Cancer Registry Data Research Articles

Methodological insights into severity distribution of non-fatal cancer burden in Belgium using a microsimulation model (2004-2019)

Abstract This study leverages a registry-based microsimulation model to analyze the non-fatal burden of cancer in Belgium from 2004 to 2019, emphasizing the methodology for severity distribution. Utilizing incidence- and prevalence-based approaches, we estimated Years Lived with Disability (YLD) through detailed national cancer registry data coupled with tailored disease models. The microsimulation model employed enabled nuanced translation of cancer incidence into prevalence estimates, incorporating the longitudinal impacts of disease severity influenced by treatment. Methodologically, the model integrated expert elicitation to adjust for treatment-related disabilities, such as surgical aftereffects, enhancing the accuracy of disability weight assignment across different cancer stages. This approach allowed for a dynamic assessment of disease burden, reflecting real-world complexities of cancer prognosis and treatment pathways. Significant findings include a substantial increase in the age-standardized non-fatal burden for non-melanoma skin cancer, highlighting the model’s capability to detect shifts in disease impact over time. By focusing on the microsimulation’s capacity to delineate severity distributions within the cancer burden landscape, this analysis underscores the model’s utility in refining health policy decisions and resource allocation. Ultimately, this study presents a robust framework for national burden of disease studies, facilitating detailed evaluations of health interventions and their longitudinal effectiveness.

The 5-year relative survival rate among cancer patients in Henan province of China, 2015-2019

Objective: To analyze the 5-year relative survival rate of cancer in Henan province based on cancer registration data. Methods: Cancer survival data were extracted from the cancer registration database of Henan province with the diagnosis date between January 1, 2010 and December 31, 2019 were included. The closing date of follow-up was set as December 31, 2019. The 5-year relative survival rate of cancer was calculated using the period survival analysis method and the Ederer II method in the R package "periodR", and the interest period was between 2015 and 2019. Results: During the period of 2015-2019, the overall 5-year relative survival rate of cancer patients in Henan province was 43.6%, and after age-standardization, it was 40.2%. The overall 5-year relative survival rate showed the characteristics of higher survival rate in females than males (45.9% vs 34.7%, Z=39.60, P＜0.001) and higher survival rate in urban areas than rural areas (44.9% vs 39.1%, Z=12.97, P＜0.001). The 5-year relative survival rate for cancer patients among children aged 0-14 was 60.2%, and for adults aged 15 and above, it was 43.5%, which was standardized to 40.2% after age adjustment. There are two types of cancers with a standardized 5-year relative survival rate exceeding 70% (thyroid cancer at 82.2% and breast cancer at 71.6%), and four cancers with a rate below 30% (pancreatic cancer at 18.2%, liver cancer at 19.6%, lung cancer at 24.0%, and gallbladder cancer at 26.6%). Conclusion: The cancer 5-year survival rate in Henan Province is lower than that of the national average, indicating the need for continued enhancement of cancer prevention and control measures.

Trends and age-period-cohort analysis of leukemia incidence in Qidong from 1972 to 2021

Objective: To describe the epidemiological characteristics and trends of leukemia incidence in Qidong between 1972 and 2021, and provide guidelines for prevention and control measures and strategies. Methods: The cancer registry data was collected and analyzed on leukemia incidence during 1972-2021 in Qidong by sex, age and time. Crude incidence rate (CR), China age-standardized rate (ASRC), world age-standardized rate (ASRW), and average annual change percentage (AAPC) was calculated by Joinpoint software. Age-period-cohort (APC) model was used to analyze the influence of age, period and birth cohort on the changes in the incidence trend of leukemia patients. Results: From 1972 to 2021, there were 2 948 patients with leukemia in Qidong, accounting for 2.00% of all cancer new cases, CR of leukemia was 5.26/105, ASRC was 4.34/105, ASRW was 4.35/105. The truncated incidence of 35-64 years old was 5.29/105, the cumulative incidence rate between the ages of 0 and 74 years old was 0.40%, the cumulative risk was 0.40%. There were 1 608 male patients, the CR, ASRC, and the ASRW were 5.81/105, 4.88/105 and 4.85/105. The number of female patients were 1 340, and the CR, ASRC, and the ASRW were 4.71/105, 3.86/105 and 3.91/105, respectively. Temporal trends indicated significant upward trends in ASRC among both gender, males and females with AAPC values of 1.41% (P＜0.001), 1.15% (P＜0.001), and 1.73% (P＜0.001), respectively. The results of the APC model showed that the average net drift value of leukemia incidence in all age groups was 1.57% (95% CI, 1.24%-1.89%), and the highest value of local drift was 3.20% (95% CI, 1.63%-4.78%) in the 80~ years old group. The incidence of leukemia increased with age. With the passage of time, the risk of leukemia incidence increased gradually compared with the rate ratio of leukemia incidence (risk ratio [RR], 1.00) in 1992-1996, the RR of leukemia incidence increased from 0.70 during 1972-1976 to 1.57 during 2017-2021. The later the cohort was born, the greater the risk of leukemia incidence compared with the relative risk of leukemia incidence (RR, 1.00) in 1952-1956 cohort, the RR of leukemia incidence increased from 0.24 in the 1892-1896 cohort to 2.73 in the 2017-2021 cohort. Conclusions: The incidence of the leukemia has presented a rising trend in the past fifty years. Leukemia incidence increased with age, and the period and cohort effects on the risk of incidence increase. Further research is needed to investigate the risk factors related to leukemia.

