Comprehensive Community Cancer Program Research Articles

Abstract PO3-02-06: Predictive Factors for adjuvant radiation use in patients >70 years with pT1N0 HR+ breast cancers

Abstract Introduction: In 2004 the CALGB 9343 study reported that women >70 years of age with pT1NO hormone receptor positive breast cancer received no meaningful benefit from breast irradiation following lumpectomy. Although there was a modest reduction in local recurrence, there was no improvement in rates of mastectomy for local recurrence, distant metastases, 5-year overall survival (OS) and breast cancer specific survival therefore concluding that it was reasonable to omit radiation therapy in this group. An update of the CALGB 9343 study in 2013 with 10-year follow-up came to the same conclusion. Previous analysis of the National Cancer Database (NCDB) and the SEER database showed, however, that the majority of women with these characteristics were still receiving radiation therapy. We conducted this retrospective analysis from NCDB to identify factors associated with the use of radiation in this population. Methods: We reviewed the NCDB database and collected records of all breast cancer patients aged >70 years, who had hormone positive (HR+), pT1N0 disease between the years of 2004-2019. They were separated into radiation and non-radiation cohorts and then stratified based on ethnicity, age groups, insurance status, income quartiles, education quartiles, areas of residence, tumor size, comorbidities, diagnosis to treatment time, treatment facility type and geographic location. We then compared mortality between the two cohorts and completed a multivariate analysis to determine the demographic and clinical factors associated with the likelihood of receiving radiation. SAS was used for analysis and p-value < 0.05 was deemed as statistically significant. Results: 147,611 patients met the criteria of age > 70, pT1N0, HR+ treated with surgical lumpectomy. The majority of them were white, aged 70-75y, had Medicare, were in higher education and income quartiles and lived in metro areas (Table 1). 57.9% of the total study population received radiation. The possibility of receiving radiation decreased as age increased beyond 75 years. Uninsured patients, Medicare patients, those with comorbities, higher educational status as well as those who lived 20+ miles away from their treatment facility and treated at urban centers in central or south Atlantic areas were less likely to receive radiation. Those treated at Comprehensive community cancer programs and middle Atlantic areas were more likely to receive radiation. The possibility of radiation also progressively increased with tumor size. However, there were no differences observed when stratified by race, income status or chemotherapy use (Table 2). We also noted a small overall survival advantage for the radiation cohort (HR 0.77, p-value < 0.0001) which could be explained by the fact that patients without comorbidities were more likely to receive radiation. Discussion: Our results provide a real-world estimate of radiation use in pT1N0 HR+ early-stage breast cancer in women > 70 years. The major predictors of radiation use included younger age, low co-morbidities, insurance and institutions providing care. Lack of awareness about recent updates or concern about local recurrence could be contributing to the continued use of radiation. Although there are minor differences when stratified by demographics, it is concerning that the overall trend of radiation use has not significantly decreased over time. Since there is currently no data to support the routine use of radiation in this patient group as evidenced by randomized controlled trials, it is prudent to avoid radiation. This approach would help reduce healthcare costs, patient inconvenience and associated morbidity. Table 1 Baseline characteristics Table 2 Factors affecting radiation use Citation Format: Suma Sri Chennapragada, Runhua Shi, Shivani Sharma, Gary Burton. Predictive Factors for adjuvant radiation use in patients >70 years with pT1N0 HR+ breast cancers [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-02-06.

Abstract 4863: A retrospective study characterizing 1714 cases of epithelioid cell melanoma

Abstract Introduction: Epithelioid cell melanoma (ECM) is a variant of cutaneous melanoma (CM) typically characterized by large malignant cells with abundant, glassy cytoplasm and large nuclei. ECMs are aggressive neoplasms and tend to have worse prognosis than other subtypes of CM with a higher risk of metastasis1. Few studies have explored the demographic features of ECM and their effects on outcomes. Using data from the National Cancer Database (NCDB), we hope to fill this gap. Methods: This is a retrospective study of patients diagnosed with ECM(ICD-8771) between 2004 and 2020 in the National Cancer Database (NCDB) describing demographic features associated with and tumor characteristics of ECM (N = 1714). Descriptive statistics were collected for all patients with ECM and CM (N = 827623) and were compared using Pearson Chi-Square test. Overall survival was determined by the Kaplan-Meier test. Cox regression analysis was used to determine which factors led to decreased survival in ECM. All statistical tests were evaluated for a significance of P < 0.05. Exclusion criteria included missing data. Results: The cases of ECM were composed mainly of White (96%) males (58.9%), and most had private insurance as the primary payor at diagnosis (50.1%). Greater than half of ECM cases had a primary site of skin on the trunk, upper limbs, or shoulders. Cox regression analysis revealed that patients with ECM treated at integrated network cancer programs had a HR of 0.46 when compared to community centers (95% CI 0.257 - 0.831, P < 0.05). Those with ECM treated at academic programs and comprehensive community cancer programs had hazard ratios of 0.41 (95% CI 0.239 - 0.701, P < 0.05) and 0.49 (95% CI 0.288 - 0.845, P < 0.05) respectively when compared to community programs. Only patients with ECM who had private insurance as primary payor at diagnosis had better outcomes when compared to non-insured with an HR of 0.40 (95% CI 0.225 - 0.714, P < 0.05). In addition, patients with ECM were more likely to be treated at academic centers than patients with CM (55.48% vs 46.95%, P < 0.05). The mean survival of patients with ECM was 12.3 months less than those with CM (141.1 months versus 153.4 months.) Conclusion: Overall survival for patients was better at academic centers, integrated network cancer programs, and comprehensive community cancer programs when compared to community centers. In addition, only patients who had private insurance were found to have better outcomes than those who were uninsured. These findings help shed light on the effects of certain socioeconomic and factors on outcomes in ECM. We hope this study will be a launching point for further inquiry into the causal relationships these factors have on outcomes in this rare cancer. 1. (Russo A, Avitabile T et al. Iris Melanoma: Management and Prognosis. Appl Sci 2020; 10: 8766). Citation Format: Mohammed Al Kurnas, Xinxin Wu, Anusha Mubin, Peter T. Silberstein. A retrospective study characterizing 1714 cases of epithelioid cell melanoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4863.

