransferase-1 in blood mononuclear cells as a potential pharmacodynamic marker to assess intracellular drug targeting in 8 patients. No correlation with AZA dose or response was observed. Low-dose AZA appears to have comparable efficacy to higher-dose AZA post-HCT. A significant proportion of this poor-risk population responded to low-dose AZA, suggesting a dose-independent, noncytotoxic mechanism for antileukemic activity.

Introduction Risk of venous thromboembolism (VTE) is increased in patients (pts) with multiple myeloma (MM) as a result of the biology of the disease and the use of immunomodulatory drugs (IMiDs). These patients frequently undergo autologous hematopoietic cell transplantation (AHCT) transplantation in order to improve disease-free and potentially overall survival. We conducted this study to better understand the incidence and risk factors associated with peri-transplant VTE in this population. Methods 160 MM pts who received IMiD therapy and underwent AHCT between 6/2004 and 11/2016 at our institution were the subjects of this analysis. The peri-transplant period was defined as time from central venous catheter (CVC) insertion up to 60 days post-transplant. None of the pts received VTE prophylaxis during this period. Results All patients received at least one IMiD-based regimen before transplant including thalidomide (31%), lenalidomide (74%), pomalidomide (6%). Imids were stopped at a median of 38 days prior to collection (range 0 days-4 years). CVCs (double lumen n=103, triple lumen n=50, unknown n=7) were inserted a median of 2.5 days prior to mobilized blood collection (range 0-48 days) and were removed a median of 52.5 days after insertion (range 2-303 days). Twenty of 160 patients (12.5%) developed VTE in the peri-transplant period; there was 11 (55%) CVC-related VTE, 6 (30%) lower extremity VTE and 3 (15%) pulmonary embolism. There was no VTE-related death. Median platelet count at the time of VTE was 90 (range, 30-130) x109/L. Eleven VTEs occurred between time of initiation of progenitor cell mobilization and infusion (T-0), and 9 occurred between T-0 and 60 days post-transplant. The rate of catheter-related VTE that occurred before or after T-0 was similar (55%). Thirty-nine percent of pts had a catheter size of less than 14 french; 49% had a catheter size of 14 french or more; the size could not be collected in 12% of the pts. Rate of catheter-related VTE in pts with ≥ 14 and Conclusion In this retrospective single institution analysis, we found a 12.5% incidence of peri-transplant VTEs, which is higher than what was reported in patients receiving transplant for other malignancies [1]. The size of the catheter did not affect the risk of VTE. About half of the VTEs were catheter-related, half of which occurred before T-0. If confirmed on a larger scale, it may be beneficial to give VTE prophylaxis during mobilization to minimize this risk.

Graft Versus Host Disease (GVHD) is common, complex and at times difficult to differentiate from other complications. GVHD is the leading cause of non-relapse mortality after hematopoietic cell transplant (HCT). Current treatments for GVHD are only partially effective and response rates for first-line treatment of acute GVHD are A 12-person multidisciplinary GVHD committee was formed consisting of advanced practice providers, oncologists, and data and quality specialists. This committee meets monthly to systematically review all current cases of acute and chronic GVHD. Documentation review consists of date of incidence, maximum grade, treatment initiation, discontinuation and response to each line of treatment for weekly acute GVHD assessment and the completion of assessment at 100 days, 6 months, and 1 year for chronic GVHD. Documentation feedback and/or request for clarification is entered into the electronic medical record in the form of a documentation clarification entry. Additional efforts to promote a team based approach include GVHD educational opportunities to enhance assessment skills and discussion of treatment options, including GVHD clinical trials. Documentation review triggers an email recommendation to the provider to consider referral to our chronic GVHD multidisciplinary clinic and the resources of a GVHD specialist. Metrics used to evaluate this project include incidence and grade of acute GVHD, frequency of clarification requests, accuracy of provider documentation, and number of referrals to chronic GVHD clinic. Preliminary results at 6 months for 19 acute GVHD and 44 chronic GVHD cases reviewed indicate improved accuracy in documentation.

Patients with multiple myeloma and their family caregivers must master self-management tasks related not only to the disease and treatment, but also associated with transitioning to living with chronic illness. The aim of this study was to assess the feasibility, acceptability, safety, and fidelity of an intervention that had a psychoeducational approach and included a low-impact, home-based walking activity. A secondary aim was to obtain preliminary data of the effect of the intervention, as compared to an attention control group, on anxiety, activation for self-management, fatigue, depression and health-related quality of life (HRQOL). A sample of 15 adult patients with multiple myeloma and their family caregivers were randomized into either an intervention or attention-control group. The intervention was delivered to the dyad in one session and booster calls were made at 1 and 3 weeks. The control group received printed educational resources and telephone contacts. Measures were done at baseline, and 6 and 12 weeks. Descriptive statistics were used. The intervention was safe, feasible, and acceptable to patients and caregivers. Fidelity was high for the initial session, but low with booster calls. Improvement in scores for activation, fatigue, depression, anxiety, physical HRQOL, and emotional distress was seen in at least 40% of patients in the intervention group. Fewer caregivers in the intervention group showed improvement on the outcome variables. Leveraging a behavioral strategy such as walking, along with supportive and educational resources, is promising for promoting well-being within the patient/caregiver dyad. Further refinement of the intervention is needed to strengthen its efficacy for the caregiver and exploratory work is essential to understand the interpersonal supportive processes associated with the walking activity.

When oncology nurses have strong communication skills, they play a pivotal role in influencing patient satisfaction, adherence to plans of care, and overall clinical outcomes. However, research studies indicate that nurses tend to keep communication with patients and families at a superficial, nontherapeutic level. Processes for teaching goals-of-care communication skills and for implementing skills into clinical practice are not clearly defined. Nurses at a large comprehensive cancer center recognized the need for help with this skill set and sought out communication experts to assist in providing the needed education. An educational project was developed to improve therapeutic communication skills in oncology nurses during goals-of-care discussions and giving bad news. The program was tailored to nurses and social workers providing care to patients in a busy, urban, academic, outpatient oncology setting. Program topics included exploring the patient's world, eliciting hopes and concerns, and dealing with conflict about goals. Sharing and discussing specific difficult questions and scenarios were encouraged throughout the program. The program was well attended and well received by oncology nurses and social workers. Participants expressed interest in the continuation of communication programs to further enhance skills.

This study examines the perception of power among young adult males. A sampleof 1971 male graduates of a state university were asked in 1974 to choose from among pluralistic and elitist models of power in the U.S. The correlates of the various perceptions of power were elaborated using political attitudes, degree of political activism, change in political beliefs, locus of control, and status inconsistency. The findings were that: (1) the respondents tended to perceive an elitist model, although they preferred a pluralist model; and (2) those most likely to perceive power in elitist terms were activists, those with changed political beliefs, those most status inconsistent, and those with external locus of control.

The phenomenon of status inconsisitency, while having rich potential as an explanatory variable, has been beset with methodological problems and conflicting findings. Nelson has argued that the use of objective and subjective components of status inconsistency will allow for a more accurate test of its usefulness (1973). The present study, using a sample of 1971 male college graduates interviewed in 1974, analyzed the attitudinal and behavioral consequences of one type of status inconsistency (under-rewarded) incorporating objective and subjective techniques. The tentative conclusions were: (1) the use of subjective measures of inconsistency validates this phenomenon as an explanatory variable; (2) the use of subjective measures minimizes the methodological criticisms of the objective approach; and (3) both objective and subjective measures of status inconsistency should be incorporated in future research.