Income disparities have a significant impact on thyroid cancer recurrence and survival

PurposeIncome inequality profoundly impacts cancer outcomes, yet its specific effects on thyroid cancer remain unclear. Elucidating the influence of socioeconomic disparities is imperative to advance health equity and optimize patient care. This study evaluates associations between median household income and thyroid cancer recurrence and survival using national cancer registry data. Methods139,302 thyroid cancer patients undergoing surgery from 2000 to 2019 were analyzed from the Surveillance, Epidemiology, and End Results (SEER) database. Patients were categorized by median annual household income at the county level (> or <$75,000). Multivariable regression determined the impact of income on recurrence and overall mortality. ResultsHigher-income patients had 26 % lower recurrence odds (OR 0.74, 95 %CI 0.55–0.99, p=0.042) and longer median survival (18.1 vs 17.7 years, p<0.001) compared to lower-income patients. On multivariate analysis, high income remained an independent predictor of reduced mortality after adjusting for demographics, tumor factors, and treatment (adjusted HR=0.84, 95 %CI=0.81–0.87, p<0.001). Cancer-directed surgery (HR=0.28, 95 %CI=0.26–0.30, p<0.001) and radioactive iodine (HR=0.69, 95 %CI=0.66–0.71, p<0.001) were associated with lower mortality risk. ConclusionsIncome disparities have a significant influence on thyroid cancer outcomes, including lower recurrence and reduced mortality. Targeting socioeconomic inequity could substantially reduce recurrence, improve survival, and promote health equity for all patients.

Comparative analysis of hypofractionated short-course versus standard radiation therapy in elderly patients with glioblastoma: analysis of nationwide database.

Hypofractionated short-course radiation therapy (SCRT) is an alternative treatment option for elderly or frail patients with newly diagnosed glioblastoma (GBM) post-surgery. This study compares survival outcomes and treatment costs between patients receiving SCRT and those undergoing standard long-course radiation therapy (LCRT). This retrospective study utilized health insurance claims and national cancer registry data from Korea to compare overall survival (OS) and treatment costs between patients receiving SCRT and LCRT across all ages and sub-group analysis within the subgroup of cases aged 65 and older from 2016 onwards, a period when intensity-modulated radiotherapy (IMRT) was widely adopted. A total of 1,598 patients were included. Median OS since the first day of radiation therapy was 10.4 months (95% CI [9.6; 12.8]) for SCRT (n = 197) versus 16.2 months (95% CI [15.5; 16.9]) for LCRT (n = 1401) respectively. Subgroup analysis using stabilized inverse probability of treatment weighting (S-IPTW) showed indicating non-inferiority in elderly patients in median OS for elderly patients (≥ 65) with 10.6 months (95% CI [8.9; 14.0]) for SCRT (n = 147) versus 13.2 months (95% CI [8.9; 14.0]) for LCRT (n = 541). The median treatment cost of SCRT is about 6,000 USD lower, 25% less than LCRT. Compliance with the standard TMZ regimen post-radiation improved OS across all age groups. Considering comparable OS and shorter treatment duration, SCRT offers a viable, cost-effective option for elderly GBM patients. Adhering to standard TMZ also contributes to OS improvement. Further research reflecting key prognostic factors is essential to refining the role of SCRT.

Global view of haematolymphoid tumor classifications and their application in low- and middle-income countries.

The accurate diagnosis of haematolymphoid malignancies is crucial for effective cancer care, but major obstacles to diagnosis exist in low- and middle-income countries (LMICs). This article explores the global applicability of current haematolymphoid classification systems, which are predominantly derived from data generated in high-income countries (HICs). Although disproportionately burdened with poor cancer outcomes, LMICs are generally faced with limited diagnostic resources, suboptimal access to therapeutics, and inadequate healthcare infrastructure. The article highlights the challenges faced by LMICs, including inconsistent access to high-quality pathology services, limited availability of advanced diagnostic techniques, and a lack of population-based cancer registry data. It also discusses the progress made in narrowing the gap between LMICs and HICs, such as the introduction of resource-adapted classifications, improved guidance on essential diagnostic tools, and strengthening of in-country professional pathology networks. Innovative diagnostic approaches, including gene expression profiling and machine learning, represent potential solutions for improving the diagnostic accuracy in LMICs, but addressable gaps remain. Recommendations are suggested for sustainable investments in diagnostic infrastructure, capacity-building, and population-based cancer registries to enhance the global applicability of haematolymphoid classification systems and improve outcomes for patients in LMICs.

