Variations in the Anterolateral Thigh Flap's Vascular Anatomy in African Americans

Background Variations in anterolateral thigh (ALT) arterial anatomy are well documented. Ethnicity is a known risk factor for vascular variation in several organ systems, but its impact on ALT anatomy has not been studied. Anecdotally, we observed frequent ALT arterial variation in African American (AA) patients. We thus hypothesized that AA patients have higher rates of anomalous branching. Materials and Methods A total of 277 computed tomography angiograms (513 lower extremities) captured between May 1, 2013 and May 31, 2015 at a tertiary academic medical center were retrospectively analyzed to determine ALT arterial branching. Patient records were examined to ascertain demographics. Data were analyzed using descriptive statistics and multinomial logistic regression. Results Males comprised 84.5%. Ethnic distribution was 55.2% AA and 36.5% Caucasian. The descending branch of the lateral circumflex femoral artery (dLCFA) originated from non-LCFA arteries (deep femoral, common femoral, or superficial femoral arteries) in 18.9% of Caucasian versus 9.1% of AA (odds ratio [OR]: 2.28; 95% confidence interval [CI]: 1.33–3.93, p < 0.01). An oblique branch was identified in 41.1% of Caucasian versus 51.9% of AA (OR: 1.56; 95% CI: 1.08–2.24, p = 0.02). Ethnicity was the only driving factor of dLCFA and oblique branch of the LCFA (oLCFA) anatomy (Wald chi-square: 14 and 11, p = 0.03 and 0.02, respectively). Conclusions Ethnicity significantly affects ALT arterial anatomy. AA are more likely to have classical dLCFA branching with a fourth oLCFA branch. A flap with an unrecognized oLCFA-dominant supply places patients at a higher risk for flap failure and loss. We recommend preoperative imaging before undertaking an ALT flap reconstruction.

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Does Nursing Shift Influence Adherence to Central-Line Maintenance Bundles?

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.735 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s195-s195

Author(s):

Josephine Fox ◽

Robert Russell ◽

Lydia Grimes ◽

Heather Gasama ◽

Carrie Sona ◽

...

Keyword(s):

Multinomial Logistic Regression ◽

Medical Center ◽

Academic Medical Center ◽

Night Shift ◽

Insertion Site ◽

Central Line ◽

Central Lines ◽

Bundle Compliance ◽

Evening Shift ◽

Infusion Tubing

Background: Proper care and maintenance of central lines is essential to prevent central-line–associated bloodstream infections (CLABSI). Our facility implemented a hospital-wide central-line maintenance bundle based on CLABSI prevention guidelines. The objective of this study was to determine whether maintenance bundle adherence was influenced by nursing shift or the day of week. Methods: A central-line maintenance bundle was implemented in April 2018 at a 1,266-bed academic medical center. The maintenance bundle components included alcohol-impregnated disinfection caps on all ports and infusion tubing, infusion tubing dated, dressings, not damp or soiled, no oozing at insertion site greater than the size of a quarter, dressings occlusive with all edges intact, transparent dressing change recorded within 7 days, and no gauze dressings in place for >48 hours. To monitor bundle compliance, 4 non–unit-based nurse observers were trained to audit central lines. Observations were collected between August 2018 and October 2019. Observations were performed during all shifts and 7 days per week. Just-in-time feedback was provided for noncompliant central lines. Nursing shifts were defined as day (7:00 a.m. to 3:00 p.m.), evening (3:00 p.m. to 11:00 p.m.), and night (11:00 p.m. to 7:00 a.m.). Central-line bundle compliance between shifts were compared using multinomial logistic regression. Bundle compliance between week day and weekend were compared using Mantel-Haenszel 2 analysis. Results: Of the 25,902 observations collected, 11,135 (42.9%) were day-shift observations, 11,559 (44.6%) occurred on evening shift, and 3,208 (12.4%) occurred on the night shift. Overall, 22,114 (85.9%) observations occurred on a week day versus 3,788 (14.6%) on a Saturday or Sunday (median observations per day of the week, 2,570; range, 1,680–6,800). In total, 4,599 CLs (17.8%) were noncompliant with >1 bundle component. The most common reasons for noncompliance were dressing not dated (n = 1,577; 44.0%) and dressings not occlusive with all edges intact (n = 1340; 37.4%). The noncompliant rates for central-line observations by shift were 12.8% (1,430 of 1,1,135) on day shift, 20.4% (2,361 of 11,559) on evening shift, and 25.2% (808 of 3,208) on night shift. Compared to day shift, evening shift (OR, 1.74; 95% CI, 1.62–1.87; P < .001) and night shift (OR, 2.29; 95% CI, 2.07–2.52; P < .001) were more likely to have a noncompliant central lines. Compared to a weekday, observations on weekend days were more likely to find a noncompliant central line: 914 of 3,788 (24.4%) weekend days versus 3,685 of 22,114 (16.7%) week days (P < .001). Conclusions: Noncompliance with central-line maintenance bundle was more likely on evening and night shifts and during the weekends.Funding: NoneDisclosures: None