Abstract 999: Clinical trial matchmaking: Connecting sites to sponsors

Abstract Background: Oncology programs may encounter many challenges engaging in clinical trials. The Association of Community Cancer Center’s (ACCC) Community Oncology Research Institute (ACORI) conducted a survey to gather insights on barriers to clinical trial provision and implementation, patient recruitment, and identifying resources to support cancer programs. Methods: A survey of 29 questions was administered via Qualtrics. The survey focused on research-naïve sites (i.e., sites with little to no clinical research experience). Survey recipients were identified from ACCC’s membership database, and the survey was open from May 5 to October 10, 2023. One survey response was captured per program. Results: Of the 350 respondents, most were physicians, investigators, or oncology fellows (20%), directors/administrators (16%), patient navigators (12%), and APPs (12%). Responding programs were categorized as a comprehensive community cancer program (28%), community practice (26%), or academic medical center (21%). Eighty percent of respondents indicated their program currently conducts clinical research. The most common challenges included: patient recruitment (40%), limited staffing (36%), limited clinician time (32%), and lack of training in research administration and conduct (25%). The top 3 resources desired were communication about clinical research opportunities (65%), connections to clinical trial sponsors (49%), and clinical research coordinator training (41%). Conclusions: Survey results showed a clear need for improved communication regarding clinical research opportunities, connections to clinical trial sponsors, and education around clinical trial implementation. Data from this survey will be used to match sites with trial sponsors, especially sites that serve patients with cancer from under resourced geographic, socioeconomic, racial, and ethnic groups. Future efforts will seek to engage clinical trial sponsors in improving trial engagement and feasibility, workforce support, training, and clinical mentorship. Citation Format: Lyndsey Griffin, Latha Shivakumar, Leigh Boehmer, Savannah Dodson, Elana Plotkin, Sumanta Pal, Al B. Benson. Clinical trial matchmaking: Connecting sites to sponsors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 999.

Abstract 4813: Demographic, treatment, and survival patterns in Hispanic vs. non-Hispanic patients with lymphoplasmacytic lymphoma/Waldenstrom macroglobulinemia: A national retrospective analysis from the National Cancer Database

Abstract Background: Lymphoplasmacytic lymphoma (LPL) is a rare type of non-Hodgkin B cell lymphoma. Waldenstrom macroglobulinemia (WM) is a form of LPL that presents with overproduction of IgM monoclonal protein. The understanding and treatment of LPL/WM has improved. However, few studies analyze LPL/WM in Hispanic (HI) patients specifically. This study aims to evaluate demographics, treatment, and survival patterns in HI vs. Non-Hispanic (NH) patients with LPL/WM. Methods: Data were analyzed on LPL/WM patients in the US reported to the NCDB from 2004-2019. Demographic and treatment characteristics were compared between ethnic groups. Kaplan-Meier and Cox regression analyses were used to compare overall survival (OS) between HI and NH. Multivariate analysis and propensity score matching were performed with adjustment for age, stage, co-morbidity score, insurance status, type of facility and great circle distance (GCD). Results: 17,915 patients were identified. 92% were NH, 3% were HI. Most patients were male in both NH and HI (p = 0.120). The median age at diagnosis for HI was 68 vs. 71 for NH (p < 0.001). Most HI and NH were white (87% HI, 91% NH p < 0.001). More HI were uninsured (8% HI, 1% NH p < 0.001) and were less likely to have government sponsored insurance (60% HI, 66% NH p < 0.001). Regarding income, most NH (42%) were in the $63,000+ bracket while most HI were in the $48,000-$62,999 bracket. Regarding education, reported in percent quartiles with no high school degree, most HI (41%) were in the > 21% bracket while most NH (35%) were in the 7-12.9% bracket (p < 0.001). Most HI (43%) were treated at academic/research programs; most NH were treated at comprehensive community cancer programs (38.4%, p < 0.001). Regarding comorbidities score, 9% of HI scored ≥ 2 vs 8% of NH (p 0.029). Regarding GCD, the median distance in miles between the patient’s residence and the hospital that reported the case, HI lived at a median of 6.7 miles vs 9 miles for NH (p < 0.001). Regarding treatment, 68% of HI were given treatment vs. 62% of NH (p < 0.001). There was no difference in mortality between HI vs. NH (30 day mortality p = 0.322; 90 day mortality p = 0.217). On survival analysis, the survival probability at 2, 5 and 10 years of HI vs NH were 81% vs 83%, 69% vs 68%, and 52% vs 46%, respectively. The median survival time (MS) was 10.6 years for HI vs 9 years for NH. There was no OS difference between HI vs. NH (p = 0.47). On multivariate analysis, there were no independent variables associated with better or worse OS. The propensity matched analysis showed no MS difference between HI vs NH (8.96 y vs. 8.74 y). Conclusion: We identified ethnic differences in age, race, insurance, education, income, location of treatment, GCD, staging, and treatment patterns. However, there was no statistically significant ethnic difference in MS or OS. Citation Format: Maria Elena Fierro, Heidi Latiolais, Qianquian Liu, Joel Michalek, Adolfo Enrique Diaz Duque. Demographic, treatment, and survival patterns in Hispanic vs. non-Hispanic patients with lymphoplasmacytic lymphoma/Waldenstrom macroglobulinemia: A national retrospective analysis from the National Cancer Database [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 4813.

