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Digital exercise interventions to improve physical functioning of people with breast cancer: Protocol for a scoping review

Introduction Breast cancer incidence rates are rising due to early detection, improved screening methods and advances in treatment options. As mortality rates reduce, there is a growing population living longer with treatment side-effects who require assistance. Prevalent issues arising after breast cancer treatment include pain, fatigue, lymphoedema and arm and shoulder mobility issues. Evidence demonstrates that upper limb exercises help reduce these common side effects and improve day-to-day functioning and quality of life. However, access to physiotherapy and rehabilitation services remains limited due to resource and access constraints. Despite a growing interest in digital health resources, little is known about the effectiveness of using digital exercise interventions to help resolve this problem. Methods and analysis A scoping review of available literature will be undertaken to explore what digital or online prehabilitation or rehabilitation interventions exist for people with breast cancer that incorporate an exercise component aimed at improving physical function or mobility. Peer-reviewed studies in English will be eligible for inclusion. A systematic search of Medline ALL, Embase, CINAHL, and Web of Science will be conducted and any relevant grey literature form trusted sources will also be included in our review. The Arksey and O’Malley framework will be applied together with updated guidance from other authors. To enhance rigour, the Joanna Briggs Institute methodology for scoping reviews will also be used to ensure accurate reporting. Articles will be screened by title and abstract against eligibility criteria before independent full text screening by two researchers. Arising conflicts will be resolved by consulting a third reviewer. To summarise the available evidence, data will be extracted using a tailored charting template and a descriptive narrative synthesis will follow. Ethics and dissemination As this research involves the analysis of already published, peer-reviewed literature, ethical approval is not required. The results of this scoping review will be submitted for publication in a peer-reviewed journal. Any significant deviations from the original protocol will be transparently reported and justified.

Self-referenced terahertz time-domain ATR spectroscopy of solutions

Terahertz spectroscopy and imaging have emerged as sophisticated, nondestructive tools for material analysis in physical and biomedical sciences, owing to their sensitivity to molecular vibrations. However, the high absorption of terahertz radiation by water raises a significant challenge for studying liquids and biological samples. This work introduces a novel self-referenced time-domain attenuated total reflection (ATR) spectroscopy technique that overcomes this limitation by simultaneously recording both sample and reference terahertz waveforms. The method is based on ATR geometry, along with two time-delayed, synchronized sub-waveforms. This configuration enables precise differential measurements, thereby significantly improving detection sensitivity and long-term stability by mitigating environmental fluctuations and laser noise. The technique makes possible the direct extraction of both amplitude and phase information from the ATR reflection coefficient. The potential of this approach is demonstrated by measuring the relative power and phase spectra of NaCl, ATP, and saccharose solutions at various concentrations. The results obtained from this study indicate the presence of distinct spectral signatures for each molecule. This advancement opens novel prospects for high-fidelity spectral analysis, particularly in biomedical applications such as real-time monitoring of biochemical processes and cellular responses.

Characterization of acid soluble collagen from skin of variable torpedo ray(Torpedo sinuspersici) and antibacterial activity

Regulating Li Extraction in Transition Metal Layer for High‐Performance Li‐Excess Layered Oxide Cathode with Intergrowth Structure

ABSTRACT In lithium‐excess layered oxide cathodes, the extra lithium within transition metal (TM) layers (i.e., Li [TM] ) can trigger anionic redox to provide additional capacity. However, substantial extraction of Li [TM] may induce irreversible/detrimental local structural rearrangements. The conventional edge‐shared connecting configuration between LiO 6 and TMO 6 octahedra facilitates interlayer migration of Li [TM] . In contrast, the face‐shared configuration has the potential to limit the mobility of Li [TM] , but this metastable configuration cannot be harvested via traditional calcination. Herein, during Na‐to‐Li ion exchange in P2 phase Na 0.66 [Li 0.22 TM 0.78 ]O 2 precursor, we observe that the random gliding of TMO 2 layers yielding Li 0.66 [Li 0.22 TM 0.78 ]O 2 with O2/O6 intergrowth structure. Despite the random gliding, the functional face‐shared configuration is successfully obtained and proven to effectively restrict interlayer migration of Li [TM] during charging. Consequently, we observe the suppressed formation of aggregated vacancies and O–O dimers within the TM layers. Ultimately, our synthesized O2/O6 Li‐excess demonstrates enhanced structural reversibility and improved capacity/voltage retention. This oxygen‐stacking engineering provides a compelling strategy for developing cathodes with enhanced local structural reversibility.

Life prediction model of feedback rod in electro-hydraulic servo valve

Systematic mapping of O-GlcNAc transferase and O-GlcNAcase defines disease-associated variants

Preliminary results of a phase II study to evaluate the efficacy and safety of disitamab vedotin (RC48-ADC) in combination with radiotherapy for adjuvant therapy in upper tract urothelial carcinoma.

