bluuebunny/crossref_metadata_2025 huggingface dataset:
Correlates of cervical cancer screening from four Sub-Saharan African (SSA) countries: Results from the Demographic Health Survey (DHS)—2013-2015.
Authors: Menon Manoj , Krantz Elizabeth , Casper Corey
Published: September 2018

e18006

Background: Widespread cervical cancer screening has led to a dramatic reduction in cervical-cancer related mortality in resource-rich regions. However, cervical cancer remains a leading cause of cancer-related death in SSA due in part to a lack of accessible screening and treatment options. Methods: The DHS is a nationally representative household survey designed by ICF International and typically implemented every 5 years. In addition to demographic characteristics, select surveys collect data on cervical cancer awareness and screening. We included women aged ≥21 years from Côte d'Ivoire, Kenya, Namibia, and Zimbabwe who participated in the DHS. After sample weights were applied, we used logistic regression to examine associations of demographics and national cervical cancer incidence (as per the International Agency on Research on Cancer) with cervical cancer screening. Factors with p < 0.20 in bivariate analyses were included in a multivariate model. Results: We analyzed data from 45,947 women aged 21 to 49 years (mean = 32.2); 69% were married with an average of 3 children. Nearly half had completed secondary education (47%), 73% were literate, and 48% belonged to the highest two wealth quintiles. Over 70% of women were aware of cervical cancer; 24% of all women reported a previous screening exam with variation by country. Namibia, with the highest rates of screening (46%), had the lowest incidence. In multivariate analyses, cervical cancer screening was associated with increasing age (OR = 1.06; CI = 1.05, 1.07), education (OR = 1.48; CI = 1.30, 1.69), literacy (OR = 1.80; CI = 1.53, 2.13), and wealth (OR = 1.14; CI = 1.09, 1.20). Higher cervical cancer incidence at the national level (OR = .980; CI = .976, .983) and rural residence (OR = .839; CI = .738, .953) were inversely associated with odds of cervical cancer screening. Conclusions: Based on DHS data from four SSA countries, awareness of cervical cancer is high, but receipt of cervical cancer screening is low and may be associated with reductions in cervical cancer incidence. Targeted efforts to increase utilization of cervical cancer screening in SSA are warranted to reduce the preventable burden of cervical cancer.
A demonstration project: Providing colon cancer screening to homeless people—Capitalizing on community partnerships.
Authors: Foreman Leslie , Green Donna Akerson , Thorpe Beverly , Haddock Malia , Burns William , Roberts M.Parker , Remick Scot C.
Published: September 2018

e18009

Background: Homeless people encounter many barriers to healthcare and preventative services, while having an increased prevalence of most risk factors for cancer. A group of homeless adults (40) receiving services from Preble Street in Portland Maine were successfully provided access, support and coaching to participate in colon cancer screening using Fecal Immunochemical Test (FIT) over a period of six weeks. Maine Medical Center Cancer Institute (MMCCI) recruited a Physician champion, while Preble Street gathered multiple internal and external community partners and together help plan the project identify resources needed, plan for data collection and address potential barriers for participation. Methods: Community partners (MMCCI, Preble Street, Casco Bay Surgery, NorDx, MaineHealth Care Partners and Homeless Health Partners Case Managers, Me Health LRC, and Maine Medical Center Magnet Council) created a detailed protocol to be used to overcome barriers and facilitate screening. The combination of a simple screening tool and caseworker relationship proved to be an effective strategy. Community Partners were used to identify barriers in the process, monitor all test results and navigate patients testing positive to colonoscopy. Small incentives of $10 food cards were provided for those participating in the screening event. Results: Of the 40 participants who were screened 8 (20%) tested positive and are in colonoscopy follow-up, with ages ranging from 50-74 years. The majority of participants 28 (70%) reported never having a provider conversation about colon cancer screening. Conclusions: Providing cancer prevention education and access to screening can have a positive impact on early detection in the homeless population. Identifying practical barriers and solutions are essential to improving cancer screening participation for homeless people.
Impact of cancer therapy on oral care utilization.
Authors: Smith Derek , Castellanos Emily , Murphy Barbara A.
Published: September 2018

e18010

Background: Cancer therapy can result in lifelong detrimental changes to oral function. These changes often result in negative effects on patients' quality of life. The primary objective of this study is to evaluate attendance at dental visits among patients receiving a cancer diagnosis, and how attendance may change as patients move through pre-diagnosis, diagnosis and into survivorship. Methods: The Health and Retirement Study is a publically available dataset containing longitudinal survey data detailing financial and health information on 4195 patients, over 51 years old who received a new cancer diagnosis during the study. The odds of reporting a dental visit were examined as patients proceed through various phases of cancer therapy using a mixed-effects logistic regression model. A propensity score weighted analysis of the association between dental attendance in the survey wave in which the cancer was diagnosed and survival was also undertaken. Results: The odds of attending a dental visit were substantially lower in the diagnosis wave OR = 0.784 (0.700, 0.876) and the post-diagnosis waves OR = 0.734 (0.655, 0.823) compared to pre-diagnosis waves. This effect persisted in patients who survived for at least two years indicating that the decline in oral health visits was not due to extremely low expected survival. The decrease in oral health visits was not affected by age, race, gender, income, insurance coverage or education. After propensity score weighting, patients who attended a dental visit in their diagnosis wave demonstrated a reduced hazard of all-cause mortality HR = 0.825 (0.681, 0.979) compared with those with no attendance. Conclusions: Dental attendance decreases by a statistically and clinically significant amount both during and after cancer therapy despite indications for dental referral existing for many types of cancer therapy. Attendance at dental appointments during cancer therapy is associated with improved survival, which is likely due to a combination of direct and indirect effects. The fact that the decreases in care were not modified by socioeconomic factors suggests that it is not driven by strictly financial concerns and more research is necessary to identify barriers to adequate care.
Comprehensively assessing the clinical trial landscape in oncology over the last 10 years.
Authors: Crowther Jonathan , Cocker David john
Published: September 2018

