Renown Health

Abstract Background: Antibody-drug conjugates (ADCs) such as trastuzumab deruxtecan (T-DXd) and sacituzumab govitecan (SG) have revolutionized breast cancer (BC) treatment, providing superior efficacy that allows for extended treatment durations. Nausea and vomiting (NV) are among the most frequent adverse effects associated with T-DXd and SG, with nausea rates of >70% for T-DXd and >60% for SG in BC clinical trials. According to antiemetic guidelines, patients receiving T-DXd and SG are at moderate-to-high risk for NV and should routinely receive prophylaxis with an NK1 receptor antagonist (RA)-containing regimen. With limited real-world data on antiemetic efficacy in the ADC setting, a survey of international healthcare providers (HCPs) was conducted to assess their experience. Methods: At SABCS 2024, HCPs completed a brief web-based survey to assess their experiences and perceptions of ADC emetogenicity and approaches to antiemetic prophylaxis. Target participants included HCPs familiar with ADCs who manage patients with BC. Eligible participants completed the survey on computers located in the exhibit hall. Results: Of 209 HCPs surveyed, 112 were eligible. Most were oncologists (69%) or hematologist/oncologists (21%) who spent 73% of time in patient care; nearly half were US-based (46%). Among all HCPs, 80% reported using ADCs in practice and/or in clinical trials; 99% had experience with T-DXd and 87% with SG. Among HCPs using T-DXd and SG, 78% and 83%, respectively, perceived them as either highly (32% and 28%) or moderately (46% and 55%) emetogenic. NV reported by HCPs in this survey was much lower than in the T-DXd and SG clinical trials; HCPs reported that 30%, 25% and 15% of their BC patients treated with T-DXd experience N and/or V during the acute (0-24 hours), delayed (days 2-5), and long-delayed (beyond day 5) phases, respectively. Similarly, the reported NV rates were 29%, 26% and 13%, respectively, for SG. HCPs reported that 88% of patients treated with any ADCs in an average month receive antiemetic prophylaxis; however, only 39% of HCPs report exclusively using a guideline-recommended NK1 RA regimen with T-DXd or SG. The majority of HCPs (94%) reported implementing some type of dose adjustments of ADCs due to NV. A third to nearly half of HCPs had at least sometimes implemented an ADC dose reduction or delay due to NV while a quarter reported interrupting or discontinuing ADC treatment (Table). More than half reported using rescue medication at least sometimes for delayed NV. Conclusions: This survey highlights a gap between evidence and HCP perceptions regarding NV with T-DXd and SG, and reveals higher-than-expected dose reductions, likely reflecting suboptimal adherence to antiemetic guidelines. As ADCs gain prominence in BC treatment, these findings underscore the need for education and guideline-implementation to optimize NV prevention. Citation Format: L. S. Schwartzberg, L. Licata, G. Bianchini, Y. H. Park, E. J. Roeland, M. Massagrande, F. Dato, H. Iihara, F. Scotte, K. Jordan, M. Aapro, H. S. Rugo. Examining Antiemetic Management with Antibody-Drug Conjugates (ADCs) in Patients with Breast Cancer: Healthcare Provider (HCP) Insights from a SABCS Survey [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 PS1-01-13.

Patients receiving moderately emetogenic chemotherapy (MEC) are commonly prescribed a 5-hydroxytryptamine-3 (5-HT3) receptor antagonist (RA) and dexamethasone (DEX) as standard-of-care (SOC) antiemetic prophylaxis. However, in patients with an elevated risk of chemotherapy-induced nausea and vomiting (CINV) due to individual risk factors, prophylaxis with an neurokinin-1 (NK1) RA-containing regimen may optimise their antiemetic prevention. To address this unmet need for a more personalised antiemetic strategy, the MyRisk trial incorporated a predictive risk factor algorithm to select patients at increased risk of CINV who may benefit from enhanced antiemetic prophylaxis. MyRisk was a phase IV, randomised, open-label, multicentre, multinational trial. Adult patients scheduled to receive three cycles of MEC with a high-risk CINV score were randomly assigned to NEPA (a fixed combination of an NK1 RA, netupitant, and 5-HT3 RA, palonosetron) + DEX or SOC. The CINV risk score was calculated based on an algorithm that considered seven risk factors. The primary endpoint was complete response (CR: no emesis/no rescue medication) during the overall phase (0-120 h) across three consecutive cycles. Of 401 randomly allocated patients, 388 were included in the efficacy analysis. The most common cancers were colorectal and lung; oxaliplatin and carboplatin were the most common MECs. Patients randomly assigned to NEPA were significantly more likely to experience a CR compared with SOC (odds ratio 1.67, 95% confidence interval 1.12-2.49, P = 0.012). The NEPA group had a significantly higher probability of CR, no nausea, no emesis, and complete protection (81.0%, 63.7%, 95.4%, and 71.8%, respectively) compared with the SOC arm (71.8%, 54.9%, 86.7%, and 62.4%, respectively) across three cycles of chemotherapy. When individual risk factors are considered before MEC, a three-drug regimen including NEPA provides superior CINV prevention across multiple cycles compared with the standard two-drug approach. These findings underscore the value of personalised risk-adapted antiemetic strategies and have practice-changing potential for optimising antiemetic control.