4605 Background: Although postoperative platinum-based adjuvant chemotherapy improves disease-free survival (DFS), many upper tract urothelial carcinoma (UTUC) patients (pts) were ineligible for cisplatin after radical nephroureterectomy (RNU). UTUCs did not seem to benefit from adjuvant immunotherapy. Previous evidence demonstrated adjuvant radiotherapy improvesd cancer-specific survival in HR UTUCs. Further exploration of alternative adjuvant treatment strategies is needed. This study aims to evaluate the therapeutic potential of RC48-ADC in combination with radiotherapy in HER2 overexpressing UTUCs. Methods: This is an open-label, phase II, non-randomised study to evaluate the efficacy and safety of disitamab vedotin (RC48-ADC), a humanized anti-HER2 antibody, in combination with radiotherapy as a novel adjuvant therapy strategy in UTUC. We recruited cisplatin-intolerant pts with HER2-overexpressing (Immunohistochemistry, IHC 2+, 3+) UTUC after nephroureterectomy staged as pT2N0M0 with high-grade/multifocal disease/positive surgical margin, pT3-4 N0 M0 or pTany N1-2 M0. Pts who declined any adjuvant therapy were assigned to the surveillance group. Pts in adjuvant therapy group received RC48-ADC (2.0 mg/kg D1 Q2W, 6 months) and radiotherapy (45-50Gy/25f/5w, lymphatic drainage regions; 62.5Gy/25f/5w, enlarged lymphnode). The therapy was initiated within 90 days of surgery. The primary end point was DFS. Secondary end points were overall survival (OS), metastasis-free survival (MFS), local-recurrence free survival (LRFS) and safety. The trial is registered with ClinicalTrials.gov, NCT06210490. Results: As of January 2026, 54 patients out of the planned 60 pts have been enrolled in the study. Thirty pts were assigned to adjuvant therapy group and 24 in surveillance. In therapy group, 17 pts completed adjuvant therapy, while 13 pts were undergoing treatment. At a median follow-up of 12.4 months, one recurrence was observed in the therapy group, while 9 patients in surveillance experienced recurrence. The 1-year disease-free survival rates were 95% (95% CI 85.9–100) in the adjuvant therapy group and 69.6% (95% CI 53.1–91.2) in the surveillance group. As of now, the most common (≥20%) treatment-related adverse events (TRAEs) were peripheral sensory neuropathy (40%), increased AST (28%), asthenia (28%) and alopecia (20%). Grade ≥ 3 TRAE was observed in 2 patients (8%), the patients experienced gastrointestinal hemorrhage and peripheral sensory neuropathy, respectively. Conclusions: This study is the first to evaluate the efficacy and safety in adjuvant treatment of ADC plus radiotherapy in UTUCs. The combination of RC48-ADC and radiotherapy as a new adjuvant therapy demonstrated a tolerable safety profile in pts with HER2-overexpressing UTUC. Clinical trial information: NCT06210490 .

Early outpatient palliative care for patients with multiple myeloma: A randomized pilot study.

12051 Background: Early palliative care is recommended for patients with advanced or incurable cancer. Despite these recommendations, patients with multiple myeloma are often referred late to palliative care, or not at all. We assessed the feasibility of an early outpatient palliative care intervention for patients with multiple myeloma. Methods: English-speaking adults (≥18 years) with newly-diagnosed or relapsed multiple myeloma and at least one symptom scored ≥3/10 on the revised version of the Edmonton Symptom Assessment System (with constipation and sleep added, ESAS-rCS) were recruited from multiple myeloma outpatient clinics at the Princess Margaret Cancer Centre, Toronto, Canada. Participants were randomized to routine outpatient care from their multiple myeloma team (usual care arm), or to monthly in-person or virtual interdisciplinary outpatient palliative care clinic visits for 3 months alongside usual multiple myeloma care (intervention arm). The primary outcome was feasibility (recruitment of 40 patients/12 months; ≥60% completion of patient-reported outcome measures monthly for 3 months; ≥60% of those randomized to the intervention arm attending ≥1 palliative care clinic visit). Exploratory efficacy outcomes were measured at 1-, 2- and 3-months (primary endpoint), including quality of life (FACIT-Pal, primary efficacy outcome), symptom burden (ESAS-rCS), mood (PHQ-9) and satisfaction with care (FAMCARE-P16). Results: Of 40 patients recruited within 12 months (median age 66.5 years [range 33-92]; 17 [42.5%] female), 21 were randomized to the intervention arm and 19 to usual care. The 1-, 2- and 3-month completion rates among all participants for all measures were 37/39 (94.9%), 36/39 (92.3%), and 33/38 (86.8%), respectively; one intervention arm participant withdrew and one died during the study period. In the intervention arm, 17/21 (80.9%) attended at least one palliative care clinic visit; in the usual care arm, 3/19 (15.8%) were referred to the palliative care clinic during the study period. The mean difference (B) in change in the FACIT-Pal total score at 3-months from baseline between the intervention and usual care arm was 15.5 (standard error [SE] 8.8, p=0.09) after adjusting for baseline scores. The change in ESAS-rCS total distress scores at 3-months was improved in the intervention arm compared with usual care (adj. B=-13.7 [SE 5.4], p=0.02]), as were individual symptom scores for drowsiness (adj. B=-2.1 [SE 0.9], p=0.02), constipation (adj. B=-2.1 [SE 1.0], p=0.03) and sleep (adj. B=-3.6 [SE 0.8], p=0.0002). Changes in PHQ-9 and FAMCARE-P16 total scores at 3-months did not differ between study arms. Conclusions: This pilot trial demonstrated that a larger randomized controlled trial of early palliative care versus usual care for patients with multiple myeloma is feasible. Preliminary results are encouraging for improvements in symptom burden and quality of life. Clinical trial information: NCT06485076 .