e18023

Background: Since the establishment of clinical trial registries such as ClinicalTrials.gov the number of such registries and the volume of data within the registries has quadrupled. Many studies have assessed the clinical trial landscape within their research field and have been hindered by inadequate search queries. Several approaches within these studies have implemented descriptive statistical analysis by examining specific indications or by searching for trials often using vague search terms such as “neoplasms”. This type of analysis permits the integration of potentially non-relevant noisy data which, impairs the overall analysis quality, Methods: In this study, we developed a semantic ontology linking algorithm to comprehensively merge 16 trial registries, 198,000 clinical trials, 10,000 molecules from multiple drug databases and PubMed, thus rendering and identifying indications, treatment, sites and investigators into one resource. The method allowed for a semantically cleaned and collapsed database to be queried more effectively with higher reliability in results. Results: The second proponent of our study was to assess the international oncology trial landscape over the last 10 years. The last major analysis in 2009 identified a significant preference for United States clinical sites in large cancer trials. Since this study, oncology has evolved toward a precision therapy approach and adaptive design model. This 2017 analysis shows an increasing concentration of US based clinical activity. For lung cancer trials with a US component, the top 100 US clinical research sites in the US are involved in 86% of the phase 1 trials, representing 55% of the total enrolment. When analyzing site usage for phase 3, this share drops to 67% of trials, representing just 8,5% of the total patient enrolment targets. Conclusions: The semantic ontology and algorithms and exploiting real-world data to mapped out and re-evaluate the status of cancer trials globally and gave insights into how cancer trials are progressing in the future. Understanding this evolution is of high importance for clinical trial planning and global trial country and site optimization.
Utilization of advanced molecular analyses in lung cancer: A country perspective—Young Research Group.
Authors: Petekkaya H. Ibrahim , Abali Huseyin
Published: September 2018

e18027

Background: Molecular and genetic analyses in cancer treatment are continuously evolving, and taking part in patient management. This study evaluated the clinical practices of medical oncologists in Turkey for utilization of these methods in lung cancer patients. Methods: All medical oncologists registered to Turkish M.Oncology Society were called to participate an online survey about their practice patterns of using molecular and genetic analyses for the management of lung cancer patients. Survey included 19 questions for demographic data, work environment, knowledge about the molecular and genetic analyses, and barriers to use these methods. Results: A total of 188 medical oncologists (M/F: 117/71; mean age 39.3±6.7) were participated. The key findings: Work environment: Academia 49%; others 51% Checking mutations in adenocancer: 88.4% Molecular analyses available at home institution: 61.4% Checking EGFR, EML-ALK, ROS-1 in NSCLC: 75.7% Non-specifically checking markers: 58.2% Checking markers only for locally advanced/metastatic disease at diagnose: 75.1% Obtaining analyze results in: 8-14 days 45%; 15-21 days 31.2% Obtaining a positive EGFR/ALK report after initiating chemo: re-evaluate patient after 2/3 cycles 68.3%; stop chemo and shift to targeted therapy 20.6%; continue full-regimen 12.2% Maintenance therapy after response regardless of mutation: 36% If targeted therapy initiated regardless of mutation, the preferred 1st step cytotoxic chemo regimen in metastatic adenocancer: cisplatin+pemetrexed 50.2% Analyzing mutation from primary lung biopsy: 95.8% Re-biopsy if sample was inadequate: 91.5% Secondary biopsy for: EGFR/ALK discordance 38.1%; progression under treatment 46%; young patient 22.2%; never-smoker 34.9%; test-negative but presumed to be clinically-positive patient 46.6% Conclusions: Majority of the medical oncologists in Turkey use molecular and genetic analyses in clinical practice. But, the limited availability and the lags in obtaining results lead oncologists to initiate treatment primarily based on clinical findings. Once these methods become more available, targeted therapies and consequent favorable outcomes will increase in oncology practice.
Changes in clinical trial participation among adolescent and young adult (AYA) cancer patients from 2006 to 2013 in the United States.
Authors: Keegan Theresa , Penn Dolly , Li Qian , Pollock Brad , Malogolowkin Marcio H. , Wun Theodore , Parsons Helen M.
Published: September 2018