Abstract 6468: Nodular lymphocyte predominant hodgkin lymphoma: A national cancer database analysis with focus on hispanics

Abstract Background:Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare and distinct subtype of Hodgkin Lymphoma.(PMID 26149294) 80% manifest at early stages, with a male and black race predilection.(PMID 26149195) Previous analysis have shown similar survival of Hispanics (HI) compared to Non-Hispanics (NH).(J Clin Oncol 10.1200/JCO.2023.41.16_suppl.e19512) This National Cancer Database (NCDB) analysis aims to clarify how sociodemographic factors affect presentation and survival in HI vs NH patients with NLPHL. Methods:Data were analyzed on NLPHL patients in the United States reported to the NCDB 2004-2019. Demographic and treatment characteristics were compared between ethnic groups. Kaplan-Meier and Cox regression analyses were used to compare overall survival (OS) between HI and NH populations. Multivariate analysis and propensity score matching was performed. Results:Of 5517 of NLPHL patients, 379 were HI, and 4904 NH. Male gender and white race predominated for both. HI were diagnosed at a younger median age of 44 years (y) vs 48 y for NH, p=0.001. Most patients were diagnosed between years 2016-2019. Stage I predominated for both, p<0.001. As to Charlson-Deyo score ≥2, both HI and NH had 4%. Private insurance as primary payer was the most prevalent type for HI (53%) and NH (65%). HI had a higher percentage of unknown/uninsured, 12% vs 6% for NH, p<0.001. In relation to census median income (2008-2012), the most prevalent bracket for HI (27%) was $48,000-$62,000, and for NH (35%) was >$63,000. Regarding median income of <$38,000, HI were 29% vs 16% for NH, p<0.001. For median distance in miles (mi) between the patient’s residence and the hospital that reported the case (great circle distance), HI lived at a median of 6.3mi, vs NH at median of 9.5mi. Majority of HI (56%) were treated at Academic/Research programs; while most of NH (39%) were treated at Comprehensive Community Cancer programs, p<0.001. On survival analysis, the survival probability at 2, 5 and 10 y for HI was 96%, 92%, 86%, vs for NH was 96%, 92%, 84%, respectively. The median survival time wasn’t reached for both HI and NH, and no statically significant difference was seen, p=0.57. On multivariate analysis, HI was not associated with worse OS (HR 0.76, CI 0.44-1.31, p=0,33). The propensity matched analysis confirmed not reached OS on both cohorts. Conclusion:NLPHL is a disease that affects young males, at early stages, for both HI and NH. Unlike previous studies, in this analysis white race predominates; which could be explained by the increase in reported cases over years. Despite HI having more uninsured population with lower median income quartiles, this wasn’t a barrier to access care at academic/research programs. Although no difference in OS was seen among ethnicities, there is a tendency that might favor HI. More studies are needed to determine if specific demographic factors truly influence survival in NLPHL. Citation Format: Esteban Toro Velez, Daniel Rosas, Carolina Velez-Mejia, Qianqian Liu, Joel Michalek, Adolfo Enrique Diaz Duque. Nodular lymphocyte predominant hodgkin lymphoma: A national cancer database analysis with focus on hispanics [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 6468.

Trends in utilization of MSI testing and reporting among patients with gastrointestinal cancers: A review of NCDB Database.

