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

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112s Cancer Prevention/Epidemiology<br />

1608 General Poster Session (Board #10B), Sat, 1:15 PM-5:15 PM<br />

<strong>American</strong> BRCA outcomes and utilization <strong>of</strong> testing (ABOUT) study.<br />

Presenting Author: Rebecca Sutphen, Epidemiology Center, University <strong>of</strong><br />

South Florida Morsani College <strong>of</strong> Medicine, Tampa, FL<br />

Background: An estimated 100,000 individuals currently undergo genetic<br />

testing for hereditary susceptibility to breast and ovarian cancer annually in<br />

the U.S., yet little is known about their characteristics, testing experience<br />

or outcomes. Research in this high-risk group has been limited to patients<br />

recruited at academic medical centers where case ascertainment, health<br />

services delivery, decision-making and, quite likely, outcomes are different<br />

from those in the community setting where the majority <strong>of</strong> individuals<br />

currently receive healthcare services. Methods: Eligible subjects include<br />

10,000 consecutive individuals requesting BRCA testing through the<br />

nation’s third-largest health insurer, Aetna, beginning in December, 2011.<br />

De-identified data are analyzed from each test request form submitted by<br />

the ordering provider. Each eligible subject is mailed a study packet<br />

inviting them to complete a questionnaire (by mail, online or telephone)<br />

designed to investigate informational and healthcare services, test results,<br />

knowledge, risk perception and medical intentions. Results: Of 442<br />

subjects contacted during the first two weeks <strong>of</strong> accrual, 143 (32%) have<br />

completed the questionnaire to date. Similar to Aetna member demographics,<br />

7% are African-<strong>American</strong> and 7% report Hispanic ethnicity. Based on<br />

Chi-Square tests, there were no differences between respondents and<br />

non-respondents with regard to age (51% under age 50), race, ethnicity or<br />

personal history <strong>of</strong> cancer (58%). Among respondents, deleterious mutations<br />

were identified in 8%. Testing for a known familial mutation was<br />

performed in 8%. Among women with breast cancer, 13% were undergoing<br />

testing prior to initial surgical treatment. Updated results from 3000<br />

eligible subjects will be presented. Conclusions: This innovative, academicindustry<br />

collaboration enables an unprecedented investigation <strong>of</strong> significant<br />

issues surrounding individuals at increased risk for hereditary breast<br />

and ovarian cancer and undergoing genetic testing in the U.S. The results<br />

will guide the development and dissemination <strong>of</strong> more targeted decisionsupport<br />

tools and strategies to improve medical outcomes for such<br />

individuals.<br />

1610 General Poster Session (Board #10D), Sat, 1:15 PM-5:15 PM<br />

Health and quality <strong>of</strong> life (QOL) issues in four groups <strong>of</strong> lung cancer<br />

patients: Low-dose computed tomography (LDCT) screened, chest x-ray<br />

detected, incidentally found, and routinely diagnosed. Presenting Author:<br />

Ping Yang, Mayo Clinic, Rochester, MN<br />

Background: Low dose computed tomography (LDCT) scans have reduced<br />

lung cancer deaths by 20.3% in high risk populations, although there is an<br />

unknown balance between the benefits and harms <strong>of</strong> LDCT scans as a<br />

screening tool. Our purpose was to compare health-related QOL issues<br />

among lung cancer patients who were initially detected by LDCT scans; 4<br />

comparison groups included: lung cancer diagnosed by a screening chest<br />

X-ray, as an incidental finding from procedures taken for other medical<br />

reasons, or based on symptoms indicative for lung cancer and routinely<br />

diagnosed, and individuals who were LDCT screened but found no lung<br />

cancer (controls who participated in Mayo’s lung cancer CT screening trial).<br />

Methods: A total <strong>of</strong> 1,658 lung cancer patients (cared at Mayo Clinic) in the<br />

4 groups (37, 151, 389, and 1081 respectively) and 488 controls were<br />

compared on following patient-reported outcomes (collected via validated<br />

tools): overall QOL, four symptoms (cough, pain, dyspnea, fatigue), mental/<br />

physical/ emotional/ social/ spiritual QOL, and other concerns (e.g., family/<br />

friends/ financial/ legal). A clinically significant deficit was defined as at<br />

least 10-points in difference (or �50 points) on a 0-100 scale. The rates <strong>of</strong><br />

deficits were compared via Fisher’s exact tests and average QOL values via<br />

Kruskal-Wallis tests. Results: Overall QOL and individual symptoms were<br />

significantly worse (p�0.05) in all lung cancer groups than in controls,<br />

except for pain. LDCT-screened patients reported the greatest deficit<br />

among the 4 lung cancer groups in physical (41%), emotional (24%),<br />

social (38%), and spiritual QOL (24%); whereas chest X-ray detected<br />

patients had the least deficit in overall QOL (22%) and pain (32%). All 4<br />

lung cancer groups experienced much worse fatigue (52-64%) than the<br />

controls (32%). Conclusions: Our preliminary results suggest that LDCTscreening<br />

detected lung cancer patients reported a different QOL pr<strong>of</strong>ile<br />

from other lung cancer patients and non-lung cancer controls. The clinical<br />

course, smoking behavior, and QOL related health issues associated with<br />

LDCT screening for lung cancer warrant thorough investigation.<br />

1609 General Poster Session (Board #10C), Sat, 1:15 PM-5:15 PM<br />

Association between age, gender, residential region, and prevalence <strong>of</strong><br />

subependymal giant cell astrocytoma among patients with tuberous sclerosis<br />

complex: A U.S. Healthcare Claims Database study. Presenting Author:<br />

Michael Kohrman, University <strong>of</strong> Chicago, Chicago, IL<br />

Background: Subependymal giant-cell astrocytomas (SEGA) are slow growing<br />

non-cancerous tumors that can occur in patients with tuberous sclerosis<br />

complex (TSC). The objectives <strong>of</strong> this study were to examine SEGA<br />

prevalence among TSC patients in a real world setting, and to ascertain the<br />

relationships between SEGA prevalence and age groups, genders, or<br />

residential regions. Methods: We conducted a retrospective cohort study<br />

based on a large US commercial healthcare claims database. Patients with<br />

a TSC claim between 2000 and 2009 and with 12-month continuous<br />

enrollment after their first TSC claim were included into the study. SEGA<br />

was identified based on ICD-9CM codes in inpatient or outpatient claims.<br />

Patients’ genders, residential regions and ages <strong>of</strong> their first TSC claim and<br />

