bluuebunny/crossref_metadata_2025 huggingface dataset:
Randomized controlled trial to test the efficacy of trans-tympanic injections of a sodium thiosulfate gel to prevent cisplatin-induced ototoxicity.
Authors: Meyer Francois , Rolland Viannique , Bairati Isabelle , Guitton Matthieu , Fortin André , Côté Mathieu
Published: September 2018

e17560

Background: The hearing loss due to cisplatin cochlear damage is frequent and severe. Antioxidants, such as sodium thiosulfate (STS), can neutralize the effects of cisplatin, but, when administered systemically, they decrease its efficacy. In animal experiments, STS deposited in the middle ear reached the cochlea and reduced cisplatin ototoxicity. We conducted a randomized controlled trial to test the efficacy of trans-tympanic injections of a STS gel to prevent cisplatin-induced ototoxicity. Methods: Eligible participants were patients with symmetrical hearing treated for a locally advanced head and neck cancer with chemoradiation including 3 cisplatin cycles (100 mg/m2). For each participant, one randomly selected ear received the injections while the other ear did not. On the eve of each cisplatin treatment, a trans-tympanic injection deposited 0.1 ml of an immediately prepared STS-hyaluronate gel (0.5 M) on the round window. The main outcome was assessed blindly using the shift of hearing threshold in decibels (dB) from before chemoradiation to one month thereafter for pure-tone air conduction at 0.5-14 kHz frequencies. Adverse effects were noted according to CTCAE. Assuming a lower hearing loss of 7.0 dB for the treated ears, 0.90 power and 0.05 two-sided statistical significance, 25 patients were needed. The main outcome was assessed in a mixed linear model with hearing threshold shift as dependent variable and intervention, frequency and radiation dose to the cochlea as independent variables. Results: From January to December 2015, 13 patients were randomized. The trial was stopped in June 2016 for poor accrual. The average loss of hearing over all frequencies was 1.5 dB less for the treated ears than for the control ears. The difference was not statistically (p = 0.56) nor clinically significant, but was consistently in favor of the treated ears for all frequencies between 3 and 10 kHz. The intervention adverse effects were mild. Conclusions: Our trial suggests that STS deposited in the middle ear reached the cochlea but was not clinically effective. More work is needed to improve the efficacy of trans-tympanic administration of cisplatin antidotes. Clinical trial information: NTC02281006.
Global history and clinical experiences of gene therapy: A brief review.
Authors: Li Yi
Published: September 2018

e17562

Background: Based on the theoretic and clinical development of modern medicine, gene therapy has been a promising treatment strategy for cancer and other patients. Methods: In the present paper, we reviewed the history and clinical experiences of gene therapy from the aspects of treatment protocol, administration cycle, dosage calculation and evaluation of therapeutic effects, in order to provide more information for the further development of this promising treatment. Results: although the development of gene therapy has not gone smoothly since the beginning of the clinical trials, the results showed that this was a promising treatment for the cancer patients. There are still a lot of researches needed to be done to further solve the theoretic and clinical issues, and to improve the therapeutic effects. Conclusions: In conclusion, although the development of gene therapy has not gone smoothly since the beginning of the clinical trials, the results showed that this was a promising treatment for the cancer patients. There are still a lot of researches needed to be done to further solve the theoretic and clinical issues, and to improve the therapeutic effects. But the future of the gene therapy will be bright, and it will become a new basic strategy to help more patients.
Rate of false-negative findings in sentinel lymph node biopsy in patients with head and neck malignant melanoma.
Authors: Rahimi-Nedjat Roman , Sagheb Keyvan , Hormes Maike , Tuettenberg Andrea , Al-Nawas Bilal , Walter Christian
Published: September 2018

e17566

Background: Sentinel Lymph Node Biopsy (SLNB) is the standard procedure for malignant melanoma with a thicknes above 1mm. However, the benefits of this procedure have recently been questioned because of a high number of false negative findings. The aim of our study was to investigate the number of early recurrence in patients with negative SLNB. Methods: All patients with malignant melanoma of the head and neck region who underwent SLNB between 2010 and 2016 in our department were included and data reviewed retrospectively. Recurrence in the same cervical lymph node region of the previously extirpated sentinel lymph node (SLN) within one year was defined as primary false-negative. Results: Allover 101 patients were investigated (mean age 62.48 years (±17.66; 73.3% ♂, 26.7% ♀). Most frequent location of the primary melanoma were the cheeks and ears (each 18.8%), followed by the hair bearing region (13.9%). Superficial Spreading Melanoma and Nodular Melanoma were the most frequently seen subtypes (each 23.8%), followed by Lentigo maligna Melanoma (19.8%). Median thickness of all patients was 2.5mm (min: 0.15 – max: 10.0 mm). In average 3 SLN were removed during operation (min: 1 – max 16). In 79.2% of the cases the SLN was negative. 13% showed one metastasis, 5.2% showed two and 1.6% three metastases. Positive findings in the SLN were significantly correlated with T-classification. Ulceration and tumor thickness showed significant tendencies in Χ2-Test and Mann-Whitney-Test. Out of the patients with negative SLN 13.1% had at least one metastasis in a cervical lymph node of the same region within one year. Mean duration until recurrence was 6.5 months. 75.0% of the metastases in our study were diagnosed within this period. 62.5% of the patients with secondary positive SLN had a tumor of intermediate thickness (between 1mm and 4mm). Conclusions: With 13.1 % secondary positive SLN this study shows that SLNB has a high rate of false-negative findings. However, SLNB has lower complication rates compared to traditional lymph node extirpation. This study shows that patients with negative SLN especially with intermediate tumor thickness should be controlled by ultrasound or computer tomography in short intervals.
Carotid body tumors in Japan: A multi-institutional study.
Authors: Shiga Kiyoto , Ikeda Aya , Saitoh Daisuke , Katagiri Katsunori , Oikawa Shin-ichi
Published: September 2018

