Austin Wesevich

The Clonal Hematopoiesis Risk Score (CHRS) stratifies patients with clonal hematopoiesis of indeterminate potential (CHIP) or clonal cytopenia of undetermined significance (CCUS) into three different risk categories: low-risk (88.4%), intermediate-risk (10.5%), and high-risk (1.1%). These risk categories correspond to 10-year cumulative incidence of myeloid neoplasm of 0.7%, 7.8%, and 52.2%.

The International Prognostic Scoring System for Mastocytosis (IPSM) risk score is prognostic of survival outcomes for patients with non-advanced and advanced systemic mastocytosis. The IPSM score for non-advanced systemic mastocytosis is based on age and alkaline phosphatase level while the IPSM score for advanced systemic mastocytosis is based on age, skin involvement, and tryptase, leukocyte, hemoglobin, and platelet levels.

Background: We analyzed trends in survival of children and adolescents diagnosed with cancer in the United States from 1975 to 2022 using the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) 8 and 17 databases. Our goal was to provide an updated overview of outcomes and highlight disparities to guide future research. Methods: Data were obtained from the SEER 8 and 17 registries for patients diagnosed at ages 0-19 years. Overall survival was stratified by race and ethnicity, diagnosis, and population density. Temporal trends in 5-year overall survival were evaluated using the National Cancer Institute Joinpoint Regression Program. Kaplan–Meier survival curves with log-rank tests assessed survival differences across subgroups. Multivariable Cox proportional hazards models evaluated overall survival, adjusted for age, decade of diagnosis, and race and ethnicity. Results: A total of 52 165 patients were diagnosed with cancer in SEER 8 and 100 110 in SEER 17. Five-year overall survival for all cancers improved from 60% (95% CI = 56% to 64%) in 1975 to 90% (95% CI = 88% to 91%) in 2017. Survival gains were greatest in acute lymphoblastic leukemia, with more modest improvements in solid tumors. Mortality beyond 20 years persisted for some cancers, including Hodgkin lymphoma. Survival differed statistically by race and ethnicity (P < .001), with non-Hispanic Black patients experiencing the lowest 5-year overall survival across multiple cancers, even after adjusting for age and decade of diagnosis. Conclusions: Survival for childhood and adolescent cancers has markedly improved over the past 5 decades, yet progress remains uneven across cancer types and race and ethnicity. Understanding drivers of disparities is essential to achieve equitable outcomes for all young cancer patients.

The American Society for Transplantation and Cellular Therapy (ASTCT) developed this consensus grading system based on prior Common Terminology Criteria for Adverse Events (CTCAE) and Immune Effector Cells Therapy Toxicity Assessment and Management (CARTOX) grading systems. Grade of Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS) should guide management.

The 4Ts score is widely used for determining the probability of heparin-induced thrombocytopenia (HIT). This should guide testing and management decision-making when a patient has a decrease in platelets or thrombocytopenia.

Importance: Patients with sickle cell disease (SCD) may experience clinician biases due to intersecting stigmatizing factors because most patients with SCD racially identify as Black, have pain as the most common presenting symptom, and are often treated with opioids. Objective: To examine intersecting stigmatizing identities of patients with SCD—identifying as Black, presenting with pain, and being treated with opioids—and compare differences in negative descriptors in the electronic health record relative to SCD. Design, Setting, and Participants: This cross-sectional, single-center study of outpatient, emergency department, and inpatient encounters examined clinician notes from January 1, 2019, to October 1, 2020. Clinician notes were included for patients who racially identified as Black or had diagnoses of SCD, chronic pain, or opioid use disorder (OUD). Notes were also included for a counterfactual group of patients who were not Black and did not have SCD, chronic pain, or OUD. Data were analyzed from November 2024 to February 2026. Exposure: Patients with SCD were compared with 4 groups, all without SCD: (1) Black patients, (2) patients with chronic pain, (3) patients with OUD, and (4) the counterfactual group. Main Outcomes and Measures: Using natural language processing and a machine learning model, clinician notes were contextually coded for the application of 7 negative descriptors: aggressive , agitated , angry , nonadherent , noncompliant , noncooperative , and refuse . Results: A total of 39 871 clinician notes across 18 326 patients were analyzed (mean [SD] age, 47 [23] years); 2183 patients were pediatric (12%), 10 243 were female (56%), 11 137 were Black (63%), 5907 were married (32%), and 5884 had Medicaid (32%). Negative descriptors were present in 220 of 1443 notes (15%) among patients with SCD and 124 of 643 notes (19%) among those with all 4 stigmatizing identities. There were higher odds of a negative descriptor in notes about patients with SCD compared with Black patients without SCD (aOR, 2.46; 95% CI, 1.62-3.73), patients with chronic pain without SCD (aOR, 1.96; 95% CI, 1.18-3.27), and patients in the counterfactual group (aOR, 14.26; 95% CI, 5.92-34.36), but there was no difference compared with patients with OUD without SCD (aOR, 0.76; 95% CI, 0.42-1.38). Conclusions and Relevance: In this cross-sectional study of 18 326 patients, those with SCD had more negative descriptors than Black patients without SCD or those with chronic pain but at a similar level as those with OUD.