e18037

Background: Stagnant outcomes for AYAs (15 to 39 years) with cancer are partly attributed to poor enrollment onto clinical trials. Initiatives have focused on increasing accrual, but changes at the population-level are unknown. We examined patterns of clinical trial participation over time in AYA cancer patients. Methods: We utilized medical record data from AYAs in two National Cancer Institute Patterns of Care Studies identified through the Surveillance, Epidemiology and End Results (SEER) Program. Among 1,358 AYAs diagnosed with non-Hodgkin lymphoma (NHL), Hodgkin lymphoma (HL), acute lymphoblastic leukemia (ALL), germ cell cancer, and sarcoma in 2006 and 3,560 AYAs diagnosed with NHL, HL, ALL, sarcoma, and breast cancer in 2012/2013, we used unconditional logistic regression to evaluate patient and provider characteristics associated with enrollment by year of diagnosis. Analyses were weighted to reflect the SEER populations and associations are summarized as adjusted odds ratios (OR) with 95% confidence intervals (CI). Results: From 2006 to 2012/2013, clinical trial participation increased from 14.8% to 17.9% among AYAs diagnosed with NHL, HL, ALL and sarcoma (p < 0.0001), primarily due to increased participation among ALL patients (2006: 37.4%; 2012/2013: 42.3%). In 2012/2013, participation varied by type of cancer, with the highest among those with ALL and sarcoma (31.2%), followed by HL (9.4%), NHL (6.9%) and breast cancer (4.3%). In both study years, multivariate analyses demonstrated that younger patients and those treated by pediatric oncologists (OR = 3.5; CI: 2.6-4.7) were more likely to enroll onto clinical trials. Uninsured AYAs were less likely to enroll in 2006 but no association was observed in 2012/2013. Hispanic (OR = 0.5; CI: 0.4-0.6), Black (OR = 0.6; CI: 0.5-0.9) and Asian (OR = 0.4; CI: 0.3-0.6) AYAs were less likely to enroll in 2012/2013 but not 2006. Conclusions: Our study identified increasing overall clinical trial participation over time. Disparities in likelihood of participating for racial/ethnic minority groups increased suggesting the need to improve access to clinical trials for all racial/ethnic groups to improve care and outcomes.
Timeliness of adjuvant chemotherapy in patients with resected pancreatic cancer.
Authors: Deng David , Cheung Winson Y.
Published: September 2018

e18038

Background: Timeliness of adjuvant chemotherapy is an important predictor of survival for patients with breast and colorectal cancer whereby long delays has been shown to detrimentally impact outcomes. The effects of adjuvant treatment timing remain largely unknown for early pancreatic cancer. This study aims to identify independent predictors of treatment timeliness and overall survival in this patient population. Methods: We conducted a retrospective, population-based analysis of 179 patients with resected pancreatic cancer who subsequently started adjuvant chemotherapy between 2008 and 2014 at any 1 of 6 cancer centers across British Columbia, Canada. Logistic regression was used to identify predictive factors for adjuvant chemotherapy timing. Prognostic factors for survival were ascertained using multivariate Cox proportional hazards models. Results: Our study cohort included 91 men (51%) and 88 women (49%). At time of diagnosis, 145 patients (81%) had nodal involvement and 107 patients (60%) had good ECOG performance status (ECOG 0-1). The median age of diagnosis was 67 (range 37-85) years. The median interval between surgery and start of adjuvant chemotherapy was 70 (range 19-46) days. Abnormal bilirubin was the only factor significantly correlated with delayed chemotherapy (OR, 3.89; 95% CI, 1.55-9.73; P = 0.004). Median overall survival was 468 days following resection (95% CI, 425-538). Multivariate survival analysis showed that high CA 19-9 levels (HR, 2.44, 95% CI: 1.36-4.40, P = 0.003) and abnormal bilirubin (HR, 0.40; 95% CI, 0.22-0.73; P = 0.003) were prognostic factors for overall survival. Median survival for patients who waited up to 35, 70 or 105 days for chemotherapy following resection were 588 days (95% CI, 270-776), 490 days (95% CI, 360-688) and 466 days (95% CI, 432-538) respectively. Overall, timeliness was not predictive of survival (HR, 1.12; 95% CI, 0.64-1.97; P= 0.70). Conclusions: Patients with hyperbilirubinema experienced delays in adjuvant chemotherapy, likely due to the need for relief of biliary obstruction and subsequent recovery. However, timeliness of adjuvant chemotherapy did not influence outcomes, suggesting that treatment should still be considered irrespective of timing.
Outcomes among minority patients with stage IV colorectal cancer in the Harris County Health System.
Authors: Lau-Min Kelsey S. , Prakash Preeti , Thrift Aaron , Musher Benjamin Leon
Published: September 2018

