11000 Background: The diversification of the healthcare workforce has been identified as a strategy to address health disparities and increase patient-physician trust. A prior review of diversity among oncology fellows up to 2010, showed an increase in female representation over 17 years, but no change in underrepresented minorities (URM). We aim to assess the changes in hematology and oncology (HO) fellowship diversity over the last decade and how this compares to our workforce. Methods: Publicly available registries were used to assess differences among female and URM HO fellows, HO fellowship applicants, internal medicine (IM) academic faculty, IM residents, medical school graduates (MSG), and the US population in 2019. These were compared to the 2016 HO practicing physicians. Changes in URM and female HO fellow representation from 2009 to 2019 were assessed. Data was analyzed using binomial tests and simple linear regression models. Results: Female representation among HO fellows (43.8%) was increased when compared with HO practicing physicians (+11.8%, p < 0.0001) and IM faculty (+3.2%, p = 0.0079); no difference from IM residents or HO applicants. Female HO fellows were underrepresented when compared with MSG (-4.0%, p = 0.0014) and US population (P < 0.0001). Hispanic HO fellows (6.1%) had increased representation when compared to IM faculty (+2.7%, p < 0.0001), but were underrepresented when compared to IM residents (-2.2%, p = 0.0012) and US population (p < 0.0001). The proportion of Hispanic HO fellows was no different when compared to HO practicing physicians, HO applicants, and MSG. African American (AA) fellows (3.8%) were underrepresented when compared to IM residents (-2.0%, p = 0.0005), HO applicants (-1.7%, p = 0.0465), MSG (-2.4%, p = 0.0001), and US population (p < 0.0001). AA fellows were increased when compared to HO practicing physicians (+1.5%, p = 0.0002), but no different than IM faculty. Asian HO fellows were increased when compared to IM residents, MSG, and US population. Over the last 10 years there has been no significant change in the proportion of AA or female HO fellow representation, with a decreasing trend in Hispanics (-0.14% per year, p = 0.04).Conclusions: The current state of diversity in HO workforce still requires attention. Despite ongoing efforts, females, AA, and Hispanics continue to be underrepresented. The decreasing trend in Hispanic representation and clear differences in diversity between HO fellowships and IM residencies calls for action among fellowship programs and national societies to increase URM engagement and recruitment.

Paroxysmal cold hemoglobinuria (PCH) is a rare form of cold autoimmune hemolytic anemia first discovered in the early 20th century in adults with tertiary syphilis. Today, it is more commonly seen in children as a life-threatening anemia during a viral upper respiratory tract infection (URI). Although respiratory syncytial virus (RSV) has previously been reported to cause PCH in a child, herein we present the first documented case in an adult. The Donath–Landsteiner (DL) test, the diagnostic test for PCH, was positive on two separate occasions. The patient was treated successfully with warming and avoidance of cold temperatures. To facilitate identification of this rare entity by clinicians, we include a discussion about the pathophysiology, diagnosis, and treatment of PCH.

PURPOSE: To study factors that have an impact on the conduct of high-quality goals of care (GoC) discussions and productivity of oncologists among four different practice settings in patients with advanced cancer. METHODS: Solid-tumor oncologists from community, academic, municipal, and rural hospitals were randomly assigned to receive a coaching model of communication skills to help them facilitate a GoC discussion with newly diagnosed patients with advanced cancer who had a less-than-2-year prognosis. Patients were surveyed after the first restaging visit regarding the quality of the GoC discussion on a scale of 0 to 10 (0, worst; 10, best) with a score of 8 or better indicating a high-quality GoC discussion. Productivity was measured by work revenue value units (wRVUs) per hour for the day each oncologist saw the study patient after imaging. RESULTS: The four sites differed significantly in the socioeconomic patient populations they served and in the characteristics of the oncologists who cared for the patients. Overall median productivity across the four sites was 3.6 wRVU/hour, with the highest observed in the community hospital (4.3 wRVU/hour) and the lowest in the rural setting (2.9 wRVU/hour; P < .001). There was no significant difference in productivity observed when high-quality GOC discussion occurred versus when it did not (3.6 v 3.7 wRVU/hour; P = .86). CONCLUSION: Despite differences in patient populations and oncologists’ characteristics between the four practice settings, the conduct of high-quality GoC discussions did not affect productivity.

Background: New NCCN guidelines recommend germline testing for all patients with confirmed pancreatic cancer (PC) regardless of stage, family history, or ethnicity. PC is linked to inherited cancer susceptibility syndromes, with approximately 10% of cases occurring in the presence of family history. Per SEER statistics, African-Americans (AA) have the highest incidence rate (67% higher) of PC of all ethnic groups and the worse prognosis. Current data links this risk to social and access issues rather than biology. We aim to determine whether the prevalence of germline mutations associated with increased PC susceptibility varies by ethnicity. Methods: We retrospectively examined publicly-available, de-identified, germline and clinical data of patients with a diagnosis of pancreatic cancer (PC) referred to Color Genomics by a healthcare provider for testing of 30 genes associated with hereditary cancer risk. Clinical data included age at diagnosis, sex, self-reported ethnicity, family history of cancer, and personal history of cancer. Ashkenazi Jewish (AJ) ancestry was classified as an ethnic group. Germline genetic variants were classified as pathogenic (P), likely pathogenic (LP), variant of uncertain significance (VUS), likely benign, or benign. Prevalence of P/LP and VUS variants was compared among subgroups classified by age at diagnosis (£ 65 or &gt; 65 years-old), sex, self-reported ethnicity, family history of PC, and personal history of other cancer using chi-square tests. Results: We identified 167 patients with PC of any stage who underwent germline testing. Among these, 47.9% were female and 52.1% male. Ethnic composition was 73.1% Caucasian, 8.4% AJ, 3.6% Hispanic, 3.6% AA, 4.2% Asian, and 7.2% of other or unknown ethnicity. Twenty-four (14.4%) patients carried a P/LP variant, and 45 (26.9%) patients carried a VUS. The most prevalent P/LP variants were BRCA2 (29.6%), ATM (22.2%), and MUTYH (14.8%). APC (18.4%), BRCA2 (14.3%), and ATM (12.2%) were the most prevalent VUS variants. AJ patients had an increased prevalence of P/LP BRCA2 variants (83%, n=5). Ethnicity was significantly associated with risk of carrying any P/LP variant (p = 0.049) but not with a VUS; this association was lost when excluding those of AJ ancestry. Age, sex, family history of PC, and personal history of a second cancer were not associated with risk of carrying any P/LP or VUS variants. Conclusions: Germline mutations are prevalent among PC patients and highest among those of AJ ancestry. Although the prevalence of germline variants is not associated with other ethnic groups, our study highlights the underrepresentation of minorities in germline testing databases, particularly AA. The prevalence of germline variants in minority ethnic groups with PC remains an understudied area and is an example of how barriers to access can limit our understanding of diseases. Further studies are needed to address this critical unmet need. Citation Format: Ana I Velazquez, Carolina Bernabe Ramirez, Daniel H Kwon, Ryan Leibrandt, Narjust Duma. Ethnic disparities among pancreatic cancer patients undergoing germline testing [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C043.