Women's College Hospital

The CLSA is a national data platform for aging research that used epidemiology-based sampling methods and explicitly excluded people living on First Nations Reserves and other provincial First Nations settlements as possible CLSA participants. As such, the CLSA research approach did not use Indigenous community engagement. Nevertheless, the CLSA sample includes a sizeable subsample of participants who self-identified as First Nations, Métis, or Inuit. This project seeks to describe the self-identified Indigenous subsample of the CLSA from the baseline data collection and interpret that description with the aid of an Elder Advisory Circle. We conducted a descriptive analysis of the self-identified Indigenous subsample of the CLSA from the baseline data collection. The analysis was presented to an Elder Advisory Circle for consultation. The lack of community-engaged approaches to Indigenous research and sampling approaches appears to have resulted in a sociodemographic profile of older Indigenous Peoples that does not match the lived experience of the Elder Advisory Circle and contrasts with other data available on Indigenous Peoples in Canada. We feel the existing CLSA data does not reflect the sociodemographic profile of older Indigenous Peoples. We use this community consultation process to provide recommendations for the appropriate use of the Indigenous-identified data in the CLSA, and we conclude by recommending great caution when using the data from the Indigenous subsample in the CLSA data.

Hip arthroscopy is an increasingly common outpatient surgical procedure where postoperative pain can be severe. Peripheral nerve blocks have been evaluated for analgesia following hip arthroscopy; however, there is no consensus on an optimal technique that provides effective local anesthetic-based postoperative analgesia without motor blockade. We hypothesized that the pericapsular nerve group (PENG) block would provide effective motor-sparing analgesia following ambulatory hip arthroscopy. We conducted a randomized placebo-controlled double-blind trial comparing an ultrasound-guided PENG block with 20 mL of 0.5% ropivacaine to a control with a sham injection. Our primary outcomes were cumulative opioid consumption (oral morphine equivalent) and quality of recovery (QoR-15) scores at 24 hours postoperatively. Secondary outcomes included pain, postoperative opioid consumption, time to first analgesic request, postanesthesia care unit (PACU) length of stay, and opioid and block-related side effects. 94 patients were included (47 per group). QoR was similar between groups at 24 hours as measured by the QoR-15 (range 0-150, higher scores indicate better recovery): mean SD 96.8±20.9 in the PENG group versus 101.0±20.9 in the control group (mean difference -4.2; adjusted p=0.414). Opioid consumption at 24 hours was also similar between groups. In adjusted analyses, the PENG group required less opioid analgesia in the PACU (mean difference -9.5 MME; p=0.039) and had a shorter PACU stay (mean difference -20.5 min; p=0.027). Pain scores at rest and on movement decreased over time in both groups, with no consistent differences in overall pain trajectories. Opioid consumption at 48 hours, opioid-related adverse effects and block-related complications were similar between groups. When administered preoperatively, the PENG block provides only modest early perioperative benefits without improving overall postoperative analgesia or QoR in patients undergoing ambulatory hip arthroscopy. Based on these findings, routine preoperative use of the PENG block for ambulatory hip arthroscopy cannot be recommended beyond standard multimodal analgesia, although it may be considered selectively to facilitate early PACU recovery in carefully chosen patients. The potential role of postoperative PENG block as a rescue intervention warrants further investigation. NCT03449680; https://clinicaltrials.gov/study/NCT03449680.

Knee osteoarthritis (OA) and type 2 diabetes (T2D) commonly coexist, but their combined impact on health-related quality of life (HRQoL) remains understudied. We assessed the association between symptomatic knee OA and HRQoL in individuals with T2D and explored potential explanations. We conducted a secondary analysis of a cross-sectional study of individuals with T2D. Symptomatic knee OA was defined using NICE criteria (age ≥45 years, activity-related knee pain, morning stiffness ≤30 min; no inflammatory arthritis). HRQoL (EQ-VAS, 0-100), sleep disturbance (PROMIS Sleep Disturbance 4a), depressed symptoms (PROMIS Depression 8b), fatigue (PROMIS Fatigue 4a), and walking limitation (Health Assessment Questionnaire) were assessed via questionnaire. Linear regression modeled associations between knee OA and HRQoL, adjusting for age, gender, BMI, education, and comorbidities. The explanatory effects of sleep, mood, and mobility were assessed via further sequential adjustment. We included 341 participants: mean age 66.4 years, 51.9 % female, 29.0 % had knee OA. Participants with T2D and knee OA reported lower HRQoL, greater sleep disturbance, fatigue, depressive symptoms, and walking limitations than those without knee OA. Knee OA was associated with lower HRQoL (β = -11.96; 95 % CI: -16.59 to -7.32) in the unadjusted analysis. Adjustment for confounders partially attenuated this effect (β = -8.33; 95 % CI: -12.72 to -3.94). Further adjustment for sleep, mood, and walking limitations fully attenuated the association. Symptomatic knee OA is strongly associated with impaired HRQoL in T2D, explained by sleep disturbance, low mood, and mobility limitation. Integrated care addressing OA may improve quality of life in this population.

