Cancer-specific Screening Research Articles

Cancer Screening and Treatment Delays During the COVID-19 Pandemic and the Role of Health Literacy in Care Re-engagement: Findings from an NCI-Designated Comprehensive Cancer Center sample.

The COVID-19 pandemic has led to numerous delays in cancer-related care and cancer-specific screening, but the extent is not fully understood. For those that experience a delay or disruption in care, health related self-management is required to re-engage in care pathways and the role of health literacy in this pathway has not been explored. The purpose of this analysis is to (1) report the frequency of self-reported delays in cancer treatment and preventative screening services at an academic, NCI-designated center during the COVID-19 pandemic and (2) investigate cancer-related care and screening delays among those with adequate and limited health literacy. A cross-sectional survey was administered from an NCI-designated Cancer Center with a rural catchment area during November 2020 through March 2021. A total of 1,533 participants completed the survey, and nearly 19 percent of participants were categorized as having limited health literacy. Twenty percent of those with a cancer diagnosis reported a delay in cancer-related care; and 23-30% of the sample reported a delay in cancer screening. In general, the proportions of delays among those with adequate and limited health literacy were similar with the exception of colorectal cancer screening. There was also a notable difference in the ability to re-engage in cervical cancer screening among those with adequate and limited health literacy. Thus, there is a role for those engaged in cancer-related education and outreach to offer additional navigation resources for those at risk to cancer-related care and screening disruptions. Future study is warranted to investigate the role of health literacy on cancer care engagement.

Abstract A017: Identifying priority neighborhoods for mobile cancer screening using georeferenced data

Abstract Background: Mobile screening units (MSUs) are an evidence-based approach known to reduce barriers and increase access to preventive services such as cancer screening. Less is known about how to plan and prioritize where MSUs are deployed to maximize impact and reduce the burden of disease. We used a geographic-based approach to create an index to identify which census tracts were of greatest priority for cancer screening, thereby creating a priority scoring metric for deploying the MSU across our 7-county cancer center catchment area. Methods: We assessed publicly available data reported at the census tract level for cancer relevance, choosing those data that were most likely to be associated with disparities in cancer screening or outcomes. This included data from the Social Vulnerability Index (socioeconomic status, percent of residents without health insurance, percent of residents reporting minority race or ethnicity, percent renting their housing, and percent with no transportation) as well as data from the Centers for Disease Control and Prevention (CDC) Places on the percent screened for breast cancer, cervical cancer, and colon cancer. Data was transformed from CDC Places to be percentage in need of breast cancer, cervical cancer, and colon screening rather than percentage screened. To construct the index, each of the variables was ranked from highest to lowest across all census tracts in Pennsylvania and New Jersey with a non-zero population (n=1,184). A percentile rank was then calculated for each census tract over each of these variables. Finally, an overall percentile rank for each tract was calculated. Index scores could range from 0.000000 (low priority for cancer screening) to 1.000000 (high priority for cancer screening). Results: There are 1,184 census tracts within our cancer center catchment area. Gloucester County NJ has the fewest census tracts (n=63) while Philadelphia County PA has the most census tracts (n=384). The mean index score across all census tracts was 0.400593 (SD = .198556) with a range of 0.000000 to 0.938343. Philadelphia County had the highest mean index score (0.400953) while Bucks County PA had the lowest mean index score (0.281576). In Philadelphia County, 76% of census tracts are above the mean index score, indicating high need for cancer screening, while in Bucks County, only 22% of census tracts are above the mean index score. A catchment area map by census tract visualizes the index score across the counties. Conclusion: A cancer screening index for census tracts in a cancer center catchment area can be used to prioritize resources such as a MSU in an evidenced-based manner. Next steps involve validating the index score against cancer disparities data in our catchment area and creating disease specific index scores to use with cancer specific screening initiatives. Citation Format: Krista Mar, Yawei Song, Khaldoun Hamade, Maria Katerina Alfaro, Alex Wrem, Christopher McNair, Amy Leader. Identifying priority neighborhoods for mobile cancer screening using georeferenced data [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A017.