e18039

Background: Colorectal cancer (CRC) mortality has declined over the last three decades, but significant racial disparities in CRC survival continue to be reported, especially for stage IV disease. Hypothesizing that these disparities arise from differences in access to care rather than tumor biology, we examined treatment patterns and outcomes among minority patients evaluated and treated for stage IV CRC in an academic safety net health system. Methods: The Harris Health System is an integrated health delivery network that utilizes tax revenue to care for predominantly minority and uninsured residents of Harris County, Texas. As the largest Harris Health facility and an affiliate of the Dan L. Duncan Comprehensive Cancer Center at Baylor College of Medicine, Ben Taub Hospital delivers cancer care through multidisciplinary subspecialty clinics and a robust patient assistance program. We performed a retrospective analysis of minority patients diagnosed with stage IV CRC between 1/2010 and 12/2012 who were evaluated and treated at Ben Taub Hospital. Results: We identified 103 patients of whom 40% were black, 49% were Hispanic, and 12% were Asian or Middle Eastern. 65% spoke English as their preferred language; 74% were uninsured and covered by the Harris Health Plan, a financial assistance program for individuals with incomes under 300% of the federal poverty level. 85% of patients received cancer-directed therapy, of whom 99% received standard chemotherapy with a best response rate of 67% and a disease control rate of 87%. Median overall survival was 20.7 months for all patients and 23.0 months for patients who received chemotherapy. Conclusions: The Harris Health System provides the health delivery infrastructure through which minority patients with significant socioeconomic challenges obtain financial assistance and access to quality cancer care in an academic setting, thereby leading to clinical outcomes comparable to those of the predominantly Caucasian and insured populations studied in randomized control trials. Efforts to resolve disparities in CRC outcomes should focus on improving access of at-risk populations to comprehensive cancer care.
Patient navigation core metrics before and after implementation of a nurse navigation program at CHI St. Francis Cancer Treatment Center: A community based cancer program.
Authors: Copur Mehmet Sitki , McDonald Monica , Zhou Yuzhen , Hurley Vicki , Tasa Adriene , Johnson Christine , Evans Rhonda , Fuller Courtney , Hadenfeldt Rebecca , Schriner Megan , Kezeor Jami , Woodward Alexis , Cleveland Darla , Ramaekers Ryan C. , Crockett David , Gauchan Dron , Clark Douglas , Mickey Mary , Norvell Max
Published: September 2018

e18040

Background: Patient navigation is an intervention to improve cancer outcomes by facilitating timely access to cancer care. Few comparative data exist about the effects of nurse navigation in core navigation metrics (CNM) in a community oncology setting. Methods: During one-year period of a community-based/patient entry-point navigation program, CNMs of newly diagnosed breast and non-breast cancer patients were collected and compared to that of a demographic and tumor characteristics-matched control group prior to navigation. Electronic medical records and tumor registry data were utilized to gather 10 CNMs and 12-mo survival. Results: 72 breast/107 non-breast newly diagnosed navigated cancer patients were compared to same number of matched patients who did not receive navigation. With navigation, significant improvements were observed in interval time to biopsy, pathologic diagnosis, oncology visit, first treatment, and frequency of ancillary consults in breast cancer group. In non-breast cancer group, significant improvements were observed in all CNMs except interval time to pathology diagnosis. Adherence to guidelines and treatment, and 12-mo survival were not different between two groups. Conclusions: A dedicated community based nurse navigation program can significantly improve CNMs and enhance care in both breast and non-breast cancer population in a community oncology setting. [Table: see text]
Comparison of neoadjuvant anti-HER2 therapy for breast cancer in public versus private health care: Time to shorten the distance.
Authors: Braga Virginia , Gomes Jessica Ribeiro , Wassano Noelle Suemi , Tsukamoto Jessica Sayuri , Barbosa Luiza Damian Ribeiro , Andrade Diocesio Alves Pinto de , Cruz Marcelo Rocha De Sousa
Published: September 2018

e18045

Background: In the neoadjuvant setting (NAC) of HER2-positive breast cancer (BC), the addition of pertuzumab (P) to trastuzumab (T) and chemotherapy (chemo) has increased pathological complete response (pCR) from 40-50% to over 70%. Recent data has shown that pCR is a reliable surrogate marker of disease-free (DFS) and overall survival (OS). In Brazil, there is an important gap between cancer drugs approved in the public health care system (PHCS) vs. the private setting. Although P approval for NAC (Aug/2016) and metastatic setting (Sep/2015) in the private health system, it is not approved for any indication in the PHCS. Likewise, T is not approved for use as NAC at the PHCS. We aim to compare private practice experience of T + P + chemo in the NAC vs. HER2-positive advanced BC patients treated at the PHCS. Methods: Retrospective analysis of 95 patients diagnosed with locally advanced HER2-positive BC by immunohistochemistry 3+ or FISH according to ASCO/CAP definition. We evaluated 17 consecutive patients at the COAEM private cancer center in Brazil since Feb/2014 (cohort 1). Neoadjuvant therapy was T and P plus docetaxel-based chemo. A cohort of 78 patients with locally advanced HER2-positive BC treated in a PHCS cancer center was analyzed (cohort 2). They received standard NAC regimen according to PHCS guidance: anthracycline and taxane-based therapy without anti-HER2 therapy. Results: Cohort 1: 17 patients with median age of 50 years (range 34-70); Four patients had clinical stage IIA; 2 patients IIB; 7 patients IIIA; 3 patients IIIB; one patient IIIC. The pCR rate was 70.5% (12 patients). Cohort 2: 78 patients with median age of 48 years (range 26-79). One patient IIB; 33 patients IIIA; 37 patients IIIB; 7 patients IIIC. The pCR rate was 16.7% (13 patients); 29 patients (37.2%) had clinical complete response. Only 26 patients (33.3%) received T in the adjuvant setting. Conclusions: Neoadjuvant P and T combined with chemo has shown pCR rates superior to 70% in clinical trials, which is a surrogate marker for DFS and OS in HER2-positive BC. The absence of anti-HER2 therapy in the PHCS must be urgently reviewed not just in light of double-blockage strategy but also in T monotherapy use.
A tale of two cohorts: Patients presenting for endoscopy in Kigali, Rwanda compared to an academic medical center in New Hampshire, U.S.
Authors: Chamberlin Mary D. , Lee Angela
Published: September 2018