A German perspective on the impact of socioeconomic status in diffuse large B-cell lymphoma

The prognostic influence of socioeconomic status (SES) on the survival of diffuse large B-cell lymphoma (DLBCL) patients remains controversial. This observational study examines the potential impact of regional SES inequalities on overall survival (OS) among DLBCL patients in Germany. We analyzed data from the German nationwide population-based dataset spanning 2004-2019 sourced from the German Center for Cancer Registry Data (n = 49,465). The primary objective was to assess the 5-year OS among patients with low SES compared to those living in middle and high SES areas. SES was grouped according to quintiles of the German Index of Socioeconomic Deprivation, which summarized nine indicators covering aspects of regional education, employment, and income. DLBCL patients in low SES areas had significantly impaired 5-year OS compared to those in middle and high SES regions (59.2% vs. 61.8% vs. 64.1%, p < 0.0001). Yet, additionally accounting for regional premature mortality removed the impact of SES on survival (Hazard Ratio 0.94, 95% CI 0.87–1.01). Our findings indicate that the prognostic impact of socioeconomic deprivation on long-term survival is not due to variations in diagnosis and treatment of DLBCL itself but rather a higher comorbidity burden.

Cancer of the paranasal sinuses in Germany: Data on incidence and survival from a population-based cancer registry

PurposeThis study aims to provide a broad overview of the epidemiology of cancer of the paranasal sinuses (PSC) in Germany. The data include information on incidence, staging, clinicopathological features and survival from one of the largest cancer registries in Europe. MethodsPopulation-based data on PSC diagnosed from January 1st, 2009 until December 31st, 2019 were retrieved from the German Centre for Cancer Registry Data (ZfKD). Age standardized incidence was calculated and relative survival estimates were computed by sex, histological subtype, age group and T-, N-, and M-Stage. ResultsIn total, 3975 cases were included in this study. The age-adjusted incidence rate (ASR) for PSC was 0.3/100,000 which remained stable during the observation period. The most frequent tumor localization was the maxillary sinus (41.9 %) and the most common histological subtype was keratinizing squamous cell carcinoma (kSCC) (44.3 %). All subtypes were predominantly found in the maxillary sinus except for adenocarcinoma and neuroendocrine carcinomas (SNEC), which were most frequently located in the ethmoidal sinus. The majority of the patients with a known T stage was diagnosed in tumor stage T4 (60.8 %). The overall 5-year relative survival (RS) for all patients with PSC was 52 %. RS dropped from 93 % for T1 stage tumors to 39 % for T4 tumors. RS was 58 % for N0 and 31 % for N+ cases, 54 % for M0 and 27 % for M1 cases. ConclusionAge-adjusted incidence for PSC is low and has been stable for the observed 11-year period. RS decreases continuously with increasing T-, N- and M-stage.

6550 National Statin Prescription Trends in Patients With Breast Cancer and Diabetes for Primary Cardiovascular Disease Prevention

Abstract Disclosure: A.B. Yang: None. G. Mhango: None. C. Kong: None. J.J. Lin: None. J.P. Wisnivesky: Consulting Fee; Self; Sanofi, Banook, PPD. Grant Recipient; Self; Sanofi, Regeneron Pharmaceuticals, Axella, Arnold Consultants. A. Leiter: None. Background: Cardiovascular disease (CVD) is the leading cause of death in older early-stage breast cancer (BC) survivors. Due to cardiotoxic BC treatments such as chemotherapy and radiation, patients with BC and diabetes (DM) are at increased risk of CVD. In patients with BC and DM, statins decrease CVD mortality. Since 2013, many clinical guidelines broadened statin indications for primary CVD prevention in patients with DM, making &amp;gt;85% of patients eligible. Little is known about statin prescription (Rx) patterns in older BC survivors with DM, a group at high risk of CVD. Hypothesis: We hypothesized that statin Rxs increased over time, but were less likely in BC survivors with more advanced locoregional BC and lower comorbidity burden. Methods: A population-based, retrospective cohort study was conducted using Surveillance, Epidemiology and End Results (SEER) cancer registry data linked to Medicare claims. We identified women with preexisting DM who were diagnosed with stage 0-III primary BC between 2008-17. We excluded patients with prior CVD who died &amp;lt;1 year after BC diagnosis. Statin Rx (atorvastatin, pravastatin, rosuvastatin, simvastatin, fluvastatin, lovastatin) was defined as ≥1 statin pharmacy claim &amp;lt;1 year after BC diagnosis. Comorbidity burden was assessed with a modified Charlson Comorbidity Index (CCI). We compared patient demographic and clinical characteristics by statin Rx status using the chi-square test. Using a multivariate logistic regression adjusting for age, race, CCI, BC stage, and diagnosis year, independent predictors of statin Rx were identified. Results: Of 8,423 BC patients with pre-existing DM, 5,698 (68%) had a statin Rx. Statin Rx increased over time (BC diagnosis year 2008-10: 66%, 2011-13: 66%, 2014-15: 69%, 2016-17: 70%; p=0.01) and differed by age (66-69: 66%, 70-74: 70%, 75-79: 69%, ≥80: 65%; p&amp;lt;0.01) and race (White: 68%, Black: 62%, Latinx: 66%, Other: 72%; p&amp;lt;0.01). Statin Rx did not differ by comorbidity burden (CCI 0: 68%, 1-2: 67%, ≥3: 67%; p=0.87) and declined with higher BC stage (0: 73%, I: 70%, II: 65%, III: 63%; p&amp;lt;0.01). In adjusted analyses, more recent BC diagnosis (2016-17 vs. 2008-10: odds ratio [OR]: 1.19, 95% confidence interval [CI]: 1.04-1.38), age group (70-74 vs. 66-69: OR: 1.24, 95% CI: 1.09-1.41), race (Black vs. White: OR 0.77, 95% CI: 0.66-0.89) and higher BC stages (II vs. 0: OR: 0.76, 95% CI: 0.58-1.00; III vs. 0: OR: 0.72, 95% CI: 0.54-0.97) remained predictors of statin Rx. Conclusions: In a nationally representative cohort analysis of older early-stage BC patients, statin Rx increased between 2008-17 and varied by age, race, and BC stage. Elucidating gaps in statin Rx can potentially improve guideline-concordant Rx in a group at high risk for CVD and reduce disparities. Presentation: 6/2/2024