Risk of second primary malignancies among patients with nasopharyngeal cancer in the United States: A population-based study.

e18056 Background: Nasopharyngeal cancers (NPCs) have an estimated incidence of 0.5 to 2 cases per 100,000 in the United States. Treatment of NPC with combination chemoradiotherapy has resulted in an 18% increase in 5-year overall survival in the US. It is essential to focus on the developments of second primary malignancies (SPMs) with improved survival. We aim to analyze the risk of SPMs among NPC survivors in this study. Methods: We estimated the incidence of SPMs among two-month survivors of NPC using the Surveillance, Epidemiology, and End Results (SEER)-18 registries between 2006 to 2018. The risk of SPMs was calculated using standardized incidence ratios (SIRs). Results: We included 7,560 patients with NPC in this study. The median age of diagnosis was 56 yrs (range 0 to 85 yrs). The median follow-up duration was 33 months (range 0 to 155 months). The median time for SPM development from initial diagnosis was 41 months (range 2 to 140 months). A total of 367 (5%) patients developed 398 SPMs at the last follow-up, of which 89% were solid organ malignancies, and 11% were hematologic neoplasms. The SPM risk for cohort was significantly elevated (SIR = 1.88, 95% confidence interval [CI] = 1.7 to 2.07) compared with the general population. The SIR was slightly higher in males (SIR = 1.90, 95% CI = 1.69 to 2.13) compared to females (SIR = 1.81, 95% CI = 1.48 to 2.20). The SIR according to age groups were as follows: age < 65 years (SIR = 2.03, 95% CI = 1.79 to 2.29), age > 65 years (SIR = 1.65, 95% CI = 1.38 to 1.94). Sites with highest risk included the nose, nasal cavity, and middle ear (SIR = 22.98, 95% CI = 9.92 to 45.27), nasopharynx (SIR = 17.28, 95% CI = 8.93 to 30.19), oral cavity and pharynx (SIR = 10.07, 95% CI = 7.81 to 12.79), esophagus (SIR = 3.97, 95% CI = 1.9 to 7.29), lung and bronchus (SIR = 3.53, 95% CI = 2.86 to 4.32), and liver (SIR = 3.05, 95% CI = 1.86 to 4.71) (Table). The risk of malignancies of the esophagus and lung were higher within the first year of diagnosis of NPC. The risk of malignancies of the nasopharynx, oral and nasal cavity, and liver was higher after one year of latency and remained statistically significantly elevated throughout the follow-up period. Conclusions: Our study reveals that patients with NPC are at higher risk of SPMs than the general population, most notably in the oral and nasal cavity, nasopharynx, esophagus, and lungs. These patients may benefit from cancer-specific screening during follow-up.[Table: see text]

Advancements in the identification of EV derived mRNA biomarkers for liquid biopsy of clear cell renal cell carcinomas

ObjectiveTo propose EV-derived mRNA as a potential diagnostic biomarker detecting the presence of clear cell renal cell carcinoma (ccRCC). There is currently no kidney cancer specific screening or diagnostic technology. Therefore, one-third of kidney cancer diagnoses occur after the cancer has metastasized and is past curative measures Materials and MethodsUrine, plasma, normal tumor adjacent tissue, and tumor tissue was collected from a limited population of ccRCC patients. Extracellular vesicle (EV) isolation was performed on each sample, followed by mRNA extraction from isolated EVs. NanoString nCounter technology was utilized to count the mRNA transcripts present in matched plasma, urine, tumor tissue, and normal tumor adjacent tissue samples. Results770 mRNA transcripts related to gene's affecting cancer's progression and metastasis processes were evaluated. Four EV derived mRNA transcripts (ALOX5, RBL2, VEGFA, TLK2) were found specific to urine and tumor tissue samples. ConclusionFour candidate RCC-specific urine EV biomarkers were identified. However, due to the lack of a true negative control and urine collection techniques, further re-examination is necessary for validation. This study demonstrates the promise of defining disease-specific EV biomarkers in liquid biopsy patient samples.