e18057

Background: Gastric cancer is the third leading cause of cancer death worldwide. In Rwanda and East Africs in general, gastric cancer is common in young men and women to the point where the region is known as the "stomach cancer region." Previously reported molecular profiling of Rwandan gastric cancer specimens indicate a lower mutation burden than expected based on historic western-based data; the corresponding database of endoscopy results suggests lsrge differences in access to care. This study compares a US endoscopy database to one from the University of Rwanda, to highlight the disparities of care in low and middle income countries (LMIC’s) compared to higher income countries. Methods: Retrospective pathology, demographic and radiographic data was collected from 164 Rwandan patients who presented for endoscopy at the Kigali University Teaching Hospital and compared with a matching cohort of patients at Dartmouth-Hitchcock Medical Center , Lebanon, NH (DHMC). Results: Approximately 85% of the Rwandan endoscopy cohort presented with gastric cancer, whereas none was seen in the DHMC cohort; the latter group was older than the Rwandan cohort (62.3 vs. 58.6 years). The most common indication for endoscopy among the DHMC cohort was gastroesophageal reflux disease (GERD) or anemia (72%) while the Rwandan cohort most commonly presented with pain or vomiting (68%). A matched US gastric cancer cohort revealed that 63% of US cases of gastric cancer receive treatment with curative intent compared to 7.4% of Rwandan cases. Conclusions: The Rwandan cohort presented with more severe symptoms and was more likely to be diagnosed with gastric cancer than the DHMC patients yet less likely to receive treatment with curative intent. These results highlight the disparities of care in LMIC’s and the need for improving access to early detection and curative treatments.
Mammography screening and detection of early stage breast cancer in Hispanic and African American women at a Minnesota safety net healthcare system.
Authors: Pease Daniel Fellows , Gilbertson David T. , Wiernik Andres
Published: September 2018

e18074

Background: Approximately 12% of breast cancer cases occur in women younger than 50 years, per SEER data from 2012. Hispanic women are known to present at a younger age and African American women with more advanced stage disease. In this study, we describe the impact of age and race on the initial presentation of breast cancer among minority women treated at the Hennepin Healthcare System (HHS) in the state of Minnesota. Methods: A single-institution retrospective analysis of data from our electronic health record of all breast cancer diagnoses from 2010-2015. Cases were compared by age ( < 50 or > 50 years), race (Caucasian, African American, Hispanic, other), stage (AJCC 7th edition), and method of diagnosis (self-reported mass or screening mammography). Results: A total of 315 breast cancer diagnoses occurred at HHS from 2010-2015. In our cohort, 29% of all breast cancer cases were diagnosed in women < 50yrs. Hispanic and African American women had higher rates of diagnosis at < 50yrs compared to Caucasian women (38.9% vs 37.1% vs 18.1 respectively, p < 0.05). Early stage cancer (stage 0 or I) accounted for most diagnoses in those > 50yrs (54.8%), while advanced stage (stage II-IV) was more prevalent in the < 50yrs age group (59.5%) (p < 0.05). Of all women diagnosed with breast cancer, 63% presented with a self-reported mass and 37% were diagnosed by screening mammography. Hispanics and African American women had a higher rate of presentation with a self-reported mass (74% and 66% respectively) compared to Caucasian women (55%). Women with breast cancer < 50yrs were more likely to present with a self-reported mass than women > 50yrs (80% vs 55%, p < 0.05). 92% of Hispanic and 80% of African American women < 50yrs presented with a self-reported mass, compared to 62% of Caucasian women (p = 0.095). Conclusions: At our institution, Hispanic and African American women are diagnosed at a significantly younger age than Caucasian women, and those diagnosed at a younger age have more advanced disease. Presenting with a self-reported mass is very common for young non-Caucasian women. Whether screening mammography can be better utilized to change these trends requires further study.
No improvement in metastatic bladder cancer health disparity over the last two decades.
Authors: Pan Kevin , Klapheke Amy , Cress Rosemary , Yap Stanley
Published: September 2018

e18076

Background: Bladder cancer (BCa) is one of the top ten most common cancers in the world. However, very few studies have reported on health disparities involving advanced BCa. Methods: Patients with metastatic BCa diagnosed between 1991 and 2014 were identified through the California Cancer Registry. Included in the analysis were age at diagnosis, sex, race/ethnicity, area-based socioeconomic status (SES), first course of treatment, and survival time. Predictors of treatment were identified using logistic regression, and cause-specific survival was analyzed using Cox regression. Results: A total of 3,073 cases of metastatic BCa were identified. Among these cases, 67.39% were male, and 32.61% were female. The race distribution was 74.78% non-Hispanic white (NHW), 6.25% non-Hispanic black (NHB), 12.46% Hispanic and 5.96% NH Asian/Pacific Islander (Asian/PI). A Cox proportional hazards model analysis showed that NHB were more likely to die from BCa. After adjustment for sex, age, and SES quintile, the hazard ratio of overall survival for NHB over NHW was 1.18 (p=0.214) during 1991-2002, but it increased to 1.24 (p=0.041) during 2003-2014. A smaller proportion of NH black patients survived two years after diagnosis (6.5% versus 14.4% NH white, 18.3% Hispanic, and 15.4% Asian/PI). Patients over age 65, female patients and those residing in all but the wealthiest census tracts were less likely to receive chemotherapy with or without local treatment. Patients diagnosed between 2003 and 2014 were 32% more likely to receive chemotherapy than those diagnosed between 1991 and 2002 (p<.001). There was no improvement of overall survival in the most recent time period. Conclusions: There had been no improvement in this heath disparity or in overall survival over the last two decades. Non-Hispanic blacks and patients who were not treated with chemotherapy experienced poorer survival than other groups. [Table: see text]
Impact of marital status on colorectal cancer (CRC) disease-specific survival in New York state.
Authors: Justiniano Carla Francesca , Xu Zhaomin , Becerra Adan Z , Aquina Christopher Thomas , Boscoe Francis P. , Schymura Maria J. , Temple Larissa K. F. , Morrow Gary R. , Fleming Fergal J.
Published: September 2018

