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

6036 Poster Discussion Session (Board #24), Tue, 8:00 AM-12:00 PM and
11:30 AM-12:30 PM
Which women with breast cancer do, and do not, undergo receptor status
testing? A population-based study. Presenting Author: Linda Sharp, National
Cancer Registry Ireland, Cork, Ireland
Background: Receptor status is a determinant of breast cancer (BC)
treatment and prognosis. Clinical practice guidelines advise that all women
diagnosed with BC may undergo estrogen (ER), progesterone (ER) and
human epidermal growth factor 2 (HER2) receptor tests. We conducted a
population-based study to investigate what proportions of women undergo
testing and predictors of test receipt. Methods: Incident BCs (ICD10 C50)
diagnosed 2006-2008 were identified from the National Cancer Registry
Ireland. Receptor tests were identified from registration records augmented
by review of selected medical records. For each of the three receptors
separately, logistic regression was used to identify which socio-demographic
(age, marital status, smoking status, area of residence, and
deprivation category) and clinical factors (grade, tumour size (T), nodal
status (N), distant metastasis (M)) were associated with undergoing
testing. Adjusted odds ratios (OR) and 95% confidence intervals were
computed. Results: 7619 BCs were included. 7% were not tested for any of
the receptors. 73% were tested for all three. Considering each receptor
separately, 90% had an ER test, 86% a HER2 test and 80% a PR test.
Women with T4 tumours were less likely to have ER and HER2 tests, and
more likely to have a PR test, than women with T1 tumours. After
adjustment for clinical variables, age was not a significant predictor for ER
and HER2 testing, while older women (�70) were more likely than younger
women to have a PR test. For all three tests, non-married women were
significantly less likely to be tested (ER: OR�0.65, 95%CI 0.52-0.8; PR:
OR�0.81, 95%CI 0.7-,0.93; HER2: OR�0.72, 95%CI 0.62-0.85) and
current smokers more likely (ER: OR�1.55, 95%CI 1.14-2.1: PR:
OR�1.38, 95%CI 1.15-1.66; HER2: OR�1.25, 95%CI 1.01-1.55). Area
of residence at diagnosis was a significant predictor of having each test,
although the geographical patterns varied. Conclusions: More than onequarter
of women with BC do not have one or more of the receptor tests.
After adjusting for clinical variables, socio-demographic factors were
significant predictors of test receipt. In the interests of equity, the reasons
underlying these associations should be further investigated.
6038 General Poster Session (Board #1A), Mon, 1:15 PM-5:15 PM
Somatic mutation spectrum of non-small cell lung cancers (NSCLCs) from
African Americans (AAs). Presenting Author: Philip Edward Lammers,
Vanderbilt-Ingram Cancer Center, Nashville, TN
Background: In the AA population, previous studies have presented conflicting
data on the frequency of EGFR mutations (Reinersman JTO 2011;
Leidner JCO 2009), while frequencies of other gene mutations and
translocations, including anaplastic lymphoma kinase (ALK), have not
been described. Methods: 161 archival FFPE tumor specimens from self
reported AA patients with any stage NSCLC from 1997-2010 were
collected from 3 sites in Tennessee (132 samples) and one site in Michigan
(29 samples). Samples were evaluated for known recurrent driver mutations
in EGFR, KRAS, BRAF, NRAS, AKT1, PI3KCA, PTEN, HER-2, MEK1
by standard SNaPshot/sizing assays, and translocations in ALK by FISH.
Clinical data was collected on 119 patients. Chi-square was used to
compare the frequency of mutations in subgroups and Kaplan-Meier and
log rank were used to calculate and compare PFS between groups. Results:
5.0% of tumors had EGFR mutations, 14.9% had KRAS mutations, 0.6%
had a BRAF, AKT1, PI3KCA, or HER2 mutation, and 0% had NRAS, PTEN,
or MEK1 mutations. Of 35 ‘pan-negative’ non-squamous specimens, 0 had
ALK translocations. PFS was the same in those with and without KRAS
mutation (p�0.74) and showed a trend towards improvement in those with
EGFR mutation (p�0.08). The frequency of EGFR mutations was higher in
samples from Detroit versus those from Tennessee (17% vs 2.3%,
p�0.01), as was the frequency of adenocarcinoma (62% vs 44%,
p�0.05). The frequency of EGFR mutations in never smokers was higher in
the samples from Detroit versus Tennessee (83% vs 7.1%, p�0.01).
Conclusions: In the largest tumor mutational profiling study of NSCLC from
AAs to date, EGFR mutations occurred less frequently than would be
expected from a North American population. We noted a regional difference,
with fewer EGFR mutations in Tennessee than in Michigan, a finding
that may have been the result of more adenocarcinoma samples from
Michigan. The rates of other mutations and translocations including ALK
were low. While lung cancer tumors should continue to undergo routine
molecular testing to prioritize therapy, future comprehensive genotyping
efforts should focus on identifying novel driver mutations in this population.