221 Background: MSI-H tumors have a different disease biology and clinical outcomes compared to MSS/MSI-low tumors. The frequency and pattern for MSI testing and reporting is unknown. The aim of this study was to characterize the trends of MSI testing and reporting among GI cancers. Methods: From the National Cancer Database, we identified all GI cancer patients from 2010 to 2016 to determine the number of patients where MSS/MSI low or MSI-H data were available. We describe the basic tumor and disease characteristics and treatment utilization for the two groups. Results: Between 2010-2016, MSI testing was done in 140,602 patients in colon, small intestine and rectal cancers among all GI cancers. MSI testing increased significantly during this study period (11,400 in 2010; 15,021 in 2011; 17,968 in 2012; 20,810 in 2013; 21,973 in 2014; 25,012 in 2015; 28,418 in 2016). We identified a total of 120,349 patients with MSI status reported, among these three tumor types, most commonly among colon followed by rectal and then small intestinal cancers. Overall 111,694 (92.8%) were MSS/MSI-low and 8,655 were MSI-H (7.2%). Among patients with reported MSI status, 52.1% were males and 47.9% were females. The mean age was 64.4 years. Most patients were whites (87.6%) and had insurance (96.8%), no existing comorbidities (70.4%), and grade 2 (70.8%) and AJCC Clinical Stage 4 (26.1%) GI cancer. A higher proportion of GI cancer patients with MSS/MSI-low utilized chemotherapy as first course compared to those with MSI high (48.2% vs 34.0%) whereas a lower proportion of GI cancer patients with MSS/MSI-low underwent a surgical procedure compared to those with MSI high (94.7% vs 97.1%). MSI status was reported most frequently in comprehensive community cancer program (40.3%) and academic center (34.8%), followed by integrated network cancer program (16.8%) and Community Cancer program (8.1%). Conclusions: The utilization of MSI testing has increased significantly between 2010 and 2016. Among all GI cancer patients, MSI status was most frequently reported in colon, rectum and small intestinal cancers. Comprehensive community cancer centers and academic centers reported MSI status more frequently than Integrated Network Cancer program and Community Cancer program.

Abstract B048: Disparities in treatment course and outcomes in females diagnosed with non-metastatic inflammatory breast cancer

Abstract Background: Inflammatory breast cancer (IBC) is an uncommon, aggressive disease with a poor prognosis. National treatment guidelines recommend neoadjuvant chemotherapy followed by modified radical mastectomy (MRM) and radiation. Disparities in treatment may contribute to survival differences, and few studies have assessed factors contributing to such variation. We aimed to identify demographic and facility differences in treatment and survival among females with non-metastatic IBC. Methods: Secondary analysis of the National Cancer Database (2012-2016) on females diagnosed with non-metastatic IBC was performed. Demographics, treatment, and facility data were collected. Statistical analysis was performed with SAS. Results: A total of 5,438 patients met the inclusion criteria. Receiving surgical intervention was associated with age (p<0.0001), race (p<0.0001), and facility (p=0.03), with increased odds of surgery for younger, white, and comprehensive community cancer program patients. Receiving radiation therapy was associated with age (p <0.0001) and race (p<0.0001), with decreased odds of radiation for older, Black, and Hispanic patients. Receiving chemotherapy was associated with age (p <0.0001), with increased odds of chemotherapy for younger patients. Days from diagnosis to treatment initiation was associated with race (p<0.0001) and facility (p=0.0089), with increased time for Black, Hispanic, and academic facility patients. Survival time was associated with age (p<0.0001), race (p<0.0001), facility (p=0.0002), Charlson-Deyo (CD) score (p<0.0001), and surgery (p<0.0001), with decreased survival for older, Black, non-academic facility, higher CD score, and non-surgery patients. Conclusions: Treatment trends and survival of IBC patients are impacted by sociodemographic and facility-level variation, which, when addressed, may help to improve patient outcomes. Citation Format: Kirsten Lung, Young Sheng, Brandon George, Alliric Willis, Melissa Lazar. Disparities in treatment course and outcomes in females diagnosed with non-metastatic inflammatory breast cancer [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B048.

Nationwide Outcomes After Neoadjuvant Chemotherapy for Locally Advanced Sigmoid Colon Cancer-A Propensity Score-Matched Analysis.

The role of neoadjuvant chemotherapy (NAC) in advanced sigmoid colon carcinoma remains to be further characterized. Rationale for NAC includes downstaging on final pathology and optimization of microscopically negative margins (R0 resection). We investigated rates of neoadjuvant chemotherapy use in advanced sigmoid colon cancer at academic cancer centers and assessed factors associated with likelihood of NAC administration. The National Cancer Database was queried from 2004 to 2017 for patients with clinical T3 or T4, N0-2, M0 sigmoid colon cancer who underwent surgical resection. Those with neoadjuvant radiation or metastatic disease were excluded. The outcomes of patients who did and did not receive neoadjuvant chemotherapy were evaluated for this retrospective cohort study. There were 23,597 patients of whom 364 (1.5%) received NAC. More patients received NAC at academic (41%, P < .001) and high-volume centers (27%, P < .001). Patients with Medicare/Medicaid (39%) and private insurance (52%) were more likely to receive NAC (P < .001). There was a significantly higher rate of N2 to N1 downstaging in the NAC group. Propensity-score matching demonstrated comprehensive community cancer programs (CCCP) were less likely to provide NAC (OR 0.4; 95% CI 0.23, 0.70, P < .001). There was no difference in survival (P = .20), R0 resection (P = .090), or 30-day readmission rates (P = .30) in the NAC cohort compared to the non-NAC cohort. Access to centers offering multi-disciplinary care with NAC prior to surgical resection is important. This care was associated with academic and high-volume centers and private or government-sponsored insurance. There was no difference in survival between NAC and non-NAC cohort.

Development and initial evaluation of a visualization tool for multidisciplinary treatment discussion of patients with pancreatic cancer.