e18084

Background: CRC is the second leading cause of cancer death in the US. Social support and financial resources vary by marital status. This study analyzes the impact of marital status by sex on survival after resection for CRC. Methods: The New York State Cancer Registry and Statewide Planning and Research Cooperative System were queried for 2004-2013 colectomy or proctectomy Stage I-III CRC patients and categorized by marital status: single/never married (single), married/domestic partner (married), and widowed/separated/divorced (previously married). Competing risk analysis of 5-year mortality was executed adjusting for patient (age at diagnosis, sex, race, Medicaid, income, marital status, smoking history, comorbidities, year of diagnosis, and stage), treatment (scheduled surgery and complications, chemotherapy, radiation), surgeon (colorectal board, volume), and hospital factors (volume, academic, rural). Results: 38,020 (colon 32,451, rectal 5,569) met inclusion criteria, of which 28% died within 5 years. Single patients were more likely than married to be current smokers (17 vs 12%), be on Medicaid (42 vs 27%) and present emergently (38 vs 25%), and less likely to be treated by high volume surgeons (32 vs 40%). Married patients had decreased risk of 5-year CRC-specific mortality (hazard ratio [HR] 0.86, confidence interval [CI] 0.80-0.94) vs single. When stratified by sex, married males had a decreased risk of death but married females did not and this persists if stratified by colon vs rectum (Table). Income was not significantly associated with survival and previously married patients did not significantly differ from single. Conclusions: Marital status impacts CRC-specific survival in males and females differently. Married men have a protective effect from marriage, whereas married females do not and may benefit from additional support throughout their cancer care. [Table: see text]
A comprehensive study comparing smokers and non-smokers with lung cancer in an urban minority population.
Authors: Patel Poras , Thar Yu Yu , Zarubin Vadim , Castro Daniel , Nagaraj Savitha , Lin Aung , Guevara Elizabeth
Published: September 2018

e18087

Background: Cigarette smoking is strongly associated with lung cancer; however, very few studies have been conducted in the urban minority population comparing various parameters between smokers and non-smokers with lung cancer. We investigated epidemiological profiles, histological subtypes, staging at diagnosis, survival after diagnosis and the quality of life. Methods: This retrospective study included urban minority population diagnosed with primary lung cancer at the Brooklyn Hospital Center between 2005-2016. The study population was divided into two groups based on smoking history and various parameters listed below were compared. The health care quality of life (HcQOL) was assessed using parameters of weight loss, cough/hemoptysis, shortness of breath, pain, opioid use and functional capacity. Results: Of the total 576 patients, 432 met inclusion criteria, who were divided into Group A (GA) - Smokers (n = 341 (78.9%)) and Group B (GB) - Non-Smokers (n = 91 (21.1%)). Majority of our study population were African American (GA 71.8%, GB 65.9%) followed by Hispanics. The prevalence of lung cancer was higher in females (GA 56%, GB 52.7%). Patients diagnosed with lung cancer before age 60 were 48.4% in GA versus 5.5% in GB. SCLC pathology was 20% in GA & 0% in GB; NSCLC pathology was 80% in GA & 100% in GB. At the time of diagnosis, 27% in GA had metastatic stage-4 (0% in GB), and 71.4% in GB had stage-1 (27% in GA) NSCLC. Less than 1 year survival was 15.5% in GA and 2.4% in GB; > 3 years survival was 32.3% in GA and 95.2% in GB. HcQOL measure of weight loss of > 10 pounds, hemoptysis, shortness of breath at rest, uncontrolled pain, opioid dependence and functional capacity < 1 block was 67.6%, 17%, 61.9%, 54.1%, 75.1% and 92.2% respectively in GA and 29.1%, 3.5%, 23.2%, 18.5%, 49.4% and 24.3% respectively in GB. A 6-minute walk test was abnormal in 77% of GA and 39.1% of GB. Conclusions: In comparison to non-smokers, smokers were diagnosed with lung cancer at a younger age, had advanced stages of cancer at the time of diagnosis, higher mortality and increased opioid dependence. Smokers had significantly poor HcQOL, which was supported by abnormal six-minute walk test results. Females had overall increased incidence of lung cancer.
Toxicity disparities between Hispanics and non-Hispanics enrolled in clinical trials in south Texas.
Authors: Vyas Ojas Harihar , Mazo- Canola Marcela , Garza Juan Francisco , Hamal Ruchi , Royster Lashandra , Johnson Ellen , Bohanini Leyla , Kaklamani Virginia G.
Published: September 2018