Automated identification of phenotypically aberrant cells in acute myeloid leukemia MRD: An unsupervised machine learning approach.

e18560 Background: Measurable residual disease (MRD) serves as a robust prognostic marker in acute myeloid leukemia (AML), guiding therapeutic stratification and treatment response assessment. Invivoscribe's AML MRD Assay is a multiparametric flow cytometry (MFC) 12-color panel of 21 biomarkers to characterize potential AML blast cells using a leukemia-associated immunophenotype (LAIP) based and different-from-normal (DfN) approach. We developed an unsupervised algorithm (FlowER) to automatically identify phenotypically aberrant cells from flow cytometry data without relying on or training on human-drawn gates. This retrospective internal validation study assessed FlowER's concordance with clinical MRD gates in distinguishing aberrant from normal cell populations. Methods: We analyzed bone marrow samples from 59 AML patients and 25 normal controls processed using one tube from our panel (Tube 2: CD15, CD13, 7-AAD, CD33, CD34, CD45, CD117, HLA-DR, CD5, CD7, CD2). The 25 controls served as a healthy reference pool to establish expected phenotypic distributions. For each patient sample, after density-aware subsampling, FlowER assigned anomaly scores to all cells using k-nearest neighbor distances to the reference pool in dimensionality-reduced feature space, agnostic to immunophenotypic lineage. To validate this unsupervised approach, clinical MRD gates were independently defined by expert cytometrists using standard LAIP-based approaches. We compared median anomaly scores between these clinically-defined aberrant cells and CD45 Dim non-MRD background cells within each patient. The primary outcome was the magnitude and significance of score separation (using a Wilcoxon signed-rank test). Results: Total samples analyzed: 59 patients. Median difference in anomaly scores: MRD cells +1.328 higher (35.6% increase) vs. CD45 Dim background; p = 1.78 × 10⁻¹⁰ (one-sided Wilcoxon signed-rank test). Samples with elevated anomaly scores in MRD cells: 52/59 (88%). Cohen’s d (effect size): 1.204. Separation was consistent across CD34+, CD117+, and CD34-/CD117- LAIP populations. Conclusions: FlowER demonstrated highly significant concordance with clinical MRD gating, successfully distinguishing aberrant from normal cells within immunophenotypic populations (p = 1.78 × 10⁻¹⁰). The consistent median score elevation in clinically-aberrant cells (88% of patients) with large effect size (Cohen's d = 1.204) indicates the algorithm captures phenotypic abnormalities without requiring labeled training data or manual gate definitions. This unsupervised, reference-based approach could enable standardized MRD quantification across institutions with reduced turnaround time, complement expert-driven assessment, and reduce inter-observer variability. Prospective validation with clinical outcome correlation is warranted to assess benefit for clinicians.

DISCO app: Feasibility and acceptability of an intervention to reduce the financial burden of cancer in a diverse patient population.

e13729 Background: Financial toxicity, the burden of treatment cost, affects up to half of people with cancer and can affect survival. Financial toxicity is a health equity issue, disproportionately affecting Black patients. Patient education about cost and patient-provider cost discussions are recommended to mitigate financial toxicity but occur infrequently. The Discussions of Cost (DISCO) App, designed to mitigate financial toxicity through a tailorable education and communication intervention, was assessed for efficacy in an RCT with Black and White patients. Here we describe the DISCO App's feasibility and acceptability. Methods: Data were collected from 2021 to 2025 at an NCI-designated comprehensive cancer center. Participants were Black or White patients diagnosed with solid tumor cancers. While waiting to see their provider, patients randomized to the intervention arm used the DISCO App on a tablet. The DISCO App includes a video about treatment costs, ways to manage costs, and the importance of discussing costs with providers. Once patients enter their socio-demographic information (e.g., employment) and financial concerns, they receive a tailored list of cost questions to ask their provider. Patients responded to measures immediately after using the DISCO App. Feasibility was assessed by patient reports of how much time they needed to use the DISCO App and if they were able to use the DISCO App before the provider entered the exam room. Acceptability was measured by items assessing patient perceptions of the DISCO App (1 = strongly disagree; 5 = strongly agree). Descriptive statistics summarized results and mean comparisons were used to assess perceptions by patient self-identified race. Results: Of the 202 patients recruited, 124 were randomized to the intervention arm (67 Black patients; 57 White patients). All patients completed using the DISCO App prior to their provider entering the exam room and 80% of patients needed 15 minutes or less to use the DISCO App, with no difference by patient race. Black patients ( M = 4.4) reported finding the DISCO App more helpful than White patients ( M = 3.9; p = .02) and it brought up cost issues they had not considered (Black patients = 3.5; White patients = 3.0; p = .05). Patients reported the questions were easy to understand ( M = 4.4), helped them feel it was okay to talk with their provider about cost ( M = 4.0), that it prompted cost questions ( M = 3.3), that they learned what costs to consider (55%), and learned ways to manage cost (62%) with no differences by patient race. Conclusions: The DISCO App was feasible and acceptable to Black and White patients with cancer, with Black patients reporting more favorable perceptions than White patients. Next steps include assessing effectiveness in improving outcomes including prompting patient-provider treatment cost discussions and related financial toxicity outcomes (e.g., treatment adherence). Clinical trial information: NCT04766190 .

