United States

Background
Randomized controlled trials (RCTs) are designed to provide the highest levels of evidence for clinical practice; consequently, RCTs are the mainstay for creating guidelines and approving new treatments. It is ethically essential for patients assigned to the control arm in RCTs to receive standard-of-care treatment. This serves to protect patients, optimize adequate treatment, and ensures that RCT findings are compared to current standard-of-care therapy – an ethical imperative of RCT design and implementation. Oncologic medical trials investigating new systemic agents for cancer have a high proportion of RCTs with inadequate control arms (PMID 31046071). It is unknown whether this finding is prevalent in oncologic trials investigating radiation therapy (RT) for cancer.

Methods
We identified registered clinical trials investigating RT in patients with cancer over the past decade. ClinicalTrials.gov was queried for RT as the intervention and cancer and other related terms as the condition between 1/1/13 and 1/1/23. Exclusion criteria included trials with incomplete status or non-oncologic indications. Trials were categorized by indication/primary disease site, first posted date, investigational arm, control arm, and sponsor/collaborator. Each control arm was analyzed, and the standard of care was determined according to National Comprehensive Cancer Center Network (NCCN) guidelines at the time of first posting.

Results
A total of 508 interventional studies with results registered on ClinicalTrials.gov were included. Of these, 360 single-arm studies were excluded. 116 studies investigating a treatment other than RT were excluded. 20 studies that were not completed were excluded. The remaining 12 studies were included in the final analysis. Of the included trials, 2 each investigated RT usage in central nervous system, prostate, head and neck, and breast disease sites, and 1 each for lung, hepatobiliary, rectal, and bone disease sites. A majority of the trials were industry-funded (83%), and over 2/3 of studies took place in the United States (75%). 100% of the trials were found to have an adequate control arm per the corresponding NCCN.

Conclusion
100% of oncologic RCTs investigating radiation therapy for cancer were found to have an adequate control arm. This finding contrasts with medical oncology trials, which have been shown to have a high proportion of RCTs with inadequate control arms. This disparity highlights the importance of designing oncologic RCTs with adequate control arms, which is crucial for providing the highest level of evidence to guide optimal clinical practice and ensure the safety of patients. These findings suggest that adequate control arm treatments are feasible to achieve in trial design, emphasizing both the need for continued focus on improving the quality of ethical oncologic research trials and a possible subspecialty that may serve as an exemplar.

AMA Research Challenge 2025 

Evaluation of Control Arm Quality in Recent Radiation Oncology Randomized Clinical Trials

Our aim is to encourage research into the quality and credibility of peer review and scientific publication, to establish the evidence base on which scientists can improve the conduct, reporting, and dissemination of scientific research.
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Abstract Title
Ovarian Cancer with Gastric Metastasis: A Rare Presentation

Background
Metastatic gastric malignancy is rare, representing 0.7-5.4% of all gastric cancers. The most common tumors metastatic to the stomach are the breast and lung cancer, and melanoma. Gastric metastasis from ovarian serous cancer is extremely rare, accounting for only 0.013% to 1.600% of all gastric metastatic tumors. We present a case of ovarian cancer metastasizing to the stomach presenting with symptomatic anemia.

Case Presentation
A 64-year-old female patient with past medical history of low grade serous ovarian cancer S/P simple hysterectomy and oophorectomy five years ago with metastatic disease to the liver, lung, and peritoneum, S/P Carboplatin and Taxol three months ago and currently receiving BRAF directed therapy (Dabrafenib/Trametinib), presented from medical oncology office after being found with a low hemoglobin of 6.4. Patient also reported symptoms of fatigue, nausea, lightheadedness and shortness of breath. Patient denied any melena or hematochezia. On examination, vital signs were stable and physical examination was unremarkable. CT abdomen
showed intraabdominal mass with progression and likely infiltration into stomach within the lumen. A prior esophagogstroduodenoscopy (EGD) six months ago was normal. Patient received blood transfusion and underwent an EGD which showed a large, fungating, infiltrative, polypoid and ulcerated, partially circumferential (involving one-third of the lumen circumference) mass with no bleeding and no stigmata of recent bleeding in the gastric fundus. Surgical pathology was consistent with serous carcinoma with psammomatous calcification with immunostains positive for PAX8, p16, p53, estrogen receptor and CK7. Patient was treated with
Ribociclib and Fulvestrant and received palliative radiation to the abdomen to control gastrointestinal bleeding and abdominal pain. Therapy was changed from Ribociclib to Trastuzumab deruxtecan as the patient was intolerant to Ribociclib and due to the IHC from the gastric mass being HER2 1+ positive. Subsequent PET CT showed shrinkage of intraabdominal mass and liver lesions.