585 Background: Pancreatic cancer is the third leading cause of cancer death in the United States; it is a complex disease requiring coordinated patient care. Multidisciplinary tumor boards (MTB) are today's gold standard in pancreatic cancer but are frequently criticized for being time-intensive and inefficient. To address this issue, Cancer Collective and Hive Networks have developed a novel patient-information visualization tool designed to improve the communication and efficiency of multidisciplinary tumor board meetings. This pilot study investigated the patient-information visualization tool's usability, efficiency, and feasibility in pancreatic cancer tumor board meetings. Methods: A prospective multi-center pilot study was conducted at Northwell Health (a comprehensive community cancer program [NCCCP] in the Northeastern United States) and the University of California San Diego (an NCI-designated comprehensive cancer center in [NCCC] in the Southwestern United States. The feasibility of the tool was assessed by measuring the percentage of MTB cases discussed that used the patient-information visualization tool. The usability and efficiency of the tool were assessed via Likert scale questions. Acceptable usability and effectiveness were defined as a 70% score or higher. Additionally, MTB participants were queried for input on design improvements for future iterations and expected future directions of tool use. Results: The patient-information visualization tool was rolled out on 07/22/2022 at the NCCP and NCCC. From 07/22/2022-05/31/2023, 170 (92%) MTB cases were reviewed at the NCCP. From 07/22/2022-05/31/2023, 74 cases (100%) of MTB cases were reviewed using the patient-information visualization tool at the NCCP. The NCCP (n=9) mean scores for usability and efficiency were 4.31 (86%) and 4.17 (83%) respectively. The NCCC (n=6) mean scores for usability and efficiency were 4.04 (81%) and 3.96 (79%) respectively. Qualitative feedback, reported on survey open-ended questions, included suggested enhancements to improve the tool’s usability, such as leveraging data automation to reduce data entry burden, improving the user interface for ease of data visualization, and adding additional data elements (e.g., specific procedure and appointment details) to improve decision-making utility. Conclusions: Implementing the novel digital dashboard to visualize pancreatic cancer patient data was highly feasible, usable, and efficient. Future directions of tool use include refining based on qualitative feedback from end users and planning for data automation and interoperability with the EMR.

Facility-Level Analysis of Twice Daily Radiation Utilization for Limited Stage Small Cell Lung Cancer

Treatment of limited stage SCLC (LS-SCLC) with twice daily (BID) fractionation (fx) to 45 Gy remains the standard of care for many decades. However, many patients receive once daily (QD) treatment as outcomes appear similar. Recent data have suggested that dose escalation to 60 Gy BID may improve outcomes, stressing the importance of BID delivery for SCLC. In this study, we examined the use of BID fractionation across treatment facilities and hypothesized that a substantial number of centers may never utilize BID treatment. The National Cancer Database (NCDB) was used to identify U.S. facilities treating LS-SCLC patients with definitive chemoradiation from 2004 to 2019. Included patients had stage I-III disease, received doublet chemotherapy, and did not undergo surgery. All patients received thoracic radiation therapy (RT), defined as QD (59.4-70.2 Gy in 30-39 fx) or BID (45 Gy in 30 fx). Other RT regimens were excluded. Facilities were classified into two cohorts (BID-treating and QD-only) based on whether or not at least one patient received BID treatment over the study period. Facility-level statistics including facility type, geographic location, and facility volume were analyzed. Predictors of BID-treating facility classification were determined using Chi-squared tests and uni/multivariable logistic regression. From 2004 to 2019, 22,545 LS-SCLC patients were treated by 1,222 facilities. Of the 1,222 facilities, 832 (68%) were BID-treating facilities while 391 (32%) were QD-only facilities. On univariable analysis, facility type (community cancer program, comprehensive community cancer program, integrated network cancer program, or academic program; p = 0.783) and geographic location (Northeast, Midwest, South, West; p = 0.417) were not associated with classification as a BID-treating facility. In contrast, facility volume was significantly associated with classification as a BID-treating facility, with BID use noted in 42.8% of the lowest quartile volume facilities vs. 84.0% of the highest quartile volume facilities (p<0.001). Dichotomized facility type (academic vs. non-academic), geographic location (South vs. other), and facility volume (greater or less than median volume) were included in a multivariable analysis. Facility volume (p<0.001) remained significant while facility type (p = 0.956) and facility location (p = 0.516) remained insignificant. Despite evidence supporting BID fractionation as the standard of care for LS-SCLC, 32% of facilities have never delivered BID treatment over the 15-year study period. Facilities with a low volume of patients are most likely to use QD-only. Barriers to BID treatment adoption will need to be overcome if dose escalated BID fractionation defines a new standard of care for LS-SCLC.

Thyroid carcinoma showing thymus-like element: A national analysis of demographic features.