Lungs recovered from donation after circulatory death (DCD) are markedly underutilized for transplantation in the U.S. Evidence demonstrating excellent outcomes after DCD lung transplantation underpins the need for strategies to mitigate barriers to DCD lung utilization, including data driven revisions to allocation policy, revising program-specific quality metrics, removing financial barriers, and minimizing logistical disincentives. Expanded DCD transplantation is vital to reduce waitlist mortality and increase lung transplant rate.

Introduction: In the current climate of cost containment and fiscal responsibility, high-value implant alternatives offer a substantial opportunity for savings in the treatment of orthopedic trauma patients. As patents have expired on many commonly used trauma implants, high-value alternatives have become available. The purpose of this study was to examine the clinical and economic impact of a cost containment program utilizing high-value, single lag screw cephalomedullary hip nail implants for treating intertrochanteric femur fractures. Design: Retrospective comparative cohort study. Setting: Level II trauma center Patients/Participants: 885 patients (347 Males and 538 Females) with intertrochanteric femur fractures. Intervention: Patients treated with high-value single lag screw cephalomedullary implants were compared to those treated with conventional implants during the same period. Main Outcome Measurements: Operative records were reviewed to identify intraoperative complications, operative time, and estimated blood loss. Cases involving infection, malunion, nonunion, or the need for repeat surgery were documented. Hospital financial records were evaluated to determine implant costs. Results: 443 patients were treated with the high-value implant, while 442 patients received conventional single lag screw cephalomedullary implants over the same period. No difference was observed in intraoperative complications or estimated blood loss. Operative time was significantly shorter in the high-value implant group (p=2.3E-10). There was no increase in postoperative infection rates, implant complications, malunion, or nonunion. Overall, the hospital saved a total of $512,994 on implant costs. Conclusions: Implant costs decreased significantly without an increase in complication rates or changes in radiographic outcomes. These savings were essential to our success in the Bundled Payment for Care Improvement (BPCI) initiative. Additionally, the savings can be reinvested into the trauma program in alignment with OTA/AAOS position statements and guidelines, as well as to support gainsharing and co-management initiatives. Level of Evidence: Level III - Retrospective comparative cohort study Keywords: Cephalomedullary nail, Hip fracture, High-value implants, Cost containment, Orthopaedic trauma.

Abstract RATIONALE Lung cancer screening rates are low nationally at 5.8% and clinicians are looking for innovative methods to detect early lung cancer. Artificial intelligence (AI) can use algorithms to detect lung nodules size and morphology with sensitivity to detect suspicious cancerous nodules reported in up to 97%. A promising benefit of AI is implementation in a clinical workflow to engage and follow up with patients on suspicious incidental lung nodules. Our hypothesis is that by using an AI text based Pulmonary Nodule Patient Management tool (Aidoc, Tel Aviv, Israel), we will see an increase in patients engaging in healthcare utilization, due to following physicians interfacing with the tool for lung nodule detection and management. METHODS This is a prospective study using natural processing language (NPL) to identify incidental pulmonary nodules in reports of CT chests that were performed at Renown Health. Nodules were separated by size based on the Fleishner guidelines. Nodule clinical provider, pulmonologists, and internal medicine residents then followed the workflow presented in Appendix A and B. RESULTS 14,133 reports analyzed were identified with pulmonary nodules of which 3,709 identified nodules that are 8 mm or greater. All of these the patients that were known to the nodule clinic, pulmonary clinic or oncology clinic were removed as part of the algorithm. Using the Pulmonary Nodule Patient Management tool positive predictive value (PPV) was 95% in identifying 8 mm nodules needing follow up and a sensitivity of 100% with no false negatives. 81% of patients who required follow up were scheduled for follow up, 8% to be scheduled for follow up in nodule clinic or with a pulmonologist. The remaining patients are patients who have received a letter to notify them of the finding as the patient has no primary care provider to send the referral. CONCLUSIONS To date, this study shows that AI text based patient management solution algorithm can be implemented into clinical workflows with excellent accuracy as shown with the PPV of 95%. The next step would be to see how many of the incidental lung nodules identified by Pulmonary Nodule Patient Management tool were diagnosed with lung cancer when initially identified. Additional upgrades to the algorithm will be to integrate directly with electronic health system for contacting patient's and their primary care providers of their results and for patients to schedule their appointment, improving follow up.