Public attitudes towards screening for kidney cancer: an online survey

BackgroundKidney cancer is often asymptomatic, leading to proposals for a screening programme. The views of the public towards introducing a new screening programme for kidney cancer are unknown. The aim of this study was to explore attitudes towards kidney cancer screening and factors influencing intention to attend a future screening programme.MethodsWe conducted an online population-based survey of 1021 adults aged 45–77 years. The main outcome measure was intention to attend four possible screening tests (urine, blood, ultrasound scan, low-dose CT) as well as extended low-dose CT scans within lung cancer screening programmes. We used multivariable regression to examine the association between intention and each screening test.ResultsMost participants stated that they would be ‘very likely’ or ‘likely’ to undergo each of the screening tests [urine test: n = 961 (94.1%); blood test: n = 922 (90.3%); ultrasound: n = 914 (89.5%); low-dose CT: n = 804 (78.8%); lung CT: n = 962 (95.2%)]. Greater intention to attend was associated with higher general cancer worry and less perceived burden/inconvenience about the screening tests. Less worry about the screening test was also associated with higher intention to attend, but only in those with low general cancer worry (cancer worry scale ≤ 5). Compared with intention to take up screening with a urine test, participants were half as likely to report that they intended to undergo blood [OR 0.56 (0.43–0.73)] or ultrasound [OR 0.50 (0.38–0.67)] testing, and half as likely again to report that they intended to take part in a screening programme featuring a low dose CT scan for kidney cancer screening alone [OR 0.19 (0.14–0.27)].ConclusionParticipants in this study expressed high levels of intention to accept an invitation to screening for kidney cancer, both within a kidney cancer specific screening programme and in conjunction with lung cancer screening. The choice of screening test is likely to influence uptake. Together these findings support on-going research into kidney cancer screening tests and the potential for combining kidney cancer screening with existing or new screening programmes.

Abstract B044: Assessing knowledge and perceptions about cancer among American Indians of Zuni Pueblo, New Mexico

Abstract New Mexico is one of the most geographically and culturally diverse states and faces serious cancer health disparities among its poor, rural, and ethnically diverse populations of American Indians (AIs). They have lower cancer screening rates compared to other populations and are more likely to be diagnosed with a later stage of cancer but less likely to receive treatment (Li et al, 2003). In turn, AIs have the lowest five-year cancer survival rates compared to any ethnic/racial group in the US (Clegg, 2002; Edwards, 2005). Numerous barriers such as cultural beliefs in health and health care, fear, fatalism, mistrust, stigma and lack of culturally appropriate interventions contribute to low cancer screening rates and low cancer survivorship (Daley et al, 2012; Filippi et al, 2013; James et al, 2013). Zuni Health Initiative conducted a community-based participatory research project in collaborations with community stakeholders from the Zuni Pueblo to assess knowledge and perceptions about common cancers among Zuni adults. We used trained Community Health Representatives (CHRs) from Zuni along with Zuni undergraduate students who led six one-hour focus group sessions using structured questionnaire with probes designed to illicit information on knowledge and perceptions about cancer among Zuni adults. The focus groups were conducted among 51 participants from different age groups (20-29 yrs, n=19; 30-49 yrs, n=17; and 50 yrs and older, n=15) stratified by gender. Focus groups were conducted in English and Shiwi language and were audio recorded, with the Zuni students maintaining extensive notes on the focus group discussions. The Zuni CHRs transcribed the audio recordings, and developed a codebook based on the transcriptions and notes for the qualitative data analysis. Overall, the responses given by participants fell into three distinct categories including, (1) a general lack of knowledge, (2) the perception that the disease is uncontrollable in nature, and (3) general negative connotations. Although some participants acknowledged that cancer could come in many forms, there were many participants who were uncertain about the different factors that contribute to the disease, as well as specific outcomes associated with the disease. Many participants mentioned cancer being uncontrollable in nature, that cancer always comes back, and expressed that death is the inevitable outcome. Finally, several participants displayed general uncertainty and discomfort when discussing cancer. There was negative connotations when participants heard the word “cancer”, as well as construed negative implications about discussing personal experiences with cancer. Findings from this formative study provides evidence that can guide the development and testing of interventions aimed at enhancing knowledge about cancer and cancer-specific screening practices. Citation Format: Safia Safi, Donica Ghahate, Jeanette Bobelu, Angela Wandinger-Ness, Thomas Faber, Shiraz Mishra, Cheryl Willman, Vallabh (Raj) Shah. Assessing knowledge and perceptions about cancer among American Indians of Zuni Pueblo, New Mexico [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B044.