e17574

Background: Carotid body tumor (CBT) is thought to be a rare disease derived from carotid body paraganglion cells. It is well known that this tumor is related to some hereditary tendencies that linked to such as SDH gene mutations. CBTs have rich vascular contents and capsules supplied by many feeding arteries. When we head and neck surgeons perform resection sugery, we sometimes encounter much blood loss or injuries of carotid arteries. There has been no study to reveal the characteristic features of CBT patients in Japan because of lack of registration and survey system for them. Methods: We attempted to analyze CBT patients all over Japan by integrating information of CBT patients from institutions which had head and neck surgeries. Results: 399 patients were referred to 112 institutes for past 20 years. Among these patients, 150 were registered to our study. There were 87 female and 63 male patients and their mean and median age were 48.0 years old and 49 years old, respectively, ranging from 8 to 78 years old. Eighteen patients had family history of paragangliomas. 15 patients had bilateral CBTs. Among 94 patients who underwent surgery to remove CBT, 23 patients had tumors classified as Shamblin type I, 59 as type II and 12 as type III. Mean operation time of the surgery and the mean amount of blood loss were calculated to compare. Angiography revealed that most frequent feeding artery of these CBTs was ascending pharyngeal artery followed by superior thyroid artery and occipital artery. Preoperative embolization of these arteries was effective to reduce the blood loss but operation time in Shamblin type I and II tumors. Conclusions: Further investigation will be needed to clarify gene mutations for hereditary paragangliomas including CBTs in Japan.
Postoperative concurrent chemoradiation (CCRT) for non-squamous cell carcinoma (NSCCA) of head and neck.
Authors: Thamlikitkul Lucksamon , Petsuksiri Janjira , Ithimakin Suthinee
Published: September 2018

e17582

Background: Surgery is the mainstay of treatment for resectable non-metastatic NSCCA of head and neck. Postoperative radiation (RT) is delivered to patients (pt) with high risk for recurrence. Unlike the squamous cell counterpart where survival advantage from adding chemotherapy (CMT) as a radio-sensitizer is evident, the benefit of CCRT is uncertain in NSCCA pt. We hypothesized that CCRT would improve disease free survival (DFS), comparing to RT alone. Methods: NSCCA of head and neck pt who underwent curative surgery and RT at Siriraj hospital from 2006 to 2015 were included in this retrospective study. Patients with residual tumor after surgery or neuroendocrine histology were excluded. The primary outcome was DFS. The secondary outcome was overall survival (OS). Results: We included 139 pt, 99 (71.2%) had RT while 40 (28.8%) had CCRT. Baseline characteristics, including age, gender, primary site, histology and radiation dose were similar between 2 groups. Salivary gland was the most common primary site (67.6%). The most common histology was adenoid cystic carcinoma (35.3%), followed by mucoepidermoid carcinoma (25.9%). Patients who received RT alone had earlier stage (Stage I 29.3%, Stage IVa 14.1%), compared to CCRT group (Stage I 7.7%, Stage IVa 38.5%), p = 0.003. High risk features (positive margin, extranodal extension or ≥ 2 cervical lymph nodes metastasis) were found in 42% and 62% of pt with RT and CCRT, respectively (p = 0.03). In CCRT group, 92% of pt received cisplatin every 3 weeks during RT period. With the median follow-up time of 54.9 months, 3-year DFS was 79.4% and 79.5% in RT and CCRT groups, respectively (p = 0.22). There was no significant difference in 3-year OS between RT and CCRT groups (89.2% vs 89.9%, p = 0.76). Among pt with high-risk features (n = 67, 48.2%), 3-year DFS and OS were not significantly different between treatment groups. However, among pt without high-risk features, 3-year DFS in RT group was significantly higher than CCRT group (84.8% vs 79.0%, p = 0.04). Conclusions: This study demonstrates no survival benefit from adding concurrent CMT to RT following curative surgery in NSCCA of head and neck. Moreover, addition of CMT may be detrimental in pt without high-risk features.
Risk factors for central neck lymph node metastases in papillary thyroid microcarcinoma.
Authors: Zheng Weihui , Shang Jinbiao
Published: September 2018