Discussion
The most common symptoms of ovarian cancer with gastric metastasis are abdominal pain, anemia, vomiting, and melena. It is important to distinguish a primary gastric malignancy from metastatic disease with ovarian origin in a patient with history of ovarian cancer presenting with anemia.

Ovarian Cancer with Gastric Metastasis: A Rare Presentation

Abstract Title
Hypertensive Crisis Unresponsive to Standard Therapy: The Interplay of Pulmonary
Hypertension and Scleroderma Renal Crisis in Systemic Sclerosis
Background
Systemic sclerosis (SSc) is a complex autoimmune disease that can affect nearly every organ system, often leading to serious and sometimes life-threatening complications. Among its most challenging manifestations are pulmonary hypertension (PH) and scleroderma renal crisis (SRC), both of which can dramatically impact patient outcomes. This case report describes a
54-year-old African American woman with a 12-year history of SSc who developed refractory hypertension, right heart failure due to PH, and SRC. Despite aggressive antihypertensive therapy (on seven drugs), her blood pressure remained uncontrolled, highlighting the complexities of managing overlapping pathologies.
Case Presentation
A 54-year-old African American woman with a 12-year history of systemic sclerosis
presented with progressive dyspnea, fatigue, and new-onset lower extremity edema.
Diagnostic workup confirmed pulmonary arterial hypertension (PAH) through right heart catheterization and revealed right ventricular dysfunction on echocardiography. Concurrently, she developed acute kidney injury with a serum creatinine of 3.5 mg/dL and malignant hypertension, consistent with scleroderma renal crisis (SRC). Despite an intensive antihypertensive regimen that included amlodipine, carvedilol, spironolactone, hydrochlorothiazide, clonidine patch, hydralazine, and losartan, her blood pressure remained uncontrolled, averaging 170/105 mmHg. ACE inhibitors, typically the cornerstone treatment
for SRC, were contraindicated due to an allergy. Intravenous prostacyclin therapy was initiated to manage her PAH, but her renal function continued to decline, prompting consideration for renal replacement therapy.
Discussion
Scleroderma renal crisis, characterized by malignant hypertension and rapid renal
deterioration, is a life-threatening complication of SSc. The coexistence of pulmonary hypertension adds another layer of complexity, as therapies for PH may interact with anti-hypertensive agents. Refractory hypertension in this context is driven by endothelial dysfunction and vasculopathy, limiting the efficacy of conventional treatments. Targeted therapies, such as endothelin receptor antagonists and prostacyclin analogs, may offer additional benefits but require careful consideration. This case highlights the critical need for a multidisciplinary approach, involving rheumatology, cardiology, nephrology, and often pulmonology. Close collaboration ensures that care is tailored and responsive to the patient’s dynamic needs. Such complex scenarios remind us of the importance of tailored, patient-focused care and ongoing innovation in the management of systemic sclerosis and its complications. Future research should focus on developing novel therapeutic strategies to address the unique pathophysiology of these intertwined conditions.

Hypertensive Crisis Unresponsive to Standard Therapy: The Interplay of Pulmonary Hypertension and Scleroderma Renal Crisis in Systemic Sclerosis 


Abstract Title: Ivosidenib Therapy for IDH-mutant WHO Grade 4 Astrocytoma

Background:
Isocitrate Dehydrogenase (IDH) is a commonly mutated gene in gliomas, present in approximately 10% of high-grade gliomas. Its oncometabolite, D-2-hydroxyglutarate, has been implicated in promoting gliomagenesis and epileptogenesis. IDH-1 or IDH-2 mutations confer a more favorable prognosis in gliomas than wildtype IDH, leading to the differentiation between IDH-wild type glioblastoma and IDH-mutant WHO Grade 4 astrocytoma. Although IDH-mutant WHO Grade 4 astrocytomas tend to occur in younger patients and show an improved survival, prognosis remains poor and treatment options are limited. Ivosidenib is a small molecule inhibitor of IDH-1 that has shown promise for treating low-grade IDH-mutant glioma. However, little is known about its efficacy in IDH-mutant WHO Grade 4 astrocytoma.