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Abstract 17004: Using mHealth to Capture Patient-Reported Sexual Satisfaction in Heart Failure

Circulation ◽

10.1161/circ.142.suppl_3.17004 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Brittany N Taylor ◽

Meghan Reading Turchioe ◽

Parag Goyal ◽

Ruth M Masterson Creber

Keyword(s):

Heart Failure ◽

Sexual Satisfaction ◽

Medical Center ◽

Academic Medical Center ◽

Symptom Burden ◽

Self Report ◽

Patient Comfort ◽

Measurement Information ◽

Chi Square ◽

Patient Reported

Introduction: Over 60% of heart failure (HF) patients have reported problems with sexual satisfaction, which is a major reason for medication non-adherence. While many patients are reticent to verbally self-report impaired sexual satisfaction, mobile health (mHealth) technology may improve patient comfort in reporting these symptoms. We aimed to evaluate the feasibility of HF patients using mHealth to self-report sexual satisfaction by comparing responders to non-responders and evaluating symptom burden. Methods: We prospectively recruited HF patients from inpatient and outpatient cardiology clinics at an urban academic medical center from October 2016 to January 2017. Patients completed Patient Reported Outcomes Measurement Information System (PROMIS ® ) questionnaires via an mHealth application, mi.Symptoms . The specific outcomes of interest were fatigue- and pain-related impairment of sexual satisfaction, due to the prevalence of those symptoms in HF. Data were analyzed using descriptive statistics and Chi-square tests to evaluate differences between responders and non-responders. Results: The mean age of participants (n=168) was 59 years (±12.5); 37% were female; 37% were Latino; 32% were Black, 32% White, and 36% Other Race . Few significant differences in demographic characteristics of responders and non-responders were noted ( Table ). Of the 117 participants (69.6%) who responded regarding fatigue, 59 (50.4%) indicated that fatigue affected sexual satisfaction “quite a bit” or “very much.” Of the 114 participants (67.9%) who responded regarding pain, 44 (38.6%) indicated that pain affected sexual satisfaction “quite a bit” or “very much.” Conclusion: This study showed that mHealth can be a feasible way to collect sexual satisfaction data with fairly high response rates and few differences between responders and non-responders. Participants’ reported high burden of impairment underscores the importance of measuring this symptom.

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Far-Lateral Transcondylar Approach to a Right Cervicomedullary Dural Arteriovenous Fistula of the Posterior Fossa

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0040-1705162 ◽

2020 ◽

Author(s):

Roberto R. Rubio ◽

Ricky Chae ◽

Todd Dubnicoff ◽

Ethan Winkler ◽

Adib A. Abla

Keyword(s):

Posterior Fossa ◽

Medical Center ◽

Academic Medical Center ◽

Deep Understanding ◽

Preoperative Imaging ◽

Arteriovenous Shunting ◽

Postoperative Imaging ◽

Transcondylar Approach ◽

Cervicomedullary Junction ◽

Far Lateral

Abstract Objectives Dural arteriovenous fistulas (DAVFs) at the cervicomedullary junction are uncommon and often accompanied by subarachnoid hemorrhage (SAH). We aim to illustrate in detail the microsurgical procedure for treating a DAVF located at the cervicomedullary junction. Design We present a two-dimensional operative video that includes clinical history, preoperative imaging, surgical strategy, still images with labels, clinical course, and postoperative imaging. Setting The microsurgery was performed at an academic medical center. Participant The patient is a 55-year-old female who presented with SAH, acute onset headache, nausea, and vomiting. Angiography demonstrated right vertebral artery vasospasm and a persistent arteriovenous shunt at the cervicomedullary junction supplied by small perforating arteries of the right vertebrobasilar junction (Fig. 1). Main Outcome Measures The patient was placed in the park-bench position with the head turned to the contralateral side. A hockey stick incision was made, followed by a right-side far-lateral transcondylar approach. Indocynanine green videoangiography was performed to help identify the areas of arteriovenous shunting. Multiple clips were placed to interrupt vessels that corresponded to arterial feeders at the level of the C1 and C2 nerve root sleeves (Fig. 2). The dura was closed in a water tight fashion and the posterior fossa was reconstructed with a titanium mesh. Results Postoperative imaging showed no evidence of continued arteriovenous shunting. The patient was discharged in good clinical condition with an uneventful postoperative course. Conclusion A deep understanding of the microsurgical vascular anatomy is necessary for successful occlusion of a cervicomedullary DAVF.The link to the video can be found at: https://youtu.be/-LfOcNB05BY.

