The aim of this study was to evaluate the current barriers associated with gynecologic care as perceived by women who use wheelchairs. MethodsThis qualitative study evaluated the barriers to gynecologic healthcare as described by female wheelchair users. We recruited English-speaking female participants aged 18 years and older who primarily used a wheelchair for mobility through flyer and email distribution. Interviews were conducted by three investigators using a semi-structured interview guide and recorded for transcription. Two investigators reviewed all transcriptions for accuracy which were then coded to identify emergent themes. ResultsThe thematic saturation was achieved with 16 interviews. The most common barrier cited was transferring to the exam table (n=16). Women reported that their providers lacked knowledge and experience with women who use wheelchairs (n= 11). ConclusionThere are many barriers to gynecologic care for women who use wheelchairs. Interventions are needed to improve accessibility to care for women who use wheelchairs.

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8517 Background: The combination of bortezomib (Bort) and alkylating agent (AA) is a frequently used first-line therapy for AL amyloidosis. Kastritis et al. compared melphalan and dexamethasone with or without bortezomib as primary therapy and demonstrated increased hematologic response rate with the bortezomib and melphalan combination. However, the role of AA is unclear. This study aimed to evaluate if adding AA to Bort improved patient outcomes in AL amyloidosis. Methods: We retrospectively reviewed clinical data on 209 patients with systemic AL Amyloidosis at Moffitt Cancer Center between 2008 and 2020. We excluded patients with localized amyloidosis or amyloid other than AL. Patients were divided into two groups based on upfront therapy: A) Bort and B) Bort + AA. All patients also received dexamethasone. The staging was per Mayo 2012. Organ involvement, response, and progression were defined based on the 2005 criteria. Overall survival (OS) was defined as the time from initial diagnosis until death or last contact. Time to next therapy (TTNT) was calculated in patients with the documented hematologic response from the time of initiation of therapy to time of the next therapy/last follow up/death. Results: Of 209 patients, 36% (n=76) received Bort+AA; 30% (n=62) received Bort. No significant difference in clinical characteristics was seen in both groups except for age (which was higher for arm A: median 65 and 62 years, respectively, p=0.043) (table). In addition, Bort+AA became more commonly used as a frontline therapy after 1/1/2014 (p=0.001). Group A and B had similar median OS (69.9 months [95% CI. 44.7-95.2] and 64.4 mo [95% CI 40.5-88.3] respectively, p=0.60). 86% of patients in group B achieved a hematologic response as compared to 74% of patients in group A (p=0.15). Similarly, 47% of patients in group B achieved an organ response as compared to 34% of patients in group A (p=0.22). TTNT was higher in group A than group B (16.9 mo [95% CI, 0-41.5] and 7.8 mo [95% CI, 3.5-12.0], respectively, p=0.08). Conclusions: While Bort+AA is a commonly used regimen for amyloidosis, the addition of AA to Bort did not result in superior OS, TTNT compared to Bort alone in this retrospective study. This finding should be confirmed in prospective studies. Baseline Characteristics. [Table: see text]

e20568 Background: It has been shown in mouse models doxycycline(Doxy) interferes with amyloid fibril formation. Retrospective data suggests the addition of Doxy to standard chemotherapy(chemo) reduces mortality in cardiac amyloidosis. We examined the relationship between Doxy use, treatment, and OS in a cohort of AL Amyloidosis(AL) within an academic center. Methods: AL pts between 2008 and 2020 at Moffitt Cancer Center. For this study we included patients with AL, with all types of organ involvement. We excluded pts with non-AL Amyloidosis and pts with localized amyloidosis were excluded. Data on organ involved, organ response, date of death, treatment were obtained for each pt. OS was defined as time from AL diagnosis to date of death. Univariate comparisons were performed to identify differences in treatment and other prognostic variables between Doxy groups, where appropriate (Table). Results: 209 pts that met inclusion criteria, 13 pts(6%) had cardiac involvement with AL. Of those 13 pts, only 3 pts(23%) received Doxy in addition to standard of care chemo. For this study, we included all types of AL for total 209 pts. Of the 209 pts, 9.5% received Doxy in addition to standard of care chemo and 90.5% pts did not receive Doxy and had chemo alone. Pts who received Doxy had more proteinuria (suggesting more significant renal involvement) but other characteristics were not statistically different including cardiac biomarkers (table). A numerically higher rate of organ response (67% versus 43%) was noted in patients who received Doxy but this didn’t reach statistical significance. Further the OS was numerically higher for Doxy treated pts however again this didn’t meet statistical significance. Conclusions: We noted higher organ responses and overall survival in Doxy treated pts, we could not identify statistical differences in outcomes possibly because of the sample size. Nevertheless, further follow up is warranted and Doxy may be associated with improved outcomes in AL. [Table: see text]

INTRODUCTION: Individuals with disabilities face significant barriers to healthcare and are at a higher risk of receiving inadequate care. Specifically, women with disabilities are more likely to be behind on routine screening examinations including Pap tests and screening mammography. This project aims to identify and explain the barriers that prevent female wheelchair users from obtaining standard gynecologic health care. METHODS: This IRB approved qualitative study was conducted to evaluate the barriers associated with seeking gynecologic health care among female wheelchair users. We recruited English-speaking female participants ages 18 and older who primarily used a wheelchair for mobility through flyer distribution and word of mouth. Interviews were conducted by a single investigator using a semi-structured interview guide and recorded for transcription. Two investigators reviewed all transcriptions for accuracy which were then coded to identify emergent themes. RESULTS: The thematic saturation was achieved with sixteen interviews. The most common barrier cited was lack of proper positioning on the exam table to perform a pelvic exam (n=13). Furthermore, another common theme was that women felt that their providers lacked knowledge and experience with women who use wheelchairs (n=13). CONCLUSION: There are many barriers to OB/GYN care for women who use wheelchairs. This study has identified how current knowledge, attitudes, practices, and existing infrastructure serve as barriers to gynecologic care. Interventions are needed to improve accessibility to care for women who use wheelchairs.