Supportive Care Needs of Patients with Head and Neck Cancer Referred to Palliative Medicine.

Patients with head and neck cancer (HNC) face a unique set of unmet needs. A subset of these patients experience symptom control challenges related to their disease burden and treatments. A multidisciplinary approach involving palliative medicine is underutilized but crucial to identify and address these concerns. There is limited information on palliative integration with head and neck oncology. Case series with planned data collection. Academic quaternary care center. We provide descriptive analyses of patients with HNC, including psychodiagnostic assessment and validated quality-of-life screening, from patients' first encounter at outpatient palliative medicine. HNC (N = 80) contributed the greatest number of palliative referrals (25%) between 2010 and 2012. This cohort was 74% male and 79% Caucasian with a mean age of 53 years (95% CI, 51.1-54.9) and with stage IV disease of the oral cavity (28%) or oropharynx (31%). Sixty-three percent of patients had no evidence of disease. Seventy-five percent had a psychological history based on DSM-IV criteria (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition), and 70% had a history of substance use disorder. The most distressing quality-of-life concerns were pain, housing and financial problems, and xerostomia. Patients with HNC who were referred to palliative medicine are burdened by multiple physical, psychological, substance use, and social challenges. We recommend comprehensive cancer-specific screening, such as the James Supportive Care Screening, to triage patients to appropriate supportive care services. Palliative care is one of many services that these patients may need, and it should be utilized at any point of the disease trajectory rather than reserved for end-of-life care.

Cancer risk among patients with type 2 diabetes: A real-world study in Shanghai, China.

The aim of this study was to investigate the risk of 23 common types of cancer among patients with type 2 diabetes (T2D) compared with the general Chinese population. Based on the Shanghai Hospital Link database, 410 191 patients with T2D (age 20-99 years) were identified from July 2013 to December 2016, and were followed-up for cancer incidence until December 2017. In all, 8485 cases of newly diagnosed cancer were identified. The standardized incidence ratios (SIRs) of total cancer were 1.34 and 1.62 among males and females, respectively. Among males with T2D, the risk of cancer of the prostate (highest SIR of 1.86), blood (leukemia, lymphoma), skin, thyroid, kidney, liver, pancreas, lung, colorectum, and stomach was increased significantly. There was a significant decrease in the risk of esophageal cancer. In females with T2D, there were significantly greater risks of cancer of the nasopharynx (highest SIR of 2.33), liver, esophagus, thyroid, lung, pancreas, blood (lymphoma, leukemia), uterus, colorectum, breast, cervix, and stomach. In contrast, there was significantly decrease risk of gallbladder cancer in females with T2D. This study shows significantly increased risks of overall and some site-specific cancers among patients with T2D. We suggest that establishing strategies for regular cancer-specific screening and prevention care among patients with T2D are necessary.

Cardiovascular Disease Screening Among Immigrants from Eight World Regions.