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532. Establishing a SARS-CoV-2 Monoclonal Antibody Infusion Clinic: Early Trends in Outcomes and Disparities

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.731 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S367-S367

Author(s):

Allison J Hare ◽

Judith M Rivera McPhaul ◽

Patrick Cargan ◽

Pablo Tebas ◽

Kathleen Degnan ◽

...

Keyword(s):

Adverse Reactions ◽

Medical Center ◽

Academic Medical Center ◽

Area Deprivation ◽

Chi Square ◽

Equitable Distribution ◽

Duration Of Symptoms ◽

Black Patients ◽

Number Of Patients ◽

White Patients

Abstract Background SARS-CoV-2 monoclonal antibodies (SMA) have demonstrated efficacy in treatment of early, mild to moderate COVID-19 in patients at high risk for progression to severe COVID-19. We created an SMA infusion clinic at a large, urban academic medical center using both internal and community-based referral mechanisms to promote the equitable distribution of treatment. Methods Data were analyzed from clinic referrals from December 13, 2020 through April 20, 2021. Patient demographics, census-based area deprivation index (ADI) scores (scale of 1-10, with 1 representing least socioeconomic deprivation and 10 representing most), and relevant comorbidities were collected. Outcomes included days of symptoms until referral, patient receipt of SMA therapy after referral, adverse events, and ER visits and hospitalizations within 14 days of SMA administration. Association between demographic factors and relevant outcomes were determined using chi-square or Wilcoxon rank-sum tests as appropriate. Results 47/433 (11%) referred patients were ineligible based on inclusion and exclusion criteria. Of eligible patients, 310/386 (80%) received treatment; patients who did not receive treatment either declined (93%), could not be contacted (5%), no-showed (1%), or were admitted for hypoxia (1%). Of treated patients, only 3 (1%) had adverse reactions. Within 14 days of SMA administration, 28 (9%) patients visited the ER or were admitted for COVID-19. Black patients had a longer median duration of symptoms prior to referral compared to White patients (5 vs. 3 days, p < 0.01) (Figure 1). White patients were more likely to receive SMA after referral compared to Black patients (88% vs. 64%, p < 0.01), as were patients with ADI score 1-5 compared to those with ADI score 6-10 (88% vs. 70%, p < 0.01) (Figures 2 and 3). Black patients who received SMA had a higher rate of ER visits or admissions than White patients, although the difference was not statistically significant (14% vs. 7%, p = 0.10). Figure 1. Bar graph displaying number of patients per race (White, Black, or Other) by duration of symptoms prior to referral. Figure 2. Bar graph displaying number of patients who did and did not receive SMA by race Figure 3. Bar graph displaying number of patients who did and did not receive SMA by ADI. Conclusion Rate of adverse reactions and COVID-related ER visits or admissions were low in patients who received SMA. Despite efforts to promote the equitable distribution of treatment through multiple referral mechanisms, racial and socioeconomic disparities still exist. Disclosures All Authors: No reported disclosures

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Safety of 2-Octyl Cyanoacrylate in Spreader Grafting

Facial Plastic Surgery ◽

10.1055/s-0036-1597998 ◽

2017 ◽

Vol 33 (02) ◽

pp. 213-216 ◽

Cited By ~ 2

Author(s):

Aurora Standlee ◽

Marc Hohman

Keyword(s):