Qualitative research in health equity contexts relies on trust, authenticity, and careful interpretation of lived experiences. Yet underrepresented communities, racialized individuals, people with disabilities, and those experiencing socioeconomic marginalization have often been excluded or superficially engaged, reinforcing structural inequities. Participant misrepresentation, including inaccurate demographics or inconsistent narratives, often reflects systemic forces such as racism, economic precarity, and historical mistrust rather than individual deceit. Using intersectionality and community-based participatory research, we illustrate how recruitment, screening, and data collection intersect with participants’ lived experiences. We offer recommendations, including co-developed eligibility, community verification, reflexivity, and culturally responsive engagement, to uphold rigor, trust, and participant well-being.

Abstract Introduction: Pleomorphic lobular carcinoma (PLC) is an understudied, rare and aggressive form of invasive lobular carcinoma (ILC), distinct from both invasive ductal carcinoma (IDC) and classical ILC. Though histologically related to ILC, PLC clinically resembles high-grade IDC. We evaluated overall survival (OS) and disease-specific survival (DSS) in PLC relative to IDC and ILC, using robust causal inference methods to adjust for clinicopathologic and treatment differences. Methods: The SEER (Surveillance, Epidemiology, and End Results) 17 database was used to identify all adult female patients with primary invasive breast cancer between 2000 and 2022. Inverse probability of treatment weighting (IPTW) based on a multinomial propensity score was used to adjust for baseline differences in demographics (age, race, income, rurality), tumor characteristics (grade, AJCC stage, receptor subtype) and treatment variables (surgery, radiation, chemotherapy). Covariate balance was assessed using standardized mean differences (SMDs) via Love plots. Residual imbalances (SMDs >0.15) were addressed using multivariable Cox models for doubly robust estimation. Proportional hazards (PH) assumption was assessed via Schoenfeld residuals. If satisfied, IPTW-weighted Cox models were used; if violated, time-varying Cox models with log(time) interactions estimated dynamic hazard ratios. Analyses were conducted at all-time, 5- and 10-year follow-ups. Kaplan-Meier curves were used to visualize survival by subtype. LASSO-regularized logistic regression identified 5- and 10-year OS and DSS predictors among PLC patients. Statistical analysis was conducted in R using p < 0.05. Results: Of the 721,127 patients identified, those with PLC (n = 181) when compared with IDC (n = 631,198) and ILC (n = 75,653) presented with larger (PLC: 3.49 ± 2.57 cm, IDC: 2.06 ± 1.53 cm, ILC: 2.73 ± 1.94 cm), higher-grade (grade 3+; PLC: 51.4%, IDC: 35.3%, ILC: 8.1%) and more advanced-stage tumors (stage III; PLC: 23.2%, IDC: 9.8%, ILC: 14.2%). PLC tumors were less likely to be HR+ (ER+ PLC: 70.7%, IDC: 77.6%, ILC: 94.3%; PR+ PLC: 58.6%, IDC: 67.4%, ILC: 80.0%), less likely to be HER2- (PLC: 43.6%, IDC: 50%, ILC: 60%) and more frequently triple negative (PLC: 8.8%, IDC: 6.9%, ILC: 0.8%). PLC patients received more mastectomies (PLC: 55.2%, IDC: 37.9%, ILC: 48.7%) and chemotherapy (PLC: 56.9%, IDC: 43.4%, ILC: 31.9%) yet had comparatively worse unadjusted OS (PLC: 64.1%, IDC 75.9%, ILC: 74.2%) and DSS (PLC: 86.7%,IDC: 91.4%, ILC: 91.1%). PH assumptions were violated in PLC vs ILC comparisons at all-time and 10-year follow-ups. Time-varying models demonstrated a significant early survival advantage in ILC over PLC in both OS (HR = 0.12, 95% CI: 0.05-0.28, p < 0.0001) and DSS (HR = 0.05, 95% CI: 0.02-0.14, p < 0.0001), though this benefit diminished over time (OS HR(tt) = 1.58, 95% CI: 1.29-1.93, p < 0.0001; DSS HR(tt) = 1.88, 95% CI: 1.46-2.43, p < 0.0001). For IDC, a survival advantage was present against PLC in OS at all-time (HR: 0.72, 95% CI: 0.56-0.93, p < 0.05), 5-year (HR = 0.68, 95% CI: 0.49-0.95, p < 0.05) and 10-year follow-up (HR = 0.74, 95% CI: 0.55-0.98, p < 0.05). In the PLC-specific LASSO analysis, poorer outcomes were associated with larger tumors, more advanced stage tumors and identifying as Black, while improved outcomes were associated with lower grade, HR+/HER2+ status and receiving chemotherapy. Conclusion: PLC is associated with significantly worse survival outcomes compared to both IDC and ILC. While ILC confers an early survival benefit that diminishes over time, IDC maintains a consistent OS advantage. Our findings support PLC as an aggressive subtype of ILC warranting dedicated research to improve earlier detection and treatment. Citation Format: D. Walji, V. Giannakeas, D. W. Lim. Clinical characteristics and survival outcomes of Pleomorphic Lobular Carcinoma: a comparative analysis with classical ILC and IDC [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 PS4-08-10.