e17583

Background: Papillary thyroid microcarcinoma (PTMC) accounts for nearly half of all cases of thyroid papillary cancer. Although PTMC has a good prognosis, lymph node metastasis, especially central lymph node metastasis (CLNM), is the leading cause of local recurrence. The value of central lymph node dissection in PTMC remains controversial. Few studies have focused on the relationship between CLNM and multifocality in PTMC. This retrospective study of a large cohort of patients with PTMC aimed to identify assess the predictive value of multifocality for identifying patients at high risk of CLNM who may benefit from central lymph node dissection. Methods: Patients with PTMC who underwent total or hemi-thyroidectomy with effective unilateral or bilateral central lymph node dissection at Zhejiang Caner Hospital between January 2007 and December 2015 were enrolled ( n = 3543). Number and laterality of PTMC foci, extrathyroidal extension (ETE), tumor size, age, sex, positive/total number of central lymph nodes and other clinicopathological factors were recorded. The chi-square test was used for univariate analysis; logistic regression, for multivariate analysis. Results: Multifocality, age, sex, tumor size, ETE and nodular goiter were significantly associated with central lymph node metastasis (CLNM) in univariate analysis. Multifocality was an independent predictive factor for CLNM in multivariate analysis. Compared to unifocal disease, the odds ratio (OR) for CLNM was 1.447 for patients with ¡Ý 2 tumor foci ( P < 0.001) and 2.978 for patients with ¡Ý 3 tumor foci ( P < 0.001). Conclusions: Multifocality with ¡Ý 3 tumor foci was an independent predictive factor for CLNM in PTMC. Multifocality should be assessed when selecting patients for prophylactic central neck lymph node dissection, and we recommend patients with multifocality should undergo more radical treatment.
Radioiodine I-131 ablation therapy and impaired renal function: Possible impact on guidelines.
Authors: El-Zeftawy Hossam A , Zekri Jamal M , Farag Kamel , Al-Saadi Rawan , Bin Sadiq Bakr M , Miliebari Salman
Published: September 2018

e17591

Background: Sodium iodide (I-131) is eliminated predominantly through renal clearance. There is no consensus on the ideal dose of I-131 to be administered for patients with impaired kidney function. We aim to compare the rate of I-131 clearance in patients with impaired to those with normal renal functions. Methods: 27 cases (34 treatments) of differentiated thyroid cancer and eGFR 15-59 ml/min/1.73 m2 received I-131 (mean dose of 150 mCi) for remnant ablation between 2010 and 2016. Another 34 patients matched for age, gender, weight and I-131 dose with eGFR ≥ 60 ml/min/1.73 m2 were selected as controls. Endpoints of interest were (a) Length of hospital stay (LOHS) until the patient’s I-131 activity declines to < 30 mCi (b) Exposure rate measured by Geiger counter 0 to 48 hours after treatments (ER 48). Paired t-test was used to compare both groups. Results: Mean LOHS for cases vs. controls was 2.47 vs. 2 days respectively (P = 0.007). Results of ER 48 were available and matched in 18 cases and controls. Mean ER 48 for cases vs. controls was 3.74 vs. 1.8 mR/h respectively (P = 0.002). The mean proportional reduction of exposure rate after 48 hours compared to hour 0 for cases and controls was (-88% vs. -92.6%, P = 0.008), (-93.5% vs. -94.5%, P = 0.5) and (-67.2% vs. 94.3%, P = 0.04) for eGFR 46-59 (n = 13), 30-45 (n = 3) and 15-29 ml/min/1.73m2 (n = 2) respectively. Conclusions: Patients with impaired renal function are subject to longer hospital stay and delayed renal clearance of the tracer with consequent increased radiation exposure. Guidelines should consider adjusting the dose of I-131 in these patients to avoid possible harmful effects of excess I-131 on vital organs.
Barriers in time to initiation of therapy for newly prescribed novel oral oncolytics.
Authors: Tapia Christopher , Wang Ann Andee , Bhanji Yasin , Campbell Christopher , Larsen Daniel , Ganatra Seema , Gross Derick , Stein Regina Michelle , Tellez Claudia , Jain Shikha
Published: September 2018

e18005

Background: Novel oral oncolytics have been incorporated into standard of care for many malignancies. With increasing utility of these medications, accessibility issues have emerged. The purpose of this study is to examine the time-to-therapy initiation of novel oral oncolytics and to identify barriers that result in delays and access issues. Methods: A retrospective review of our electronic data warehouse was performed of adults newly prescribed a novel oral oncolytic for FDA approved indications from 04/01/16 to 12/31/16. Exclusion criteria: traditional chemotherapy or previous treatment with the same agent. Primary outcome: time from date prescribed to date filled. Record of pharmacy transfer, manufacturer assistance, and delays in treatment were also extracted. Kruskall-Wallis and Mann Whitney U tests of association were performed to identify whether pharmacy transfers or manufacturer assistance were associated with delays in time to treatment filled. Fisher’s Exact tests were performed to identify drug or insurance related associations with delays. Results: Of our interim analysis of 92 patients who met inclusion criteria, 9 (9.8%) were insured by Medicaid, 32 (34.8%) by Medicare, 51 (55.0%) by private insurance or other. The median time between date prescribed and date filled was 6 days (range 0-109 days). The most frequently prescribed drug was palbociclib (n = 22, 23.9%). 25 (27.2%) of patients had a pharmacy transfer prior to receiving their drug, 15 (16.3%) patients received manufacturer assistance, and 17 (19%) of patients’ records indicated a delay. Transfers, manufacturer assistance, and delays each had a statistically significant relation with time-to-fill (p < 0.05), though none were significantly associated with drug or insurance type. Time-to-fill was not significantly associated with a particular drug or insurance type. Conclusions: As the landscape of oncology changes, barriers to treatment will be discovered as new novel agents are approved. Our study shows that potential exists to prevent treatment delays and improve access to care. By studying the factors affecting time-to-treatment, quality improvement initiatives can be developed to better streamline the process.
Oncologic patients attitudes and participation in clinical trials.
Authors: Asher Nethanel , Wolf Ido , Pelles Sharon , Geva Ravit
Published: September 2018

