Hospital Authority

Abstract Background: Metaplastic breast cancer (MpBC) is a rare and aggressive subtype of breast cancer with limited guidance on an optimal management approach in existing clinical guidelines. We evaluated long-term outcomes and treatment efficacy in early MpBC patients across major cancer centers in Hong Kong. Methods: Women with non-metastatic MpBC diagnosed from January 2001 to December 2023 at four Hong Kong hospitals were identified via Hong Kong Cancer Registry. Clinical data, treatment response, recurrence, and survival were analyzed by histological and molecular subtype according to current standards, based on review of original pathology reports. Survival analyses were conducted using the Kaplan-Meier method and compared using log-rank test. Factors associated with survival were evaluated by univariate and multivariate Cox regression. Results: In total, 145 consecutive patients with non-metastatic MpBC were included. The median age at diagnosis was 57 years (IQR 51-68 years), with 64.8% being postmenopausal. Most patients presented with a solitary tumor (94.5%), commonly in upper outer quadrant (58.6%). Squamous cell carcinoma (20.7%) and spindle cell carcinoma (13.1%) were the most common histological subtypes. Most cases were stage II (55.2%), with a median tumor size of 3.5 cm (IQR 2.4-6.0 cm), node-negative at diagnosis (66.2%), and grade 3 tumors (66.9%). Molecular subtyping showed that 49.7% of tumors were triple-negative, 45.5% were hormone receptor-positive only (≥1% ER and/or PR-positive tumor cells), 2.8% were HER2-positive only, and 2.1% were both ER/PR-positive and HER2-positive. 4.1% of tumors were ER low, and 37.9% HER2 low. Most patients underwent mastectomy (77.2%) with axillary dissection (58.6%), and 93.8% achieved clear margins. Neoadjuvant chemotherapy was given to 13.8% of patients, with a pathological complete response (pCR) in 5.0% and a partial response in 50.0%. Adjuvant chemotherapy and radiotherapy were given to 57.2% and 60.7% of patients, respectively. At a median follow-up of 112 months (IQR 28-165), the 5-year overall survival was 67%. Five-year locoregional and distant relapse-free survival rates were 90.4% and 72.1%, respectively. Locoregional recurrence occurred in 11%, and distant metastases in 27.6% of patients, mainly involving visceral sites (90%). Upon univariate analysis followed by multivariate analysis adjusted for grade, T stage, and molecular subtype, adjuvant chemotherapy was significantly associated with improved overall survival (HR 0.42, 95% CI 0.22-0.82, p=0.01), while adjuvant radiotherapy was not (HR 0.69, 95% CI 0.38-1.24, p=0.21). In T3/4 or node-positive subgroup, adjuvant chemotherapy remained significantly associated with improved overall survival (HR 0.32, 95% CI 0.12-0.83, p=0.02), whereas adjuvant radiotherapy did not show significance for overall survival (HR 0.65, 95% CI 0.29-1.45, p=0.29) or for locoregional relapse-free survival (HR 0.98, 95% CI 0.40-2.40, p=0.96). No significant differences in pCR rates following neoadjuvant chemotherapy were observed across molecular subtypes (p=0.67). Adjuvant endocrine therapy was not associated with overall survival in hormone receptor-positive cases (p=0.88), nor was targeted therapy in HER2-positive cases (p=0.47). Conclusion: This study showed that MpBC is a distinct subtype of breast cancer, characterized by unique clinicopathological characteristics and responsiveness to treatments. Adjuvant chemotherapy was associated with improved overall survival in non-metastatic MpBC, while adjuvant radiotherapy did not demonstrate a significant benefit. The low response rate to neoadjuvant chemotherapy highlights the urgent need to develop novel therapeutic strategies to enhance outcomes for this challenging patient population. Citation Format: S. S. Tse, K. Bao, K. Cheung, J. Chow, I. Wong, C. Wong, O. Mang, H. Yiu, C. Kwan. Long-term outcomes and prognostic factors in metaplastic breast cancer treated with curative intent: a 22-year multicenter retrospective cohort study [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 PS4-08-09.

