HealthEast Care System

Abstract Purpose African American breast cancer patients remain significantly underrepresented in clinical trials, despite experiencing more aggressive disease and disproportionately worse outcomes. While awareness of clinical trials has increased, there is still a gap between awareness and participation, especially due to limited access to personalized support and actionable next steps. BreastCancerTrials.org and Sisters Network® Inc. partnered to assess attitudes, knowledge, beliefs, and experiences related to clinical trials as part of a larger initiative to improve trial awareness and enrollment in African American women. Methods Sisters Network® Inc distributed a survey to over 100 African American breast cancer survivors affiliated with the organization to gather insights on their knowledge, experiences, and beliefs about clinical trials. As the largest national African American breast cancer survivorship organization with more than 30 chapters across the U.S., Sisters Network® Inc utilized its extensive network to reach a broad and diverse community of survivors. The survey asked about participants demographics, breast cancer details, and familiarity with clinical trials. It covered communication with healthcare providers, trial eligibility and experience, barriers to participation, challenges finding trial information, and interest in using clinical trial navigation for support. Results Preliminary findings show that more than 65% of respondents were familiar or somewhat familiar with clinical trials. When asked about participation, 44% said they would join a trial if their healthcare provider offered it as an option. Most participants lived in urban (51%) or suburban (46%) areas and were early-stage breast cancer survivors. Specifically, 14% were diagnosed at stage 0, 34% at stage 1, 46% at stages 2 or 3, and 3% had metastatic cancer. Regarding biomarker status, 34% reported being ER/PR positive, 21% had Triple Negative breast cancer, and 22% were unsure of their status. Thirty percent of respondents had discussed clinical trial participation with their healthcare team. Of those, 67% said the healthcare team initiated the conversation, while 16% reported bringing it up themselves. Key barriers to clinical trial participation included difficulty determining eligibility, challenges finding a trial, and limited understanding of how trials work. Despite these challenges, most respondents expressed interest in learning more. Over half indicated they would be interested in clinical trial navigation services, with 52% identified as having interest in receiving education and support from a clinical trial navigator. Conclusion This study further demonstrates the barriers that African American breast cancer patients experience, and the fact that they could benefit from culturally competent, personalized navigation. This survey was the first step in a broader effort to build trust and increase clinical trial knowledge, awareness, and participation among African American breast cancer patients through the development of customized, culturally responsive education programs and navigation support. BreastCancerTrials.org and Sisters Network® Inc. efforts to improve access and diversity in clinical trials will support broader initiatives within both organizations. Insights from this study will also help refine our enrollment strategies for the I-SPY clinical trials. Citation Format: S. Mayhew, S. Colen, L. Patel, S. Horton, K. E. Jackson, C. Allen, O. Akanni, J. LaCoursiere, T. Heather, E. Laura. Listening to the Community: Barriers and Beliefs About Clinical Trials Among Black Women with Breast Cancer [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS4-09-01.

Abstract Background: Despite an unparalleled global refugee crisis, there are almost no studies in primary care addressing real-world conditions and longer courses of treatment that are typical when resettled refugees present to their physician with critical psychosocial needs and complex symptoms. We studied the effects of a year of psychotherapy and case management in a primary care setting on common symptoms and functioning for Karen refugees (a newly arrived population in St Paul, Minnesota) with depression. Methods: A pragmatic parallel-group randomized control trial was conducted at two primary care clinics with large resettled Karen refugee patient populations, with simple random allocation to one year of either: (1) intensive psychotherapy and case management (IPCM), or (2) care-as-usual (CAU). Eligibility criteria included Major Depression diagnosis determined by structured diagnostic clinical interview, Karen refugee, ages 18-65. IPCM (n=112) received a year of psychotherapy and case management coordinated onsite between the case manager, psychotherapist, and primary care providers; CAU (n=102) received care-as-usual from their primary care clinic, including behavioral health referrals and/or brief onsite interventions. Blinded assessors collected outcomes of mean changes in depression and anxiety symptoms (measured by Hopkins Symptom Checklist-25), PTSD symptoms (Posttraumatic Diagnostic Scale), pain (internally developed 5-item Pain Scale), and social functioning (internally developed 37-item instrument standardized on refugees) at baseline, 3, 6 and 12 months. After propensity score matching, data were analyzed with the intention-to-treat principle using repeated measures ANOVA with partial eta-squared estimates of effect size. Results: Of 214 participants, 193 completed a baseline and follow up assessment (90.2%). IPCM patients showed significant improvements in depression, PTSD, anxiety, and pain symptoms and in social functioning at all time points, with magnitude of improvement increasing over time. CAU patients did not show significant improvements. The largest mean differences observed between groups were in depression (difference, 5.5, 95% CI, 3.9 to 7.1, P <.001) and basic needs/safety (difference, 5.4, 95% CI, 3.8 to 7.0, P <.001). Conclusions: Adult Karen refugees with depression benefited from intensive psychotherapy and case management coordinated and delivered under usual conditions in primary care. Intervention effects strengthened at each interval, suggesting robust recovery is possible.