Prospective evaluation of the pan-immune-inflammation value (PIV) as an independent prognostic biomarker in EGFR-mutated advanced non-small cell lung cancer.

e20512 Background: EGFR mutations are frequent in Non-Small Cell Lung Cancer (NSCLC), with an estimated prevalence of 38.8% in the Asian population. In resource-constrained countries like India, the combination of Tyrosine Kinase Inhibitors (TKI) plus chemotherapy remains the optimal treatment strategy. However, survival outcomes in EGFR-mutated NSCLC remain heterogeneous. Systemic inflammation significantly influences cancer progression and treatment response. The Pan-Immune-Inflammation Value (PIV)—derived from peripheral blood counts has emerged as a potential prognostic biomarker. Evaluating its utility in patients with EGFR-mutated NSCLC receiving TKI with chemotherapy is essential for better patient stratification. Methods: In this prospective study, 165 treatment-naïve patients with EGFR-mutated (Exon 19del or L858R) NSCLC were enrolled. Participants received first-line Tyrosine Kinase Inhibitors (TKIs) combined with platinum-based chemotherapy. Baseline Pan-Immune-Inflammation Value (PIV) was calculated from absolute peripheral blood counts: (Neutrophils × Platelets × Monocytes) / Lymphocytes. Survival outcomes, including Overall Survival (OS) and Progression-Free Survival (PFS), were analyzed using the Kaplan-Meier method and Log-rank test. Spearman Rank Correlation (ρ) assessed the relationship between PIV and survival duration. A multivariate Cox proportional hazards model was utilized to determine the independent prognostic value of PIV, adjusting for ECOG performance status and brain metastasis. Results: The median follow-up for the cohort was 26 months. The most frequent molecular alterations were Exon 19 deletions (57.8%) and L858R substitutions (25.5%). The survival outcomes for the entire population (n = 165) showed a 2-year OS rate of 71.78% (median OS: 26.31 months) and a 2-year PFS rate of 27.04% (median: 19.05 months). In the univariate analysis, higher baseline PIV, ECOG performance status ≥ 2, and the presence of brain metastasis were significantly associated with shorter PFS and OS (p < 0.05). In the multivariate cox regression model, high baseline PIV remained a significant independent predictor of poorer outcomes. For OS, high PIV was associated with a hazard ratio (HR) of 2.42 (95% ci: 1.68–3.49; p < 0.001), while for PFS, the HR was 2.18 (95% ci: 1.54–3.08; p < 0.001). These findings indicate that systemic inflammation, as measured by PIV, independently influences survival regardless of other clinical factors. Conclusions: Baseline PIV can be a powerful, non-invasive, and cost-effective independent prognostic biomarker in EGFR-mutated NSCLC and could be utilized in clinical practice to identify patients who may benefit from combination therapeutic strategies beyond standard TKI monotherapy.

Characterizing patient self-reported adherence to BTKis and symptoms in CLL/SLL using an electronic patient-reported outcomes (ePRO) platform.

e19030 Background: The covalent Bruton tyrosine kinase inhibitors (BTKis) zanubrutinib and acalabrutinib have revolutionized the treatment of hematological cancers, including chronic lymphocytic leukemia and small lymphocytic lymphoma (CLL/SLL). These oral therapies, designed for outpatient care, require ongoing attention to support adherence and monitor for potential side effects. The Canopy Remote Therapeutic Monitoring (RTM) electronic patient-reported outcomes (ePRO) platform is an electronic health record-integrated cloud-based questionnaire delivered via smartphone/web app or interactive voice response that has demonstrated value for measuring adherence and symptoms in the real world. This study examined self-reported medication adherence and symptoms among adult patients with CLL/SLL treated with zanubrutinib or acalabrutinib in a community oncology setting. Methods: This was a retrospective study of patients with CLL/SLL who submitted at least one ePRO report during treatment with zanubrutinib or acalabrutinib from January 1, 2024 to Nov 1, 2025. ePRO monitoring began at enrollment and was followed by weekly reminders. Results: A total of 1,749 ePRO reports were submitted by 241 patients over 65 days of treatment. Of these, 1,026 (58.6%) reports were submitted by patients treated with zanubrutinib and 723 (41.3%) by patients treated with acalabrutinib. Fewer reports submitted by patients treated with zanubrutinib vs acalabrutinib indicated a missed dose (7.6% vs 11.6%, respectively, P< .008). On reports describing a missed dose, fewer reports submitted by patients treated with zanubrutinib vs acalabrutinib noted diarrhea (3.8% vs 19.0%, respectively), headache (3.8% vs 14.3%), or sleep issues (2.5% vs 9.5%), but comparable proportions included bruising (7.6% vs 9.5%) or weakness/fatigue (16.5% vs 17.9%). Conclusions: Patients treated with zanubrutinib reported fewer missed doses than those treated with acalabrutinib, and among ePRO reports of missed doses, fewer patients treated with zanubrutinib experienced common symptoms. Limitations include the retrospective nature of the study and patient self-selection for participation, which may limit generalizability.

