bluuebunny/crossref_metadata_2025 huggingface dataset:
Capecitabine therapy in recurrent/metastatic nasopharyngeal cancers.
Authors: Alshamsan Bader I , Alata Maaz Kamal , Gad Ahmed , Alzahrani Mashari J , Elhassan Tusneem , Atallah Jean Paul
Published: May 2020

e18515

Background: A wide range of chemotherapeutic agents have demonstrated antitumor activity in patients with recurrent or metastatic Nasopharyngeal Cancers (NPC). These therapeutic agents have different efficacy and toxicity profile. Capecitabine monotherapy had activity in recurrent/metastatic NPC based on small previous retrospective studies. The primary objective is to evaluate the overall response rate and tolerability of capecitabine in recurrent/metastatic NPC. Methods: A retrospective electronic chart review performed for 51 cases of recurrent/metastatic NPC patients who received capecitabine 1000-1,250 mg/m² twice daily two weeks on, one week off between 2011 to 2019 at King Faisal Specialist Hospital & Research Center (KFSH&RC). The Common Terminology Criteria for Adverse Events (CTCAE) Version 5.0 was used. Results: The median age at diagnosis was 42 years. 98% had a non-keratinized undifferentiated squamous cell carcinoma (Grade III). The most common sites for metastases were Bone (58.3%), Lung (50.0%), and liver (45.8%). 95% of patients received platinum-based chemotherapy and radiation therapy as the primary treatment. Capecitabine was used as the second or third line of treatment in the metastatic setting 45.1% and 43.1%, respectively. The patients tolerated the standard dose for a median of 6 cycles; only 20.0% of patients required a 25% dose reduction. The best response for capecitabine was complete response in 8 patients (15.7%), partial response in 14 patients (27.5%), stable disease in 10 patients, (19.6%), with a clinical benefit achieved in 32 patients (62.7%), and progressive disease in 16 patients (31.4%). The overall response rate to capecitabine was 43.2%, which was consistent regardless of the site of metastasis. The median progression-free survival was seven months (95%.CI: 5.3 -8.8). The one and three-year survival rates were 79% and 53%, respectively. Capecitabine was generally tolerated, the most common grade I & II adverse events were hand-foot syndrome (HFS) in 9 patients (20.5%), fatigue in 8 patients (15.7%), Diarrhea in 6 patients (11.7%), anemia in 5 patients (9.8 %), thrombocytopenia in 4 patients (7.8%) and neutropenia in 2 patients (4.0%). The most common grade III & IV was HFS in 3 patients (6%) and fatigue in one patient (2%) that led to treatment discontinuation after the first cycle. Conclusions: Capecitabine in Recurrent/Metastatic NPC is an effective and well-tolerated oral agent; however, a randomized prospective trial to evaluate capecitabine efficacy in this setting still recommended.
Incidence trends of squamous cell carcinoma of the head and neck (SCCHN) in the aging population: A SEER based analysis from 2000-2016.
Authors: Taylor Melissa , Patel Mihir , Switchenko Jeffrey M. , McDonald Mark William , Steuer Conor Ernst , Beitler Jonathan Jay , Shin Dong Moon , Saba Nabil F.
Published: May 2020

e18522

Background: SCCHN is more prevalent in the elderly. As the United States population ages, it is increasingly important to evaluate the change in the incidence of SCCHN in this population. Methods: This was a retrospective study using data from a population-based cancer registry (Surveillance, Epidemiology, and End Results) to identify patients ≥65 years old with the diagnosis of SCCHN between the years 2000-2016. The subgroups of oral cavity (OCC)and oropharynx cancer (OPC) were also analyzed independently. The incidence per year was calculated and joinpoint detection was used to identity significant changes in incidence trends. Annual percent change (APC) was detected to determine if the incidence trend was statistically significant. The study population was further stratified by sex. Results: For all sites, a joinpoint was found in 2003 with a statistically significant decrease in APC in incidence for males from 2000-2003 of -2.45%. For OCC, there was a joinpoint in 2005 with a statistically significant increase in APC in incidence for male patients of 1.41%. For (OPC), no joinpoint was found, but there was a statistically significant increase in APC in incidence for males of 3.41%. For females no joinpoint was found, but for OCC there was a statistically significant decrease in APC in incidence of -0.40%. Conclusions: In patients ≥ 65 years old the trend in incidence rate for all SCCHN sites stratified by sex has decreased between 2000-2016. However, for males the annual percent change in incidence has increased for OCC from 2005-2016 and for OPC from 2000-2016. [Table: see text]
Second malignancy post-chemoradiation in head and neck cancer patients.
Authors: Singh Gunjesh Kumar , Swami Rohit , Patil Vijay Maruti , Noronha Vanita , Joshi Amit , Menon Nandini Sharrel , Prabhash Kumar
Published: May 2020