e18029

Background: Clinical trials are an essential part of the oncological care. However, literature indicates low accrual of only 2-4% of the oncologic population. One of the leading known barriers is the patient's hesitant attitude toward participation. This study aimed to evaluate the patients' population treated in the Tel Aviv Sourasky Medical Center (TASMC) oncology division and their understanding of clinical research in order to improve local recruitment strategies. Methods: An observatory, questionnaire based research was conducted. Patients receiving active oncology treatment in the TASMC oncologic day care unit were asked to complete an anonymous questionnaire, which was comprised of two main parts: the first evaluate demographic information and past experience in clinical research. The second investigated basic knowledge true/false test regarding clinical trials. The questionnaire was validated by both external and internal validity tests (α-Cronbach validity test) and was approved by the local ethics committee. Results: Two hundred patients completed the questionnaires. Median age was 60. 64% would consider participating in a clinical study. 23% (N = 46) had past experience in research, and compared to those with no experience they were found to have higher academic education (67.4% vs 36.9%, p < 0.0001), be more secular (76.1% vs 58.3, p = 0.037) and to have a better understanding of medical research (84.4%, vs 36.5%, p < 0.0001). They were also more inclined to participate in a future research (73% vs 44.9%, p = 0.01). Of those who would decline to participate and had failed the knowledge test (score less than 60%), the most frequent concern was related to the placebo arm (p = 0.055), ability to reject consent, and to trust issues with the treating oncologist. Conclusions: Despite a noteworthy readiness to enroll in clinical trials among the TASMC oncologic population, there were found significant knowledge and basic understanding gaps regarding clinical trials. Further efforts are needed to better understand specific accrual barriers and to develop an adapted information system.
Patterns of unavoidable and potentially avoidable hospitalizations among cancer patients.
Authors: Lau Sally C , Samawi Haider , Bae Steven , Cheung Winson Y.
Published: September 2018

e18030

Background: Hospitalizations can be distressing to patients and caregivers as well as costly to the healthcare system. Prior research in the non-oncology setting indicates that up to 50% of admissions are potentially avoidable. Our aims were to characterize the patterns of hospitalizations in cancer patients within a universal healthcare system and describe factors associated with potentially avoidable admissions. Methods: We reviewed all patients admitted to the British Columbia Cancer Agency over an 18 month period from 2013 to 2014. Pre-planned hospitalizations for inpatient treatments were excluded. Eligible hospitalizations were divided into 2 groups: unavoidable (UH) and potentially avoidable hospitalizations (PAH) based on pre-defined criteria, with discrepancies resolved via a consensus of clinicians. A multivariate analysis was conducted to test the associations of patient, disease, and treatment factors with UH and PAH. Results: Of 701 hospitalizations reviewed, 350 were eligible for inclusion. Among them, 286 (82%) and 64 (18%) were UH and PAH, respectively. Comparing between the UH and PAH groups, median ages at admission were 64 and 63 years, 48% and 45% were men, 67% and 66% were receiving palliative therapy, and median lengths of stay were 5 and 7 days, respectively (all p > 0.05). Patients with PAH were more likely to have a non-hematologic malignancy (92% vs 76% p < 0.01) and undergo a palliative care discussion while in hospital (14% vs 9% p = 0.03). The 30-day mortality rate after discharge was higher in the PAH subset (34% vs 13% p < 0.01). In multivariate analysis, significant factors associated with PAH included presence of cancer-related symptoms (OR 4.7 95% CI 1.7-13.3 p < 0.01), treatment toxicities (OR 3.9 95% CI 1.2-12 p = 0.02) and admissions in the preceding year (OR 3.4 95% CI 1.7-6.8 p < 0.01). In the 64 patients with PAH, admissions may be prevented with intensive follow-up (52%), better coordination of community supports (25%) and early palliative care discussions (20%). Conclusions: In our cohort, PAH were frequent in cancer patients and associated with poor short term outcomes. Optimization of outpatient care and better utilization of community and palliative care resources may reduce PAH.
Current status of availability of radiotherapy machines in Nepal.
Authors: Karn Ambuj
Published: September 2018

e18042

Background: Nepal is a developing country with about 29 million populations. The incidence of cancer is 100-120 per 100 thousand populations and the number is increasing. The most common cancers in Nepal are of lung (13.2%), cervix (9.5%) and breast (8.6%). More than 80% of cancer patients present in advanced or metastatic stage where palliation can only be the goal of treatment. Radiotherapy is one of the essential treatment modalities for cancer, for both curative and palliative intent. This study aims to find the availability of radiotherapy machines throughout the country. Methods: Data regarding Radiotherapy machines in the country were collected by on site visit and by telephone conversations. Results: There are only seven centers having radiotherapy machines. Bir hospital was the first to start radiotherapy with telecobalt machine. At present there are 4 Tele-Cobalt machines, 5 Linear Accelerators and 5 High Dose Rate (HDR) Brachytherapy machines in the country. Most of the centers do only conventional 2-dimensional radiotherapy treatment. Newer centers which are non-government centers have high end linear accelerators with IMRT and IGRT facilities. HDR brachytherapy are used for intracavitory radiotherapy for endometrial and cervical cancers only. Conclusions: Nepal is far below the World Health Organization (WHO) recommendation of one megavoltage machine per million populations which means that Nepal should have at least 29 megavoltage machines. Combined efforts of public, government and international agencies are required to upgrade the situation.[Table: see text]
A population-based analysis of urban-rural disparities in advanced pancreatic cancer (APC) management and outcomes.
Authors: Canale Thomas , Cheung Winson Y.
Published: September 2018