e18099 Background: CASTLE, or Thyroid Carcinoma Showing Thymus-Like Elements, is an indolent and uncommon cancer that is believed to originate from either ectopic thymus tissue or remnants from the branchial pouches and affects the thyroid gland. It makes up a small portion, less than 0.1 - 0.15%, of all thyroid carcinomas and tends to affect slightly more females than males. Due to the lack of literature on this malignancy, understanding the trend in its diagnoses can provide valuable information about its epidemiology. The demographic factors of patients diagnosed with CASTLE were analyzed using data from the National Cancer Database (NCDB). Methods: A study was conducted using the NCDB from 2004 – 2020 to examine patients diagnosed with CASTLE (N = 23). Demographic factors such as age, sex, race, Hispanic ethnicity, education level, insurance coverage, type of medical facility, distance from the facility, and Charleson-Deyo score were analyzed using descriptive statistics. Trends in the incidence of the disease were analyzed through regression analysis. Results: The National Cancer Database was analyzed and revealed that 23 patients were diagnosed with CASTLE between the years 2004 to 2020, with a stable incidence rate per year (R2 = 0.1). The average age of diagnosis was 61.0 years (SD = 14.3, range = 31 – 87). The average Charlson-Deyo comorbidity score was 0.5, with 0 being the most common score (69.6%). The majority of patients (87.0%) were non-Hispanic and White. Most patients were found to be in the top two income quartiles (60.8%) earning more than $57,857 per year. A larger portion of patients had private insurance coverage (60.9%) compared to those who were uninsured or covered by Medicare/Medicaid. A greater number of patients lived in metropolitan counties with a population over 1 million (47.8%) than in other metropolitan counties (43.5%). Patients were more likely to receive treatment in a non-academic program (63.6%) such as community cancer programs, comprehensive community cancer programs, or integrated network cancer programs. On average, patients lived 11.4 miles (SD = 11.1, range = 0.7 – 46.7) from the treatment facility. Conclusions: This is the first analysis of CASTLE in the National Cancer Database, filling a significant gap in knowledge on the subject, particularly regarding the socioeconomic characteristics of CASTLE patients. The average CASTLE patient is a 60-year-old White, non-Hispanic male. These patients are more likely to be upper-middle-class citizens, have private insurance, live in densely populated metropolitan areas, and receive treatment at comprehensive community cancer programs. Further investigation is necessary to explore the statistical correlation between demographic and socioeconomic variables and the diagnosis, treatment, and outcomes of CASTLE patients.

Abstract 97: Who Gets Diagnosed Later? Demographic Differences in Early Vs. Late-Stage Medullary Thyroid Carcinoma: A NCDB Analysis

Abstract Purpose: Medullary thyroid cancer (MTC) is a less common cancer of the thyroid. Earlier diagnosis is associated with better survival and patient outcomes with less treatment. This study evaluates how various demographic factors impact the stage of MTC at diagnosis. Methods: 9,652 patients with MTC were analyzed within the National Cancer Database (NCDB) between the years 2004-2020. Demographics between those with early (I) or late-stage (IV) disease were compared including sex, race, Hispanic origin, primary insurance payer, median income, percentage with a high school degree, and facility type. Multivariate binary logistic regression analysis was performed with SPSS version 28 with a significance level of p &amp;lt; 0.05. Results: Female patients were 68% less likely to be diagnosed with late-stage MTC than male patients (p=&amp;lt;0.001; 95% CI= [0.283-0.356]). Patients with an income &amp;gt;$63,000 were 23% less likely to be diagnosed with late-stage MTC than those with an income &amp;lt;$38,000 (p=0.024; 95% CI= [0.613-0.967]). Those with private insurance, Medicaid, Medicare, and other government insurance were less likely (65%, 57%, 67%, and 61% respectively) to be diagnosed with late-stage MTC compared with those who were uninsured (private insurance: p=&amp;lt;0.001; 95% CI= [0.241-0.510], Medicaid: p=&amp;lt;0.001; 95% CI= [0.284-0.655], Medicare: p=&amp;lt;0.001; 95% CI= [0.226-0.486], other government insurance: p=0.004; 95% CI= [0.210-0.744]). Patients treated at Integrated Network Cancer Programs (INCP) and Comprehensive Community Cancer Programs (CCCP) are less likely to be diagnosed with late-stage MTC than Academic/Research Programs (21% and 18% respectively), with no significant difference found with Community Cancer Programs (INCP: p=0.002; 95% CI= [0.674-0.917], CCCP: p=0.004; 95% CI= [0.717-0.940]). No significant difference was found between race, Hispanic origin, or percentage with a high school degree. Conclusions: Patients who are male, uninsured, have low socioeconomic status, or are treated at Academic/Research Programs are more likely to be diagnosed later than their counterparts. This data demonstrates demographics that may influence whether a patient is diagnosed with a favorable, early-stage MTC or a late-stage MTC that results in worsened outcomes. Identifying these possible inequities contributes to a greater understanding of social determinants of health. Literature on such inequities can be used to advocate for better care for our cancer patients. Citation Format: Darby Keirns, Beau Hsia, Peter Silberstein, Xinxin Wu. Who Gets Diagnosed Later? Demographic Differences in Early Vs. Late-Stage Medullary Thyroid Carcinoma: A NCDB Analysis [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 97.