e18525

Background: There is limited data available in the literature regarding incidence and treatment of second malignancy post-chemo-radiation (CTRT) in head and neck cancer patients. Hence we planned this analysis to address this lacuna in the current literature. Methods: We have already published a randomized study of 536 head and neck cancer patients, comparing radical CTRT with weekly cisplatin with or without nimotuzumab. The database of this study was used for the current analysis. Data regarding occurrence, site, stage, treatment details and outcomes were extracted from the database. Continuous variables were expressed in terms of the median with range, while non-continuous variables were reported in percentage. Kaplan Meier method was used for estimating the overall survival (OS). Results: Out of 536 patients, 18 (3.35%) patients developed second malignancy. The most common site was head and neck (44.44%) followed by lung (27.77%), prostate, ovary, breast, gallbladder and thyroid. 16/18 (88.88%) patients developed metachronous, while 2/18 (11.11%) had synchronous second malignancy. Most of the patients (55.55%) presented with locally advanced and metastatic disease, while 44.44% of patients had early-stage disease. 8/18 (44.44%) patients received palliative treatment. Of these, 6/18 (33.33%) patients received best supportive care and 2/18 (11.11%) patients were given palliative chemotherapy and palliative radiotherapy. 10/18 (55.55%) patients received radical treatment in the form of radical surgery (22.22%), CTRT (11.11%) and radical radiotherapy (5.55%), while 16.66% patients were kept under observation only. The median OS after the diagnosis of second malignancy was 451 days (95% CI, 301.45-600.59). It was seen that median OS the diagnosis of second malignancy in the aerodigestive and non-aerodigestive system was 446 days (95% CI, 39.10 - 852.89) and 840 days (95% CI, 278.46 - 1401.53), log-rank test P-value = 0.24. Conclusions: Second malignancy is not an uncommon phenomenon in head and neck cancer patients after CTRT and if properly taken care of, the improved outcome can be expected.
The incidence of NTRK fusion in Chinese head and neck cancer and response to crizotinib treatment.
Authors: Liu Lianke , He Yuange , Xu Jiali , Wang Rong , Chen Rongrong , Xia Xuefeng
Published: May 2020

e18532

Background: Previous studies have been reported that the frequency of NTRK ( NTRK1 NTRK2 NTRK3) fusion varies from up to 1% in solid or hematological cancers but more common in rare tumor types, such as mammary-analog secretory carcinoma of the salivary gland (more than 90%), thyroid cancer (up to 25%) and gastrointestinal stromal tumour (up to 25%). The specific TRK inhibitor Larotrectinib and multiple TRK inhibitor Entrectinib have been approved by FDA for advanced solid tumors. Here we report the incidence of NTRK alteration in Chinsese Head and Neck cancer and a patient harboring ETV6- NTRK3 fusion acquired durable clinical response to multiple TRK inhibitor Crizotinib. Methods: We retrospectively analyzed the genetic aberrations in 127 patients of Chinese Head and neck cancer. All the patients were detected by hybridization capture-based NGS 1021-gene panel (including NTRK1 NTRK2 NTRK3) sequencing with tumor tissue and peripheral blood control samples. A parotid cancer patient with lung metastasis harboring ETV6-NTRK3 fusion underwent Crizotinib treatment after disease progressed with chemotherapy. Results: A parotid cancer patient with lung metastasis harboring ETV6-NTRK3 fusion was diagnosed on Mar. 2016. Five months after first-line chemotherapy, the disease progressed. Crizotinib was administered from Aug. 2017 to Sep. 2019 with regular CT examination. The latest CT on Sep. 2019 showed mixed response, some of the lesions shrunk but one of them enlarged. Then the patient received third line chemotherapy. In brief, the patient reached a progression-free survival (PFS) of 2 years. Then we reviewed 127 cases of Head and Neck cancer in our database, the most common histology type was HNSCC (87.4%), the incidence of NTRK genetic aberrations was 7.9% (10/127) including NTRK fusion (n = 4, 3.1%) and NTRK mutation (n = 6, 4.7%). The most common fusion was ETV6-NTRK3 (n = 3, 2.4%). Conclusions: In conclusion, we reported the incidence of NTRK genetic aberrations in Chinese Head and Neck cancer and an ETV6-NTRK3 fusion patient reached long-term response (2 years) with Crizotinib, indicating alternative therapy insights to Head and Neck Cancer patients.
Phase II study: Induction chemotherapy & transoral surgery as definitive treatment (Tx) for locally advanced oropharyngeal squamous cell carcinoma (OPSCC): An update and retrospective review of non-study patients.
Authors: Siegel Robert S. , Thakkar Punam , Sadeghi Nader , Goodman Joseph , Joshi Arjun , Vongpachith Anonglack
Published: May 2020

e18549

Background: The standard of care for OPSCC includes chemoradiation (CRT) or surgery with adjuvant radiation (RT). However, RT is associated with significant life long morbidity. We assessed the efficacy of a two-drug induction regimen, followed by transoral robotic assisted surgery (TORS) & neck dissection for locally advanced OPSCC. Methods: This is an IRB approved single-arm phase II study for untreated stage III or IVA (AJCC 7th edition) OPSCC patients (pts) with an ECOG < 2 and GFR > 50 cc. Induction cisplatin 75 mg/m2 and docetaxel 75 mg/m2 was administered every 21 days for 3 cycles. Patients then underwent TORS and neck dissection(s). At post-op visits, flexible laryngoscopy, blood tests, and imaging with PET/CT and/or MRI were done. Short and long term toxicity, progression-free survival, overall survival, and quality of life (QOL) were evaluated in all pts. Results: Twenty oropharyngeal pts were treated, 19 were male, 17 were Caucasian, and 19 were HPV+. Median age at dx was 57. Three pts were stage III, and 17 were stage IVA. Pathologic CR at the primary site occurred in 15 pts and CR among LN neck dissections occurred in 13 pts. Four pts were given dose-reduced chemo and 1 pt was changed to carboplatin per protocol because of renal dysfunction. Pre vs post tx QOL scores did not change. At a mean follow-up of 40.7 months (range 13 to 55), 18 pts are alive and NED. Three pts recurred a mean of 2.2 mos after surgery, and were treated with salvage CRT. Two pts died of metastatic disease, the third is alive and well. All 3 pts had positive LN (9 LN, 3 LN and 1 LN) at surgery. A fourth pt had 12 pos LN and received radiation. He has not recurred. A retrospective review of an additional 20 twenty pts treated in the same way, were also reviewed for efficacy. Mean age was 61.5. Two pts died of metastatic disease. Twenty pts have been followed for > 13 mos (17 are alive and well, 2 died, and 1 LFU), and their mean follow-up is 43.5 mos. Conclusions: Cisplatin + docetaxel followed by TORS & neck dissection(s) appears to be an effective model for the definitive treatment for OPSCC, while avoiding the adverse effects of RT. Clinical trial information: NCT02760667.
VEGF-A and TGF-β in bioptates of oral squamous cell carcinoma reflect tumor response to chemotherapy and monoclonal antibodies (cetuximab).
Authors: Vladimirova Liubov Yu , Frantsiyants Elena M. , Neskubina Irina V. , Lyanova Aza A. , Shalashnaya Elena V. , Kit Oleg I. , Engibaryan Marina A. , Abramova Natalia A. , Popova Irina L. , Ryadinskaya Ludmila A. , Tikhanovskaya Natalia M. , Teplyakova Maria A. , Novoselova Kristina A. , Myagkova Valeriya S , Sergeeva Marina M. , Fomenko Yuriy A.
Published: May 2020

