Abstract PO-057: Cancer center support for understanding statewide COVID-19 prevalence and early detection

NCI-funded cancer centers are committed to serving the needs of their catchment area—at no other time have these needs been greater or more explicit. To this end many cancer institutes are redirecting the efforts of Community Outreach and Engagement (COE) programs to address COVID-19 related needs. The Knight Cancer Institute, recognizing the substantial resources they bring in community engagement and population science, has taken a lead role in establishing a statewide study of the prevalence of COVID-19 related symptoms and active disease. The Knight team has developed and implemented a syndromic and active surveillance system that allows monitoring of COVID-19 related symptoms as early indicators of COVID-19 accompanied by symptomatic and asymptomatic testing. The Key to Oregon study, started with state funding, will create a cohort of up to 100,000 individuals. Participants are identified with household statewide random sampling with stratification and oversampling for geography (rural/urban) and race/ethnicity. A secure, HIPAA-compliant web-based data entry portal was developed and individuals are consented to provide daily information of symptoms related to COVID-19 and a series of additional surveys addressing issues such as financial impact, mental health impact, and physical impacts (including cancer screening behaviors) of the COVID-19 pandemic. Individuals meeting symptom thresholds consistent with potential coronavirus infections are offered a mailed, home-based COVID-19 testing kit. Additionally, asymptomatic testing of randomly selected individuals will be conducted at regular intervals. In the first 2 weeks of recruitment, nearly 10,000 individuals have enrolled. Weekly review of data assesses for recruitment bias and provides focus for community engagement efforts. The Knight COE team leverages their existing relationships and infrastructure to support engagement in communities of color, Native American, Latin X, and rural groups. Listening sessions have been held and Knight will direct resources to support community organizations committed to assisting with outreach for the Key to Oregon study. The value of this study as a mechanism for informing public health policy and health care resource distribution is immense. Further, the impact, while not immediate, on cancer research and cancer care is substantial, from building community-level trust that will long outlast the pandemic, to providing early indicators of infection hot spots that allow susceptible individuals to make potentially life-saving decisions, to establishing a statewide cohort of individuals who may be re-approached for future cancer-related studies. The ability of an NCI-designated cancer center to rapidly and effectively redirect and repurpose resources has allowed for the development of this innovative statewide resource.

Citation Format: Jackilen Shannon, David Bangsberg, Paul Spellman, Bridget Barnes, Jenny Lee Berry, Kim Brown, Derick DuVivier, Kathryn Goforth, Peter Graven, Christopher Peters, Kathryn Schuff, Brian Druker. Cancer center support for understanding statewide COVID-19 prevalence and early detection [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr PO-057.

American Thyroid Association Guidelines on the Management of Thyroid Nodules and Differentiated Thyroid Cancer Task Force Review and Recommendation on the Proposed Renaming of Encapsulated Follicular Variant Papillary Thyroid Carcinoma Without Invasion to Noninvasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features

American Thyroid Association (ATA) leadership asked the ATA Thyroid Nodules and Differentiated Thyroid Cancer Guidelines Task Force to review, comment on, and make recommendations related to the suggested new classification of encapsulated follicular variant papillary thyroid carcinoma (eFVPTC) without capsular or vascular invasion to noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP). The task force consists of members from the 2015 guidelines task force with the recusal of three members who were authors on the paper under review. Four pathologists and one endocrinologist were added for this specific review. The manuscript proposing the new classification and related literature were assessed. It is recommended that the histopathologic nomenclature for eFVPTC without invasion be reclassified as a NIFTP, given the excellent prognosis of this neoplastic variant. This is a weak recommendation based on moderate-quality evidence. It is also noted that prospective studies are needed to validate the observed patient outcomes (and test performance in predicting thyroid cancer outcomes), as well as implications on patients' psychosocial health and economics.

Research participant-centered outcomes at NIH-supported clinical research centers

BACKGROUND

Although research participation is essential for clinical investigation, few quantitative outcome measures exist to assess participants' experiences. To address this, we developed and deployed a survey at 15 NIH-supported clinical research centers to assess participant-centered outcomes; we report responses from 4,961 participants.

METHODS

Survey questions addressed core aspects of the research participants' experience, including their overall rating, motivation, trust, and informed consent. We describe participant characteristics, responses to individual questions, and correlations among responses.

RESULTS

Respondents broadly represented the research population in sex, race, and ethnicity. Seventy-three percent awarded top ratings to their overall research experience and 94% reported no pressure to enroll. Top ratings correlated with feeling treated with respect, listened to, and having access to the research team (R(2) = 0.80-0.96). White participants trusted researchers more (88%) than did nonwhite participants collectively (80%; p < 0.0001). Many participants felt fully prepared by the informed consent process (67%) and wanted to receive research results (72%).

CONCLUSIONS

Our survey demonstrates that a majority of participants at NIH-supported clinical research centers rate their research experience very positively and that participant-centered outcome measures identify actionable items for improvement of participant's experiences, research protections, and the conduct of clinical investigation.