A digital educational and decision-support intervention for patients with advanced lung cancer receiving immunotherapy: Results of a multi-phase, mixed-methods study.

12094 Background: Immunotherapy has transformed the treatment of advanced lung cancer, but it has also increased the complexity of information that patients must navigate. Knowledge deficits may compromise disease-management, shared decision-making, and goal-concordant care including timely integration of palliative care. This study aimed to develop and evaluate a digital application to support patients throughout this process. Methods: We employed a multiphase, mixed-methods design comprising: (1) a questionnaire-based online-survey with descriptive analysis (n = 186; SPSS); (2) semi-structured interviews with patients with advanced lung cancer analyzed using qualitative content analysis (n = 20; MAXQDA); (3) user-centered app development involving patients and health-care professionals; and (4) a pre-post pilot study (n = 69) analyzed using Wilcoxon signed-rank test. Primary outcomes for the pilot study were decisional conflict and knowledge; secondary outcomes included preparedness for decision-making, self-efficacy, usability, and acceptability. Results: Pre-development data integration revealed limited and frequently inaccurate patient knowledge regarding immunotherapy and treatment goals, as well as a discrepancy between patients' desired and actual involvement in treatment decisions, with minimal participation in physician-patient decision-making. The developed app demonstrated high usability and acceptability. In the pilot study, use of the app was associated with a statistically significant reduction in decisional conflict (median [IQR]: 20.3 [6.6–34.0] pre vs. 10.9 [3.1–29.7] post; p = 0.001), significant improvements in knowledge ( p < 0.001), and increased preparedness for decision-making. Conclusions: Insufficient patient participation in decision-making, combined with knowledge deficits about immunotherapy, underscores the need for enhanced communication strategies. The digital application developed in this study appears to be a feasible, acceptable, and effective tool to support informed decision-making among patients with advanced lung cancer. Future research should evaluate integration into routine clinical workflows, long-term impact, and adaptations to address diverse patient needs and evolving treatment options. Clinical trial information: 00032683.

GLP-1 RA for primary prevention of post-mastectomy lymphedema in breast cancer patients: A multicenter real-world analysis.

628 Background: Post-mastectomy lymphedema (PML) remains a significant morbidity for breast cancer (BC) survivors, particularly following axillary lymph node dissection (ALND). Complications, including recurrent cellulitis, lymphangitis, and chronic pain, significantly impair quality of life. While weight optimization is a cornerstone of PML management, the specific role of Glucagon-like Peptide-1 Receptor Agonists for the primary prevention of PML is poorly characterized. Data is limited to single-center retrospective studies (1) and case reports. This is the first, large-scale, multi-center, real-world analysis to evaluate the efficacy of GLP-1 RA for the primary prevention of PML in BC patients. Methods: Utilizing the TriNetX Global Collaborative Network, a retrospective cohort study was conducted on a population of 150 million patients across 108 healthcare organizations (Jan 2000 – Jan 2025). We evaluated the impact of GLP-1 RAs on the incidence of PML in BC patients. Patients were stratified into two cohorts: those who underwent mastectomy and received GLP-1 RAs, and a control group of mastectomy patients without GLP-1 RA exposure. 1:1 Propensity Score Matching (PSM) was used to balance cohorts for demographics, BMI, comorbidities, concurrent medications, and laboratory values. Following a median 650-day follow-up, hazard ratios (HR) and 95% Confidence Intervals (CI) were calculated using Kaplan-Meier survival analysis and Cox proportional hazards models to assess PML risk. Results: After 1:1 propensity score matching, 61,630 patients were included (n = 30,815 per cohort). The GLP-1 RA cohort had a mean age of 62.1 ± 10.8 years and was mainly female (99.2%). Racial distribution was 71.0% White, 18.0% Black or African American, and 2.9% Asian. Standardized mean differences for all matched covariates were <0.1, indicating excellent balance within the cohort. Kaplan-Meier survival analysis demonstrated a 63% significant reduction in incident PML among GLP-1 RA users compared to the control group (HR 0.373; 95% CI, 0.324–0.429; p < 0.0001). The absolute incidence of PML was 0.88% (258/29,259) in the GLP-1 RA cohort vs 2.58% (779/30,237) in the control group, yielding an absolute risk reduction of 1.7% and a number needed to treat (NNT) of 59. Conclusions: In this large-scale, real-world analysis, GLP-1 RA use was associated with a profound 63% reduction in the risk of PML. These findings suggest that GLP-1 RAs may serve as a potent primary preventive role in BC survivorship, potentially through mechanisms beyond weight loss, including systemic anti-inflammatory effects and a disease-modifying role in the lymphatic microenvironment. With a NNT of 59, incorporating GLP-1 RAs into the supportive care of high-risk BC patients could significantly reduce the burden of chronic lymphedema. Prospective randomized controlled trials are warranted to validate these results.