Inequalities between native-born and foreign-born individuals in screening rates for a variety of conditions have been well-documented in literature on immigrant health. A preponderance of this research focuses on the Latin American case and on cancer-specific screening. This study seeks to expand knowledge of such preventative-health screening differences by analyzing screening rates for blood sugar, blood pressure, and serum cholesterol among nine groups overall and (for immigrants) at various stages of US residency. Using nationally representative data from the National Health Interview Survey, we find that immigrants from eight geographic regions receive preventative care at lower rates than US-born Whites and that preventative screening is generally higher after 15years than during the first 4years of residency in the United States. Importantly, our data also show that screening patterns and trends vary based on region of origin and outcome. These findings improve our understanding of immigrant health and healthcare use in the United States.

Risk Scores for Occult Cancer in Patients with Venous Thromboembolism: A Post Hoc Analysis of the Hokusai-VTE Study.

Venous thromboembolism (VTE) may be the first sign of an undiagnosed cancer. In patients with unprovoked VTE, the risk is approximately 5% in the year following VTE diagnosis. Cancer-specific screening is therefore often considered in these patients, but the optimal screening strategy remains controversial. Recently, two risk classification scores have been proposed that may help in identifying patients at high risk of occult cancer in whom extensive screening may be warranted. In the present post hoc analysis of the Hokusai-VTE study, we evaluated the performance of the Registro Informatizado de Pacientes con Enfermedad TromboEmbólica (RIETE) and Screening for Occult Malignancy in Patients with Idiopathic Venous Thromboembolism (SOME) scores for occult cancer in patients with acute VTE. A total of 8,032 patients were included in the analysis of whom 218 (2.7%; 95% confidence interval [CI], 2.4-3.1) developed cancer between 30-day and 12-month follow-up. The c-statistics of the RIETE and SOME scores were 0.62 (95% CI, 0.57-0.66) and 0.59 (95% CI, 0.55-0.62), respectively. In patients classified as 'high risk', the cumulative incidence of cancer diagnosis during follow-up was 2.9% (95% CI, 2.1-3.9) for the RIETE score and 2.7% (95% CI, 1.9-3.7) for the SOME score, corresponding to hazard ratios of 1.8 (95% CI, 1.3-2.5) and 1.5 (95% CI, 1.04-2.2), respectively. In conclusion, the performance of both scores was poor. When used dichotomously, the scores were able to identify a group of patients with a significantly higher risk of occult cancer, although it remains unknown whether this translates into improved clinical important outcomes.

Exploring factors that might influence primary-care provider discussion of and recommendation for prostate and colon cancer screening.

BackgroundPrimary-care providers may contribute to the use of low-value cancer screening.ObjectiveWe sought to examine circumstances under which primary-care providers would discuss and recommend two types of cancer screening services across a spectrum of net benefit and other factors known to influence screening.Patients and methodsThis was a cross sectional survey of 126 primary-care providers in 24 primary-care clinics in the US. Participants completed surveys with two hypothetical screening scenarios for prostate or colorectal cancer (CRC). Patients in the scenarios varied by age and screening-request status. For each scenario, providers indicated whether they would discuss and recommend screening. Providers also reported on their screening attitudes and the influence of other factors known to affect screening (short patient visits, worry about lawsuits, clinical reminders/performance measures, and screening guidelines). We examined associations between providers’ attitudes and their screening recommendations for hypothetical 90-year-olds (the lowest-value screening).ResultsProviders reported they would discuss cancer screening more often than they would recommend it (P<0.001). More providers would discuss and recommend screening for CRC than prostate cancer (P<0.001), for younger than older patients (P<0.001), and when the patient requested it than when not (P<0.001). For a 90-year-old patient, every point increase in cancer-specific screening attitude increased the likelihood of a screening recommendation (30% for prostate cancer and 30% for CRC).DiscussionWhile most providers’ reported practice patterns aligned with net benefit, some providers would discuss and recommend low-value cancer screening, particularly when faced with a patient request.ConclusionMore work appears to be needed to help providers to discuss and recommend screening that aligns with value.