Defining sensitivity and specificity for quality control of organized cancer screening using Prefectural Cancer Registry data in Japan

Objective To decrease cancer mortality by implementing cancer screening programs, rigorous quality control measures that utilize standardized indicators are imperative. In Japan, although each municipality performing cancer screening programs implements quality control for their programs using the checklist authorized by the Ministry of Health, Labour and Welfare, compliance with all the items listed is not possible because calculating sensitivity and specificity using cancer registry data is difficult under these circumstances. This report elucidates the methodology for calculating indicators, including sensitivity and specificity, by delineating the parameters of false-negative cases within population-based cancer screening programs in Japan. Furthermore, the inherent challenges associated with ensuring the quality control of cancer screening procedures are expounded upon in this report.Method Data from the Prefectural Cancer Registry of Japan and cancer screening records compiled by municipalities were used to differentiate true-positive, true-negative, false-positive, and false-negative cases based on the combination of screening test outcomes and subsequent cancer incidence.Results A false-negative case was defined as an examinee who received a cancer diagnosis within one year after undergoing the screening test, notwithstanding the negative judgment of the cancer screening decision. The duration for judgment of true-positive, true-negative, and false-negative cases was also extended to one year. Cancer identification after cancer screening was ascertained using data from the Prefectural Cancer Registry, ensuring uniform categorization of the four cases. Subsequently, sensitivity and specificity values were calculated for municipalities conducting cancer screening programs.Conclusion Sensitivity and specificity are indispensable metrics for the inherent quality control of cancer screening because these parameters directly assess the efficacy of screening tests. The anticipated increase in the number of municipalities engaged in comprehensive quality control of cancer screening in Japan is poised to enhance the efficiency of cancer control policies. This augmentation will be accomplished through the meticulous utilization of the sensitivity and specificity values elucidated in the present report. The forthcoming challenges involve the proliferation of medical institutes reporting their adherence to the checklist stipulated by the National Cancer Center of Japan and the widespread dissemination of fundamental knowledge pertaining to cancer screening.

Impact of the COVID-19 Pandemic and Lockdown on Cancer Diagnoses Using Swiss Cantonal Cancer Registry Data

Background/Objectives: This study aims to investigate differences in cancer diagnosis based on absolute case numbers and age-standardized incidence rate ratios (IRRs) in the pre-Coronavirus disease 2019 (COVID-19) years (2018/19) and the first two years of the COVID-19 pandemic (2020, 2021) in two Swiss cantons. Methods: Data of the Swiss cantonal cancer registry of the cantons of Zurich (ZH) and Zug (ZG) were used to descriptively investigate differences in annual and monthly absolute numbers regarding all-cancer and the five most common cancer types. Directly age-standardized monthly incidence rates (IRs) were calculated. Multivariate Quasipoisson regression models were fitted to determine the IRRs with 95% confidence intervals (95% CI). Results: Annual absolute numbers of all investigated cancers were similar in 2018/19, 2020, and 2021, except for prostate cancer (increase of 20.8% in 2021 compared to 2018/19). In 2020, there were generally more cancer diagnoses in January and February followed by a decrease in April and May. Compared to the pre-COVID-19 period, lower IRs were observed in 2020 for all-cancer (IRR = 0.96 [95% CI 0.96, 0.97]) and female breast cancer (0.92 [0.89, 0.96]), whereas higher IRs were observed in 2021 for all-cancer (1.02 [1.02, 1.02]) and prostate cancer (1.23 [1.18, 1.28]). Conclusions: Cancer detection and diagnoses decreased during the first year of the pandemic, especially during the most stringent lockdown phase in April. The findings of this study may inform the decisions of policymakers and public health system during future pandemics.