e18049

Background: The high morbidity burden associated with APC means that its management is complex and frequently requires multidisciplinary care. Because of potential geographical barriers to healthcare access, we aimed to determine the effect of rurality on management and outcomes of APC patients. Methods: Patients diagnosed with APC (locally advanced or metastatic disease) from 2008 to 2015 and received gemcitabine (gem), gem plus nabpaclitaxel (gem/nab), or FOLFIRINOX at any 1 of 6 British Columbia cancer centers were reviewed. Using postal codes, the Google Maps Distance Matrix determined the distance from each patient’s residence to the closest cancer center. Rural and urban status were defined as patients living > / = 100 km and < 100 km to the closest treatment site, respectively. Different cut points were used in sensitivity analyses. Patients were also stratified according to Canadian census population sizes. Univariate and Cox regression analyses were applied to examine whether rurality resulted in variations in management and outcomes. Results: In total, we identified 659 patients: median age 68 years, 54.3% men, and 45.7% metastatic disease. Among them, 19.3% lived rurally. For treatment, 67.7%, 9.2%, and 23.1% received gem, gem/nab, and FOLFIRINOX, respectively. There were no differences in baseline clinical characteristics between rural and urban patients (all p > 0.05). Time from diagnosis to oncology appointment and time from appointment to treatment were 31.5 and 29.5 days for rural patients and 28.6 and 40.1 days for urban patients, respectively (all p > 0.05). In multivariate Cox regression, risk of death was similar between rural and urban groups (HR 0.864, 95% CI 0.619-1.206, p = 0.390). Furthermore, regression analysis found that population size did not pose a signficiant impact on APC outcomes (all p > 0.05). Conclusions: There was no correlation between rurality and outcomes in APC. The strategic and geographic allocation of cancer care delivery across 6 comprehensive treatment centers in British Columbia may serve as a model for other jurisdictions, particularly those that currently face outcome disparities in cancers that often require complex multidisciplinary care
Impact of socioeconomic status on anal cancer survival.
Authors: Lin Daniel , Gold Heather Taffet , Schreiber David , Leichman Lawrence P. , Sherman Scott , Becker Daniel Jacob
Published: September 2018

e18060

Background: Despite an increase in incidence of anal cancer over recent decades, improvements in awareness and therapy have improved survival outcomes. We hypothesized that the gains in outcomes were not shared equally by patients of disparate socioeconomic status (SES). We investigated whether area-based median household income (MHI) predicts survival of patients with anal cancer, after controlling for known predictors. Methods: Patients diagnosed with squamous cell carcinoma of the anus (SCCA) as the first primary malignancy from 2004 to 2013 in the Surveillance Epidemiology and End Results (SEER) registry were included. SES was defined by census-tract MHI, and divided into quintiles. Multivariable Cox Proportional Hazards models were used to evaluate the effect of (MHI) on cancer-specific (CSS) and overall survival (OS). A multivariable logistic regression was used to assess whether these same measures predicted receipt of radiation. Results: A total of 9,550 cases of SCCA were included; median age was 58 years, 63% were female, 85% were white, and 38% were married. In multivariable analyses, patients living in areas with lower MHI had worse OS and CSS compared to those in the highest income areas. Mortality HR’s in order of lowest to highest income were 1.32 (95%CI 1.18-1.49), 1.31 (95%CI 1.16-1.48), 1.19 (95%CI 1.06-1.34), 1.16 (95%CI 1.03-1.30); CSS HR similarly range from 1.34-1.22 from lowest to highest income. Other significant predictors of increased cancer specific mortality included older age, black race (HR 1.44, 95%CI 1.26-1.64), male gender, un-married, earlier year of diagnosis, higher grade, and later stage. Income level, however, was not associated with odds of initiating radiation in multivariable analysis (OR 0.87 for lowest to highest income level, 95%CI 0.63-1.20). Conclusions: SES measured by area-based MHI independently predicts cancer-specific and overall survival outcomes in patients with anal cancer, despite similar rates of initiating radiation therapy. Black race remains a predictor of anal cancer outcomes despite controlling for income. Further investigation is warranted to understand the mechanisms in which socioeconomic inequalities affect cancer care and outcomes.
Disparities in treatment-related financial burden and recurrence in a diverse sample of colorectal cancer survivors.
Authors: McDougall Jean A. , Banegas Matthew P. , Wiggins Charles , Rajput Ashwani , Chiu Vi Kien , Flores Kristina , Kinney Anita
Published: September 2018