Risk scores for occult cancer in patients with venous thromboembolism: a post-hoc analysis of the Hokusai-VTE study

Introduction: Venous thromboembolism (VTE) may be the first sign of an undiagnosed cancer. In patients with unprovoked VTE, the risk of occult cancer detection is about 5% in the year following VTE diagnosis. Cancer-specific screening is therefore often considered in these patients with the aim to detect cancers in an early, potentially curable stage. However, the optimal screening strategy remains controversial. Recently, two risk classification scores have been proposed to help clinicians identify patients at high risk of occult cancer in whom a more extensive screening approach may be warranted.

Abstract P4-06-18: Clinical application of multigene panel testing and genetic counseling for hereditary/familial breast cancer risk assessment: Prospective single center study

Abstract Background The identification of individuals at elevated risk for hereditary cancers has allowed the development of consensus recommendations for cancer screening and prevention. The introduction of multigene panels may identify more individuals with breast cancer gene mutations than does testing for BRCA1/2 alone. Therefore, the multigenerational panel increase the need for genetic counseling suggesting preventive approach or cancer-specific screening to patients and family members. The rapid clinical introduction of multigene panel testing, however, have several issues such as low- to moderate-risk gene mutations and clinical recommendations. We collect the mutation results and clinical recommendations after testing with multigene panel and giving genetic counseling. Methods We had developed multigene panel consisted of 64 genes related to hereditary cancer through previous study and prospectively enrolled 104 individuals who were appropriate candidates for hereditary breast cancer evaluation. The patients were tested with 64-gene panel(Celemics) and results were provided by us 4˜10 weeks later. We checked the family history of cancer and made a pedigree before testing. Result Among 104 participants, 26 patients harbored deleterious mutations, most commonly in high to moderate-risk breast/ovarian cancer genes (BRCA1/2, BRIP, RAD51 and RAD51D), Lynch syndrome gene(MSH6) and other genes(FH, SPINK1). We recommended the cancer-specific screening and/or preventive approach for mutation-positive patients and suggested additional genetic test for the family members. Among them, 6 (23%) patients received Risk reducing procedures (Prophylactic mastectomy or oophorectomy) and most of them(19 patients(73%)) received cancer specific screening. Conclusion We demonstrate the use of multigene panel testing for hereditary breast cancer and will suggest the process of the genetic counseling including indication and results analysis with multigene panel testing. Citation Format: Lee E-S, Han W, Kim Y, Rhu J, Park JH, Kim K-E, Ju YW, Kim R, Lee H-B, Moon H-G, Noh D-Y. Clinical application of multigene panel testing and genetic counseling for hereditary/familial breast cancer risk assessment: Prospective single center study [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-06-18.

Abstract 5293: Have you checked? Disparities in cancer screening practices among minority populations

