Annual Meeting Proceedings Part 1 - American Society of Clinical ...

112s Cancer Prevention/Epidemiology
1608 General Poster Session (Board #10B), Sat, 1:15 PM-5:15 PM
American BRCA outcomes and utilization of testing (ABOUT) study.
Presenting Author: Rebecca Sutphen, Epidemiology Center, University of
South Florida Morsani College of Medicine, Tampa, FL
Background: An estimated 100,000 individuals currently undergo genetic
testing for hereditary susceptibility to breast and ovarian cancer annually in
the U.S., yet little is known about their characteristics, testing experience
or outcomes. Research in this high-risk group has been limited to patients
recruited at academic medical centers where case ascertainment, health
services delivery, decision-making and, quite likely, outcomes are different
from those in the community setting where the majority of individuals
currently receive healthcare services. Methods: Eligible subjects include
10,000 consecutive individuals requesting BRCA testing through the
nation’s third-largest health insurer, Aetna, beginning in December, 2011.
De-identified data are analyzed from each test request form submitted by
the ordering provider. Each eligible subject is mailed a study packet
inviting them to complete a questionnaire (by mail, online or telephone)
designed to investigate informational and healthcare services, test results,
knowledge, risk perception and medical intentions. Results: Of 442
subjects contacted during the first two weeks of accrual, 143 (32%) have
completed the questionnaire to date. Similar to Aetna member demographics,
7% are African-American and 7% report Hispanic ethnicity. Based on
Chi-Square tests, there were no differences between respondents and
non-respondents with regard to age (51% under age 50), race, ethnicity or
personal history of cancer (58%). Among respondents, deleterious mutations
were identified in 8%. Testing for a known familial mutation was
performed in 8%. Among women with breast cancer, 13% were undergoing
testing prior to initial surgical treatment. Updated results from 3000
eligible subjects will be presented. Conclusions: This innovative, academicindustry
collaboration enables an unprecedented investigation of significant
issues surrounding individuals at increased risk for hereditary breast
and ovarian cancer and undergoing genetic testing in the U.S. The results
will guide the development and dissemination of more targeted decisionsupport
tools and strategies to improve medical outcomes for such
individuals.
1610 General Poster Session (Board #10D), Sat, 1:15 PM-5:15 PM
Health and quality of life (QOL) issues in four groups of lung cancer
patients: Low-dose computed tomography (LDCT) screened, chest x-ray
detected, incidentally found, and routinely diagnosed. Presenting Author:
Ping Yang, Mayo Clinic, Rochester, MN
Background: Low dose computed tomography (LDCT) scans have reduced
lung cancer deaths by 20.3% in high risk populations, although there is an
unknown balance between the benefits and harms of LDCT scans as a
screening tool. Our purpose was to compare health-related QOL issues
among lung cancer patients who were initially detected by LDCT scans; 4
comparison groups included: lung cancer diagnosed by a screening chest
X-ray, as an incidental finding from procedures taken for other medical
reasons, or based on symptoms indicative for lung cancer and routinely
diagnosed, and individuals who were LDCT screened but found no lung
cancer (controls who participated in Mayo’s lung cancer CT screening trial).
Methods: A total of 1,658 lung cancer patients (cared at Mayo Clinic) in the
4 groups (37, 151, 389, and 1081 respectively) and 488 controls were
compared on following patient-reported outcomes (collected via validated
tools): overall QOL, four symptoms (cough, pain, dyspnea, fatigue), mental/
physical/ emotional/ social/ spiritual QOL, and other concerns (e.g., family/
friends/ financial/ legal). A clinically significant deficit was defined as at
least 10-points in difference (or �50 points) on a 0-100 scale. The rates of
deficits were compared via Fisher’s exact tests and average QOL values via
Kruskal-Wallis tests. Results: Overall QOL and individual symptoms were
significantly worse (p�0.05) in all lung cancer groups than in controls,
except for pain. LDCT-screened patients reported the greatest deficit
among the 4 lung cancer groups in physical (41%), emotional (24%),
social (38%), and spiritual QOL (24%); whereas chest X-ray detected
patients had the least deficit in overall QOL (22%) and pain (32%). All 4
lung cancer groups experienced much worse fatigue (52-64%) than the
controls (32%). Conclusions: Our preliminary results suggest that LDCTscreening
detected lung cancer patients reported a different QOL profile
from other lung cancer patients and non-lung cancer controls. The clinical
course, smoking behavior, and QOL related health issues associated with
LDCT screening for lung cancer warrant thorough investigation.