e18563

Background: Cetuximab is a monoclonal antibody directed against the EGFR receptor, able to block the EGFR signaling pathway and also indirectly affect the secretion of some growth factors. The search for biomarkers responsible for cetuximab resistance is an urgent task. The purpose of the study was to analyze VEGF-A and TGF-β levels in tumor tissue bioptates in patients with squamous cell carcinoma of the oral cavity receiving chemotherapy (CT) and cetuximab. Methods: The study included 30 patients with HNSCC St III-IV, T3-4N0-1M0. All patients received 2 cycles: cisplatin 100 mg/m2, intravenously, day 1, 5-fluorouracil 1000 mg/m2/day, intravenously, 96-hour continuous infusion, in combination with targeted therapy cetuximab 400 mg/m2 on day 1 in a loading dose, then 250 mg/m2 on days 8 and 15). Patients were divided into two groups: with response to cetuximab and CT (partial regression and stabilization) n = 17 and progression considered (resistance to the treatment) n = 13. Levels of VEGF-A and TGF-β were determined in tumor tissue bioptates by ELISA using standard test systems (Bender Med System, Austria). Statistical processing of results was performed using the Statistica 6.0 program (Stat-Soft, 2001). Results: CT and cetuximab in patients with resistance did not result in statistically significant changes in levels of VEGF-A, TGF-β and the VEGF-A/TGF-β ratio in tumor tissue bioptates, compared to the initial values. The studied markers in tumor tissue bioptates in patients with response to CT were statistically significantly different from the initial values: VEGF-A was decreased by 1.46 times, TGF-β by 2.96 times, while the VEGF-A/TGF-β ratio was twice elevated (p < 0.05). Conclusions: The results on levels of VEGF-A and TGF-β and the VEGF-A/TGF-β ratio are of a prognostic value and can be used for evaluating the efficacy of cetuximab and CT in patients with HNSCC.
Patterns of thyroid dysfunctions during treatment with immune checkpoint inhibitors (ICI) in 59 solid cancer patients.
Authors: Jiang Yong , Yang Li , Han Yin , Zhang Yongshen , Kong Feng-Ming
Published: May 2020

e18567

Background: Immune checkpoint inhibitors (ICI) have now become the mainstay treatment in patients with many kinds of cancers. Thyroid dysfunction as the most common endocrine toxicity is poorly understood. This study aimed to report hypothyroidism and exam its changing dynamtic in our first series of patients treated with ICI. Methods: This is a retrospective study. Patients received nivolumab or pembrolizumab between July 2018 and December 2019 were considered. Patient must have euthyroidism within the 3 months before immunotherapy and those had previous use of levothyroxine were excluded. They were monitored by thyroid function tests every cycle until stopping ICI. Patients must have received at least 3 cycles of antibody treatment. Results: Among 89 patients treated, 59 met the inclusion criteria. There were 33 males, 26 females, including 26 (44.1%) nivolumab, and 33 (55.9%) pembrolizumab. Median age was 62 years [range: 27-88]). Cancer diagnoses observed were non small cell lung cancer 17(28.8%), small cell lung cancer 4 (6.8%),liver cancer 9 (15.3%), head and neck cancer 5 (8.5%), esophageal cancer4 (6.8%) colon cancer 3 (5.1%), nasopharygeal carcinoma 3 (5.1%) melanoma 3 (5.1%) and other cancers 11(18.6%). There were 9 patients (15.3%) developed a thyroid dysfunction, including 5 females. Four patients had thyrotoxicosis (median onset: 8 weeks) followed by hypothyroidism. There were three types of thyroid dysfunctions: the first type patients 3 (33.3%) had a brief time period of TSH flair (peak 17.4-57.8) after the first cycle of ICI, followed by TSH dramatic drop companied with rising fT4, which usually returned to normal level during 3-4 cycles of . The other 4 patients (44.4%) with thyroid dysfunction presented with remarkably elevated TSH (15.43-125.2) after 3.5-10 months’ treatment, followed by hypothyroidism development with a need of levothyroxine. The remaining 1 patient had a third type of thyroid dysfunction with elevated TSH, elavated more while the treatment continue, the patient should be given levothyroxine as soon as possible. Additionally, 1 patient developed hypopituitarism presented with both low level of TSH and fT4 after 10 month treatment. There was no significant difference in patient characteristics between patients with hypothyroidism and those without. Conclusions: There are heterogeneity in thyroid function and hypothyroidism after ICI. Before more experience is gained, frequent monitoring of thyroid function during ICI is warranted for prompt management of the hypothyroidism.
Analysis of race and gender disparities in incidence-based mortality in patients diagnosed with thyroid cancer from 2000 to 2014.
Authors: Cintron-Garcia Juan , Pappoppula Lakshmi Priyanka , Shahbandi Ashkan , Komiya Takefumi , Guddati Achuta
Published: May 2020

