Introduction: PC is the third leading cause of cancer-related death in the United States. Cigarette smoking is a known risk factor for PC. Furthermore, it has been evaluated as a possible prognostic marker and has been shown that increased number of pack years is associated with worsened overall survival in PC (Yuan et al). However, it has yet to be shown whether patients undergoing active treatment and are current smokers, are facing a worse prognosis. Our study aims to examine the effect of current smoking on survival outcomes of advanced/metastatic PC patients undergoing active treatment. Methods: This is a retrospective study. Patients diagnosed with advanced/metastatic pancreatic cancer at Henry Ford Health between January 2016 and January of 2021 were identified via chart review. Variables collected included age, gender, smoking status (subclassified as never smokers, former smokers, and active smokers), performance status (documented as Eastern Cooperative Oncology Group (ECOG), number of chemotherapy (CTX) lines, and survival status that is most recently documented by May 1st, 2002. Median survival time were calculated to present the survival time for which the proportion surviving reached 50 percent. Kaplan-Meier estimates were used to generate survival curves for each cohort. The log-rank test was performed to compare the survival distributions among smoking status. Cox model was fit to estimate the association between smoking behavior and overall survival, adjusted for demographics and cancer-related variables. CTX was treated as a time-dependent covariate. All statistical tests were 2-sided with an α (significance) level of 0.05. All data was analyzed using R version 4.1.2. Results: A total of 269 PC patients were included in the analysis. The mean age of the cohort was 66 years and 50.9% were males. The mortality rate (from time of diagnosis to May 1st, 2022 was about 89%. Around 8% of patients underwent surgery, 21% have taken radiation therapy, and only one patient did not undergo CTX. For smoking behavior, 46.1% were never smokers, 34.6% were former smokers, and 19.3% were current smokers. Looking at baseline characteristics, the mean age of active smokers were 4 to 5 years less than never/former smokers and the average ECOG score of non-smokers were 0.28 to 0.32 point less than former/active smokers. Median survival time for patients never smoking was 11.7 months, 8.9 months for former smokers, and 11.4 months for active smokers. The log-rank test did not show sufficient evidence of a difference in survival across patients’ smoking status. Conclusion: Active smoking status does not appear to influence overall survival in advanced/metastatic pancreatic cancer patients undergoing various chemotherapy treatments. This study was limited in its retrospective nature and a relatively small sample. Information regarding level of smoking (light smokers vs heavy smokers) was not readily available. The prognostic value of smoking in PC will need to be assessed prospectively. Citation Format: Aula Ramo, Zeinab Nasser, Mohamad Beidoun, Baha' Mustafa Abbad, Nayef Hikmat Abdel-Razeq, Gazala Khan. Is smoking prognostic for advanced metastatic pancreatic cancer (PC) patients undergoing treatment [abstract]. In: Proceedings of the AACR Special Conference on Pancreatic Cancer; 2022 Sep 13-16; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2022;82(22 Suppl):Abstract nr A049.

11056 Background: Gender inequalities contribute to burnout and have contributed to an ongoing exodus of women from academic oncology. Our aim was to explore the perceptions and experiences of oncology professionals regarding gender bias in the workplace with the hope of providing critical information to support equity initiatives. Methods: An anonymous, 22-question survey was sent via Survey Monkey to 1512 physicians with oncology-related specialties from National Cancer Institute (NCI) designated cancer centers whose emails were publicly available. Likert-scale questions (never-rarely-sometimes-often-very often) were analyzed with Kruskal-Wallis and Wilcoxon rank sum tests (percentages shown as frequency of having responded “sometimes-often-very often”). Chi-square test was used for categorical variables. Results: A total of 274 physicians completed the survey (response rate 18%): 152 (55.5%) self-identified as female (F); 112 (42%) as male (M); 7 (2.6%) as gender non-conforming or transgender; 3 (1.1%) chose not to answer. Most were White (59.9%), followed by Asian (20.4%), Middle Eastern (5.8 %), Multiracial (5.1%), Hispanic (3.6%), and Black (1.5%). The plurality (n = 103; 37.6%) were < 40 years old. Primary fields of practice included 118 (43.1%) in adult oncology, 45 (16.4%) in combined hematology/oncology, 44 (16.1%) in radiation oncology, 44 (16.1%) in adult hematology, and 23 (8.4%) in other specialties. Female gender was associated with experiencing gender bias more often than male gender in the following areas: clinical practice (80.9% F vs 20.6% M), research activities (73.0% F vs 15.2% M), having difficulty balancing work and non-work responsibilities (95.4% F vs 78.6% M), being held to higher standards compared to physicians of other genders (73.1% F vs 14.2% M), being mistaken as a non-physician (78.9% F vs 6.3% M), and being scrutinized by others while tending to childcare needs (48.8% F vs 23.2% M) (all p <.001). Female gender was associated with using techniques to navigate gender challenges more often than male gender, including wearing a white coat (55% F vs 7% M; p <.001), ensuring that “Doctor” is written on identification (33% F vs 3% M; p =.002), emphasizing a professional look (53% F vs 10% M; p =.003) and working harder to establish expertise in the field (72% F vs 18% M; p =.003). When asked about strategies to address workplace gender-related bias, 63% would like policies on gender-related discrimination, (66.4% F vs 65.2% M; p =.93), 62% would like policies that prioritize leadership representation (74.3% F vs 51.8% M; p <.001), and relatively few (37%) would prefer formal lectures/instruction for staff (38.2% F vs 37.5% M; p >.99). Conclusions: Self-identified female academic oncologists at NCI Cancer Centers reported facing gender-related challenges in daily practice at much higher rates than men. There is a clear need to identify root causes and create initiatives to promote gender equity in the field of oncology.

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Unilateral adrenal hemorrhage is a rare but deadly complication that can occur secondary to causes such as trauma and metastasis. A 55-year-old male with a history of metastatic lung adenocarcinoma and deep vein thrombosis managed with rivaroxaban presented with acute right abdominal and flank pain. A CT angiogram of the abdomen showed a retroperitoneal hematoma around the right adrenal gland, consistent with a unilateral adrenal hemorrhage. An MRI showed no signs of adrenal metastasis and the patient had no history of trauma. The volume of the hematoma did not change in size and the patient was hemodynamically stable, which only prompted supportive management. Anticoagulant use is a known risk factor for bilateral adrenal hemorrhage. However, this case demonstrates that unilateral adrenal hemorrhage can also be a complication, one that usually appears subclinically. It can present non-specifically but may progress to a more fatal bilateral hemorrhage. Hence, it demands a high index of suspicion for patients on systemic anticoagulation.