Development of a novel prediction model for carriage of BRCA1/2 pathogenic variant in Japanese patients with breast cancer based on Japanese organization of hereditary breast and ovarian cancer registry data.

With the increasing demand for BRCA genetic testing, most existing prediction models were developed using data from individuals of European descent. This study aimed to identify clinicopathological factors of hereditary breast and ovarian cancer (HBOC) syndrome and develop the first Japanese-specific prediction model for BRCA pathogenic variant carriers in Japan. We utilized data from 3072 Japanese patients with breast cancer aggregated by the Japanese Organization of Hereditary Breast and Ovarian Cancer registry. Prediction models were developed using 70% of the overall dataset and validated using the remaining 30%. Factors associated with the BRCA pathogenic variant status were identified using logistic univariate analysis, and significant factors were further analyzed using logistic multivariate analysis to develop prediction models for BRCA1/2 (BRCA1 and/or BRCA2), BRCA1, and BRCA2 pathogenic variants. BRCA1 showed associations with aggressive clinicopathological factors such as triple-negative breast cancer and nuclear grade 3. Moreover, the prediction model showed a high area under the curve (AUC) of 0.879. By contrast, BRCA2 exhibited fewer characteristic associated factors, and the AUC of the model was 0.669. Common factors shared by BRCA1/2, BRCA1, and BRCA2 were the age at diagnosis of breast cancer and the youngest age of relatives with breast cancer. Consistent with previous research, early-onset breast cancer appeared to be strongly associated with HBOC. We successfully developed prediction models for BRCA1/2, BRCA1, and BRCA2 pathogenic variants. By accurately stratifying patients' risk and guiding targeted screening and preventative interventions, these models will contribute to improved management and outcomes of HBOC.

The human side of cancer care in Japan: barriers and challenges

Abstract Among the core concepts of psycho-oncology, “addressing the human aspects of cancer” is one of the most important. In particular, the enhancement of physicians' empathic communication is welcomed in Japan. In 2006, the enactment of the Cancer Control Act in Japan promoted psychosocial and palliative care to anyone. Thus, the designated cancer hospitals adopted a palliative care team, including a psycho-oncologist, as well as a communication skills training program practicing empathic communication. The Cancer Registry data have suggested regional disparities in suicides among patients with cancer in Japan, suggesting fragile regions of psycho-oncology. How can we deliver empathic communication to patients across the country, and how far will technological innovation, including AI, produce innovative support? Although constant efforts are needed to move closer to solutions, the human side of cancer must not be changed; however, clinical practice must continue to change over time.

Establishing a cancer registry and baseline data for Nyandarua County, Kenya: A step towards establishing a central cancer registry

Cancer is a major global public health issue, causing a significant number of premature deaths worldwide. In 2020, the World Health Organization reported that more than 19 million individuals were diagnosed with cancer, and over 10 million lost their lives to the disease. Predictions indicate that cancer-related deaths will exceed 30 million by 2030, with around 75 % occurring in low- and middle-income countries (LMICs) like Kenya. Various factors contribute to this concerning trend, including aging populations, a high prevalence of cancer risk factors, socioeconomic disparities resulting in limited healthcare access, and deficiencies in healthcare systems within LMICs. This study focused on Nyandarua County, Kenya, which lacks a dedicated cancer registry. Without comprehensive incidence data, the county faces challenges in developing targeted programs for cancer prevention, management, and control. The main objective of this investigation was to establish a cancer registry specific to Nyandarua County, capable of continuously gathering accurate cancer data, patient treatment follow-ups and disease outcomes. A demographic survey was conducted to determine the frequency of all-cause and specific cancers among patients who attended selected health facilities between 2013 and 2020. Data were collected from existing hospital records in three main hospitals in the county. A total of 1373 cases were recorded, with 54.9 % of patients being female. North Kinangop Catholic Hospital accounted for the largest number of patients (62 %), followed by JM Kariuki County Memorial Hospital (35 %), while Engineer Hospital contributed the remaining 3 %. The top five cancer sites observed in Nyandarua County were esophagus (16.8 %), cervix uteri (13.4 %), stomach (10.6 %), breast (8.8 %), and prostate (8.6 %). Our findings provide valuable insights into the prevalence and distribution of different types of cancer in the region. With the establishment of this cancer registry, Nyandarua County is now among the pioneering counties in Kenya. It is crucial for the county government to undertake the responsibility of continuously updating the registry to draw inferences regarding cancer prevalence in the region to enhance patients follow up and survival.