e18570

Background: Well-differentiated thyroid cancer has better outcomes compared to anaplastic thyroid cancer. The incidence of well-differentiated thyroid cancer is higher in women whereas it is approximately the same in both genders for anaplastic thyroid cancer. The variability of incidence-based mortality across gender in the context of race has not been studied. This study analyzes the rates of incidence-based mortality among both the genders in four racial groups. Methods: The Surveillance, Epidemiology, and End Results Database was queried to conduct a nation-wide analysis for the years 2000 to 2016. Incidence-based mortality for all stages of well-differentiated and undifferentiated thyroid cancer was queried and the results were grouped by race (Caucasian/White, African American/Black, American Indian/Alaskan native and Asian/Pacific Islander) and gender. All stages and ages were included in the analysis. T-test was used to determine statistically significant difference between various subgroups. Results: Incidence-based mortality rates (per 100000) for well-differentiated and undifferentiated thyroid cancer for all races and both the genders are shown in the table below. The incidence-based mortality rates for both genders is approximately the same despite a 2-3:1 difference in incidence. Anaplastic thyroid cancer has a higher mortality rate in Caucasian and Asian/pacific Islander women compared to men despite an equal ratio of incidence. As expected, the mortality rates of anaplastic thyroid cancer were significantly higher compared to well-differentiated cancer across all races and genders. Also, Asian/Pacific Islander women have a higher rate of mortality compared to both the genders of Caucasian and African American races. Conclusions: Incidence-based mortality for anaplastic thyroid cancer is higher in women in all races whereas there is no difference in mortality between men and women for well-differentiated thyroid cancer. This is divergent from the incidence ratios noted in these malignancies. In the context of increasing incidence of thyroid cancer for the past few decades, this data suggests that additional resources may be devoted to decreasing the disparity of mortality in this gender. [Table: see text]
Thyroid cancer incidence in India between 2006 and 2014 and impact of overdiagnosis.
Authors: Mathew Aju , Maso Luigino Dal , Panato Chiara , Serraino Diego , Franceschi Silvia , Basu Partha , Wang Kevin , Lei Feitong , Chen Quan , Huang Bin , Vaccarella Salvatore
Published: May 2020

e18574

Background: Increases of thyroid cancer (TC) incidence emerged in the last decades in several countries. This study aimed to estimate time trends of TC incidence in India and the proportion of TC cases potentially attributable to overdiagnosis by sex, age, and area. Methods: TC cases aged 0-74 years reported to Indian cancer registries during 2006- 2014 were included. Age-standardized incidence rates (ASR) and TC overdiagnosis were estimated by sex, period, age, and area. Results: Between 2006-2008 and 2012-2014, the ASRs for TC in India increased from 2.5 to 3.5/100,000 women (+37%) and from 1.0 to 1.3/100.000 men (+27%). However, up to a 10-fold difference was found among regions in both sexes. Highest ASRs emerged in Thiruvananthapuram (14.6/100,000 women and 4.1/100,000 men in 2012- 2014), with 93% increase in women and 64% in men compared to 2006-2008. No evidence of overdiagnosis was found in Indian men. Conversely, overdiagnosis accounted for 51% of TC in Indian women: 74% in those aged < 35 years, 50% at ages 35-54 years, and 30% at ages 55-64 years. In particular, 80% of TC overdiagnosis in women emerged in Thiruvananthapuram, while none or limited evidence of overdiagnosis emerged in Kamrup, Dibrugarh, Bhopal, and Sikkim. Conclusions: Relatively high and increasing TC ASRs emerged in Indian regions where better access to healthcare was reported. In India, as elsewhere, new strategies are needed to discourage opportunistic screening practice, particularly in young women, and to avoid unnecessary and expensive treatments. Present results may serve as a warning also for other transitioning countries.
T-Cell receptor repertoire and genomic analysis of tracheal adenoid cystic carcinoma.
Authors: Wang Fei , Zhou Chengzhi , Xie Xiaohong , Liu Ming , Lin Xinqing , Qin Yinyin , Xie Zhanhong , Zhang Jiexia , Ouyang Ming , Song Mengmeng , Li Pansong , Guan Yan-Fang , Xia Xuefeng
Published: May 2020