Funding: 5RC1CA162260 R01CA060691 R01CA87895.
Health Services Research
391s
6037 Poster Discussion Session (Board #25), Tue, 8:00 AM-12:00 PM and
11:30 AM-12:30 PM
Racial differences in delay of treatment for localized prostate cancer (CaP):
A population-based study. Presenting Author: William Allen Stokes, University
of North Carolina at Chapel Hill, Chapel Hill, NC
Background: African-Americans (AA) are diagnosed with more advanced
CaP than Caucasians (CA) and are more likely to die from CaP. Treatment
delay is a potentially modifiable obstacle to care and clinically may be more
important in AA patients because of more aggressive cancer at diagnosis.
We examined time from diagnosis to curative treatment (surgery or
radiation) in AA and CA patients in the Surveillance, Epidemiologic and
End Results (SEER)-Medicare linked database. Methods: 21,454 CA and
2,506 AA patients who were diagnosed with non-metastatic CaP from
2004-08 and received treatment within 12 months of diagnosis were
included. Linear regression was used to examine factors associated with
number of days from diagnosis to treatment initiation, and logistic
regression to assess odds of treatment within 6 months of diagnosis.
Results: AA patients were more likely to have high-risk CaP than CA patients
(39 vs. 35%), and less likely to have low-risk CaP (27 vs. 31%) (p�.001).
Time to treatment was significantly prolonged for AA patients in all risk
groups of CaP, and the difference was most prominent for high-risk patients
(median 105 days for AA vs. 96 days for CA, p�.002). Racial differences in
time to treatment persisted in multivariable analysis (Table). Sensitivity
analyses examining the proportion of AA and CA patients initiating
treatment within 6 months of diagnosis revealed similar results. Conclusions:
AA patients, especially those with high-risk CaP, experience longer treatment
delays than CA patients. This is the first large-scale study to examine
treatment delays in AA and CA patients with CaP. The differences found
may contribute to our understanding of racial disparities in CaP treatment
outcomes.
Covariate Coefficient (days) P value
Race (vs. CA)
AA 6.7 �.001
Risk group (vs. low-risk)
Intermediate 1.2 .25
High 4.2 �.001
Age (vs. 65-69)
70-74 -1.4 .15
>75 -2.2 .05
Modified Charlson comorbidity (vs. 0)
>0 -0.1 .90
Controls for SEER region, regional socioeconomic indicators, marital status, and
treatment modality.
6039 General Poster Session (Board #1B), Mon, 1:15 PM-5:15 PM
Do patient-reported symptoms predict for emergency department visits? A
population-based analysis. Presenting Author: Lisa Catherine Barbera,
Odette Cancer Centre, Toronto, ON, Canada
Background: Since 2007 in Ontario, Canada, the Edmonton Symptom
Assessment System (ESAS) has been routinely used to assess symptoms in
cancer patients in both ambulatory and home-care settings. The purpose of
this study was to determine the relationship between individual patient
symptoms, and their severity, with the likelihood of an emergency department
(ED) visit. Methods: The cohort includes all cancer patients in Ontario
who completed an ESAS assessment between January 2007 and March
2009. We linked multiple provincial health databases to describe the
cohort and determine if an ED visit occurred within 7 days of the patient’s
first ESAS. Multivariate logistic regression was used to determine the
association between symptom scores (absent: score 0; mild: 1-3; moderate:
4-7; severe: 8-10) and the likelihood of an ED visit. Results: The cohort
included 45,118 unique patients whose first assessment contributes to the
study. 3.8% (n�1732) had an ED visit. The patients with ED visits were
more likely to be men, to have lung or gastro-intestinal cancer, to have had
recent radio or chemotherapy, and to have a shorter survival. The proportion
of patients with ED visits increased from 2% to 10-12% as individual
symptom scores increased from 0 to 10. Anxiety and depression were not
associated with ED visits in the model, regardless of severity. Pain, nausea,
drowsiness, appetite and shortness of breath with moderate or severe
scores were associated with ED visits. Tiredness and wellbeing were the
only symptoms to show a significant association for mild, moderate and
severe scores. A well being score of 7-10 (reference score�0) had the
highest odds ratio of 1.8 (95% CI 1.4-2.3). Conclusions: Worsening
symptoms clearly contribute to ED visits. While specific symptoms like pain
are obvious targets for management in the outpatient setting, constitutional
symptoms like wellbeing or fatigue are associated with even higher odds.
Though difficult to manage, such symptoms also warrant detailed assessment
in order to optimize patient outcomes.
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