Epidemiology and prognostic factors of hepatosplenic T-cell lymphoma (HSTL): An analysis of NCDB (National Cancer Database).

e19544 Background: Hepatosplenic T-cell lymphoma (HSTCL) is a rare T-cell malignancy, associated with rapid disease progression and generally poor outcomes. To date, few studies have been performed that examine outcomes expected survival outcomes and clinical features of this disease. We aimed to perform a large retrospective study with a focus on disease characteristics and overall survival outcomes. Methods: Utilizing the National Cancer Database (NCDB), we identified 434 patients with HSTCL 2004-2020. Patients were selected by ICD-0-3 histology code 9716. Kaplan-Meier curves and survival tables were created to calculate 1-, 5-year survival probabilities for variables including ages, race, sex, facility type, age, insurance, primary site, stage, and adjuvant therapy. Log-rank and cox regression analysis was used to compare the groups within each variable. Results: The cohort consisted of 68.9% male patients and 67.4% Caucasian patients with a median age of diagnosis of 50 years old. The most common type of insurance was private insurance 49.5% then Medicare 24%, Medicaid 16.4% and not insured 5.8% with median distance of 16.1 miles from hospital where they received care. Most patients (56.8%) were treated at academic/ research facilities, followed by comprehensive community cancer programs 22.8%. Mostly located in metro areas (85.5%) with median household income &gt; $ 46000 (43.5%). More cases diagnosed since 2013. The most common primary anatomical site was spleen 91.7% followed by lymph nodes. Stage IV was the most common stage 77.2%t. Overall, 1-, 5- year survival probabilities for patients with HSTCL were 47.4% and 25.4% respectively. Median overall survival time is 11.24 months (95% CI 9.592-12.888). Female patients had better survival outcomes than males with median survival 20.6 months and 9.5 months, respectively. Academic/research centers (12.65 months) and Medicaid (14.98 months) followed by private insurance (11.79 months) had better survival outcomes. As stage increased, overall survival probabilities decreased; stage 1 median survival 12.71 months, stage 4 (11.24 months). Spleen (12.35 months) had better survival outcomes compared to lymph nodes. With regards to treatment modalities, patient who underwent bone marrow transplant (81.64 months) followed by surgery of primary site (14.92 months) followed by multiple agent chemotherapy (11.27 months) had better survival rates compared to all other treatment modalities. Conclusions: This is the largest and most comprehensive study to date on the epidemiology and prognostic factors of Hepatosplenic T cell Lymphoma. The result of our analysis brings up several interesting trends including females had significantly longer survival when compared to males with the same disease. Other major factors influencing survival are facility type, age, sex, race, insurance status, stage, adjuvant therapy and primary site.

Demographics of the tumor formerly known as bronchiolo-alveolar carcinoma.

e20604 Background: Bronchiolo-alveolar carcinoma (BAC) is a rare subtype of non-small cell lung cancer of the lung periphery, often characterized by lepidic growth. Although BAC has undergone various reclassifications in recent years, International Classification of Disease codes still classifies these subtypes using the same codes that previously belonged to BAC. Changing diagnostic criteria and other factors cause BAC to be among the most overdiagnosed forms of lung cancer and thus a demographic study could provide insight into trends. Methods: A retrospective cohort analysis utilizing the National Cancer Database (NCDB) from 2004 – 2020 included patients with malignant forms of BAC (Invasive mucinous adenocarcinoma, mixed invasive mucinous, and nonmucinous adenocarcinoma) confirmed through histology. Demographic factors such as sex, age, race, Hispanic status, median household income, insurance status, facility type, county population, distance from facility, and Charlson Deyo score were analyzed by descriptive statistics and incidence trends. Results: In total, 12,607 patients were identified in the database with a confirmed diagnosis of BAC between 2004 – 2020. The number of cases per year remained steady (mean = 565.4) until 2018. From 2018 to 2020, the average number of diagnoses per year was 1575.0. The average age of diagnosis was 69.3 years (SD = 10.7, range = 10 to &gt; 90 years). 58.1% of the cases were female patients. The top primary sites were the lower and upper lobes (46.2% and 39.9% respectively). The majority (59.2%) had Charlson-Deyo comorbidity scores of 0. Most cases occurred in Non-Hispanic White persons (86.8%). More patients were in the top quartile of income earners (34.0%) compared to those in lower quartiles. Medicare was the insurance provider for most patients (65.0%). More patients were diagnosed in counties with a population over 1 million (52.4%). More patients were treated in comprehensive community cancer programs (38.1%) followed closely by academic cancer programs (35.2%). Patients lived an average of 31.6 miles (SD = 113.0, range = 0.1 – 2390.7) from the treatment facility. Conclusions: This is the first NCDB analysis on the demographics of BAC. The sudden rise in cases per year in 2018 aligns with the changing pathologic and histologic definitions for BAC. A 2006 review of BAC found that 50-70% of cases occur in female patients, similar to our results. The majority of BAC patients tend to be non-Hispanic and White with a primary site diagnosis in the lower lobe, followed by the upper lobe. BAC patients are more likely to be in the top income quartile, live in densely-populated metropolitan areas, and receive treatment in a non-academic program. Further research is needed to better understand the impact of demographic, socioeconomic, and environmental factors on the diagnosis and prognosis of BAC, especially because its diagnostic criteria have changed recently.