Association of county-level medical debt and survival among individuals newly diagnosed with cancer in the United States.

156 Background: Individuals diagnosed with cancer often bear significant health care costs and productivity loss, with over half incurring cancer-related medical debt. Medical debt is increasingly recognized as a social determinant of health care and health outcomes. Using newly available nationwide county-level medical debt information from 2011 to 2019 linked with national cancer registry data, we examined the association of county-level medical debt with survival among individuals newly diagnosed with cancer in the US. Methods: Individuals aged ≥18 years with newly diagnosed first primary cancer in 2011-2019 were identified from the National Cancer Database, which was linked with credit bureau data on county-level percentage of adults with medical debt in collections based on patients’ year of diagnosis. Patients were followed from diagnosis through December 31, 2019. Hazard Ratios (HR) and were derived from Cox proportional hazard models to estimate the associations of county-level medical debt quartiles with overall survival, adjusting for year of diagnosis, age, sex, race and ethnicity, insurance status, comorbidity score, metropolitan status, county-level social deprivation index and medically underserved area designation, and state of residency. Stratified analyses were conducted by cancer type and sociodemographic and clinical factors. Results: A total of 7,558,658 individuals newly diagnosed with cancer were identified, with a median county-level medical debt of 18%, ranging from 0% to 56%. County-level medical debt decreased since 2015. The highest percentage of county-level medical debts was found among patients racialized as non-Hispanic Black, uninsured, and living in medically underserved areas. In adjusted analyses, patients living in counties with the highest quartile of medical debt had 17% increased risks of death compared with those living in counties with the lowest quartile of medical debt (HR=1.17, 95%CI=1.16-1.18), with a statistically significant dose-response relationship for the higher quartiles (P-trend&lt;.0001). The pattern was consistently seen across cancer types as well as socioeconomic and clinical groups. Conclusions: County-level medical debt was strongly associated with worse survival among individuals newly diagnosed with cancer, consistent across socioeconomics and clinical subgroups. Policies preventing and relieving medical debt maybe effective ways to improve cancer outcomes at population level. Hazard ratios for risk of death associated with county-level medical debt by cancer site and stage at diagnosis. County-Level Share of Population with Medical Debt Q1 Q2 Q3 Q4 All cancers 1 1.08 1.13 1.17 Female breast 1 1.10 1.13 1.16 Prostate 1 1.06 1.11 1.13 Lung 1 1.06 1.10 1.12 Colon and rectum 1 1.07 1.11 1.14 Stage I-III 1 1.09 1.14 1.19 Stage IV 1 1.07 1.11 1.13 All P for trend &lt;.0001.

Insurance coverage for AYAs at cancer diagnosis: A claims-based analysis.

105 Background: Adolescents and Young Adults (AYAs), aged 15-39, experience unique challenges in cancer care. Frequent health insurance gaps for this population due to age, employment, and living changes hinder effective care and outcome assessments. Uninsured AYAs have lower survival rates, and insurance disparities are notable among Black, Hispanic, and rural patients; however, patterns of enrollment among AYAs have not been well described. Our study examined these patterns using insurance claims data to better inform AYA cancer care and outcomes. Methods: We conducted a retrospective cohort study with the Cancer Information and Population Health Resource (CIPHR), a linkage of cancer registry data and private and public payer data in North Carolina, including Medicaid and over 70% of the private insurance market. We included patients aged 15-39 diagnosed with common AYA cancers (leukemia, lymphoma, breast cancer, melanoma, sarcoma, germ cell tumors) from 2003-2019, linked to claims from 2003-2020. We analyzed insurance coverage patterns, comparing continuous enrollment 1) from two months pre-diagnosis to 12 months post-diagnosis and 2) from the month of diagnosis through 12 months. We compared demographics, clinical characteristics, and insurance types across scenarios. Results: The full cancer registry cohort included 21,060 AYAs; 11,024 (52.3%) had no link to Medicaid or private insurance in the year of cancer diagnosis. Continuous enrollment was 4,707 (22.4%) from two months prior through 12 months after, increasing to 5,912 (28.1%) for month of diagnosis through 12 months, particularly among Medicaid beneficiaries (from 10.8% to 15.6% of total cohort). Less restrictive criteria increased representation among Black (from 29.1% to 38.5%) and rural patients (from 25.2% to 33.1%) and those with leukemia (25.2% to 33.8%) and lymphoma (24.0% to 31.0%). Conclusions: AYAs face substantial hurdles with discontinuous insurance coverage around their cancer diagnosis. Claims-based research can characterize cancer care delivery, and use of less restrictive eligibility criteria expands the generalizability of findings to a more diverse cohort of AYAs. Increasing health insurance coverage over time may be due to the Affordable Care Act. Medicaid expansion within our state is likely to further improve access for AYAs. Continued efforts are essential to help AYAs with cancer secure necessary insurance coverage. Characteristics of AYAs by insurance enrollment criteria. Registry Cohort (n = 21,060) Continuous Enrollment –2 mos to 12 mos (n= 4,707) Continuous Enrollment 0 to 12 mos (n = 5,912) Cancer Type Breast 5817 1345 (23.1%) 1754 (30.2%) Sarcoma 1833 429 (23.4%) 532 (29.0%) Lymphoma 4436 1064 (24.0%) 1374 (31.0%) Leukemia 2393 604 (25.2%) 809 (33.8%) Race/Ethnicity Black 3951 1150 (29.1%) 1521 (38.5%) White 14620 3153 (21.6%) 3886 (26.6%) Hispanic 1296 164 (12.7%) 210 (16.2%) Location Urban 16277 Rural 4728 1190 (25.2%) 1565 (33.1%)