e18067

Background: The high cost of cancer care creates adverse financial consequences for cancer patients, impacting adherence to treatment, clinical outcomes, and quality of life. Prior studies estimate that 40% of colorectal cancer (CRC) patients experience treatment-related financial burden. This study aims to identify factors associated with financial burden and evaluate its relationship with cancer recurrence. Methods: This cross-sectional study identified individuals diagnosed with stages I-III CRC between 2001 and 2012 through the statewide New Mexico Tumor Registry. A comprehensive survey was administered in 2014. Participants were considered to have experienced financial burden if they reported any treatment-related debt accumulation, bankruptcy filing, other financial sacrifices, or inability to pay medical bills. Multivariable logistic regression was used to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI). Results: Among the 277 CRC survivors who participated in this study, 40% identified as Hispanic and 39% lived in a rural area. Financial burden was reported by 43% of CRC survivors. In a model adjusted for age at diagnosis, sex, race, ethnicity, education, and years since diagnosis, participants who spoke a mixture of English and Spanish (OR: 3.5, 95% CI: 1.3-9.5), those with low health literacy (OR: 2.4, 95% CI: 1.2-4.7), and those with public insurance (OR: 2.2, 95% CI: 1.2-4.4) were more likely to report financial burden. Ethnicity and rural status were not independently associated with financial burden. Six percent (n = 16) of participants experienced a CRC recurrence. Survivors who reported financial burden were 4-times as likely to experience a recurrence (OR: 4.3, 95% CI 1.1-17.7) as those who did not report financial burden. Conclusions: Language, low health literacy, and public insurance may increase the likelihood that CRC survivors experience financial burden. These disparities are alarming given the observed association between financial burden and CRC recurrence. Larger, prospective studies are needed to confirm the association between financial burden and recurrence and to identify potential intervention targets.
National population-based study of racial variation in characteristics and outcomes of young breast cancer patients: Analysis of temporal trends.
Authors: McClain James Thompson , Mosquera Catalina , Namireddy Praveen , Muzaffar Mahvish
Published: September 2018

e18068

Background: Breast cancer outcomes correlate with racial and socioeconomic status. Efforts to reduce disparities in breast cancer among vulnerable populations has had limited success. We sought to examine trends of racial and socioeconomic factors and its impact on outcome in young breast cancer patients. Methods: Using the Surveillance, Epidemiology, and End Results database, we identified female patients aged 20-35 with invasive breast cancer diagnosed from 1990-2012. We performed univariate, multivariate and survival analysis. Variables included patient age, race, stage, receptor status, surgery type and year of diagnosis. Results: A total of 18,999 women were identified. Mean age was 31.7. 80.8% were white and 19.1% were black. A higher percentage of blacks had stage III/IV disease (34% v 27%) and ≥ 4 positive nodes (19% v 16%) compared to whites. 54% of whites were ER receptor positive while 46% of blacks were ER receptor positive (p<0.0001). Analysis of American Community Survey attributes indicated white patents were more likely to live in counties where ≤15% of households were below the poverty line (64% v 45%) and where ≤15% of the population had less than a high school education (35% v 28%) compared to blacks. 31.2% were diagnosed in 1990-2000 while 68.7% were diagnosed in 2001-2012. 5 year disease specific survival (DSS) was 79.1% among all patients diagnosed from 1990-2000 and 84.2% among patients diagnosed from 2001-2012 (p<0.0001). In each time period, white patients had significant difference in 5 year DSS compared to black patients. While the 5 year DSS for white patients improved from 80.9% to 86.3% (p<0.0001), the 5 year DSS improvement for black patients from 1990-2000 to 2001-2012 did not reach statistical significance (71.3% vs 75.7%, p=0.24). Conclusions: Demographic and economic factors are associated with outcomes in young breast cancer patients. Absolute DSS has improved over consecutive time periods, but the improvement was not significant among blacks. More effort is needed to evaluate and address disparity in these patients. [Table: see text]
Health care disparities among octogenarians and nonagenarians with stage III lung cancer.
Authors: Cassidy Richard John , Zhang Xinyan , Patel Pretesh R , Shelton Joseph W , Tian Sibo , Steuer Conor Ernst , Pillai Rathi Narayana , Ramalingam Suresh S. , Owonikoko Taofeek Kunle , Force Seth D , Fernandez Felix G , Gillespie Theresa Wicklin , Curran Walter J , Higgins Kristin Ann
Published: September 2018

e18075

Background: Octogenarians and nonagenarians with stage III lung cancer are underrepresented in randomized trials that established the standard of care therapy of concurrent chemoradiation (CRT). The purpose of this study was to investigate factors predictive of and the impact on overall survival (OS) following CRT among patients ≥80 years old with stage III non-small cell lung cancer (NSCLC) in the National Cancer Data Base (NCDB). Methods: In the NCDB, patients ≥80 years old from 2004 to 2013 with stage III NSCLC were queried. Logistic regression, Kaplan-Meier method, and Cox-proportional hazard regression analyses were performed as well as propensity-score matched (PSM) analysis to reduce treatment selection bias. Results: A total of 12,641 stage III NSCLC patients ≥80 years old were identified with complete treatment and OS records; 7,921 (62.7%) received no treatment, 1,153 received definitive radiation alone (9.1%), and 3,567 (28.2%) received CRT. On multivariable analysis (MVA), black race, female gender, advancing age, residence in a lower-educated county, adenocarcinoma histology, and patients with stage IIIB tumors were associated with receiving no anti-cancer therapy while treatment at an academic facility and lower comorbidity status were associated with receiving anti-cancer treatment (all p < 0.05). On MVA, male gender, advancing age, non-adenocarcinoma histology, higher tumor grade, larger tumors, advancing T and N stage, stage IIIB tumors (vs. IIIA), delayed start to CRT, and not receiving CRT were associated with worse OS (all p < 0.05). OS rates at 1 and 5 years was 53.7% and 10.1% respectively for patients receiving CRT compared to 16.4% and 3.3% respectively for all other therapies (p < 0.01). PSM analysis confirmed that not receiving CRT was associated with worse OS (HR = 1.23, 95% CI 1.11-1.34; p < 0.01). Conclusions: A significant portion of patients ≥80 years old with stage III NSCLC do not receive treatment. Black race, female gender, advancing age, and residence in a lower-educated county were associated with not receiving therapy. In this NCDB series, OS is higher in patients ≥80 years old receiving CRT, even when adjusting for patient- and tumor-related factors.
A pilot study of a comprehensive financial navigation program in cancer survivors.
Authors: Shankaran Veena , Leahy Tony , Steelquist Jordan , Watabayashi Kate , Singleton Erin , Gallagher Kathleen , Balch Alan James , Linden Hannah M. , Schwartz Naomi , Ramsey Scott David , Overstreet Karen
Published: September 2018