Case Presentation:
We present a retrospective case of a 39-year-old male with a WHO Grade 4 astrocytoma. Molecular characterization revealed that it was IDH-mutant, MGMTp methylated, and 1p/19q intact. It was treated with ivosidenib at second recurrence. He was originally treated with gross total resection, followed by radiation and 6 cycles of adjuvant temozolomide. At the time of 1st progression (approximately 19 months postoperatively), he was treated with lomustine at 90mg/m2 but progressed after 2 cycles. Here we report the effects of off label use of ivosidenib.

Discussion:
Radiological surveillance showed interval decrease in tumor size starting two months after initiation of ivosidenib. The patient remained neurologically intact and no adverse effects were observed. A review of the literature revealed only three studies analyzing the effects of ivosidenib in IDH-mutated WHO Grade 4 astrocytomas with varying results.

The 2023 INDIGO trial showed evidence of efficacy in using an IDH inhibitor for low-grade gliomas. The role of these drugs in high-grade IDH-mutated gliomas is currently unknown. Further studies are needed to assess their efficacy in overall and progression free survival, specifically in IDH-mutated WHO Grade 4 astrocytoma.

Ivosidenib Therapy for IDH-mutant WHO Grade 4 Astrocytoma

Background:
Creutzfeldt-Jakob Disease is a rare, progressive neurodegenerative disease caused by the accumulation of prions and is typically fatal within 6-12 months of onset. MRI of the brain is a crucial part of the diagnostic process, evaluating for disease mimics including tumors, infections, and other neuroinflammatory conditions. A literature search of MRI findings in CJD was performed. Characteristic MRI findings include cortical and basal ganglia hyperintensities on FLAIR and DWI. Contrast-enhancing lesions have not been associated with CJD, prompting evaluation for alternative diagnoses.

Case Presentation:
We present the case of a 77-year-old woman who initially presented to her primary care physician with several months of memory loss and unsteady gait. MRI of the brain showed left temporal lobe FLAIR hyperintensity, suggestive of an underlying neoplastic process. She was lost to follow up, then presented to the hospital two months later with acute altered mental status. Her exam was notable for global aphasia, unresponsiveness, and lack of movement. MRI demonstrated new diffusion restriction in the cortex and left dorsal thalamus, along with a new contrast enhancing lesion in the left temporal lobe. Initial cerebrospinal fluid (CSF) testing showed elevated protein with normal white blood cell count. She received empiric IV methylprednisolone and IVIG for presumed inflammatory etiology, without clinical response. Later CSF testing returned positive for real time quaking-induced conversion (RT-QuIC) and 14-3-3 protein, consistent with CJD. She passed away after discharge.

Discussion:
To the authors’ knowledge, this is the first reported case to demonstrate that contrast-enhancing lesions may be seen with CJD, a neurodegenerative disease with poor prognosis. Therefore, it is critical for clinicians not to exclude CJD in the differential diagnosis of a patient with rapidly progressive neurologic decline with contrast-enhancing lesions, in addition to more characteristic imaging findings. This allows for earlier directed testing, including CSF studies, leading to an earlier probable diagnosis, prioritization of comfort care, and minimization of further unnecessary testing.

A Presentation of Creutzfeldt-Jakob Disease with Contrast Enhancement of the Temporal Lobe

Abstract Title:
Another Subconjunctival Hemorrhage? Unraveling an Unusual Ocular Surface Lesion

Background:
Kaposi’s sarcoma (KS) is a vascular neoplasm associated with immunosuppression, particularly advanced HIV with human herpesvirus 8 (HHV-8) coinfection. Classic presentation includes violaceous, cutaneous and/or mucosal lesions in the setting of a diminished CD4 count; however, reports have also described extracutaneous disease involving visceral organs, and more rarely, ocular structures such as the conjunctiva. We describe herein a rare case of conjunctival KS presenting near the time of initial HIV diagnosis and erroneously regarded as a subconjunctival hemorrhage.