Association of iterative cannabis care plans with rates of symptom relief and side effect burden in oncology patients.

12070 Background: Cannabis is increasingly used to manage cancer-related symptoms including pain, sleep disturbance, anxiety, and appetite or gastrointestinal complaints. However, patient responses are highly variable, clinicians report limited confidence in guiding use, and optimal dosing is difficult to predict from baseline characteristics. We evaluated whether an iterative, guided cannabis care model incorporating ongoing patient feedback and care-plan adjustments is associated with improved symptom relief and lower side-effect burden in a real-world oncology population. Methods: We conducted a retrospective observational analysis of cancer patients receiving cannabis-based symptom management through a structured care-planning program. Baseline demographics, cannabis experience, THC dosing, and number of care-plan adjustments were collected. Patients provided longitudinal feedback on symptom outcomes and tolerability at serial check-ins. Significant symptom relief was defined as a ≥3-point reduction in PROMIS T-scores across pain, sleep, anxiety, and appetite/nausea domains. Side-effect burden was assessed as the percentage of follow-up check-ins with reported side effects. Logistic regression examined associations between care-plan adjustments and symptom relief, adjusting for age, cannabis experience, and final THC dose. Results: A total of 136 patients receiving active cancer treatment were included (mean age 61 years; range 26–91). Overall, 56% reported significant relief across all symptom domains. Rates of global symptom relief increased with care-plan iteration: 34.6% among patients with no adjustments, 72.4% among those with 1–2 adjustments, and 96.6% among those with ≥3 adjustments, demonstrating a strong relationship. Care-plan iteration was also associated with lower longitudinal side-effect burden, with side effects reported at 25.6% of check-ins among patients with no adjustments, 17.5% with 1–2 adjustments, and 11.7% with ≥3 adjustments. In adjusted analyses, each additional adjustment was independently associated with higher odds of global symptom relief, while baseline demographic and clinical characteristics were not strong predictors of response. Conclusions: Symptom response to cannabis therapy among oncology patients is heterogeneous and not reliably predicted by baseline characteristics. In this real-world cohort, iterative cannabis care plans incorporating ongoing monitoring and adjustment were associated with substantially higher rates of meaningful symptom relief and a lower burden of side effects over time. These findings support adaptive, feedback-driven cannabis care models over fixed dosing strategies in supportive oncology.

Presenting and therapy-related psychiatric manifestations of metastatic and primary brain tumors: A meta-analysis and systematic review.

e14080 Background: Brain tumors range widely in histopathological characteristics and clinical severity. Presenting clinical cues of brain tumors range from focal neurological deficits to more insidious psychiatric symptoms. The purpose of this study is to describe the landscape of psychiatric manifestations of brain tumors. Methods: Datasets including Pubmed, MEDLINE, Scopus, Embase, PsychINFO, and Web of Science were queried for case reports between 1965-2025 using key terms for a variety of brain cancers and psychiatric symptomatology. Only case reports with adult patients with image and biopsy confirmed brain tumors with psychiatric symptoms were included. Duplicate deletion and abstract and full text screening was conducted with Rayyan.AI. Results: 16,480 total papers were extracted. 131 cases were included and 70 clinical studies. The median age of patients reported was 48 [IQR 36–59] with the majority males (53.4%). Mood (48.1%) and psychotic (40.5%) presentations were most common, with resolution commonly reported (58.8%). The majority of tumors were astrocytomas (30.5%) and meningiomas (25.2%) in the temporal lobe (26.0%). In multinomial regression (N=125), male sex was associated with psychotic vs mood presentation (aRRR 3.02, 95% CI 1.24–7.32; p=0.0146), and left laterality reduced odds of other vs mood symptoms (aRRR 0.06, 95% CI 0.01–0.70; p=0.0247). Surgery predicted resolution (Yes vs No: aOR 6.59, 95% CI 1.18–36.73; p=0.0314) and remained significant in sensitivity analysis (aOR 6.65; p=0.0018); AED/ECT was also associated (aOR 4.52; p=0.0392). Conclusions: Psychiatric manifestations of intracranial tumors were the most often reported in astrocytomas and meningiomas with laterality playing an important role in the type of psychiatric disorder. As other factors did not play a large role, psychiatric manifestations of tumors may be more related to the tumor-neural compartment interaction than mass effect. Moreover, there is a need for increased research in the psychiatric manifestation of metastatic cancers. Adjusted predictors of symptom resolution in psychiatric presentations of brain tumors. Predictor Resolution of Symptom Yes vs No (N=91) aOR (95% CI) p Sensitivity: Resolution Yes vs (No+Partial) (N=103) aOR (95% CI) p Tumor treatment: Surgery vs Non-surgery 6.59 (1.18–36.73) 0.0314 6.65 (2.02–21.90) 0.0018 Symptom mgmt: Psych meds vs None/Other 6.41 (0.59–69.87) 0.1272 1.15 (0.32–4.19) 0.8316 Symptom mgmt: AED/ECT vs None/Other 4.91 (0.87–27.80) 0.0720 4.52 (1.08–18.96) 0.0392 Tumor type: Meningioma vs Astrocytoma 8.79 (0.38–201.65) 0.1738 12.44 (0.97–159.41) 0.0527 Age (per 1-year increase) 0.98 (0.94–1.02) 0.3715 0.99 (0.96–1.02) 0.5608 Psychiatry involved: Yes vs No/NS 1.20 (0.39–3.67) 0.7548 0.59 (0.19–1.86) 0.3681 MRI used: Yes vs No/NS 0.72 (0.13–3.97) 0.7086 0.49 (0.09–2.76) 0.4203