Medical Center ◽

Academic Medical Center ◽

Tertiary Care ◽

Final Analysis ◽

Spreader Graft ◽

Chi Square ◽

Inflammatory Reactions ◽

Graft Placement ◽

Postoperative Inflammation ◽

Academic Medical

AbstractCyanoacrylate adhesives can make the placement of spreader grafts in open septorhinoplasty technically easier, but its use is off-label beneath the skin. There is a theoretical risk of toxicity from cyanoacrylate breakdown products, but this risk has not been thoroughly studied in rhinoplasty. The objective was to evaluate the effects of subcutaneous cyanoacrylate use during spreader graft placement in rhinoplasty in a retrospective review of open septorhinoplasties in which 2-octyl cyanoacrylate was used to aid placement of spreader grafts. The review was carried out in a tertiary care military academic medical center. A total of 140 adults underwent open septorhinoplasty between September 2013 and May 2016 with spreader graft placement. The authors excluded patients in whom 2-octyl cyanoacrylate was not used to aid graft placement and those who did not follow up postoperatively in our clinic. 108 (85 males and 23 females) patients were included in the final analysis. Nine (8.3%) patients had inflammatory reactions possibly attributable to 2-octyl cyanoacrylate toxicity. The overall rate of postoperative inflammation possibly attributable to 2-octyl cyanoacrylate was 17% among females and 5.9% among males, and this difference was not statistically significant (p = 0.07). However, the rate of postoperative inflammation attributable to 2-octyl cyanoacrylate that required an intervention (incision and drainage or antibiotics) was 2.7% overall, 13% among women and 0% among men, and this difference was significant based on chi-square testing (p < 0.001). Further, revision cases were significantly more likely to develop abnormal postoperative inflammation than initial cases (p = 0.02). Herein, the authors present the largest series of patients in whom 2-octyl cyanoacrylate was used to assist placement of cartilage spreader grafts during open septorhinoplasty. While 2-octyl cyanoacrylate is an effective adjunct to facilitate graft placement, they recommend against its use, as the risk of postoperative inflammation is significant.

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Disorders Involving a Persistent Craniopharyngeal Canal: A Case Series

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0039-1692638 ◽

2019 ◽

Vol 81 (05) ◽

pp. 562-566

Author(s):

Seerat K. Poonia ◽

Diego Cazzador ◽

Adam C. Kaufman ◽

Michael A. Kohanski ◽

Edward C. Kuan ◽

...

Keyword(s):

Congenital Anomaly ◽

Surgical Repair ◽

Medical Center ◽

Academic Medical Center ◽

Case Series ◽

Cerebrospinal Fluid Leak ◽

Preoperative Imaging ◽

Academic Medical ◽

Craniopharyngeal Canal ◽

Transnasal Endoscopic Repair

Objectives A persistent craniopharyngeal canal (CPC) is a rare embryologic remnant that presents as a well-corticated defect of the midline sphenoid body extending from the sellar floor to the nasopharynx. Our case series aims to describe three unique presentations of this congenital anomaly and their subsequent management.Design Retrospective review.Setting Tertiary academic medical center.Participants Patients who underwent endoscopic transnasal surgical repair of a CPC lesion.Main Outcome Measures Resolution of symptoms and surgical outcomes.Results A total of three patients were identified. The clinical presentation varied, however, all cases prompted further imaging which demonstrated a persistent CPC and associated pathologic lesion. The presentation of a persistent CPC with nasal obstruction and subsequent iatrogenic cerebrospinal fluid leak as in Case 1 demonstrates the importance of imaging in this work-up. Cases 2 and 3 in the series were representative of the larger subset of patients in the literature who present with the defect incidentally but still warrant surgical management. Nonetheless, a standard approach to diagnosis with preoperative imaging and subsequent transnasal endoscopic repair of the skull base defect was undertaken.Conclusion The persistent CPC is a rare congenital anomaly associated with diverse pathology and careful review of preoperative radiology is critical to the management. When warranted, subsequent surgical repair and reconstruction is associated with excellent postoperative outcomes.

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Effects of Bispectral Index Monitoring on Recovery from Surgical Anesthesia in 1,580 Inpatients from an Academic Medical Center

Anesthesiology ◽

10.1097/00000542-200503000-00015 ◽

2005 ◽

Vol 102 (3) ◽

pp. 566-573 ◽

Cited By ~ 33

Author(s):

Janet D. Pavlin ◽

Karen J. Souter ◽

Jae Y. Hong ◽

Peter R. Freund ◽

T Andrew Bowdle ◽

...