PURPOSE: Evaluate the longitudinal relationship between financial toxicity (FT), health-related quality of life (HR-QOL), and psychological distress for patients with cancer. METHODS: Adults with cancer applying for foundation financial assistance or receiving treatment participated in a longitudinal survey study at any point in their cancer journey and 1, 3, and 6 months later. Validated surveys measured FT (Comprehensive Score for FT [COST]), HR-QOL (Functional Assessment of Cancer Therapy-General [FACT-G]), and psychological distress (Brief-Profile of Mood States [Brief-POMS]). Multilevel ordinal logistic and linear regression models assessed longitudinal relationships. RESULTS: Out of 1,112 approached, 732 (66%) completed the enrollment survey with subsequent response rates of 66%, 58%, and 52% at 1, 3, and 6 months, respectively. Participants had a mean age of 68 years. Most were non-Hispanic White (86%), male (57%), Medicare beneficiaries (82%), and had hematologic malignancies (53%). Most common cancer types were multiple myeloma and prostate cancer. Most (80%) had FT at enrollment (grade 1+ or COST <26), and FT was higher in earlier calendar months. Access to a financial counselor was associated with lower FT for those who desired a referral (adjusted odds ratio [aOR], 0.18). Previous (OR, 1.58) and current (OR, 1.73) intravenous chemotherapy were associated with higher FT. In multivariable multilevel models clustered by participants, higher FT was significantly associated with lower HR-QOL and greater psychological distress. The probability of any FT decreased from 79% at enrollment to 72% at 1 month and 68% at 3 and 6 months. CONCLUSION: Patients with various cancer types had associations between higher FT, lower HR-QOL, and more psychological distress across repeated measures over 6-month intervals. FT screening should be repeated across the cancer care continuum, especially early in the calendar year. This will allow interventions to improve patients' emotional and physical well-being.

Background: Food insecurity is one of several household material hardships (HMH) recognized for their impact on disease severity and healthcare utilization in patients with chronic disease. Sickle cell disease (SCD) is a chronic disease, disproportionately affecting patients of lower socioeconomic status, that results in high rates of disease‐related complications and high healthcare utilization. This study examines the relationship between food insecurity and SCD‐related complications and healthcare utilization. Methods: Patients (ages 2–24 years) and/or their parents were surveyed to assess food insecurity status during routine SCD clinic visits from July 2015 to July 2019. Food insecurity status was assessed using the United States Department of Agriculture (USDA) Food Security Short Form (six‐item), with a lookback period of 12 months. Sociodemographic characteristics, disease‐related complications, and healthcare utilization were abstracted from electronic health records. Results: Overall, 22% ( n = 25) of participant households were food insecure. Food insecurity was associated with significantly higher annual rates of acute chest syndrome (aOR = 3.12, 95% CI: 1.27–7.67), prevalence of cholecystectomy (aOR = 6.29, 95% CI: 1.66–23.80), and a higher number of hospitalizations (aOR = 2.40, 95% CI: 1.04–5.52). Conclusions: The rates of food insecurity among sampled households of pediatric and young adult patients with SCD were much higher than national (13.4%) and local county rates (13%). Food insecurity was independently associated with more disease‐related complications and higher healthcare utilization even after adjusting for age, sex, and sickle cell type. These results suggest food insecurity may be a modifiable contributor impacting morbidity in patients with SCD and should prompt further study into these relationships.