Case Presentation:
A 38-year-old man with newly diagnosed HIV (CD4 18) and a history of oral thrush, cutaneous KS, and recently treated hospital-acquired pneumonia presented to our emergency department with a chief complaint of dyspnea on exertion. He was initially presumed to have a subconjunctival hemorrhage of his right eye, which he reported to have first developed as a red lesion 3 months prior. A subsequent slit-lamp examination in our outpatient ophthalmology clinic unearthed suspicions for a clinical diagnosis of conjunctival KS in addition to HIV retinopathy. An ensuing conjunctival biopsy identified a vascular mass in the substantia propria with positive HHV-8 immunohistochemical staining, confirming the diagnosis of KS. Shortly thereafter, the patient deteriorated clinically and eventually succumbed to complications of advanced HIV, despite initiation of antiretroviral therapy (ART) and linkage to our oncology service for outpatient chemotherapy.

Discussion:
In the era of ART, ocular KS is rare, although not unprecedented due to ART failure, medication nonadherence, or delayed HIV diagnosis influenced by an array of socioeconomic determinants. This case represents the interdisciplinary nature of treating advanced HIV and the importance of recognizing its unconventional ocular manifestations; furthermore, ocular KS can present as a deceptive entity mimicking common clinical findings and appearing as a harbinger of a poor prognosis.


Another Subconjunctival Hemorrhage? Unraveling an Unusual Ocular Surface Lesion

Abstract Title:
Language Matters: Assessing the Role of Interpreter Access in Patient Satisfaction
Background
The United States (U.S) is home to a large and growing immigrant population, with the number
of immigrants reaching 47.8 million in 20231. A 2011 study reported that over 55 million
individuals in the U.S.—both immigrant and U.S.-born—speak a non-English language at home,
with 8.6% considered to have limited English proficiency (LEP)2. LEP may lead to language
barriers which can hinder clear communication between patients and healthcare providers, often
resulting in confusion and dissatisfaction with care. Addressing these barriers is crucial to
enhancing the overall patient experience. The use of trained medical interpreters has been
associated with improved patient satisfaction and communication among LEP individuals2,3,4.
This study aims to evaluate the impact of interpreter services on patient satisfaction among
individuals with LEP in healthcare settings.
Methods
A systematic literature search for peer-reviewed English articles was conducted in PubMed.
Three independent researchers assessed journal eligibility based on publication date,
relevance, and study quality. The search utilized the keywords “interpreter efficiency,”
“healthcare access,” “language barriers,” and “patient satisfaction,” and was limited to
publications from 2000 to 2024, yielding four articles included in this study. The US Census was
used for information on immigration trends.
Results
Current data shows that using trained interpreters increases LEP patients’ satisfaction and trust,
understanding of their medical care, and improves patient outcomes. In contrast, ad hoc
interpreters, such as family members or untrained staff, more frequently lead to clinical
misunderstandings and breaches of confidentiality2,3,4. LEP patients also prefer in-person over
telephone or video interpreters, especially for more sensitive or complex discussions; this builds
better patient-physician rapport and connection5.
However, access to in-person interpreters is inconsistent across different healthcare settings4.
Several studies highlight the need to improve remote interpretation by expanding language
options and prioritizing video formats4,5. Additionally, providers reported greater confidence and
fewer errors when working with professional interpreters3.
Conclusion
Expanding access to trained medical interpreters, preferably in-person, and strengthening
remote services can significantly improve patient satisfaction and health outcomes for
individuals with LEP. Ensuring consistent and high-quality language services across all
healthcare settings is essential to reducing communication barriers. Thus, as the LEP patient
population continues to grow in the U.S., strengthening these services is a crucial step towards
the delivery of more equitable and patient-centered care.

Language Matters: Assessing the Role of Interpreter Access in Patient Satisfaction


Bridging Gaps in Care: Addressing Health Disparities in Colorectal Cancer Screening. 