Keyword(s):

Bispectral Index ◽

Medical Center ◽

Academic Medical Center ◽

Postanesthesia Care Unit ◽

Control Group ◽

Chi Square ◽

Anesthesia Providers ◽

Academic Medical ◽

Chi Square Test ◽

Group A

Background The purpose of this study was to determine whether monitoring Bispectral Index (BIS) would affect recovery parameters in patients undergoing inpatient surgery. Methods Anesthesia providers (n = 69) were randomly assigned to one of two groups, a BIS or non-BIS control group. A randomized crossover design was used, with reassignment at monthly intervals for 7 months. Duration of time in the postanesthesia care unit, time from the end of surgery to leaving the operating room, and incidence of delayed recovery (> 50 min in recovery) were compared in patients treated intraoperatively with or without BIS monitoring. Data were analyzed by analysis of variance, unpaired t test, or chi-square test as appropriate. Results One thousand five hundred eighty patients in an academic medical center were studied. The mean BIS in the monitored group was 47. No differences were found in recovery parameters between the BIS-monitored group and the control group when comparisons were made using all subjects or when data were analyzed within anesthetic subgroups stratified by anesthetic agent or duration of anesthesia. There were some small reductions in the intraoperative concentration of sevoflurane (but not isoflurane). Conclusions The use of BIS monitoring for inpatients undergoing a wide variety of surgical procedures in an academic medical center had some minor effects on intraoperative anesthetic use but had no impact on recovery parameters.

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Clinical Presentation of Hepatocellular Carcinoma in African Americans vs. Caucasians: A Retrospective Analysis

Pathophysiology ◽

10.3390/pathophysiology28030026 ◽

2021 ◽

Vol 28 (3) ◽

pp. 387-399

Author(s):

Hrishikesh Samant ◽

Kapil Kohli ◽

Krunal Patel ◽

Runhua Shi ◽

Paul Jordan ◽

...

Keyword(s):

Risk Factors ◽

Hepatocellular Carcinoma ◽

Medical Center ◽

Academic Medical Center ◽

Ethnic Disparities ◽

Surveillance Program ◽

Chi Square ◽

Vein Thrombosis ◽

Disease Characteristics ◽

Academic Medical

Hepatocellular carcinoma (HCC) remains an important form of cancer-related morbidity and mortality in the U.S. and worldwide. Previous U.S.-based studies on survival suggest ethnic disparities in HCC patients, but the complex interplay of multiple factors that contribute are still incompletely understood. Here we considered the influences of risk factors contributing towards HCC survival, including ethnic background, over ten years at a premier academic medical center with a majority (57.20%) African American (AA) population. Retrospective HCC data were collected from 2008–2018 at LSUHSC-Shreveport, an urban tertiary medical center. Data included demographics, comorbidities, liver disease characteristics, and tumor parameters. Statistical analysis was performed using Chi Square and one-way ANOVA. Results: 229 HCC patients were identified (male 78.6%). The mean HCC age at diagnosis was 61 years (SD = 7.3). Compared to non-Hispanic Caucasians (42.7%), AA patients (57.2% of total) were older at presentation, had more frequent diabetes/dyslipidemia/NAFLD (45 (34.3%) compared with 19 (19.3%) in non-Hispanic Caucasians, p = 0.02), and had a larger HCC burden at diagnosis. We conclude that compared to white patients, despite having similar BMI and MELD scores and rates of portal vein thrombosis, AA patients with HCC in our cohort were older at presentation, had a significantly increased incidence of modifiable metabolic risk factors including diabetes, higher AFP values, increased incidence of gallstones, and larger sized HCCs, and were more likely to be outside Milan criteria. These findings have important prognostic and diagnostic implications for developing a more targeted HCC surveillance program.

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167. Communication is Key: A Multifaceted Approach to Improving Essential ASP Metrics in Surgical Services

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.211 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S91-S91

Author(s):

Rachel S Britt ◽

David Reynoso ◽

Philip H Keiser ◽

R Scott Ferren

Keyword(s):