1609 General Poster Session (Board #10C), Sat, 1:15 PM-5:15 PM
Association between age, gender, residential region, and prevalence of
subependymal giant cell astrocytoma among patients with tuberous sclerosis
complex: A U.S. Healthcare Claims Database study. Presenting Author:
Michael Kohrman, University of Chicago, Chicago, IL
Background: Subependymal giant-cell astrocytomas (SEGA) are slow growing
non-cancerous tumors that can occur in patients with tuberous sclerosis
complex (TSC). The objectives of this study were to examine SEGA
prevalence among TSC patients in a real world setting, and to ascertain the
relationships between SEGA prevalence and age groups, genders, or
residential regions. Methods: We conducted a retrospective cohort study
based on a large US commercial healthcare claims database. Patients with
a TSC claim between 2000 and 2009 and with 12-month continuous
enrollment after their first TSC claim were included into the study. SEGA
was identified based on ICD-9CM codes in inpatient or outpatient claims.
Patients’ genders, residential regions and ages of their first TSC claim and
/or their first SEGA claim (if they had SEGA) were extracted from enrollment
files respectively. SEGA prevalence was assessed with subgroup analyses of
genders, age groups of first TSC claim, and residential regions. Two-sample
t tests and Chi-square tests were used to explore the relationships between
SEGA prevalence and age groups, genders, or residential regions. Results:
The study had 2,767 patients with a mean age of 28.5 years on their first
observed TSC claim, and 55.3% were female. Among these TSC patients,
7.7% had SEGA with variations by age groups of their first TSC claim (5.9%
for age�1 year, 12.6% for age 1-5 years, 11.0% for age 6-10 years, 11.0%
for age 11-18 years, 7.6% for age 19-25 years, and 5.1% for age 26 years
or more), by genders (8.7% for males vs. 6.9% for females), and by
residential regions (6.0%-11.0%). The associations between SEGA prevalence
and age groups, genders or residential regions were all statistically
significant with p�0.05. Conclusions: In a real world setting, and by the
end of the first post-TSC year, 7.7% TSC patients had an observed SEGA
diagnosis. This prevalence varied by age groups, genders, residential
regions. Further research is needed to explore the factors that results into
these variations.
1611 General Poster Session (Board #10E), Sat, 1:15 PM-5:15 PM
A retrospective analysis of all non-AIDS defining cancers (NADC): A subset
analysis of the County Hospital AIDS Malignancy Project (CHAMP).
Presenting Author: Shweta Gupta, John H. Stroger Jr. Hospital of Cook
County, Chicago, IL
Background: County Hospital (CCH) with its HIV clinic, the CORE Center
(CC) is the largest provider for HIV patients (pts) in Chicago, treating over
5,500 HIV pts yearly. There is paucity of data on characteristics of HIV�
cancers (ca) in the inner city. The CHAMP cohort is a retrospective study of
all HIV associated cancers at CC and CCH over past 14 years (yrs). We
analyzed all of the NADC from this cohort. Methods: All HIV pts with NADC
were identified from the CHAMP cohort and retrospectively reviewed for
HIV and cancer characteristics, overall survival (OS), and pt demographics.
Statistics: Survival data was analyzed using Kaplan-Meier analysis and Cox
Proportional Hazards model. Results: Of 438 pts identified, 157 were
NADC representing 21 ca. The average (ave) age was 48 yrs (range 44-57),
with prostate ca having highest age presentation. Over the past 10 yrs, the
number of NADC has risen from 10 to over 20 each yr. Unlike historical
controls (HC) where lung ca is most common, anal ca (21%) was most
frequent followed by lung ca (17%). Prostate, head and neck (HNSCC),
liver, and colorectal ca were seen in 9, 9, 8, and 7% respectively. 65% of
pts were African Americans (AA) and 18% Caucasians. 78% of all NADC
were men. 45% of anal ca present with stage IIIa/b disease, moderately to
poorly differentiated ca in 48%, with a median OS of 34 mo. CD4 count did
not alter OS but stage predicted better outcomes. 86% lung ca presented
as stage III/IV disease with ave CD4 count 204. Histologically, 36% were
SCC, 28% adenosquamous and 20% adenocarcinoma. OS was 5.5 mo and
did not change by histology, CD4, or age. 68% HNSCC present with stage
IVa/b but no IVc. Ave age was 48 yrs with an OS of 18mo. 50% were
oropharyngeal compared to 22% in HC. Conclusions: Based on data by
Sheilds et. al, CCH treats just over 1% of the country’s NADC population.
We demonstrate a higher incidence of NADC over time, dominated by a
younger, AA and male population. Each ca presents with advanced stage
45-86% and poorly differentiated tumors ranging from 15-30%. The OS of
each cancer is consistent with HC with exception of HNSCC. As HIV pts age
becoming prone to cancers of elderly, education and screening of inner city
HIV pts will help improve cancer rates.
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