45 Background: Despite the efficacy of oral adjuvant endocrine therapy (AET) for improving survival among women with hormone receptor-positive early-stage breast cancer, adherence rates remain low. Our THRIVE study (NCT03592771) investigated the effectiveness of a mobile health remote monitoring app with and without tailored educational messages on AET adherence among women with breast cancer and found no statistically significant treatment effects on 1-year AET adherence overall. Health literacy contributes to patients’ understanding of their treatment plans. We conducted a post hoc analysis of the THRIVE study to examine if health literacy moderates the effectiveness of this intervention. Methods: This non-blinded randomized controlled trial included women with early-stage breast cancer prescribed AET at a large cancer center with 14 clinics across three states. Participants used a pillbox to electronically monitor AET adherence for 1 year and completed surveys at enrollment. Consented participants were randomized into (1) “App”, receiving access to the study adherence and symptom monitoring app for 6 months, with increasing/severe symptoms and missed doses reported in the app triggering follow-ups from the oncology team; (2) “App+Feedback”, receiving additional weekly text messages about managing symptoms, adherence, and communication for 6 months; or (3) “Enhanced Usual Care (EUC).” The primary outcome was 1-year AET adherence captured with the pillbox (≥80% Proportion of Days Covered [PDC] vs. < 80%). The enrollment survey captured participant’s sociodemographic characteristics, including race and ethnicity, education, household income, and health literacy. We used a linear probability model to measure the interaction between the study arm and health literacy on AET adherence. Results: Among 304 women randomized (104 EUC, 98 App, and 102 App+Feedback), the 12-month follow-up retention rate was 88% (n = 266) and 19.4% reported low health literacy at enrollment. Low health literacy was more prevalent among Black (29.4%) vs. White (13.4%) participants (p < 0.001), those with incomes below the federal poverty level (34.4% vs. 17.2% of those with higher incomes, p = 0.02), and those with only a high school degree or lower education (31.7%) vs. with those with some college or higher education (16.4%, p < 0.01). In the low health literacy group, 80.0% of App+Feedback were AET adherent vs. 42.1% of EUC, a 37.9 percentage point (ppt) difference (95% CI: 4.1 to 71.7, p = 0.03); in higher literacy group adherence, 47.1% of App+Feedback vs. 59.0% of EUC were adherent, a -11.8 ppt difference (95% CI: -27.9 to 4.3, p = 0.15). Conclusions: A remote monitoring app with tailored educational text messages led to higher 1-year AET adherence among participants with low health literacy, but not for those with high health literacy. Clinical trial information: NCT03592771 .

ABSTRACT Patient-centered care and healthcare consumerism are dominant models of the patient-provider relationship. Positioning theory was applied to examine consumers’ and physicians’ positions on patient-centered care and healthcare consumerism, along with their attitudes toward direct-to-consumer healthcare service advertising and trust in the medical profession. Surveys were conducted with a convenience sample of consumers and physicians respectively. Patient-centered care was the only theoretical construct that both consumers and physicians unequivocally embraced. Both groups were either ambivalent or skeptical of the other three concepts. Between the two groups, physicians exhibited a stronger endorsement of patient-centered care and more negative attitudes toward advertising than consumers. When the relationships among the theoretical constructs were examined, a negative correlation between patient-centered care and consumerism was found among consumers. Also, patient-centered care and trust were negatively correlated in both groups. Implications of these findings are discussed for strategic communication, consumer and physician education, and future research.