Sex-based differences in in-hospital outcomes among hospitalized patients with lung cancer receiving immunotherapy: A National Inpatient Sample study.

e23073 Background: Lung cancer is the second most common malignancy and the leading cause of cancer-related mortality in the United States. Immune checkpoint inhibitors (ICI) are increasingly used within first-line therapy strategies and have improved survival. Despite these advances, inpatient hospitalizations due to ICI complications remain common during treatment. Limited data exist on sex-based differences in clinical outcomes among hospitalized patients receiving ICI. This study aims to examine sex-based differences in inpatient outcomes in this population. Methods: We conducted a retrospective cohort study using the National Inpatient Sample database from 2015 to 2022. Patients with lung cancer across all stages treated with ICI and are hospitalized for ICI-related complications were identified. Patients were stratified by sex and compared for inpatient outcomes. Multivariable logistic regression adjusted for demographics, hospital characteristics, and comorbidity burden using the Elixhauser Comorbidity Index. The primary outcome was in-hospital mortality. Secondary outcomes included ICI-related complications and intensive care unit (ICU)-level interventions. Statistical significance was defined as p < 0.001. Results: A total of 5,574 hospitalizations were studied. After multivariable adjustment, female patients had significantly higher in-hospital mortality compared with males (OR 1.83, CI 1.7 - 2.0). Female sex was associated with increased odds of hospitalizations due to ICI complications, including pneumonitis (OR 2.2, CI 2.0 - 2.04), colitis (OR 1.8, CI 1.6 - 2.0), carditis (OR 2.5, CI 2.2 - 2.8), transaminitis (OR 1.8, CI 1.7 - 2.0), anemia (OR 1.8, CI 1.7 - 1.8), acute kidney injury (OR 1.6, CI 1.5 - 1.7), and arrhythmias (OR 1.6, CI 1.8 - 1.7). Females were also more likely to experience ICU-level complications, including shock (OR 1.80, CI 1.6 - 2.1), vasopressors (OR 1.78, CI 1.6 - 2.0), mechanical ventilation (OR 1.7, CI 1.5 - 1.9), and continuous renal replacement therapy (CRRT) (OR 1.5, CI 1.3 - 1.7) (all p < 0.001). Conclusions: In this nationwide cohort, among patients with lung cancer treated with ICI, the female sex was associated with higher in-hospital mortality, and increased ICI-related complications causing hospital admissions and ICU-level care. These findings highlight clinically meaningful sex-based differences in patient outcomes. This study aims to shed light and underscore the need for further investigation into mechanisms that contribute to such differences. Future studies are warranted to guide sex-informed clinical management, from biological factors to treatment practices across hospitals.

Fragmentia AI–Lymphoma: A cfDNA language model for lymphoma detection using ultra-low-pass WGS.

7019 Background: Despite the potential of cfDNA liquid biopsy for non-invasive cancer monitoring, its clinical utility is often limited by high sequencing costs and a reliance on detectable driver mutations. To address these barriers, we introduce Fragmentia AI – Lymphoma, a novel transformer-based cfDNA language model designed for lymphoma detection using cost-effective ultra-low-pass whole genome sequencing (ULP-WGS). Methods: Trained on a cohort of 389 samples (189 lymphoma and 200 healthy), the architecture integrates genomic language model backbone with gated attention-based multiple instance learning. Fragmentia AI – lymphoma learned to identify malignancy-associated, mutation-independent signals directly from raw cfDNA sequences. We validated performance on an independent test cohort of 190 lymphoma patients and 200 healthy controls. Additionally, to evaluate clinical scalability, we conducted a read-depth titration analysis to test the minimum input requirements for sustained model performance. Results: Fragmentia AI – lymphoma achieved an AUC of 0.943 in the training cohort and 0.944 in the testing cohort. At 95% specificity, the model demonstrated a sensitivity of 0.889 (F1 score: 0.913). Notably, diagnostic performance remained robust even with a threefold reduction in sequencing reads (AUC > 0.94), significantly lowering the required depth compared to standard somatic mutation calling. Feature attribution analysis revealed that model’s decision-making was predominantly anchored in pathognomonic fragmentomic signatures, specifically GC-content biases and aberrant fragment-size distributions characteristic of malignant cfDNA. Conclusions: Our model effectively identified mutation-independent diagnostic signals from low coverage sequencing data, providing a scalable and cost-effective approach for lymphoma screening and monitoring.