e18576

Background: Tracheal adenoid cystic carcinoma (TACC) is the second type of cancer in bronchial tumors, has a high rate of postoperative recurrence and poor prognosis for which therapeutic targets are unavailable. Currently, studies were mostly about ACC of salivary gland. Our study is aim to elucidate genomic landscape and predict clinical biomarker of TACC. Methods: We performed whole-exome sequencing (WES), T cell repertoire sequencing (TCR) and immunohistochemistry (IHC) on tumor tissue samples and matched peripheral blood (PB) samples from TACC patients. All patients were followed up for their disease-free survival. Results: 13 cases were enrolled from 2010 to 2019. Median age of 13 TACCs was 35 yrs. 7 patients were female. 12 patients were stage I. In 8 WES samples, TCEB3CL (62%, 5/8), LPAR3 (50%, 4/8), ALPI (38%, 3/8), ARID1A (38%, 3/8) and BCOR (38%, 3/8) mutated most frequently. The median TMB was 3.67 (1.37-6.77) mutations/Mb. 1 patient showed microsatellite instability high (MSI-H). 2 patients with the highest TMB both had POLE mutations. We compared frequency of most mutated genes in our 8 samples with three different ACC types, including 935 ACC of salivary gland cancer, 76 ACC of the lung, and 38 ACC of breast cancer. 7 mutated frequently genes were found both in TACC and other types of ACCs, including ARID1A, BCOR, ARID1B, KMT2C, KMT2D, CREBBP and FAT3. 6 of them were more frequent in TACC. 7 FFPE tumors and 13 PB samples from 13 TACCs were used to investigate immune microenvironment. In 13 PB samples, TCR diversity (shannon index) and clonality was negatively associated with age (Pearson, r = -0.53, p = 0.06; r = 0.53, p = 0.06, respectively). There was no significant association between the other clinical characteristics (gender and smoking history) and any TCR parameter (clonality, clonotype, shannon index). Patients with lower clonotype number had longer DFS than those with higher clonotype number (15.0 vs 9.5 months, p < 0.001, 95% CI, 0.23-675.66, HR, 12.46), while shannon index and clonality was not significantly associated with DFS. Conclusions: The genetic mutations associated with TACC are different from those implicated in non-small cell lung cancer. TCR analysis as a useful of indicator of disease development and prognosis in TACC may be utilized to direct further immunotherapy.
Has Medicaid expansion improved access to care among socioeconomically disadvantaged breast cancer patients? An NCDB analysis.
Authors: Elson Leah , Bilani Nadeem , Elimimian Elizabeth Blessing , Nahleh Zeina A.
Published: May 2020

e19003

Background: For socioeconomically disadvantaged individuals without insurance, expenses related to diagnosis and management of chronic conditions, such as cancer, may be too costly to afford. This contributes to diagnoses made at later stages of disease, and inadequate treatment compliance. These factors are reported to lead to unfavorable clinical outcomes and higher mortality risk, historically making uninsured/Medicaid-ineligible patients an especially vulnerable group. With recent Affordable Care Act-related Medicaid expansion, state adoption allows new access to coverage for individuals with income <138% of the federal poverty limit. Therefore, we sought to understand how Medicaid expansion has affected demographic coverage and access to care among socioeconomically disadvantaged breast cancer patients. Methods: The data presented herein was extrapolated from a 2004-2016 NCDB breast cancer population. Sociodemographic and clinical data was evaluated for a sample of Medicaid-enrolled patients, diagnosed during pre- and post-expansion years. Results: In Medicaid-expanded states, there was a significantly increased utilization of Medicaid insurance (24.3% vs. 13.2%; p<0.001), and a significant trend towards an increased proportion of Hispanic enrollment in Medicaid (21.1% vs. 11.8%; p<0.001) than in non-expanded states. In non-expanded states, there was a larger proportion of black patients (p<0.001), and patients who live further from diagnostic centers (p<0.001), in more rural areas (p<0.001), with lower education levels (p<0.001). The total study population of Medicaid-enrolled patients was n=42,217; the total comparative uninsured population was n=13,133. Medicaid-enrolled patients were observed to have more timeliness to systemic treatment following diagnosis (85.6 vs. 87.6 days; p=0.021), and were 40% less likely to be diagnosed with late-stage disease (p<0.001) than uninsured patients. Conclusions: Medicaid expansion may be associated with a less diagnosis at late stages, more timeliness to treatment, and more Hispanic coverage, which may prove to be a positive paradigm shift in cancer outcomes for underserved and underinsured groups. Several socioeconomic factors already identified as being independently associated with poor outcomes are more prevalent in the non-expanded state populations compared to the expanded states. Therefore, while benefits have been noted in patients of expanded states, many breast cancer populations still remain vulnerable in the post-expansion era.
The influence of health disparities on risk factors in patients with colorectal cancer.
Authors: Hippalgaonkar Neha , Matin Khalid
Published: May 2020

e19006

Background: There are convincing data that suggest that lifestyle factors play a strong role in colorectal cancer. Obesity in particular is associated with higher incidence of colorectal cancer (CRC) and increased mortality. Racial and ethnic minorities are more likely to develop colorectal cancer when compared to the general population in the US, and the population in Richmond is made up of 47% of African Americans (AA), with 24% of the total persons in poverty and a median household income of $45,117, allowing us to uncover important factors that may affect the development of CRC. Purpose: We aim to uncover trends in the AA population as compared to the Caucasian population to determine the effect of health disparities in obesity-related risk factors in patients with CRC. Methods: We used the Virginia Commonwealth University (VCU) network within TriNetX, a global federated health research network that provides access to statistics in electronic medical records of diagnoses, laboratory values and vitals. We compared Caucasian and AA patients with a diagnosis of CRC from 14 different health networks in the US from 2010-2019. Results: In the TriNetX network, we found that the African American population exhibited higher rates of obesity (33% vs. 26%), irritable bowel disease (38% vs. 33%) and hypertension (71% vs. 33%) as compared to AA patients in the other 14 networks. Increased rates of diabetes (33% vs. 22%), hyperlipidemia (33% vs. 28%) and hypertension (71% vs. 56%) were found in the African American population compared to the Caucasian population in the VCU Network. Notably, we also observed increased rates of homelessness & unemployment (5% vs. 3%) in the AA population. Conclusions: These data suggest that important comorbidities are more prevalent in AA populations population than in the Caucasian populations. Our findings demonstrate the fundamental importance of considering racial and socioeconomic factors when designing screening, treatment and management plans in an effort to reduce the mortality of CRC in an underserved community.
Pancreatic cancer: Do disparities in mortality rates exist with respect to socioeconomic status?
Authors: Sheppard Richard Stephen , Adekunle Adewumi , Beale Stefani , Joseph Janet , Fletcher Gerald , Ahluwalia Meena
Published: May 2020