Abstract Background: Rates of youth vaping have become a major concern over the past decade with worries about impacts of vaping on neurodevelopment, mental health, transition to cigarettes, and unknown long-term physical sequelae. In 2023, the American Academy of Pediatrics (AAP)’s updated tobacco care guidelines encouraged primary care providers to consider using nicotine replacement therapy (NRT) products to help support youth vaping and tobacco cessation. This study sought to explore the determinants to using NRT products for youth vaping cessation per AAP recommendations amongst primary care providers in an urban, safety-net health system where use of NRT for youth was limited. Methods: This study used a mixed-methods case study design guided by the Practical, Robust Implementation and Sustainability Model (PRISM). Nine primary care providers caring for patients aged 12-17 completed key informant interviews and a modified version of the PRISM Contextual Survey Instrument (PRISM-CSI) between May and July 2025. Qualitative analysis was done using a rapid matrix approach and quantitative analysis was descriptive in nature. Themes/subthemes and mean PRISM-CSI item scores were integrated to generate final mixed meta-inferences. Results: 5 themes with 13 subthemes emerged from qualitative analysis. In quantitative analysis, all PRISM-CSI item mean scores were rated as either neutral (2.50-3.49 on 1-5 rated ordinal scale) or positive (≥3.50). A total of 14 meta-inferences were generated from integration of qualitative and quantitative results, showing that AAP guidelines on NRT were considered acceptable and met an important need, but contextual determinants important to implementation included addressing time/work demands, provider training, confidentiality, insurance coverage/affordability, managing follow up, youth perceptions of harms and treatment preferences, perceived limited concurrent public health/policy intervention, and bolstering existing practice change infrastructure. Conclusions: AAP guidelines on NRT were considered reasonable by providers interviewed and surveyed in this study while acknowledging specific contextual determinants for successful implementation. Providers also felt it was important to strengthen ongoing public health and policy efforts to address youth vaping in addition to clinical intervention. This study provides insight into the translation of efforts such as the AAP guidelines in a specific healthcare system to address a pressing health issue for youth.

ABSTRACTAimThis study aimed to investigate associations between the nurse practice environment and nurse‐sensitive patient outcomes in Hong Kong.DesignThis was a 4‐wave repeated cross‐sectional study.MethodsThe sample comprised 71 adult general medical, surgical and orthopaedic wards recruited from four public hospitals. Data on nurses' practice environment and nurse‐sensitive patient outcomes were collected quarterly from each hospital over a one‐year period from January 2016 to December 2018. The number of participating nurses per survey wave ranged from 604 to 865. Measures comprised the Practice Environment Scale of the Nursing Work Index and four nurse‐sensitive patient outcomes identified from the National Quality Forum‐endorsed nursing‐sensitive care measure set. The associations between each outcome and the practice environment were examined using multiple regression analysis.ResultsNurse practice environments were rated favourably. The ‘Nursing foundations for quality of care’ subscale received the highest score (59.6) while the ‘Staffing and resource adequacy’ subscale received the lowest score (36.7). Though no significant associations were found between the overall practice environment and nurse‐sensitive patient outcomes, the subscale of ‘Staffing and resource adequacy’ was significantly associated with the incidence of inpatient falls and catheter‐associated urinary tract infections.ConclusionsOur findings suggest that staffing is a core nurse workplace concern which impacts the outcomes of inpatient falls and catheter‐associated urinary tract infections. However, the overall nurse practice environment was not significantly associated with any patient outcomes, and further studies are needed to corroborate these results. Additional mediating factors such as nurse resilience, which may potentially affect patient outcomes, should also be explored.No Patient or Public ContributionPatients or the general public were not involved in the design, analysis, or interpretation of the data in this study.