Influence of an AYA cancer program on cancer care delivery.

4 Background: Adolescent and young adults (AYAs, aged 13-39) with cancer face barriers to care and stagnant survival outcomes. The University of North Carolina (UNC) at Chapel Hill's AYA Cancer Program, established in 2015, aims to address these challenges. The program operates through both consultations and targeted outreach based on patient risk-stratification, offering services such as fertility counseling, enhanced access to clinical trial enrollment, a dedicated sarcoma palliative care collaborative, survivorship clinic, and psychosocial support. AYA program providers work with patients to create tailored care plans that meet AYAs' psychosocial and medical needs. To better understand the reach and impact of this novel care delivery approach, we performed a retrospective cohort study over the 8-year period of program development. Methods: Using linked electronic health record (EHR) and State Cancer Registry data, we performed a retrospective cohort study of AYA patients at UNC from 2014-2022, comparing sociodemographic and clinical criteria between those with and without AYA Cancer Program contact. Our analysis included outcomes of care utilization, complications, and supportive care measures. Using SMR propensity weighting with multivariable log binomial modeling, we evaluated associations between outcomes and AYA program contact. Factors such as age at diagnosis, race, sex, insurance status, cancer site, metastatic disease, and receipt of systemic therapy were considered in the weighting scheme. Results: Of 4,016 AYAs receiving cancer care at UNC, 670 had contact with our program. Program-engaged patients were younger at diagnosis, more likely to be Black, and had higher rates of metastatic disease or hematologic malignancies. In weighted model analyses, program patients were more likely to receive guideline recommended care, including enrollment in a clinical trial, receipt of fertility counseling and palliative care, and documented advanced care planning. Over time, our program's reach expanded from 6% to more than 25% of the total AYA population. Conclusions: Our findings indicate that AYAs contacted by our program through a consult-based, targeted outreach model represent a distinct population with higher clinical needs. Despite this complexity, they were more likely to receive guideline-recommended care, including clinical trial enrollment, fertility counseling, and palliative care. Care delivery outcomes by program contact. No Program Contact (n= 3346) Program Contact (n=670) Clinical Trial Enrollment 882 (26.4%) 301 (44.9%) 1.31 (1.14, 1.49) Fertility Counseling 77 (2.3%) 119 (17.8%) 2.09 (1.56, 2.80) Palliative Care 102 (3.0%) 125 (18.7%) 3.46 (2.44, 4.91) Advanced Care Planning 176 (5.3%) 91 (13.6%) 1.55 (1.14, 2.11)

Factors associated with colon cancer fragmentation in the Keystone state.

120 Background: Fragmentation of cancer care delivery across multiple providers can impact care quality and patient outcomes. Management of non-metastatic colon cancer often involves adjuvant chemotherapy, which increases the risk of potentially deleterious care dispersion. This study assesses the extent of care fragmentation across different inpatient facilities and examines patient characteristics associated with inpatient care fragmentation. Methods: We adapt the modified Herfindahl-Hirschman market concentration index to construct a Fragmentation Index (FI) capturing the distribution of a patient’s care across inpatient facilities. For patients who underwent oncologic surgery for colon cancer from 2010-2016, we calculate FI for the 15 months post-diagnosis if at least 2 admissions occur during the study period. We use Pennsylvania Cancer Registry data linked to all-payer statewide facility discharge records to estimate the relationship between FI and patient demographics, rurality, area deprivation index (ADI), and payer status using adjusted multivariable linear regression models. Results: For the operative cohort (28.6% Stage I, 34.7% Stage II, 36.7% Stage III, n = 7803), 86% of patients lived in urban areas, 9.5% in large towns and 5% in rural areas. 60% had Medicare, 6.1% Medicaid and 7.1% were uninsured or had unknown payer status. 52% of patients were female and 87% were non-Hispanic White. The overall mean FI was 0.192; 60% (n = 4693) had an FI of 0, indicating all admissions were at the same hospital, and among those with FI&gt; 0 (n = 3110), mean FI was 0.483. The mean FI for patients potentially eligible for adjuvant chemotherapy (Stage II, III) was 0.188: 61% of patients had an FI of 0 and among those with FI &gt; 0 (n = 2173), mean FI was 0.482. Stratification by stage reveals similar proportions of FI &gt; 0.5 (stage I: 24.6%, stage II: 22.3%, stage III: 21.3%). Increased care dispersion was observed in patients from large towns (ΔFI 0.04, CI 0.03—0.06) or rural areas (ΔFI 0.04, CI 0.02—0.08) relative to urban areas, as well as for patients with relatively higher number of hospitalizations (ΔFI 0.04, CI 0.03—0.04). Less care dispersion was seen in patients with stage III disease (relative to stage I ΔFI -0.02, CI -0.03 — -0.01), uninsured status (relative to private insurance ΔFI -0.03, CI -0.05 – -0.01) or residence in the most disadvantaged ADI quartile (relative to Q1 ADI ΔFI -0.02, CI -0.04 — 0.00). Conclusions: Among patients with operatively managed colon cancer, slightly more than half did not experience inpatient care fragmentation. As expected, a higher number of total admissions and non-urban residence were associated with increased inpatient care dispersion. However, our findings of more concentrated care among patients with stage III disease, higher levels of relative economic disadvantage, and uninsured status suggest potentially complex and divergent forces driving hospital selection, to be explored in future work.