e18079

Background: Although financial toxicity is associated with poorer clinical outcomes in cancer survivors, few studies have attempted to address this toxicity. We developed a financial navigation program in collaboration with our partners (Consumer Education and Training Services (CENTS) and Patient Advocate Foundation (PAF)) to improve patients’ knowledge about cancer treatment costs, provide financial counseling, and help with out-of-pocket expenses. We conducted a pilot study to assess feasibility and early impact of this program. Methods: Patients (pts) within 1 year of a solid tumor diagnosis and 6 months of chemotherapy and/or radiation were recruited at the Seattle Cancer Care Alliance. Pts received a financial education course followed by monthly contact with a CENTS financial counselor and PAF case manager for 6 months. We measured program adherence, self-reported financial burden, anxiety about costs, program satisfaction, and type and amount of assistance provided. Results: We consented 34 pts (median age 60.5), the majority of whom were white (85%) and commercially insured (50%). Participants (n = 20) and non-participants (n = 14 who withdrew or were lost to follow up early on) did not differ in age, race, gender, education, income, or insurance type. Debt, income declines, and loans were reported by 55%, 55%, and 30% of pts. High financial burden and anxiety about costs (4 or 5; Likert scale) were reported by 37% and 47% of pts. High satisfaction with the education course, CENTS counselors, and PAF case managers were reported by 73%, 80%, and 91% of pts. CENTS counselors assisted pts most often with budgeting, retirement planning, and medical bill questions. PAF case managers assisted pts with gaps in insurance, debt or cost of living issues, and employment rights and disability applications. A total of $7,667 ($1,267 for pts and $6,400 for institutions) was obtained through charitable entities. Conclusions: Our findings confirm that a financial navigation program is feasible to implement, associated with high satisfaction, and provides concrete assistance to pts in navigating the cost of cancer care. Future work will focus on improving program adherence and measuring its impact on financial and clinical outcomes.
Comparison of rural versus urban residence for symptoms and quality of life in recurrent ovarian cancer: Baseline analysis of GOG-0259, an NRG Oncology/GOG study.
Authors: Belcher Sarah M. , Sereika Susan M. , Dodson Zan M. , Mattos Meghan K. , Hagan Teresa , Donovan Heidi AS
Published: September 2018

e18083

Background: Women with recurrent ovarian cancer (OC) experience a wide range of cancer- and treatment-related symptoms that negatively impact quality of life (QOL). Studies have reported healthcare disparities by geographic residence related to distance, time, and financial barriers to accessing high quality care. However, no studies have evaluated the impact of residence on symptoms and QOL in women with OC. Therefore, our objectives were to evaluate whether geographic residence (urban versus rural) is associated with symptoms and QOL in a sample of women with recurrent OC. Methods: The Center for Health Equity Research and Promotion conceptual framework guided analyses of baseline GOG-0259 data. We mapped zip codes to RUCA commuter codes and compared sociodemographic and clinical variables between rural and urban groups using two-sample t and chi-square tests. We used MANCOVA, adjusted for age and marital status, to test for associations between residence and symptoms (Symptom Representation Questionnaire) and QOL (Functional Assessment of Cancer Therapy-Ovarian). Results: Rural (n = 122, 25%) and urban (n = 374, 75%) women were similar in all sociodemographic and clinical comparisons except for marital status (83% vs. 70% married, p = .003). Women reported moderate symptom severity (M = 5.5, SD = 2.3) and QOL scores similar to other OC studies (M = 108.4, SD = 19.5). In multi-variate analyses, age and marital status were both associated with symptoms; marital status was associated with QOL. Geographical residence was not associated with either symptoms or QOL. Conclusions: Counter to previous research, there were no symptom or QOL disparities based on geographic residence in this sample. Possible explanations to be explored in future research include a) cooperative group selection bias for women with good access to care regardless of geographic residence and b) protective effects of marital status on symptoms and QOL.
Is cancer history associated with asset ownership, debt, and net worth in the United States?
Authors: Doroudi Maryam , Coughlan Diarmuid , Banegas Matthew P. , Yabroff K Robin
Published: September 2018