BackgroundHypertension is the most prevalent chronic condition and is the leading cause of cardiovascular diseases, imposing enormous burdens on the healthcare system. Although telemedicine may provide improved blood pressure (BP) monitoring and control, it remains unclear whether it could replace face-to-face consultations for patients with optimal BP control. Thus, the primary objective of this study is to investigate whether participants assigned to the telemedicine group show non-inferior BP control compared to the usual care group at 12 months.MethodsThis randomised controlled trial (RCT) will involve 364 patients receiving anti-HT medications who have well-controlled BP on out-of-office BP measurements, including HBPM or ambulatory blood pressure measurements (ABPM). Participants will be randomised to either the telemedicine (HealthCap) group or usual care (control) group (1:1). Patients in the intervention group will measure and transmit their 7-day home BP measurements (HBPM) to the physician’s office. The medications will be refilled without consultation when optimal control (<135/85 mmHg for patients without comorbidities and <130/80 mmHg for patients with comorbidities that increase cardiovascular risk) and safety questions are confirmed. Nevertheless, if any of the answers in the safety questions are positive or the HBPM mean is suboptimal, patients will have consultations as planned. Investigators will be blinded to the randomisation sequence and allocation. The primary outcome is the daytime ABPM systolic BP at 12 months. Secondary outcomes include HT treatment adherence, self-efficacy, number of visits to primary care clinics where they have clinical follow-up, health care utilisation other than general outpatient clinics (GOPCs) in both arms at baseline, 6 months, and 12 months. Acceptability will be assessed through interviews with the telemedicine study participants and the physician.Discussion and significanceThis trial will examine whether patients in the telemedicine group would have non-inferior BP control compared to patients in the usual care group. It has the potential to change clinical practice and have important research implications because patients with optimal BP can monitor their BP through a telemedicine system and will have fewer frequent clinical visits. This will empower primary care and allow effective and safe allocation of scarce medical resources to patients in need. Moreover, it will save patients time because of the long wait to see doctors and collect medications in GOPCs. It is also encouraging the engagement of patients in their health because they will play a proactive role in managing their chronic illnesses.Trial registrationClinicalTrials.gov NCT06524180. Registered on July 29, 2024. https://clinicaltrials.gov/study/NCT06524180?term=NCT06524180&rank=1#more-information.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13063-025-09350-3.

Background and ObjectivesInformal caregivers of people with dementia experience significant caregiving stress. Mindfulness-based interventions are effective approaches for alleviating caregiving stress. However, traditional mindfulness training is intensive and challenging to attend due to the substantial caregiving responsibilities of this population, leading to issues with program attrition and adherence. To address this limitation, a novel Mindfulness-Based Dementia Care Program (MBDCP) was developed by simplifying traditional mindfulness training and utilizing a hybrid delivery model tailored to the needs of dementia caregivers. This study aimed to evaluate the effectiveness of the MBDCP in reducing caregiving stress compared with a brief education program.Research Design and MethodsA single-blinded, parallel-group randomized controlled trial was conducted with 127 dementia caregivers (MBDCP: n = 64; Control: n = 63) recruited from three community care centers in Hong Kong. The MBDCP included six weekly 90-min sessions delivered through face-to-face and online formats. Outcomes were assessed at baseline, postintervention, and 6-month follow-up. The primary outcome was perceived stress, whereas secondary outcomes included heart rate variability, mindfulness, depressive symptoms, caregiving burden, dyadic relationships, and neuropsychiatric symptoms of care recipients.ResultsMBDCP significantly improved perceived stress, depressive symptoms, trait mindfulness, and heart rate variability compared with the control group. No significant effects were observed on caregiving burden, dyadic relationships, positive caregiving aspects, or neuropsychiatric symptoms.Discussion and ImplicationsThe MBDCP effectively reduced stress and improved psychophysiological outcomes in dementia caregivers. These findings highlight the potential of simplified, hybrid mindfulness training to enhance accessibility and effectiveness for this population.