Patterns and Differences in Lung Cancer Treatment — United States, 2015–2020

BackgroundTreatment for lung cancer can improve prognosis, but 5-year survival remains low at 26%. An examination of treatment using data with higher population coverage, and among a broader number of treatment modalities and individual characteristics, would provide greater insight into differences in lung cancer treatment. Research QuestionAmong adults diagnosed with lung cancer, how does reported receipt of lung cancer treatment differ by sociodemographic characteristics? Study Design and MethodsWe used 2015–2020 National Program of Cancer Registry data covering 89% of the US population to describe first-course treatment among persons ages ≥20 years diagnosed with lung and bronchus cancer. We performed multivariable logistic regression to examine associations between sociodemographic characteristics and treatment received. ResultsAmong 1,068,155 people diagnosed with lung cancer, 22% received surgery, 41% received chemotherapy, 40% received radiation, 13% received immunotherapy, and 75% received at least one of the four treatments. People who were ages >45 years (odds ratio [OR] range=0.08–0.67); American Indian or Alaska Native (OR=0.82; 95% CI: 0.77–0.87), Black (OR=0.82; 95% CI: 0.81–0.84), or Hispanic (OR=0.80; 95% CI: 0.78–0.82); resided in a non-metropolitan county (OR=0.98; 0.96–0.99); resided in the bottom 25% (OR=0.80; 95% CI: 0.78–0.81) and middle 50% (OR=0.87; 95% CI: 0.86–0.88) of counties by economic status (considers unemployment rate, per capita market income, and poverty rate); and in the West US census region (OR=0.95; 95% CI: 0.94–0.97) had significantly lower odds of receiving at least one of the four treatments. InterpretationChemotherapy and radiation were the most common types of first-course treatment reported. Receipt of at least one of the four treatments examined was lower among several groups, including certain racial and ethnic groups and those residing in counties with lower economic status. Future studies might further identify and intervene upon factors underlying differences.

Hepatitis C virus attributable liver cancer in the country of Georgia, 2015–2019: a case–control study

BackgroundHepatitis C virus (HCV) infection can lead to a type of primary liver cancer called hepatocellular carcinoma (HCC). Georgia, a high HCV prevalence country, started an HCV elimination program in 2015. In addition to tracking incidence and mortality, surveillance for the HCV-attributable fraction of HCC is an important indicator of the program’s impact. This study assesses HCV infection-attributable HCC in the Georgian population.MethodsThis case–control study utilized HCV programmatic and Georgian Cancer Registry data from 2015–2019. Bivariate logistic regression and age- and sex-stratified analyses assessed HCV and liver cancer association. HCV-attributable liver cancer proportions for the HCV-exposed and total population were calculated. A sub-analysis was performed for HCC cases specifically.ResultsThe total study population was 3874 with 496 liver cancer cases and 3378 controls. The odds for HCV-infected individuals developing liver cancer was 20.1 (95% confidence interval [CI] 15.97–25.37), and the odds of developing HCC was 16.84 (95% CI 12.01–23.83) compared to the HCV-negative group. Odds ratios varied across strata, with HCV-infected older individuals and women having higher odds of developing both liver cancer and HCC. A large proportion of liver cancer and HCC can be attributed to HCV in HCV-infected individuals; however, in the general population, the burden of liver cancer and HCC cannot be explained by HCV alone.ConclusionHCV was significantly associated with a higher risk of developing liver cancer and HCC in the Georgian population. In addition, given Georgia’s high HCV burden, increased HCC monitoring in HCV-infected patients is needed.