While refugee integration is defined as a bidirectional process of mutual learning and adaptation, in practice, the U.S. resettlement program continues to emphasize refugees’ acculturation processes and places little emphasis on cultural or logistical adaptation of existing services. When adaptation does happen, it is often structured around dominant notions of health and well-being. There is a need to explore bidirectional integration processes and existing systems adaptations to accommodate people with refugee backgrounds at the institutional level. This article details a framework to build a sustainable collaboration between a refugee community and existing health and social service systems to reduce harmful alcohol use. The conceptual framework emphasizes three components: 1) adaptation of refugees’ indigenous expertise, networks, systems, and resources; 2) adaptation of existing systems to serve new groups in culturally relevant and effective ways; and 3) the participatory processes through which refugees and existing systems collaborate to achieve mutual goals. This paper describes the application of this framework and concludes with a discussion of lessons to support replication of the framework in other settings. Lessons learned include: equalizing power, paying attention to relationships and roles, engaging in deep cultural adaption of interventions, and building individual and organizational capacity to support partners.

Radiofrequency (RF) ablation is effective for slow pathway ablation, but carries a risk of inadvertent AV block requiring permanent pacing. By comparison, cryoablation with a 4-mm distal electrode catheter has not been reported to cause permanent AV block but has been shown to be less effective than RF ablation. We sought to define the safety and efficacy of a 6-mm distal electrode cryoablation catheter for slow pathway ablation in patients with atrioventricular nodal reentry tachycardia (AVNRT). Twenty-six U.S. and eight Canadian centers participated in the study. Patients with supraventricular tachycardia (SVT) thought likely to be AVNRT were enrolled. If AVNRT was inducible and confirmed to be the clinical SVT, then the slow pathway was targeted with a cryoablation catheter using a standardized protocol of best practices. Acute success was defined as inducibility of no more than one echo beat after cryoablation. Primary efficacy was defined as acute success and the absence of documented recurrent AVNRT over 6 months of follow-up. Primary safety was a composite of serious procedure-related adverse events and/or device-related complications. Note that 397 subjects met enrollment criteria after the EP study and received cryoablation. Mean ablation procedure duration (including a waiting period) was 89 ± 40minutes, and mean fluoroscopy time was 4.8 ± 5.9minutes. Isoproterenol was administered before cryoablation in 53% and after the last lesion in 85% of cases. Acute procedural success was realized in 95% (378 of 397) of subjects. No subject received a permanent pacemaker due to AV block. The slow pathway could not be ablated in 19 subjects, including: 12 due to inefficacy, 2 due to transient AV block, and 5 due to both inefficacy and transient AV block. RF ablation was used in the same procedure in 11 of 19 failed subjects, and was ineffective in 3 subjects. Among the group with acute success, 10 subjects (2.7%) had documented recurrent AVNRT over the 6-month follow-up period, and all occurred within 3 months of the index cryoablation. Serious procedure-related adverse events occurred in 4 subjects (1.0%), including one each: tamponade, pulmonary embolism, femoral vein hemorrhage, and diagnostic EP catheter knotting. None of these serious adverse events were related to use of the cryoablation catheter. Overall, 93% of subjects had successful slow pathway ablation at 6 months with the study cryoablation catheter. Cryoablation for AVNRT using a focal 6-mm catheter was safe and effective. It resulted in a low risk of recurrence over 6 months of follow-up with no incidence of AV block requiring permanent pacing.

Few studies have explored the public's views of genetic counseling services, and even fewer focus on founder populations with high prevalence of genetic disease, such as Hutterites. The Hutterites are an Anabaptist religious group grounded in a strong Christian faith. The primary aim of this study was to assess Hutterites' views of genetic counseling services. A secondary aim was to compare their views to those obtained in a study of rural Midwestern U.S. residents (Riesgraf et al., Journal of Genetic Counseling, 24(4), 565-579, 2015). One-hundred eleven individuals from southern Manitoba Hutterite colonies completed an anonymous survey assessing familiarity with and attitudes about genetic counseling; perceptions of its purpose, scope and practice; and willingness to use genetic counseling services. Although many respondents were not familiar with genetic counseling, most had accurate perceptions and positive attitudes. For instance, mean ratings showed endorsement of trust in information provided by genetic counselors and agreement that genetic counseling aligns with their values. Logistic regression indicated reported willingness to use genetic counseling services increased if respondents: had a higher self-rated familiarity with genetic counseling; were younger; agreed with the statement: I would trust the information provided by a genetic counselor; and disagreed with the statements: Genetic counseling is only useful for a small group of people with rare diseases, and Genetic counselors help expectant parents choose the eye color of their child. Thematic analysis of comments regarding willingness to use genetic counseling services yielded themes of personal/family risk, pragmatism (genetic counseling is sensible and practical for managing health concerns), and desire to prevent genetic conditions in the Hutterite population. Comparison of the present findings to those of Riesgraf et al. suggests predictors of Hutterites' willingness to use genetic counseling are unique and culturally-based. Limited replication of Riesgraf et al. was achieved. Additional findings, practice implications and research recommendations are presented.

Background: To evaluate the prevalence of peripheral neuropathy associated with bortezomib and its relation to multiple myeloma versus other malignancies. Keywords: Bortezomib, chemotherapy, peripheral neuropathy, multiple myeloma and malignancy.