Background The risk of coccidioidomycosis (CM) as a life-threatening respiratory illness or disseminated CM (DCM) increases as much as 150-fold in immunosuppressed patients. The safety of biologic response modifiers (BRMs) as treatment for patients with autoimmune disease (AI) in CM-endemic regions is not well defined. We sought to determine that risk in the Tucson and Phoenix areas. Methods We conducted a retrospective study reviewing demographics, Arizona residency length, clinical presentations, specific AI diagnoses, CM test results, and BRM treatments in electronic medical records (EMR) of patients >18 years old with International Classification of Diseases (ICD-10) codes for CM and AI from 10/01/2017 to 12/31/2019. Results We reviewed 944 charts with overlapping ICD-10 codes for CM and AI, of which 138 were confirmed to have both diagnoses. Male gender was associated with more CM (p=0.003), and African ancestry was three times more likely than European to develop DCM (p<0.001). Comparing CM+/AI+ (138) with CM+/AI- (449) patients, there were no significant differences in CM clinical presentations. Patients receiving BRMs had 2.4 times more DCM compared to Pulmonary CM (PCM). Conclusions AI does not increase the risk of any specific CM clinical presentation, and BRM treatment of most AI patients does not lead to severe CM. However, BRMs significantly increase the risk of DCM, and prospective studies are needed to identify the immunogenetic subset that permits BRM-associated DCM.

Introduction Pancreatic ductal adenocarcinoma (PDAC) is a genetically heterogeneous disease often diagnosed with synchronous metastatic disease involving the liver. Tumors with extra‐abdominal spread that bypass the liver are thought to represent a unique molecular subgroup and those with isolated pulmonary metastatic disease are thought to have a more favorable clinical phenotype. Method We conducted a retrospective review of patients with pathologically confirmed PDAC treated between the years 2007 and 2020 at a Scripps Health hospital. The final study sample (N = 205) included patients with isolated pulmonary metastasis (IL), isolated liver metastasis or synchronous liver and lung metastasis (LL), or metastasis to any site other than the liver or lung (NLL). Primary endpoint was overall survival (OS). Progression‐free survival (PFS) and recurrence‐free survival (RFS) were analyzed as secondary endpoints. Each survival outcome was analyzed using Cox proportional hazards tests. Results No statistically significant differences were seen between the three groups in OS, PFS, or RFS. Median OS for the IL group was 561 days, 341 days for the LL group, and 441 days for the NLL group. Median RFS was 748 days for the IL group, 574 days for the LL group, and 545 days for the NLL group. Median PFS was 307 for the IL group, 236 for the LL group, and 265 for the NLL group. When comparing only the IL and LL groups, a statistically significant difference in OS was seen favoring the IL group (HR1.59 LL vs IL [ref], CI 1.04–2.41, p = 0.031) Conclusion Though statistically significant differences in survival outcomes were not seen in our population, there was a trend toward improved survival for patients with isolated lung metastases. When comparing only the IL to LL group, statistically significant overall survival favoring the IL group was seen. These findings highlight a potential prognostic indicator of metastatic PDAC.

e16257 Background: Pancreatic ductal adenocarcinoma (PDAC) is a genetically heterogeneous disease often diagnosed with synchronous metastatic disease involving the liver. Tumors with extra-abdominal spread that bypass the liver are thought to represent a unique molecular subgroup of the disease. Specifically, those with isolated pulmonary metastatic disease are thought to have a more favorable clinical phenotype. We sought to retrospectively investigate whether patients with isolated pulmonary metastases had improved survival compared to those with disease involving the liver. Methods: We conducted a retrospective review of patients with pathologically confirmed PDAC treated between the years 2010 and 2020 at a Scripps Health hospital. The final study sample included only patients with pulmonary and/or liver primary metastases (N = 175). Analyses were conducted on subgroups defined by metastatic sites of disease in the liver only, lung only and combined liver+lung. Primary and secondary outcome analyses compared isolated lung versus liver/liver+lung. Primary endpoint was overall survival (OS), defined as from the date of diagnosis to date of death or most recent follow up. Progression free survival (PFS) was also analyzed as a secondary endpoint and defined as from the date of diagnosis to date of radiographic progression. Each survival outcome was analyzed using Cox Proportional Hazards tests. Results: No statistically significant differences were seen in OS (HR 0.67, CI 0.44–1.03; p= 0.069) or PFS (HR 1.05, CI 0.68–1.65; p= 0.816) between patients with primary lung metastases compared to those with either liver or liver+lung metastases (reported as hazard ratios of liver/liver+lung relative to lung only). However, a trend towards improved OS was seen for patients with isolated lung metastasis and the kaplan-meier curve for OS showed improved survival for these patients at 3 years, with crossing of the survival curves around 5 years from time of diagnosis. Conclusions: There appears to be a unique clinical phenotype in patients with PDAC presenting with isolated pulmonary disease. Though there was not a statistically significant difference in OS and PFS seen in our population, there was a trend towards improved overall survival compared to those with hepatic involvement. These findings highlight a potential prognostic indicator of metastatic PDAC and further subgroup analysis will help characterize clinical variations that may lead to these differences in tumor biology.[Table: see text]

Research Objectives To prevent health complications, patients with type 2 diabetes mellitus should be regularly seen by their medical provider and routinely checked for hemoglobin A1c levels. However, many patients do not return for routine visits. The objective was to evaluate the efficacy of two communication modalities in scheduling patient appointments. Study Design/Methods Patients with a hemoglobin A1c > 9.0 not seen in clinic in >6 months were randomly assigned to a control or experimental group. All participants received an initial text message offering help with scheduling an appointment. The control group was contacted via a second text message and the experimental group was contacted via phone call. Additionally, the experimental group was asked to identify perceived healthcare barriers. In addition to the reported barriers, data included patients who scheduled and kept appointments in each group when data was available. Chi-squared test (p-value of <0.001) was performed.   Principal Findings and Quantitative Results   The total number of patients with an HbA1c greater than 9.0% was 416. A total of 156 were contacted with 34 (21.8%) participating. Twenty-five (16.0%) were lost to follow-up. Sixteen patients (47.1%) responded to voice and 18 (52.9%) to text. A chi-squared test with a value of 49.67 (p-value of <0.001) determined our findings significant. Ten (6.4%) were scheduled for follow-up. A larger proportion of patients received an appointment via voice (6 of 16, 37.5%) than text (4 of 18, 22.2%) with a chi-squared value of 118.56 (p-value of <0.0001).   Conclusions/Impact on Health Centers The study demonstrated that combined use of text messaging and phone calls could lead to higher rates of scheduled appointments. Future studies could address whether appointments made with this method of contact are kept. One factor that limited scheduled appointments was that 16% of patients indicated they were no longer being seen at El Rio. This suggests the need for an additional feature to be placed in NextGen where staff can indicate that patients are no longer being followed. Results of our research will be presented at El Rio Research Fair in May 2019.