Tumor genotype and clinical outcomes for 229 patients with non-small cell lung cancer

e19141

Background: Advances in genetic analysis have created a successful paradigm shift in the treatment of advanced lung cancer. Prior studies characterizing molecular profiles in lung cancer have been limited by analysis of a restricted number of genes and lack of clinical outcomes correlation. To overcome these limitations, this study investigates a prospective cohort of lung cancer patients using an expanded molecular profile and evaluates clinical outcomes. Methods: Non-small cell lung cancer (NSCLC) patients enrolled from April 1, 2011 through December 31, 2012 are included in this analysis. Formalin-fixed, paraffin-embedded tumor tissue was analyzed, using mass spectrometry-based panel of multiplexed assays (through July 31, 2012) or using next-generation sequencing detecting hydrogen-ions generated during DNA polymerization (using Ion Torrent from August 1 through December 31, 2012). Clinical information was collected at enrollment and throughout the study. Results: Analysis of 229 enrolled patients revealed 52% women, 95% had ECOG performance status 0-2, 89% Caucasian, and 28% never smokers. Successful molecular analysis (at least one successful analysis) occurred in 178 patients. Fifty-one patients had insufficient tissue for any successful molecular analysis. One hundred twenty-five mutations were detected among ninety-seven patients. The most frequent mutations included KRAS (28%), TP53 (20%), EGFR (13%), ALK translocations (6%), and BRAF (3%). At the time of analysis, 49% of the study population was deceased. Of the deceased, 37% harbored at least one genetic mutation within their tumor sample. Overall survival for those with mutations was 22.7 months, compared to overall survival for those without mutations of 23.3 months. Conclusions: Our analysis contributes to the growing body of data on molecular abnormalities in NSCLC by expanding the knowledge of common and less-commonly documented mutations, as well as characterizing the clinical outcomes associated with the mutations documented. These data emphasize the diversity of mutations and outcomes for NSCLC, and highlight the need for additional research of prognostic genetic markers and improvements in targeted therapies.

The role of molecular markers and tumor histological type in central lymph node metastasis of papillary thyroid carcinoma

OBJECTIVE

To look for genetic mutations that might predict central compartment lymph node metastasis (LNM) in papillary thyroid carcinoma (PTC) using strict criteria for N0 and N1 disease.

DESIGN

We identified patients with PTC from our institution's pathology archives. Strict criteria were used for assessing the presence or the absence of central neck LNM. Disease was classified as N0 only if a comprehensive ipsilateral and pretracheal central neck dissection was performed and if pathological analysis revealed no evidence of LNM. Primary tumor samples were analyzed for a panel of known or suspected PTC-associated molecular markers, including BRAF, RET -PTC, KRAS, NRAS, HRAS, PIK3CA, and their variants.

SETTING

Academic medical center.

PATIENTS

Three hundred eighty-nine patients with PTC.

MAIN OUTCOME MEASURE

Molecular mutations in tumors with and without LNM.

RESULTS

Of 389 identified cases, 209 fit the inclusion criteria, with 158 classified as node positive (N1) and 51 as node negative (N0). The follicular variant histological type was present in 7 of 158 N1 tumors (4.4%) and 24 of 51 N0 tumors (47.1%) and thus was strongly associated with lack of central neck metastasis in this study (odds ratio, 0.05; 95% CI, 0.02-0.14). Predictive factors for central LNM included extracapsular extension, angiolymphatic invasion, and higher T stage (T3 and T4). The BRAF mutation was more prevalent in the classic PTC histological type than the follicular variant. None of the molecular marker mutations that were analyzed in this study, including the BRAF mutation, predicted LNM in classic PTC.

CONCLUSIONS

Positive risk factors for central LNM include male sex, extracapsular extension, angiolymphatic invasion, and advanced T stage. The follicular variant histological type has a significantly lower incidence of central neck metastasis. In contrast to recent studies, the BRAF mutation was not significantly associated with central neck LNM from PTC when using a strict definition of a central neck dissection.

Role of Lymphocytic Thyroiditis in Metastasis of Papillary Thyroid Carcinoma

Objective: The role of chronic lymphocytic thyroiditis (CLT) in papillary thyroid carcinoma (PTC) is unclear. Studies have failed to demonstrate correlation of CLT with lymph node metastases (LNM) in part due to lack of standardized central lymph node dissection (CND). We investigate the incidence of LNM in specimens with CLT.

Method: All OHSU patients who underwent total thyroidectomy with comprehensive ipsilateral CND for PTC between 2005 and 2010 were included. All specimens underwent genomic mutation analysis using a panel of known mutations. Reports were reviewed for tumor type, presence of lymphocytic thyroiditis, extracapsular extension, angiolymphatic invasion, and nodal metastasis.

Results: A total of 139 patients met the selection criteria for this study. The overall rate of chronic lymphocytic infiltrate was 43.8%. The overall rate of central node positivity was 63%. There was a significantly higher proportion of central node positivity in the non-CLT patients (74% vs 49%, P = .003). There was also a higher rate of angiolymphatic invasion in the non-CLT patients (31% vs 15% P < .05). There was no significant difference in mean age, tumor size, and extracapsular extension. Molecular genotyping did not reveal a significant difference in the types of mutations found in both groups.

Conclusion: Our data indicates a lower incidence of LNM in those with CLT ( P = .003), suggesting a potential protective role in tumor spread. The equal distribution of mutations in tumors with and without CLT argues against mutation-specific inflammation. Further research is needed to characterize the role of autoimmunity in thyroid cancer.