/or their first SEGA claim (if they had SEGA) were extracted from enrollment<br />

files respectively. SEGA prevalence was assessed with subgroup analyses <strong>of</strong><br />

genders, age groups <strong>of</strong> first TSC claim, and residential regions. Two-sample<br />

t tests and Chi-square tests were used to explore the relationships between<br />

SEGA prevalence and age groups, genders, or residential regions. Results:<br />

The study had 2,767 patients with a mean age <strong>of</strong> 28.5 years on their first<br />

observed TSC claim, and 55.3% were female. Among these TSC patients,<br />

7.7% had SEGA with variations by age groups <strong>of</strong> their first TSC claim (5.9%<br />

for age�1 year, 12.6% for age 1-5 years, 11.0% for age 6-10 years, 11.0%<br />

for age 11-18 years, 7.6% for age 19-25 years, and 5.1% for age 26 years<br />

or more), by genders (8.7% for males vs. 6.9% for females), and by<br />

residential regions (6.0%-11.0%). The associations between SEGA prevalence<br />

and age groups, genders or residential regions were all statistically<br />

significant with p�0.05. Conclusions: In a real world setting, and by the<br />

end <strong>of</strong> the first post-TSC year, 7.7% TSC patients had an observed SEGA<br />

diagnosis. This prevalence varied by age groups, genders, residential<br />

regions. Further research is needed to explore the factors that results into<br />

these variations.<br />

1611 General Poster Session (Board #10E), Sat, 1:15 PM-5:15 PM<br />

A retrospective analysis <strong>of</strong> all non-AIDS defining cancers (NADC): A subset<br />

analysis <strong>of</strong> the County Hospital AIDS Malignancy Project (CHAMP).<br />

Presenting Author: Shweta Gupta, John H. Stroger Jr. Hospital <strong>of</strong> Cook<br />

County, Chicago, IL<br />

Background: County Hospital (CCH) with its HIV clinic, the CORE Center<br />

(CC) is the largest provider for HIV patients (pts) in Chicago, treating over<br />

5,500 HIV pts yearly. There is paucity <strong>of</strong> data on characteristics <strong>of</strong> HIV�<br />

cancers (ca) in the inner city. The CHAMP cohort is a retrospective study <strong>of</strong><br />

all HIV associated cancers at CC and CCH over past 14 years (yrs). We<br />

analyzed all <strong>of</strong> the NADC from this cohort. Methods: All HIV pts with NADC<br />

were identified from the CHAMP cohort and retrospectively reviewed for<br />

HIV and cancer characteristics, overall survival (OS), and pt demographics.<br />

Statistics: Survival data was analyzed using Kaplan-Meier analysis and Cox<br />

Proportional Hazards model. Results: Of 438 pts identified, 157 were<br />

NADC representing 21 ca. The average (ave) age was 48 yrs (range 44-57),<br />

with prostate ca having highest age presentation. Over the past 10 yrs, the<br />

number <strong>of</strong> NADC has risen from 10 to over 20 each yr. Unlike historical<br />

controls (HC) where lung ca is most common, anal ca (21%) was most<br />

frequent followed by lung ca (17%). Prostate, head and neck (HNSCC),<br />

liver, and colorectal ca were seen in 9, 9, 8, and 7% respectively. 65% <strong>of</strong><br />

pts were African <strong>American</strong>s (AA) and 18% Caucasians. 78% <strong>of</strong> all NADC<br />

were men. 45% <strong>of</strong> anal ca present with stage IIIa/b disease, moderately to<br />

poorly differentiated ca in 48%, with a median OS <strong>of</strong> 34 mo. CD4 count did<br />

not alter OS but stage predicted better outcomes. 86% lung ca presented<br />

as stage III/IV disease with ave CD4 count 204. Histologically, 36% were<br />

SCC, 28% adenosquamous and 20% adenocarcinoma. OS was 5.5 mo and<br />

did not change by histology, CD4, or age. 68% HNSCC present with stage<br />

IVa/b but no IVc. Ave age was 48 yrs with an OS <strong>of</strong> 18mo. 50% were<br />

oropharyngeal compared to 22% in HC. Conclusions: Based on data by<br />

Sheilds et. al, CCH treats just over 1% <strong>of</strong> the country’s NADC population.<br />

We demonstrate a higher incidence <strong>of</strong> NADC over time, dominated by a<br />

younger, AA and male population. Each ca presents with advanced stage<br />

45-86% and poorly differentiated tumors ranging from 15-30%. The OS <strong>of</strong><br />

each cancer is consistent with HC with exception <strong>of</strong> HNSCC. As HIV pts age<br />

becoming prone to cancers <strong>of</strong> elderly, education and screening <strong>of</strong> inner city<br />

HIV pts will help improve cancer rates.<br />

Visit abstract.asco.org and search by abstract for the full list <strong>of</strong> abstract authors and their disclosure information.

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