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

384s Health Services Research
6008 Oral Abstract Session, Sat, 3:00 PM-6:00 PM
Oncologists’ and primary care providers’ awareness of late effects of cancer
treatment: Implications for survivorship care. Presenting Author: Larissa
Nekhlyudov, Harvard Medical School and Harvard Vanguard Medical
Associates, Boston, MA
Background: There is a growing population of cancer survivors, many of
whom may experience late or long-term effects (LEs) of treatment. The goal
of our study was to describe and compare primary care providers’ (PCP) and
oncologists’ awareness of LEs. Methods: The Survey of Physician Attitudes
Regarding the Care of Cancer Survivors was completed by a nationally
representative sample of 1,072 PCPs and 1,130 oncologists (cooperation
rate 65%). Respondents were asked to report for each of four standard
chemotherapy drugs used to treat breast or colorectal cancer the five LEs
they had observed and/or had seen reported in the literature. We described
and compared the physicians’ responses and, using separate multinomial
logistic regression models, determined predictors of their ability to identify
the main LEs for all agents, adjusting for physician demographics and
practice characteristics. Results: Almost all (95.3%) oncologists identified
cardiac dysfunction as a LE of doxorubicin (Adriamycin), and peripheral
neuropathy as LEs of both taxol (97.3%) and oxaliplatin (96.6%); while
these LEs were identified by only 55.1%, 21.8% and 21.8% of PCPs,
respectively. Most oncologists identified premature menopause (71.4%)
and secondary malignancies (62.0%) as LEs of cytoxan, compared with
only 14.8% and 17.2% of PCPs. Main LEs for all four chemotherapy drugs
were identified by 65% (n�741) of oncologists and only 6% (n�60) of
PCPs. In adjusted models, oncologists were more likely to identify the main
LEs for all chemotherapy drugs if they spent 51-90% (OR 1.87, 95% CI
1.21-2.88) or �90% (OR 1.82, 95% CI 1.08-3.08) of their time on
patient care, and less likely if they were not board certified (OR 0.58, 95%
CI 0.37-0.89). African American PCPs were less likely to identify the main
LEs for all chemotherapy drugs (OR 0.19, 95% CI 0.08-0.45). Conclusions:
Oncologists often identified the main LEs of cancer drugs while PCPs did
not. While not surprising, these findings emphasize that in the transition of
patients from oncology to primary care settings, PCPs should be informed
about the LEs of cancer treatment so that they may be better prepared to
recognize and address these among survivors in their post-treatment care.
6010 Clinical Science Symposium, Sun, 8:00 AM-9:30 AM
Do insurance status and neighborhood characteristics explain why minorities
underutilize NCI cancer centers? Presenting Author: Lyen C. Huang,
Department of Surgery, Stanford University, Stanford, CA
Background: National Cancer-Institute (NCI) designated cancer centers
provide some of the highest quality cancer care in the US, in part due to the
availability of cutting edge technologies and access to cancer clinical trials.
Racial/ethnic minorities suffer from persistent disparities in cancer outcomes,
and these groups are typically under-represented in clinical trials.
This may be due in part to under-utilization of NCI centers by these groups.
Methods: A unique dataset linking the California Cancer Registry with
California patient discharge abstracts was used to identify patients undergoing
resection for a primary diagnosis of colorectal cancer (CRC) (1996-
2006). Travel distance to treatment hospital was determined using GIS
software. Chi-square analysis correlated patient demographics, clinical
characteristics, insurance status, and neighborhood socioeconomics with
NCI center use. Multivariable regression models were constructed to
predict the likelihood of using an NCI center. Results: 95,994 CRC patients
were identified. Median travel distance for care was �5 miles. Only 12,659
(13%) lived within a 5 mile radius of an NCI center; and of those, fewer
than 10% used the center for CRC care (n�1130). Black (OR 0.83 95%CI
0.72-0.95) and Hispanic (OR 0.72 95%CI 0.65-0.81) patients were less
likely than white patients to use NCI centers. Neighborhood socioeconomics,
but not insurance status, were significantly correlated with NCI
under-utilization. Asian populations were more likely to use NCI centers
than white patients (OR 1.40 95%CI 1.28-1.54). Conclusions: Black and
Hispanic patients are less likely to use nearby NCI hospitals for CRC care.
Outreach efforts in communities with low socioeconomic status and
educational attainment may increase use of NCI centers, improve CRC
outcomes, and increase minority enrollment in clinical trials.
CRA6009 Clinical Science Symposium, Sun, 8:00 AM-9:30 AM
Patterns of decision making about cancer clinical trial participation among
the online cancer treatment community: A collaboration between SWOG
and NexCura. Presenting Author: Joseph M. Unger, SWOG Statistical
Center, Seattle, WA
The full, final text of this abstract will be available at
abstract.asco.org at 12:01 AM (EDT) on Sunday, June 3,
2012, and in the Annual Meeting Proceedings online
supplement to the June 20, 2012, issue of Journal of
Clinical Oncology. Onsite at the Meeting, this abstract will
be printed in the Sunday edition of ASCO Daily News
6011 Clinical Science Symposium, Sun, 8:00 AM-9:30 AM
Insurance status and cancer disparities in adolescents and young adults
age 15 to 39: National Cancer Data Base, 1998-2003. Presenting Author:
Anthony Robbins, American Cancer Society, Atlanta, GA
Background: Since the mid-1970s there has been little progress in
improving cancer survival for adolescents and young adults (AYAs, defined
by the National Cancer Institute as individuals 15 to 39 years of age), in
contrast to the substantial improvements for children and older adults. The
association between insurance status and cancer disparities (stage at
diagnosis, survival, and treatment) in AYA patients has not been examined
in a national sample. Methods: The National Cancer Data Base, a national
hospital-based cancer registry, was used to examine insurance status and
cancer disparities in 177,359 AYA cancer patients. Cases were diagnosed
during 1998�2003 and followed for vital status through 2008. We
examined the association between insurance status and stage at diagnosis,
stage-specific survival, and receipt of the most frequently used stagespecific
treatments for common AYA sites (thyroid, female breast, non-
Hodgkin lymphoma, and acute myeloid leukemia). Results: Insurance
status was strongly related to cancer disparities in AYA patients. For
example, compared to patients with private insurance, uninsured patients
were 1.71 times more likely to be diagnosed at stage IV (95% confidence
interval [CI], 1.63�1.79), had higher risk of death within every stage
[stage I, hazard ratio (HR) (95% CI), 2.43 (2.13�2.76); stage II, 1.87
(1.70�2.06); stage III, 1.55 (1.43�1.68); stage IV, 1.39 (1.31�1.48);
and unstaged (leukemias, CNS tumors, etc.), 1.67 (1.58�1.76), and for
the four sites listed above, were less likely to receive the most frequently
used stage-specific treatments. Insurance status remained a strong independent
predictor for each of these outcomes in multivariate models adjusting
for patient, hospital, and tumor factors. Conclusions: In a large national
sample, insurance status was a strong independent predictor of cancer
disparities in AYA patients. The Affordable Care Act of 2010 should
facilitate the acquisition of adequate health insurance by AYA, who are the
most under- and uninsured age group in the US population, and should
contribute to remediation of such disparities.
Visit abstract.asco.org and search by abstract for the full list of abstract authors and their disclosure information.