e19007

Background: Pancreatic cancer continues to have one of the highest mortality rates among major cancer diagnoses with rates greater than 90 percent for all stages and with five year survival rates below 10 percent. With access to treatment modalities such as chemo-radiation, staged surgical interventions and targeted therapies, survival times have increased but due to the costs of these procedures, they may not be accessible to all members of society. Recent studies have shown that lower socioeconomic status is associated with higher mortality rates and lower survival times. With this study we aim to investigate if disparities exist among socioeconomic classes, based on zip code location, in a major multi-ethnic metropolitan city using census data. Methods: Malignant neoplasm mortality data at the ZIP code level was gathered from the New York City Department of Health Vital Statistics Mortality Data from years 2009-2011. NYC population data was gathered from the U.S. Census Bureau 2010 decennial census. We used ordinary least squares regression to assess the independent association between neighborhood median income and neighborhood mortality from malignant neoplasms arising from the pancreas. Results: In 2009-2011, 2,527 deaths from malignant neoplasms arising from the pancreas were recorded across NYC. There is no statistically significant correlation between neighborhood median income and age-adjusted mortality from malignant neoplasms arising from the pancreas for males and for females. For males, there was an R-squared of 0.001721 ( P-value > 0.05). For females, there was an adjusted adjusted R-squared of 9.818e-05 ( P-value > 0.05). Conclusions: Neighborhood median income is not associated with an increase in mortality rate with respect to neoplasms arising from the pancreas.
ER, PR, and HER2 expression in Ugandan breast cancer patients: An evaluation of in-country RT-PCR compared to IHC.
Authors: Menon Manoj , Orem Jackson , Adams Scott , Bakenga Alex , Basemera Diana , Kasozi David , Konnick Eric Quentin , Mubiru Kelvin , Mulumba Yusuf , Muwonge Catherine , Okoche Lazarus , Pierce Robert , Gralow Julie , Niyonzima Nixon
Published: May 2020

e19009

Background: Breast cancer, the most common cancer in sub-Saharan Africa (SSA), is characterized by poor survival. An accurate assessment of estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor 2 receptor (HER2) status, typically via immunohistochemistry (IHC), is considered essential to provide prognostic data and guide therapeutic decision-making. However, due to inaccessible IHC services, these data are often unavailable in many parts of SSA; alternate methods need to be explored. Given the lab infrastructure developed in response to the HIV pandemic, RT-PCR testing is more readily accessible and feasible in SSA. Here we assess the potential of RT-PCR in evaluating the receptor status of women with breast cancer in Uganda. Methods: We enrolled women with a new diagnosis of invasive breast cancer at the Uganda Cancer Institute. Demographic and clinical data were obtained. A formalin-fixed paraffin embedded (FFPE) specimen was utilized for quantitative RT-PCR, using a validated assay for the detection of the ER, PR and HER2. Receptor expression levels were expressed as relative quantity (RQ) compared to housekeeping genes (CALM2). HER2 IHC results were categorized as negative (score 0 or 1+) or positive (3+); 2+ results (n=6) were excluded as FISH testing was not performed. Unstained slides were sent to the Fred Hutchinson Cancer Research Center for IHC. Receiver operating characteristic (ROC) analysis was applied to compare RT-PCR to IHC (gold standard). Results: We analyzed interim data (anticipated N=100 of an ongoing study) from 32 women aged 35 to 56 years. The majority of women (25, 78%) presented with advanced stage disease. Of the 32 cancers, 18 were ER+ (56%), 10 were PR+ (31%), 9 were HER2+ (28%) and 8 were triple negative (25%) by IHC. From ROC analysis, the AUC were 0.94, 0.95, and 0.81 for ER, PR, and HER2 respectively with high sensitivity and specificity (Table). Conclusions: Despite the tremendous need, the ability to detect the ER, PR, and HER2 via IHC in SSA is limited. Here we demonstrate the favorable test characteristics of RT-PCR when compared to IHC. Given the relatively wide accessibility of RT-PCR and endocrine therapy for breast cancer, as well as the recent inclusion of trastuzumab in the WHO’s Essential Medicines List, the results of this study have both direct diagnostic and therapeutic implications. Clinical trial information: NCT03518242 . [Table: see text]
Feasibility of an electronic risk score questionnaire in rural practice.
Authors: Bulbul Ajaz , Campbell Sara
Published: May 2020