Jacob Culclasure, M2 student2; Hanna Anhalt, M2 student2; A. Miles Scott, DO1. 
1Prisma Health, Columbia, SC; 2University of South Carolina School of Medicine, Columbia, SC. 

Introduction: Colorectal cancer (CRC) is the third most diagnosed cancer and third leading cause of cancer-related death in both men and women in the U.S., with increasing incidence among individuals under 50 years of age. Early screening and detection improve outcomes by identifying cancers at more treatable stages. Non-adherence to screening guidelines is a major contributor to worse outcomes. Barriers to screening predominantly affect marginalized groups due to remaining systemic injustices. In South Carolina, disparities exceed the national average. 

Methods: An Epic report of patients aged 45-75 seen at FMC Colonial in the past year determined potential factors contributing to CRC screening rates. The report established each patient’s age, insurance status, sex, and race. Pivot tables were produced to describe how each demographic factor contributed to rates of CRC screening and identify areas of intervention. The percentage of patients at goal was calculated by dividing the number of patients up to date on CRC screening by the total number of patients. 

Results: Among 3,397 eligible patients, 57.96% were up to date with recommended screening. Screening rates varied significantly by age group, insurance status, and sex. Only 48.6% of patients aged 45-54 were screened, compared to 59.8% of those 55-64 (p<0.000001) and 65.9% of those 65-75 (p<0.000001). Insurance status was strongly associated with screening. Patients with Medicare (62.2%) and private insurance (60.0%) had significantly higher screening rates compared to those with Medicaid (46.9%) and the uninsured (43.7%). Specifically, Medicaid patients had lower rates than both Medicare (p<0.000001) and private insurance (p<0.00001), and uninsured patients had a lower rate compared to Medicare (p<0.000001) and private insurance (p<0.00001). Differences in screening rates among sexes were less pronounced but still significant, with screening rates higher among females (60.4%) than males (53.9%, p=0.00024). In contrast to existing literature, no significant differences were found between racial groups. 

Conclusion: CRC screening rates in this population were influenced by age, insurance status, and sex, with older, insured, and female patients more likely to be screened. While no statistically significant racial disparities were identified, screening rates were lower among younger adults, males, and uninsured patients. These findings emphasize the need for targeted, clinic-based interventions, such as in-clinic education, counseling on testing options, and connecting patients to state-funded programs to support the uninsured, to improve overall screening rates.

Bridging Gaps in Care: Addressing Health Disparities in Colorectal Cancer Screening

Title: Cybersecurity Literacy Among Clinical Staff: A Simulated Survey Reveals Risk Exposure And Training Gaps In Healthcare Settings
Author: Temitope Adewuyi MB:BS ECFMG Certified 
Background: As healthcare systems undergo rapid digitization, frontline clinical staff are increasingly exposed to cybersecurity threats such as phishing, ransomware, and HIPAA violations. Despite the sensitivity of patient data and the growing frequency of cyberattacks, cybersecurity education remains fragmented and inconsistently integrated into clinical workflows. This study explores the extent of cybersecurity literacy among medical personnel and identifies key vulnerabilities in digital hygiene and procedural awareness.
Methods: A simulated cross-sectional survey was conducted using modeled data from 100 clinical staff, including physicians, nurses, and administrative personnel. The instrument comprised ten structured items assessing familiarity with phishing detection, password hygiene, multi-factor authentication (MFA), HIPAA compliance, incident reporting, and perceptions of cybersecurity responsibility. Data were synthesized from published trends and benchmarked against national healthcare cybersecurity reports.
Results: Only 38% of respondents could accurately identify phishing email traits, while 62% admitted to reusing passwords across multiple systems. Formal cybersecurity training had been received by just 28% in the past year. Knowledge of HIPAA’s cybersecurity clauses was limited to 41%, and only 36% expressed confidence in recognizing spoofed login portals. While 52% reported using MFA, only 33% believed cybersecurity fell within their clinical role. Additionally, 59% had encountered phishing attempts within six months, 46% understood how to report a suspected cyber incident, and 48% used encrypted messaging tools for patient communication.
Conclusion: The simulated findings reveal significant gaps in cybersecurity literacy among clinical staff, with low training rates, poor password practices, and limited procedural awareness. These vulnerabilities pose a direct threat to patient data integrity and institutional resilience. To mitigate risk, healthcare systems must implement mandatory, role-specific cybersecurity education and foster a culture of digital accountability. Strengthening frontline awareness is essential to safeguarding clinical operations in an increasingly connected care environment.
Keywords: Cybersecurity, clinical staff, HIPAA, phishing, medical education, healthcare technology, data
protection