Abstract Objective: There is a disproportionately higher burden of cancer among racial and ethnic minorities, with the incidence only expected to increase significantly by 2050. These racial differences may be due to the quality of early detection screening among this population. The purpose of this research is to provide case study reports about cancer screening practices among at-risk populations as well as those from underrepresented racial and ethnic minority backgrounds as well as sexual and gender minorities in order to describe disparities in cancer screening practices. These five case studies reveal how racial disparities vary by cancer site. These case studies will share information about current cancer prevalence, current recommendations for cancer prevention, national guidelines about early detection for lung, colorectal, prostate, cervical and breast cancers, as well as discuss ways to reduce cancer health disparities and improve screening practices. Methods: Data sources for these case studies include research reports, literature review, clinically-based articles, research articles, websites, as well as clinical practice observations and experiences. Research Summary: These case studies contribute to the growing body of knowledge related to cancer health disparities, with a special emphasis on cancer screening behaviors among underrepresented, at-risk, and racial and ethnic minority backgrounds. Since cancer care is multidisciplinary, these case reports also highlight the role of oncology nurses in helping to lead in educating, promoting, and bringing awareness to cancer screening recommendations and current cancer prevention guidelines for individuals and their families. Nurses recognize that one of the biggest barriers to screening is when individual have unrelated health care priorities that overshadow priorities related to screening, such as food, shelter, and safety. Nurses are also positioned to provide cancer-specific screening guidelines and resources to help individuals implement these recommendations into their daily lives. Improving screening rates among minority populations requires collaborations with the health care systems and the community. Conclusion: Evidence indicates that there are significant disparities that exist in cancer screening practices among minority populations as well as disproportionately higher cancer mortality rates in these populations. Barriers to screening include lack of access to high-quality health care, lack of health insurance, transportation issues, fear and lack of trust in the health care team, embarrassment, stigma related to sexual orientation or gender identity, discrimination in quality care and treatment, as well as lack of awareness about screening recommendations. Recognition of barriers to screening among minority populations is critical to developing targeted interventions that promote adherence and decrease risks of cancer-related mortality. Citation Format: Tamryn F. Gray, Joycelyn Cudjoe, Hae Ra Han, Jennifer Wenzel, Roland Thorpe, Jeanne Murphy. Have you checked? Disparities in cancer screening practices among minority populations [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 5293. doi:10.1158/1538-7445.AM2017-5293

Locally advanced gastric cancer: a new definition to standardise

Gastric carcinoma is the fourth most common cancer (988 000 cases in 2008) and the second leading cause of cancer death in both sexes worldwide (736 000 deaths in 2008).1...

Development of the Psychosocial Distress Questionnaire—Breast Cancer (PDQ-BC): a breast cancer-specific screening instrument for psychosocial problems

PurposeThe aim of the present study was to develop a short, easy-to-use, and acceptable psychosocial screening instrument specific for breast cancer patients.MethodsBefore the start of adjuvant chemotherapy, 164 (98.8%) women completed the Psychosocial Distress Questionnaire-Breast Cancer (PDQ-BC) as part of routine care. The PDQ-BC consists of questions about psychological risk factors (i.e., trait anxiety and (lack of) social support), psychosocial problems (i.e., state anxiety and depressive symptoms), social problems, physical problems, body image, financial problems, sexual problems, clinical factors (type of surgery, adjuvant treatment other than chemotherapy and psychiatric morbidity), and demographic factors (marital status, age, and age of children).ResultsOn average, patients indicated that they needed 5 min to complete the PDQ-BC. All subscales were significantly correlated with each other, except the correlations of social support with physical problems and body image. Confirmatory factor analysis supported the internal structure of the PDQ-BC (comparative fit index = 0.95 (χ 2(24) = 43.3), p = 0.009; non-normed fit index = 0.91; root mean square error of approximation = 0.073). The internal consistency (Cronbach’s alphas) of the subscales trait anxiety, state anxiety, depressive symptoms, body image, social problems, and physical problems were 0.88, 0.85, 0.86, 0.79, 0.42, and 0.69, respectively.ConclusionThe PDQ-BC is an easy-to-complete, acceptable, non-burdensome, and short screening instrument for routine use in breast cancer patient care. This instrument facilitates a greater awareness of the concerns and needs for breast cancer patients care during treatment with chemotherapy and the follow-up. It is linked to a good referral system to guide allocation to the different levels of psychosocial care providers.

Effect of immunodeficiency, HIV viral load, and antiretroviral therapy on the risk of individual malignancies (FHDH-ANRS CO4): a prospective cohort study