e19014

Background: Genetic testing (GT) has significant implications for cancer management. Its implementation is difficult in small rural practices (RP). We examined an electronic risk Score questionnaire (ERSQ) that blends genetic risk factors with clinical and cancer family history to determine its feasibility. Methods: Clinic encounters between Oct 18 - Jan 20 were evaluated. Prior to Oct 19 patients were screening based on physician recommendation (PRBS) without an established screening questionnaire. Between Oct 19 - Jan 20 an ERSQ on a tablet identified patients meeting either USPSTF (US preventative Task force), NCCN (National comprehensive cancer center) or ASBS (American Society of Breast Surgeons) guidelines for GT. Statistical analysis was performed using paired t-test. Out of pocket costs (OOP$), prevalence, patient care impact, High risk negative (HRN) requiring change in screening recommendation (CSR) were evaluated. Genetic telephonic genetic counselling was offered to patients. Results: Pre-ESRQ cohort covering 12 months included 3520 patient encounters; with 1024 encounters post-ESRQ lasting 90 days. Forty three GT’s were performed over 16 months. Pre-ESRQ, seventy three patients were offered PRBS. Sixteen were tested (22% compliance), 13 reported out with two positive results (15% prevalence) and one HRN requiring CSR in 23% (3/13). Post ESRQ, 257 patients were offered GT; 68/131 (51% compliance) (p < 0.0001) screened with the ESRQ met at least one criteria for GT with one positive GT (1/18; 5% prevalence) and 4 HRN; CSR 5/18 (28% CSR)(p < 0.0003). In the Post ESRQ cohort GT was cancelled due to cost burden to patients in 6/27 (22%) and in 2/18 (11%) of the pre ESRQ group (p < 0.0001). Out of 26 patients with OOP$ information 23/26 (88%) incurred a zero OOP$. ESRQ took a median of 8 minutes in the office. Conclusions: An effective tablet based ESRQ may be feasible to adapt in a busy RP and help address disparity in access to genetic screening. There may be a beneficial effect on compliance with limited cost burden to patients that needs further study. ESRQ can improve CSR. A larger prospective cohort may help confirm these findings.
African Access Initiative: A holistic, multi-sector approach to mitigating Africa’s cancer crisis.
Authors: Dent Jennifer , Graef Katy , Hargan-Calvopina Joseph , LeJeune Analise , Seymour Daniel , Weber Callie
Published: May 2020

e19015

Background: In a dramatic reversal of trends, cancer now kills more Africans each year than malaria. Should trends continue, Africa’s cancer burden is projected to double to over 2 million new cases and over 1.4 million deaths annually by 2040. Africa’s burgeoning cancer crisis is attributable to many factors, including insufficient preventive, diagnostic, and treatment services; inadequate clinical infrastructure; and shortages of trained healthcare personnel. Methods: BVGH launched the African Access Initiative (AAI) in 2017 to address Africa’s cancer crisis. Utilizing a holistic approach that establishes sustainable access to cancer medicines, strengthens healthcare infrastructure, and builds clinical oncology capacity, BVGH is eliminating or minimizing many of the challenges African clinicians face when diagnosing and treating cancer patients. Complementing its innovative approach, BVGH engages experts across sectors to build capacity and execute programs. African ministries of health and cancer leaders are engaged to ensure AAI activities are driven by their priorities and needs. AAI is not a donation-based program. Pharmaceutical companies are engaged to ensure access to quality, lifesaving cancer drugs in a sustainable and patient-focused manner. International cancer experts are enlisted in capacity building programs that directly align with their expertise and meet their global oncology goals. Results: BVGH is applying its multi-faceted, multi-sector model in Cameroon, Côte d'Ivoire, Kenya, Nigeria, Rwanda, and Senegal. In partnership with Nigeria’s Ministry of Health, BVGH held a cancer stakeholder meeting to define the country’s priority cancers, drugs, and treatment regimens. Following the meeting, BVGH launched an RFP to pharmaceutical companies and subsequently developed reports that forecast full treatment costs based on the companies’ offerings of deeply-discounted drug prices. While simultaneously coordinating drug access, BVGH began planning training refreshers to ensure recipient Nigerian hospitals were ready to use the prioritized cancer drugs successfully. Beyond Nigeria, BVGH has improved Rwanda’s ability to diagnose cancer efficiently; improved Côte d'Ivoire’s multidisciplinary approach to diagnosing and treating cancer patients; and helped Kenya refine its cancer patient sample referral mechanisms. Conclusions: This presentation will describe BVGH’s holistic, multi-sector approach to addressing Africa’s cancer crisis, including partners, activities, lessons learned, and best practices.
Role of patient navigation in improving access to radiotherapy treatment in a limited resource setting.
Authors: Vieira Carolina Martins , Krush Lindsay , Goss Paul E. , Rodrigues Angelica Nogueira
Published: May 2020

e19019

Background: Approximately 60% of cancer patients in low- and middle-income countries (LMICs) require radiotherapy (RT), with RT contributing 40% of curative treatment for cancers. Timely RT impacts prognosis. There are several difficulties in accessing RT in the Brazilian public health system: deficit of devices, obsolete machines, heterogeneous distribution of services, lack of investment in human resources and socioeconomic obstacles. Thus, it becomes necessary to optimize available resources. Although there are examples of successful patient navigation (PN) programs in vulnerable populations in high-income countries (HICs), data is scarce for LMICs. Considering the high incidence of cancer, complex difficulties in accessing treatment, and the positive results of PN in HICs, it was decided to evaluate this tool to improve RT access in the public system in Brazil. Methods: This pilot study was carried out in in a public school hospital in Belo Horizonte, Brazil, in partnership with the Global Cancer Institute, with a historical cohort as the control arm. The primary objective was to evaluate the changes in the time from definitive diagnosis to the start of treatment with the implementation of PN. Secondary objectives included: evaluating changes in the time between the beginning and end of RT, identification of the obstacles to access care, and quality of life data. Candidates for the program would be those considered for neoadjuvant or definitive RT, without previous cancer treatment. Results: 124 patients were included in the retrospective arm (12 excluded) and 73 in the navigation arm (1 excluded). Most had loco-regionally advanced disease, the most prevalent sites being esophagus, head, neck, and rectum. PN decreased the median time from biopsy result to the beginning of RT from 108 to 74 days (p < 0.001). PN also decreased the time between biopsy results and referral to RT (53 to 40.5 days, p = 0.011); between the referral and the first consultation in the RT (25 to 13 days, p < 0.001) and between the referral and the end of the RT (98 to 78 days, p < 0.003). There was an increase in the proportion of patients who started RT within 60 days (maximum period established by law to start cancer treatment), from 20.5% in the retrospective arm to 38.5% in the prospective arm (p = 0.026). PN in this context showed no impeditive costs ( < $140 USD per patient) with a satisfaction rate greater than 90% from patients. Conclusions: In an oncological context of socioeconomic vulnerability, PN is a financially viable and efficient tool to optimize access to timely radiotherapy.
Disparities in utilization of palliative care during terminal hospitalizations in patients with metastatic cancer: A nationwide analysis.
Authors: Lingamaneni Prasanth , Moturi Krishna Rekha , Vohra Ishaan , Farooq Muhammad Zain , Gupta Shweta
Published: May 2020