e18089

Background: The U.S. Hispanic (H) population is estimated to increase from 55 million in 2014 to 119 million in 2060, growing from 17% to 29% of the total population. H are underrepresented in cancer trials. A review of practice-changing oncology trials showed only 3.9% of included patients were H. Disparities have been identified in time to diagnosis, treatment and outcomes in H patients, including those on clinical trials, despite uniform stage, treatment, and follow-up. Given our institution’s history of strong H accrual, we aimed to look at the rate of enrollment and toxicity in our early phase cancer trials of H compared with non-Hispanic whites (NHW). Methods: We retrospectively reviewed charts of patients enrolled in Phase I trials at UTHSCSA to assess rates of selected toxicities, death, hospitalizations and reasons for withdrawal from phase 1 trials. The following toxicities were recorded: anemia, neutropenia, neuropathy, nausea, vomiting, and fatigue. All H patients were compared to randomly selected statistical controls. Patients who were on multiple trials were excluded. Results: Of the 520 patients reviewed, 376 (72.3%) self-identified as H, 123(23.7%) as NHW, and 448 (86.2%) of patients had a solid tumor diagnosis. H and NHW with solid tumors are compared in the Table. They were similarly matched for sex, but H were noted to be older and more likely to receive cytotoxic therapy. Rates of patients experiencing any grade 3/4 toxicity or hospitalization were similar as shown. H were more likely to withdraw from trial due to disease progression. Conclusions: This retrospective analysis shows H patients did not experience significantly more toxicities in early phase clinical trials at an academic center in a minority-majority community. Prospective data collection is needed to provide more detailed information in the disparities that exist in toxicity and outcomes in H compared with NHW in cancer trials. [Table: see text]
Performing combined breast and gynecologic surgery does not increase the rate of surgical site infections: A NSQIP database analysis.
Authors: Mayor Paul , Etter John , Szender James Brian , Zsiros Emese , Frederick Peter Jonathan , Lele Shashikant B.
Published: September 2018

e18093

Background: The purpose of this study is to determine and compare the overall rates of surgical site infections (SSI) in patients undergoing breast surgery, hysterectomy and combined breast surgery and hysterectomy. Methods: We inspected the National Surgical Quality Improvement Program (NSQIP) Participant Use Files from 2005-2014 for subjects undergoing breast surgery (CPT codes 19300-19307, 19340, 19342, 19350, 19357, 19361, 19364, 19366-19369, 19380, 19396), Gynecologic surgery ( CPT Codes 58150, 58152, 58180, 58200, 58210, 58240, 58260, 58262, 58263, 58267, 58270, 58275, 58280, 58285, 58290-58294, 58541-58544, 58548, 58550, 58552-58554, 58570-58573), or a combined surgery (the NSQIP databased was queried for encounters that contained both a breast surgery code and hysterectomy procedure code). We then queried the database for SSI rates within 30 days of surgery. SSI rates were compared using a χ2 test with a nominal value of p < 0.05 as a test for significance. Results: We identified a total of 174,605 patients who underwent a breast surgery and found a SSI rate of 2.59%. We identified a total of 137,121 patients who underwent hysterectomy and found a SSI rate of 2.58%. We identified 383 patients who underwent a combined breast surgery and hysterectomy and found a SSI rate of 2.87%. When comparing SSI rates of combined breast surgery and hysterectomy, to breast surgery or hysterectomy alone, we found no significant difference in the rates of SSI between these groups (p = .7304). We analyzed SSI rates in patients by different surgical approaches including combined breast surgery and open hysterectomy and found an SSI rate of 4.35% (p = .357), combined breast surgery and laparoscopic hysterectomy and found an SSI rate of 2.38% (p = .931), and combined breast surgery and laparoscopic assisted vaginal hysterectomy and found an SSI rate of 2.75% (p = .916). Conclusions: The rates of SSI in patients undergoing combined breast surgery and hysterectomy is not significantly different from breast surgery or hysterectomy alone. Gynecologic oncologist should coordinate with breast surgeons to perform a combined procedure in patients who require both breast surgery and hysterectomy.
Immunotherapy in non-small cell lung cancer and the abscopal effect.
Authors: Jafri Syed Imran Mustafa , Malik Faizan , Ali Naveed , Naglak Mary , Sundermeyer Mark L.
Published: September 2018

e18104

Background: Advanced research and better understanding of the human immune system has led to the development of targeted immunotherapy such as PD-1 inhibitors. We studied patients with both squamous and non-squamous Non-Small Cell Lung Cancer in a community setting who are being treated with Nivolumab. Our primary objective was to determine response to therapy (overall response rate-ORR). Our secondary objective was to study the abscopal response of our population and if the tumor response was better in those patients who received radiotherapy in the preceding 6 months of the start of immunotherapy Methods: Data were summarized using descriptive statistics including means, standard deviations, medians, frequencies and percentages. Chi square analyses were used to make comparisons between response and categorical variables. Overall response rate was calculated by combining people with partial and complete response. All p-values were two tailed and a level of ≤ 0.05 was considered significant. Results: Out of 21 patients, eight (38%) did not show any disease progression. Five out of these eight patients (23% of total study population) had stable disease. Three remaining patients had partial response to the treatment. The ORR was 14% which is comparable to 20% and 19% ORR in the CheckMate trials for nivolumab. Thirteen (62%) patients had progressive disease. Our study showed no significant effect of radiotherapy on disease response to nivolumab. There was one incidence of treatment discontinuation permanently due to the side effects of Nivolumab. Conclusions: Immunotherapy is a promising new option in lung cancer treatment. Fewer side effects and improved survival compared to traditional second line chemotherapy makes it more appealing. In our study group, nivolumab has shown ORR of 14% and stable disease in an additional 23% of the patients resulting in a disease control rate of 37%.
Genome-wide association study (GWAS) of chemotherapy-induced Raynaud's phenomenon (RP) to reveal shared pathways with cardiovascular disease (CVD).
Authors: El Charif Omar , Wheeler Heather E. , Trendowski Matthew , Gamazon Eric R , Ardeshirrouhanifard Shirin , Feldman Darren R. , Hamilton Robert James , Vaughn David J. , Beard Clair , Fung Chunkit , Kim Jeri , Fossa Sophie D. , Abu Zaid Mohammad Issam , Mushiroda Taisei , Kubo Michiaki , Einhorn Lawrence H. , Cox Nancy , Travis Lois B. , Dolan M. Eileen ,   The Platinum Study Group
Published: September 2018