The relative roles of immunodeficiency, HIV viral load, and combination antiretroviral therapy (cART) in the onset of individual cancers have rarely been examined. We examined the effect of these factors on the risk of specific cancers in patients infected with HIV-1. We investigated the incidence of both AIDS-defining cancers (Kaposi's sarcoma, non-Hodgkin lymphoma, and cervical cancer) and non-AIDS-defining cancers (Hodgkin's lymphoma, lung cancer, liver cancer, and anal cancer) in 52 278 patients followed up in the French Hospital Database on HIV cohort during 1998-2006 (median follow-up 4.9 years, IQR 2.1-7.9; 255 353 person-years). We tested 78 models with different classifications of immunodeficiency, viral load, and cART with Poisson regression. Current CD4 cell count was the most predictive risk factor for all malignancies apart from anal cancer. Compared with patients with CD4 count greater than 500 cells per microL, rate ratios (RR) ranged from 1.9 (95% CI 1.3-2.7) for CD4 counts 350-499 cells per microL to 25.2 (17.1-37.0) for counts less than 50 cells per microL for Kaposi's sarcoma (p<0.0001), from 1.3 (0.9-2.0) to 14.8 (9.7-22.6) for non-Hodgkin lymphoma (p<0.0001), from 1.2 (0.7-2.2) to 5.4 (2.4-12.1) for Hodgkin's lymphoma (p<0.0001), from 2.2 (1.3-3.6) to 8.5 (4.3-16.7) for lung cancer (p<0.0001), and from 2.0 (0.9-4.5) to 7.6 (2.7-20.8) for liver cancer (p<0.0001). For cervical cancer, we noted a strong effect of current CD4 (RR 0.7 per log(2), 95% CI 0.6-0.8; p=0.0002). The risk of Kaposi's sarcoma and non-Hodgkin lymphoma increased for current plasma HIV RNA greater than 100 000 copies per mL compared with patients with controlled viral load (RR 3.1, 95% CI 2.3-4.2, p<0.0001; and 2.9, 2.1-3.9, p<0.0001, respectively), whereas cART was independently associated with a decreased incidence (0.3, 0.2-0.4, p<0.0001; and 0.8, 0.6-1.0, p=0.07, respectively). The RR of cervical cancer for those receiving cART was 0.5 (0.3-0.9; p=0.03). The risk of anal cancer increased with the time during which the CD4 count was less than 200 cells per microL (1.3 per year, 1.2-1.5; p=0.0001), and viral load was greater than 100 000 copies per mL (1.2 per year, 1.1-1.4, p=0.005). cART would be most beneficial if it restores or maintains CD4 count above 500 cells per microL, thereby indicating an earlier diagnosis of HIV infection and an earlier treatment initiation. Cancer-specific screening programmes need to be assessed in patients with HIV. Agence Nationale de Recherches sur le SIDA et les hépatites (ANRS), INSERM, and the French Ministry of Health.

The Psychosocial Screen for Cancer (PSSCAN): Further validation and normative data

BackgroundWe have previously reported on the development of a cancer-specific screening instrument for anxiety and depression (PSSCAN). No information on cut-off scores or their meaning for diagnosis was available when PSSCAN was first described. Needed were additional analyses to recommend empirically justified cut-off scores as well as data norms for healthy adult samples so as to lend meaning to the recommended cut-off scores.MethodsWe computed sensitivity/specificity indices based on a sample of 101 cancer patients who had provided PSSCAN data on anxiety and depression and who had completed another standardized instrument with strong psychometrics. Next, we compared mean scores for four samples with known differences in health status, a healthy community sample (n = 561), a sample of patients with a representative mix of cancer subtypes (n = 570), a more severely ill sample of in-patients with cancer (n = 78), and a community sample with a chronic illness other than cancer (n = 85).ResultsSensitivity/specificity analyses revealed that an excellent balance of sensitivity/specificity was achievable with 92%/98% respectively for clinical anxiety and 100% and 86% respectively for clinical depression. Newly diagnosed patients with cancer were no more anxious than healthy community controls but showed elevations in depression scores. Both, patients with chronic illness other than cancer and those with longer-standing cancer diagnoses revealed greater levels of distress than newly diagnosed cancer patients or healthy adult controls.ConclusionThese additional data on criterion validity and community versus patient norms for PSSCAN serve to enhance its utility for clinical practice.