Cybersecurity Literacy Among Clinical Staff

Despite the prevalence of domestic abuse and its profound dermatological impacts, there remains a scarcity of comprehensive research exploring this issue through a cross-cultural lens. The objective of this review was to synthesize available evidence on the dermatological impacts of domestic abuse across cultural contexts. This systematic review was conducted and reported according to PRISMA guidelines. Research studies focusing on individuals who have experienced domestic abuse in various cultural contexts were included. The primary exposure was domestic abuse, and studies investigating its dermatological impacts were eligible for inclusion. Eleven studies were included in the review. Majority of the included studies were observational studies (n=8) while 4 studies were case reports, covering diverse regions including North America, Europe, South America, Asia, and Australia. The majority of participants were female survivors of intimate partner violence (IPV), with mean ages typically falling in the early to mid-30s. The most frequently reported dermatological injuries included bruises and contusions primarily affecting the face, neck, upper and lower limbs, and scalp. Lacerations and incised wounds were reported in multiple studies, followed by abrasions, ecchymosis, burns, scarring and permanent disfigurement. While the types of injuries were largely consistent across geographical settings, some regional patterns were observed. The findings highlight the global burden of dermatological injuries in survivors of domestic abuse. The findings suggest that while patterns of skin injuries are relatively consistent, cultural and regional factors may influence the nature and severity of injuries, warranting further investigation.

Skin and Scars Across Cultures: The Dermatological Impacts of Domestic Abuse - A Systematic Review

Introduction
Preventive services are cornerstones of population health, yet uptake remains suboptimal and inequitable. Health literacy, defined as the capacity to obtain, process, and understand basic health information, is a recognized driver of individual and community health. This study aims to understand the relationship between health literacy and preventive care utilization. Based on prior literature, we used educational attainment and spoken home language as proxies for health literacy in our sample. 
Methods
We analyzed data from the 2023 National Health Interview Survey, identifying adults eligible for five USPSTF-recommended preventive services: colonoscopy, Pap smear, mammography, non-diabetics blood sugar testing, and annual influenza vaccination. Each outcome was modeled via survey-weighted logistic regression, assessing home language (English vs. non-English) and education level as primary predictors. Additionally, a composite metric, defined as receiving at least three of the five preventive care services per USPSTF guidelines, was modeled similarly. All models adjusted for age, race/ethnicity, and insurance coverage.
Results
A total of 21,110 respondents were included in our sample, representing 184.5 million US adults after survey weighting. Lower educational attainment was linked to significantly reduced odds of guideline-concordant screening for pap smears (OR 0.59, 95% CI 0.49-0.72, p<0.001), mammogram (OR 0.62, 95% 0.51-0.77, p<0.001), blood sugar testing (OR 0.64, 95% CI 0.54-0.76, p<0.001), and influenza vaccination (OR 0.47, 95% CI 0.43-0.51, p<0.001), but not colonoscopy. Non-English speakers had significantly lower odds of Pap smear (OR 0.65, 95% CI 0.50-0.85, p<0.001) and blood sugar testing (OR 0.81, 95% CI 0.66-0.99, p<0.04), but not the other services. In our composite model, respondents with lower education had 41% lower odds of obtaining at least three of the five preventive care services (OR 0.59, 95% CI 0.54-0.64, p<0.001), whereas home language was not a significant predictor. 
Discussion
Using education and home language as proxies for health literacy, we identified clear disparities in preventive‐care uptake. Targeted interventions such as expanded language assistance and interpretation services, in addition to culturally sensitive health resources, may aid in closing these gaps in preventive health behaviors.


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