Infectious Diseases ◽

Medical Center ◽

Academic Medical Center ◽

Trauma Surgery ◽

Antimicrobial Use ◽

Post Intervention ◽

Chi Square ◽

Surgical Services ◽

Days Of Therapy ◽

Post Period

Abstract Background Despite widespread antimicrobial resistance, suboptimal antimicrobial use is common, particularly among surgical services. Studies show that antimicrobial stewardship programs (ASPs) effectively improve antimicrobial use and decrease adverse events. However, evidence for optimal ASP intervention in surgical departments is lacking, and some surgical services perceive ASPs negatively. This study aimed to evaluate the effect of several collaborative ASP interventions and workflow changes on the non-acceptance rate (NAR) of ASP recommendations and antimicrobial use among surgical services. Methods This was a retrospective, pre-post study of services in the department of surgery at a 681-bed, academic medical center between 12/01/2018 and 5/31/2020. Throughout 10/2019 and 11/2019, the core ASP, which consists of two infectious diseases physicians and two infectious diseases pharmacists, performed several interventions with surgical services. These included meetings with the chairman, vice chairs, and division chiefs of the surgery department, a grand rounds presentation to surgical house staff, and monthly surgeon NAR reporting to the chairman. Also, per feedback from surgeons, the ASP began to communicate recommendations directly to attending surgeons instead of residents or via ASP notes in the medical record. Data for the pre-period was collected from 12/2018 to 9/2019; data for the post-period was collected from 12/2019 to 5/2020. Wilcoxson rank sum, chi-square, and Fisher’s exact tests were used to compare outcomes. Results The ASP communicated 353 recommendations to surgical services in the pre-period, and 181 in the post-period. ASP offered most recommendations to trauma (n=244), cardiothoracic (n=60), and plastic surgery (n=54) during the study periods. NAR decreased post-intervention overall (43% vs 29%, p=0.0013) and in trauma surgery (63% vs 47%, p=0.03). Mean monthly days of therapy per 1000 patient days trended towards a decrease post-intervention (1105 vs 1044, p=0.26). Cost per 1000 patient days decreased post-intervention ($27,677.91 vs $19,766.31, p =0.0075). Conclusion A communicative and adaptive approach to ASP in surgical services improved NAR and antimicrobial costs and trended towards a reduction in antimicrobial use. Disclosures All Authors: No reported disclosures

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Factors and barriers associated with changes in physical activity after cancer diagnosis.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.5_suppl.162 ◽

2017 ◽

Vol 35 (5_suppl) ◽

pp. 162-162 ◽

Cited By ~ 4

Author(s):

Sally A. D. Romero ◽

Qing Susan Li ◽

Jun J. Mao

Keyword(s):

Physical Activity ◽

Cancer Patients ◽

Metastatic Disease ◽

Cancer Diagnosis ◽

Medical Center ◽

Academic Medical Center ◽

Cross Sectional Study ◽

Chi Square ◽

Cross Sectional ◽

Logistic Regression Models

162 Background: Cancer patients experience a variety of symptoms (e.g., pain, fatigue) that can impact their ability to maintain physical activity (PA) levels. The objectives of this study were to examine factors associated with decreased levels of PA following cancer diagnosis and to identify barriers to PA. Methods: We recruited cancer patients from one urban academic medical center and 11 affiliated community hospitals to participate in a cross-sectional study. We conducted chi-square tests and multivariate logistic regression models to examine patient demographics, clinical characteristics and self-reported barriers associated with decrease in PA levels since cancer diagnosis. Results: Among 662 participants, mean age (SD) was 59.9 (11.6) years. The majority were female (65%), White (81%), and overweight/obese (65%). Common cancer types were breast (32%), lung/thoracic (15%), and hematological (15%), 53% had non-metastatic disease, and 53% were > 12 months post-cancer diagnosis. The majority received chemotherapy (88%), radiation (53%), and/or surgery (53%). Since their cancer diagnosis, 499 (75%) participants reported decreasing their PA levels, 16% maintained, and 4% increased their PA levels. In multivariate analyses, decreased PA levels were significantly associated with receiving chemotherapy [Adjusted Odds Ratio (AOR) 3.54, 95% CI 2.06-6.06] and having metastatic disease (AOR 1.64, 95% CI 1.07-2.52). For barriers to PA, the most common were fatigue (78%), pain (71%), difficulty getting motivated (68%) and difficulty remaining disciplined (65%). In bivariate analyses, the presence of symptoms (i.e., pain, nausea, fatigue, treatment side effects, or surgical complications), difficulty getting motivated, difficulty remaining disciplined, and sadness were significantly associated (p < 0.05) with decreasing PA levels. Conclusions: The majority of cancer patients, especially those who received chemotherapy and those with advanced disease, decreased their PA levels since cancer diagnosis. In addition, physical and psychological barriers exist that influence PA levels. Interventions targeting these barriers are needed to promote maintenance of PA levels throughout the cancer continuum.

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