e18085

Background: Financial hardships experienced by cancer survivors in the United States have become significant social and public health issues. Few studies have assessed the underlying financial holdings, including ownership and values of assets and debts, of individuals following a cancer diagnosis. This study assessed the association between a cancer history and asset ownership, debt, and net worth. Methods: We identified 1,603 cancer survivors and 34,915 individuals without a history of cancer aged 18-64 from the nationally representative Medical Expenditure Panel Survey (MEPS) Household Component and Asset sections (years 2008-2011). Descriptive statistics were used to assess demographic characteristics, cancer history, asset ownership, debt, and net worth by cancer history. Regression analysis was conducted to assess the association between cancer history and net worth, stratified by age group (18-34, 35-44, 45-54, and 55-64 years) to reflect stages of the life-course. Results: Asset ownership was least common for cancer survivors and individuals without a cancer history in the 18-34 age group and most common in the 55-64 age group. Cancers survivors aged 45-54 had a lower proportion of home ownership than individuals without a cancer history (59% vs 67%; p = 0.001). Nearly 20% of all respondents reported at least some debt. The proportion of cancer survivors with debt was higher than individuals without a history of cancer, especially in the 18-34 age group (41% vs 27%; p < 0.001), although it did not vary by age group. When asset and debt values were combined to assess net worth, cancer survivors aged 45-54 were significantly more likely to have a negative net worth and significantly less likely to have a positive net worth than those individuals without a history of cancer in fully adjusted models. Findings on net worth were similar in the 18-34 age group, although only statistically significant in unadjusted and partially adjusted models. Conclusions: We found that cancer history is associated with asset ownership, debt, and net worth, especially in those aged 45-54 years. Longitudinal studies to assess patterns of financial holdings throughout the cancer experience are warranted.
Appendiceal adenocarcinoma: Analysis of SEER database.
Authors: Chandana Sreenivasa Rao , Shah Chintan
Published: September 2018

e18097

Background: Appediceal cancers (AC) are rare, and often found on appendectomies. Adenocarcinomas represents approximately two-thirds of all AC. We performed the analysis of SEER database to understand the overall incidence and survival trends. Methods: We analyzed SEER database: Incidence - SEER 18 RegsResearch Data + Hurricane Katrina Impacted Louisiana Cases, Nov 2015 Sub (1973-2013 varying). Cases diagnosed of AC between 1988 and 2013 were identified. Trend of incidence rate was calculated. Relative survival rates (RSR) were calculated stratified by age, gender, race, stage, histological subtypes which were divided into mucinous, non-mucinous and signet ring cell carcinoma (SRCC). We calculated survival difference for patient diagnosed before and after 2000. Results: Age adjusted incidence rate of appendiceal adenocarcinoma was 0.4 cases per 100,000 person years. Overall incidence rate increased on average 3.7% per 100,000 person years (P < 0.05). The highest increase was seen in SRCC (4.8% per 100,000 person years). Survival was worst in SRCC (5 years RSR-28.40%) compared to other types (5 year RSR- 61.0% and 52.90% for mucinous and non-mucinous carcinoma (P < 0.01). Survival significantly improved for patients diagnosed after 2000 for mucinous (5 years RSR -51.90% and 64.30%) and SRCC (5 year RSR-18.0% and 31.0%), respectively before and after 2000 in each category. No improvement in survival was found in non-mucinous carcinomas since 2000. While survival among different histological types was not different for localized disease, it was significantly better for regional or distant stages in mucinous cancers when compared to non-mucinous cancers (P < 0.01). Elderly patient ( > 65 years) showed significantly poor survival for mucinous and non-mucinous carcinomas, while there was no variation in survival based on age for SRCC. Moreover, females showed significantly poor survival (P < 0.05) compared to males for SRCC, while no variation in survival based on gender for other types. Survival was not different among different races. Conclusions: Incidence of appendiceal adenocarcinomas is increasing. The highest increase is seen in SRCC which has the worst survival. Survival from mucinous adenocarcinomas has improved significantly in last decade.
Variations in cost for non-metastatic HER2- breast cancer (BC), non-small cell lung cancer (NSCLC), and colorectal cancer (CRC).
Authors: Malin Jennifer , Byfield Stacey DaCosta , Chastek Benjamin , Korrer Stephanie , Horstman Thomas , Newcomer Lee N.
Published: September 2018

e18106

Background: We aim to quantify economic outcomes of the most commonly used chemotherapy regimens for BC, NSCLC, and CRC in a commercially insured population. Methods: This analysis used clinical data from a prior authorization program for chemotherapy regimens linked with administrative claims data from 6/1/2015 to 5/31/2016. Clinical data included cancer type, stage at diagnosis, and biomarkers. Eligible patients were commercially insured members with a prior authorization request for one of the most commonly used NCCN recommended regimens for BC, NSCLC and CRC. Outcomes, including total healthcare cost and cost of chemotherapy were tracked from first claim for chemotherapy until end of treatment due to discontinuation, death or change in treatment. Patients were censored at 5/31/2016 or end of enrollment. Results: There were 1612 BC, 237 NSCLC, and 386 CRC non-censored patients who received therapy during the study period. Mean (SD) total and monthly drug costs and total health care costs for the most common regimens by cancer are summarized in the table. Conclusions: The relative value of the most common therapies for BC, NSCLC, and CRC varied significantly depending on the metric used underscoring the importance of comparing total healthcare costs when assessing the value of therapies. Information on these and other regimens will increase as the database grows over time. [Table: see text]