e18162

Background: RP is an adverse drug reaction characterized by reduced blood flow to the extremities causing pain and sensations of cold. Few studies have examined the genetic basis for RP, although family studies suggest a heritable component to primary RP. Methods: Eligible testicular cancer survivors (TCS) were < 55 y at diagnosis, treated with first line cisplatin-based chemotherapy, and completed questionnaires. Genotyping with standard quality control and imputation were performed. A case-control RP phenotype was derived from patient-reported outcomes and associations were computed by logistic regression. GWAS used cumulative bleomycin dose and 10 genetic principal components as covariates. Gene set enrichment analysis (GSEA) utilized genes ranked by the most significant GWAS SNP in/within 20 kilobases. A polygenic risk score for CVD derived from four prior independent GWAS (Khera et al. NEJM 2016) was assessed for association with RP. Results: Of 749 patients (median age 38 y, median time since chemotherapy 5 y), 38% reported RP. Bleomycin dose was the most significant predictor of RP (OR100 mg/m2 = 1.25, p < 0.0001). Number of years smoking also correlated with RP (ORyear = 1.05, p = 0.002). Age and hypertension showed no significant correlation with RP. GSEA revealed several significant pathways (FDR q < 0.1), including “ cellular response to VEGF stimulus” (q = 0.05) and “ cardiac muscle cell action potential” (q = 0.09). We hypothesized that RP may share genetic architecture with CVD. Deriving a polygenic risk score from genome-wide significant SNPs in prior CVD GWAS (n = 4260-22,389), we showed nearly significant case-control differences in CVD polygenic risk score (two-tailed t-test, p = 0.053). RP frequency significantly increased with polygenic risk score quartile (OR = 1.19, p = 0.008). Conclusions: Over one third of TCS report RP, with greater frequency among bleomycin-treated patients and smokers. Implicated genetic pathways include ones established in CVD. Although shared genetic risk between chemotherapy-induced RP and CVD may be possible, further investigation is required. Primary RP has been inconsistently linked with CVD.
Primary care vs. oncology-driven surveillance following adjuvant chemotherapy in resected pancreas cancer.
Authors: Samawi Haider , Yin Yaling , Lim Howard John , Renouf Daniel John , Cheung Winson Y.
Published: September 2018

e18163

Background: No standard surveillance strategy exists following resection of pancreas cancer. Our aims were to describe patterns of surveillance and to evaluate their impact on outcomes. Methods: Patients who received at least one cycle of adjuvant gemcitabine or 5-fluorouracil monotherapy at any 1 of 5 cancer centers in British Columbia from 2004 to 2015 were included. Surveillance was divided into two groups: discharged to primary care physicians (PCP) or follow up with oncologists (ONC) that included regular clinical assessments, laboratory testing and/or imaging. Results: We identified 147 patients. Median age at diagnosis was 64 (range 38-85) years and 48% were men. More patients were followed by ONC than PCP (66% vs. 44%). ONC were more likely to follow patients with T3/4 (78% vs. 62%, P = 0.03), while all other prognostic factors were balanced between the two groups. At the time of analysis, 68% of patients had a documented recurrence and 59% died. The median overall survival (OS) was 2.82 (95% CI 2.17-3.32) years in the ONC group and 3.35 (95% CI 2.85-5.06) years in the PCP group while the median relapse free survival (RFS) was 1.4 (95% CI 1.37-1.77) and 2.4 (95% CI 2.07-4.59) years, respectively. On multivariate analysis, there was no significant difference in OS between ONC and PCP-driven surveillance (HR 1.23; 95% CI 0.74-2.04, P = 0.4); however, RFS favored the PCP group (HR 1.62; 95% CI 1.01-2.56, P = 0.04, for oncology). On recurrence, 51% of patients received chemotherapy where the most common first line regimens were FOLFIRINOX (21%) and Gemcitabine/Nab-paclitaxel (20%). Patients followed by ONC were more likely to receive chemotherapy on recurrence than those followed by PCP (58% vs. 34%, respectively, P = 0.03), however, there was no difference in survival after recurrence between PCP & ONC (recurrence to death, 5.7 vs 8.9 months, respectively (P = 0.21). Conclusions: Surveillance tests and imaging performed by ONC detected recurrences earlier and correlated with a higher likelihood of aggressive therapy when compared to follow up by PCPs, but this did not result in OS differences. PCPs may have a larger role in the follow up care of selected patients with resected pancreas cancer.