Morphologic and genomic changes in clinical relapse of young onset tongue cancer.

e18133 Background: The morphological and genomic changes associated with relapse in young-onset tongue cancer remain unclear. Methods: Medical records of 107 patients aged <40 years with tongue squamous cell carcinoma were reviewed, and the patient characteristics, therapies, and clinical outcomes were analyzed. The pathological features of biopsied/resected specimens were characterized based on the tumor differentiation status, fibrosis, and immunostaining of p16. We performed next-generation sequencing on 16 paired primary and recurrent tumor samples from patients whose relapse was pathologically confirmed. Results: The age of the patients was 20–29 years in 33 patients and 30–39 years in 74 patients. The clinical stage was AJCC, stages 0–II in 68 patients (64%), and the well-differentiated pathological subtype was present in 74% of the cases. The 3-year overall survival (OS) rate in 107 young patients and the relapse-free survival (RFS) rate in 106 patients who underwent initial surgery were 80% and 71%, respectively. Patients with stages III to IV had worse OS and RFS than those with stages 0-II (3-year OS rate: 60% vs. 92%, P <0.001; 3-year RFS rate: 57% vs. 79%, P = 0.004). Thirty-three of the 106 patients (31%) experienced clinical relapse (with 25 with localized relapse and eight with metastatic relapse). Among the 33 patients with clinical relapse, 16 pairs were subjected to histopathological assessment and whole-exome sequencing. Twelve of the 16 paired specimens showed consistent tumor differentiation status between initial and relapsed samples (9 well-, 2 moderately-, and 1 poorly- differentiated tumors). Meanwhile, four pairs (25%) had altered differentiation status at relapse: two changed to differentiation, and two changed to dedifferentiation, including one case that relapsed as the scirrhous type. Immunostaining for p16, which suggests the involvement of human papillomavirus, was negative in all 16 pairs. Thirteen of the 16 pairs harbored mutations in either the initial or relapsed specimen. Concordant mutations were found in seven pairs (44%), including four with TP53 , one with concurrent TP53 and CDKN2A , one with CDKN2A , and one with PIK3CA . Discordant mutations were detected in five pairs (31%) as follows: two with TP53 , one with NOTCH1 , AJUBA and MAP4K3, one with PIK3CA and IPO7 , and one with FAT1 . At clinical relapse, out of eight discordant mutations, two mutations in TP53 and AJUB A emerged, while the other six mutations disappeared. No cases were found to harbor pathogenic germline variants associated with hereditary genetic syndromes. Conclusions: This analysis indicates that, in the context of clinical relapse, some cases exhibit unique morphological changes and clonal alterations in driver genes. TP53 -mutated clones were preserved in one-third of the cases. These findings provide insight into the molecular mechanisms underlying tumor relapse.

Efficacy and safety analysis of furmonertinib in the treatment of <i>EGFR</i> -mutated lung adenocarcinoma: A single-center real-world study based on high-risk stratification.

8651 Background: Real-world data on furmonertinib, a third-generation EGFR-TKI, for high-risk EGFR-mutant NSCLC patients (e.g., with brain metastasis, high tumor burden) are limited. This study evaluated its efficacy and safety via risk stratification. Methods: This retrospective study included 98 patients with locally advanced/metastatic EGFR-mutant NSCLC treated with furmonertinib (first-or later-line) from Sep 2021 to Dec 2024. Patients were stratified into high-risk (n = 73) and non-high-risk (n = 25) groups based on predefined criteria (brain/leptomeningeal metastases, high tumor burden, key co-mutations like TP53, or acquired T790M). Primary endpoint was investigator-assessed PFS. Secondary endpoints included ORR, DCR, iORR, iPFS, and OS. Safety assessed TRAEs (CTCAE v5.0). Results: Median follow-up was 17.7 months. In first-line group (n = 43), ORR was 69.8%, DCR 83.72%; in later-line group (n = 55), ORR was 64%, DCR 72.73%. PFS did not differ significantly between lines (P = 0.22). Median PFS was not reached overall. High-risk stratification analysis showed median PFS of 26.41 months in non-high-risk group vs not reached in high-risk group, with significant difference (P = 0.009). However, PFS rates showed a time-dependent effect: non-high-risk group had higher early PFS (96.0% vs 76.0% at 6 months), but high-risk group showed higher late PFS (98.6% vs 52.9% at 24 months). A time-dependent model confirmed high-risk features were detrimental early (HR = 33.03, P = 0.016) but protective after 6 months (interaction HR = 0.01, P = 0.001). In patients with measurable brain metastases (n = 39), iORR was 79.5%; median iPFS was not reached. TP53 co-mutation within high-risk group did not affect PFS (P = 0.731). TRAEs occurred in 15.3% (all grade 1-2, most common rash [5.1%] and diarrhea [4.1%]). Grade ≥3 events occurred in 6.1%, primarily elevated transaminases. No dose adjustments/discontinuations or fatal toxicities occurred. Conclusions: Furmonertinib showed durable efficacy in EGFR-mutant NSCLC, unaffected by line of therapy. Risk stratification had time-dependent prognostic value, with high-risk features transforming into a protective factor for PFS after 6 months. Furmonertinib demonstrated strong intracranial activity (iORR 79.5%). TP53 co-mutation did not confer additional prognostic value in the high-risk subgroup. Furmonertinib was well-tolerated with a favorable safety profile.