The purpose of this study is to provide insight for improvement in care for young adults diagnosed with cancer (YADC), by identifying underemphasized outcomes that strongly matter to YADC and the gaps in care that may limit achieving these outcomes for this unique and vulnerable population. Methods: Twenty-seven YADC, ages 25-39, participated in unstructured discussions focusing on topics relating to diagnosis, daily experiences living with cancer outside of the clinical setting, goals, concerns, and clinical care experience. Most participants engaged in group discussions using Experience Group methodology. Discussions were designed to collect information on three dimensions of health: capability, comfort, and calm (CCC). Data were coded using thematic analysis with NVivo software. Results: Several themes were identified within the CCC framework: capability in terms of confronting mortality at a young age, losing youthful identity and control over major life course decisions, especially fertility, and debilitating side effects, comfort in terms of the lack of understanding from peers and family and the fear of cancer recurrence, and calm was discussed as the difficulty of making complex medical decisions, financial toxicity, and loss of clinical support in survivorship. Conclusion: This research highlighted four care additions that are important for YADC: (1) concise and understandable education about their condition and treatment; (2) same-age support groups; (3) fertility support; and (4) better care transitions for life after cancer. These findings emphasize the importance of creating a collaborative, multidisciplinary care team and a holistic approach with care innovations that support clinicians to meet the unique needs of YADC.

Background. Delivery of high-quality colonoscopy and adherence to evidence-based surveillance guidelines is essential to a high-quality screening program, especially in safety net systems with limited resources. We sought to assess colonoscopy quality and ensure appropriate surveillance in a network of safety net practices. Methods. We identified age-eligible patients ages 50-75 within a Federally Qualified Health Center (FQHC) clinic system with evidence of colonoscopy in preceding 10 years. We performed chart reviews to assess key aspects of colonoscopy quality: bowel preparation quality, evidence of cecal intubation, cecal withdrawal time, and the adenoma detection rate. We then utilized established guidelines to assess and revise surveillance colonoscopy intervals, determine whether appropriate surveillance had taken place, and schedule overdue patients as appropriate. Results. Of 26,394 age-eligible patients, a total of 3,970 patients had evidence of prior colonoscopy and 1,709 charts were selected and reviewed. Mean age was 57, 54% identified as women and 51% identified as Hispanic. Of 1709 colonoscopies reviewed, 77% had data on bowel preparation, and of those, 85% had adequate preparation quality. Cecal intubation was documented in 89% of procedures. Adequate cecal withdrawal time was documented in 59% of those with documented cecal intubation. Overall adenoma detection rate was 42%. Initial surveillance interval was clearly stated in 72% ( n = 1238 ) of procedures. Of these, initial recommended intervals were too short in 24.5% ( n = 304 ) and too long in 3.6% ( n = 45 ). A total of 132 patients (10.7%) were overdue for appropriate surveillance and were referred for follow-up colonoscopy. Conclusions. Overall, the quality of screening colonoscopy was high, but reporting was incomplete. We found fair adherence to evidence-based surveillance guidelines, with significant opportunities to extend surveillance intervals and improve adherence to best practices.

Pancreatic ductal adenocarcinoma (PDAC) is one of the most aggressive malignancies and is the fourth leading cause of cancer-related deaths in the United States. Unfortunately, 80–85% of patients are diagnosed with unresectable, advanced stage tumors. These tumors are incurable and result in a median survival less than approximately six months and an overall 5-year survival rate of less than 7%. Whilst chemotherapy is a critical treatment, cure is not possible without surgical resection. The poor clinical outcomes in PDAC can be partially attributed to its dense desmoplastic stroma, taking up roughly 80% of the tumor mass. The stroma surrounding the tumor disrupts the normal architecture of pancreatic tissue leading to poor vascularization, high intratumoral pressure along with hypoxia and an acidic tumor microenvironment. This complicated microenvironment presents a significant challenge for drug delivery. The current manuscript discusses a novel approach to overcome many of these various obstacles. A complex of gemcitabine (GEM) and hemoglobin S (HbS) was formulated, which self-polymerizes under hypoxic and acidic conditions. When polymerized, HbS has the potential to break the tumor stroma, decrease intratumoral pressure, and therefore improve the treatment efficacy of standard therapy. Intratumoral injection of HbS with a fluorescent small molecule surrogate for GEM into a pancreatic tumor xenograft resulted in improved dissemination of the small molecule throughout the pancreatic tumor. The self-polymerization of HbS + GEM was significantly more effective than either agent individually at decreasing tumor size in an in vivo PDAC mouse model. These findings would suggest a clinical benefit from delivering the complex of GEM and HbS via direct injection by endoscopic ultrasound (EUS). With such a treatment option, patients with locally advanced disease would have the potential to become surgical candidates, offering them a chance for cure.

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INTRODUCTION: Metastatic Crohn’s disease (MCD) is a rare cutaneous entity of Crohn’s disease that mandates specific histopathologic findings and exclusion of other granulomatous diseases and infectious processes for a diagnosis. Due to its heterogeneous clinical presentation, MCD poses a diagnostic challenge for providers. We present a case of MCD in a woman with previously undiagnosed Crohn’s disease at initial presentation. CASE DESCRIPTION/METHODS: A 68-year-old woman presented to the Emergency Room with an acute onset of left-sided abdominal pain. She also noted a 6-month history of watery diarrhea with up to 8 bowel movements daily, describing them as bloody with a jelly consistency. On examination a painful 8 cm ulcer within her intergluteal fold extending to the anus was observed. Other “knife-like” ulcerations were noted of the left inframammary breast, under the pannus and bilaterally in the inguinal folds. She underwent a flexible sigmoidoscopy which demonstrated edematous and friable mucosa with a cobblestone appearance extending from the descending colon to the rectum. Mucosal biopsies and serologic testing were both diagnostic of Crohn’s disease. Punch biopsy of the pannus ulcer showed non-caseating granulomas and was negative for mycobacterial or fungal organisms, confirming the rare diagnosis of MCD. The patient was treated with systemic and topical steroids with subsequent symptomatic improvement of both her Crohn’s flare-up and cutaneous ulcerative lesions. DISCUSSION: MCD is a rare dermatologic manifestation characterized by its non-caseating granulomatous histopathology in non-contiguous areas from the gastrointestinal tract. Typically the GI disease precedes the skin disease for at least six months, however the skin manifestation can be the first sign of Crohn’s disease. The diagnosis should be suspected when “knife-like” ulcerations are seen on physical exam in a patient with known or suspected Crohn’s disease. Exclusion of other granulomatous diseases that could mimic MCD is required to confirm the diagnosis. Early recognition of this disease may ultimately spare unnecessary tests or treatments.