e19027

Background: Palliative care during the end of life is associated with greater patient satisfaction, improved quality of life and lower health care costs. Our aim was to study temporal trends of aggressive end of life care and palliative care during terminal hospitalizations in patients with metastatic cancer. We also studied disparities in palliative care in this population. Methods: Adult patients with metastatic cancer who died in the hospital from January 2012 to December 2017 were identified from the Nationwide Inpatient Sample database. Statistical tests for temporal trends of resource utilization were performed. Multivariable logistic regression was used to evaluate predictors of utilization of palliative care. Results: A total of 443,360 patients met the inclusion criteria. Mean age was 66.5 years. Patients were predominantly white (66.6%) with a slight male preponderance (51.9%). Most common primary cancers were lung (27.1%), GI tract (23.6%) and breast (7.6%). Use of chemotherapy and radiation decreased from 3.4% to 2.4% ( P < 0.001) and 2.8% to 1.4% ( P < 0.001), respectively, over the years. There was no statistically significant change in ICU care (26.6% to 27.2%, P= 0.61) or hospitalization costs ($22k to $23k, P =0.14). There was an increase in use of palliative care, from 45.7% to 61.2% ( P < 0.001). Patients were more likely to receive palliative care if they were older, female or treated at teaching hospitals. Blacks and Hispanics were less likely receive palliative care. Compared to patients insured by Medicare, those with Medicaid and private insurance were more likely to be offered palliative care. ICU care and chemotherapy predicted decreased use of palliative services. Conclusions: There is an overall trend towards increased use of palliative services and decrease in chemotherapy and radiation in terminal admissions. There are racial disparities in the utilization of palliative care services, with previous studies attributing knowledge gap, with mistrust of the system in African Americans, and language barriers in Hispanics to be causes for racial disparities. There is a need to increase efforts towards development of palliative care programs in non-academic hospitals. [Table: see text]
Prognostication based on TNM staging for socioeconomically disadvantaged colorectal cancer patients.
Authors: Lu Yan , Gehr Aaron , Bullock Jolonda , Ghabach Bassam , Neerukonda Latha Sri , Narra Kalyani , Ojha Rohit P.
Published: May 2020

e19036

Background: The TNM classification system is the global standard for staging solid tumors, but the ability of TNM to differentiate prognostic groups may vary between settings because of differences in case-mix and treatments. Little information is available about prognostication using TNM in safety-net health systems, which provide care for socioeconomically disadvantaged individuals and have limited resources. Therefore, we aimed to assess the ability of TNM to differentiate prognostic groups for colorectal cancer patients in an urban safety-net cancer center. Methods: We used institutional registry data from the JPS Oncology and Infusion Center (Fort Worth, TX), which is a Comprehensive Community Cancer Program. Our eligible population included adults who were diagnosed with first primary colorectal cancer between 2008 and 2017, had TNM pathologic stage I – IV, and received at least part of the first course treatment at JPS. Our outcome of interest was 5-year all-cause mortality and our exposure of interest was TNM pathologic stage. Patients were followed from cancer diagnosis until death, loss to follow up, or end of study (December 31, 2018), whichever occurred first. We used a pseudo-observation approach and generalized linear models with log link to estimate risk ratios (RR) and corresponding 95% confidence limits (CL) comparing 5-year mortality between TNM stages, where stage I was the reference category. Results: Our eligible population comprised 655 colorectal cancer survivors, of whom 85% were aged < 65 years, 54% were male, 60% were racial/ethnic minorities, and 65% were uninsured at time of diagnosis. Stage IV patients had 4.4 times higher risk of 5-year mortality compared with stage I (RR = 4.4, 95% CL: 2.9, 6.6). Stage III patients had 2.1 times higher risk of 5-year mortality compared with stage I (RR = 2.1, 95% CL: 1.3, 3.2). Stage II patients had 1.4 times higher risk of 5-year mortality compared with stage I (RR = 1.4, 95% CL: 0.81, 2.3). Conclusions: Our findings suggest that TNM stages do not adequately differentiate colorectal cancer prognostic groups in a socioeconomically disadvantaged population. Stage IV is distinct, but stages I – III have limited differentiation and notable overlap. The use of TNM stages for colorectal cancer prognostication may be misleading for socioeconomically disadvantaged individuals. Factors beyond TNM should be considered for better prognostication in this population.