Demographic factors affecting patients with AML with myelodysplasia-related changes.

e19027 Background: Acute myeloid leukemia with myelodysplasia-related changes (AML-MRC) is a rare and aggressive form of acute myeloid leukemia (AML) that makes up about 25-34% of its annual cases. The subtype includes a varied group of tumors with clinical, genetic, and morphological characteristics that confer poor outcomes. AML-MRC is commonly treated with intensive chemotherapy, but the median survival is only 9-12 months. Given the poor outcomes, gaining a better understanding of epidemiologic factors could reveal opportunities for earlier diagnosis and improved treatment planning. Demographic characteristics of AML-MRC patients were identified and examined using the National Cancer Database (NCDB). Methods: Individuals with a confirmed diagnosis of AML-MRC (N = 14,536) were identified using the NCDB for a retrospective analysis from 2004 to 2020. Patient sex, age at diagnosis, race, household income, insurance status, urban/rural residence, and Charlson-Deyo score were examined by descriptive statistics, and diagnostic trends by year were identified and calculated with regression analysis. Results: A total of 14,536 patients diagnosed with AML-MRC between 2004 – 2020 were identified in the NCDB. Within this timeframe, there was an increasing incidence of diagnosis per year (R2 = 0.9). AML-MRC was more common in males (61.1%) than females (38.9%), and the average age at diagnosis was 68.9 years (SD = 13.0, range = 0 – 90 years). The majority of patients (87.3%) were White. Patients were most likely to be a part of the highest median household income quartile (33.6%) and least likely to be a part of the bottom quartile (13.2%). A higher percentage of patients were insured by Medicare (63.0%) compared to private insurance (25.3%). Most patients lived in counties in metro areas of 1 million population or more (51.4%). Most individuals had Charlson-Deyo comorbidity scores of zero (68.1%). The most common type of treatment facility was academic/research programs (55.1%) followed by comprehensive community cancer programs (23.3%). Conclusions: AML-MRC is a common subtype of AML with a poor prognosis. Previous studies have found that most individuals with AML-MRC are older-aged, White males. Our study corroborated this finding and examined additional demographic factors. We found that these patients were more likely to hold insurance through Medicare, likely reflecting the older average age at diagnosis. Additionally, patients were most commonly in the highest household income quartile and living in a metropolitan area with the highest population density. This could suggest that better access to healthcare improves rates of diagnosis of AML-MRC. Especially given that more people are being diagnosed each year, further research should work to understand the effects of these, and other, socioeconomic factors on the diagnosis, treatment, and prognosis of patients with AML-MRC.

Mixed medullary-follicular carcinoma: A national analysis and the demographic features.

e18090 Background: Mixed medullary-follicular carcinoma (MMFC) is a rare malignant type of cancer that affects the thyroid. Unlike other thyroid cancers, MMFC is distinct by its solid-nonfollicular pattern which includes both follicular and C-cell elements. Nearly 70% of patients present with distant metastasis to the lungs, bone, brain and/or liver with a median survival time of 75 months, plus or minus 51 months. Because MMFC is a rare cancer, analyzing the trend in diagnoses can provide important information about its epidemiology. The National Cancer Database (NCDB) was analyzed to determine how patient demographic characteristics affected diagnosis of MMFC. Methods: A retrospective cohort study from 2004 to 2020 was conducted using the NCDB. 153 patients were found with a histologically confirmed diagnosis of MMFC (ICD-8346-3). Gender, race, Hispanic origin, level of education, insurance coverage, type of treatment facility, and distance from facility were analyzed via descriptive statistics and trends in incidence were interpreted using regression analysis. Results: The frequency of patients diagnosed with MMFC has remained consistent since 2004 (R2 = 0.1) with over 10 diagnoses per year. Of the 153 patients found, the average age of diagnosis was 59.05 years (SD = 14.36, range = 18 – 90 years). Approximately two-thirds of patients were female (62.7%) and the remainder were male (37.3%). Most of the patients were Non-Hispanic White (86.3%) compared to 7.2% of the patients which were of Spanish-hispanic origin. More patients were in the top income quartile (37.3%) than those in the second (18.3%), third (21.6%), or fourth (11.1%) quartiles. The other 11.8% were of unknown income status. The majority of patients were privately insured (52.9%), followed by coverage under Medicare/Medicaid (43.1%). More patients lived in metropolitan counties with a population of 250,000 or more (88.2%) compared to urban or rural areas (11.8%). A large percentage of patients were treated at an academic or comprehensive community cancer program (72.6%) compared to non-academic programs (27.4%). Patients traveled an average of 33.9 miles (SD = 93.90, Range = 0.5 – 806.8) to get to the treatment facility. Conclusions: MMFC remains a rare diagnosis. This study explores a significant gap in existing knowledge on patient characteristics that might present with MMFC. The majority of patients were White, non-Hispanic, insured by private insurance, lived in metropolitan areas, and in the top quartile of income earners. This novel study of socioeconomic factors in MMFC patients suggest that patients diagnosed with this uncommon cancer might have better access to diagnosis. Previous literature on MMFC suggested a predilection for males, but our findings serve as contrary evidence for such preference. As such, additional research to comprehend the role that sex and socioeconomic status might have on MMFC would be valuable.

Demographic and socioeconomic factors of patients with nonencapsulated sclerosing carcinoma: An NCDB analysis.

e18103 Background: Nonencapsulated sclerosing carcinoma (NSC) is a rare and aggressive variant of papillary thyroid carcinoma (PTC) that accounts for 0.7-6.6% of its cases. It is associated with greater rates of vascular invasion, metastasis, and relapse compared to classic PTC. With prompt initiation of aggressive treatment including radical surgery, lymph node resection, and possible radioiodine treatment, NSC has a 10-year survival rate of 93%. Given the importance of proper diagnosis and selection of aggressive treatments, data regarding its epidemiology could further improve patient outcomes. The demographics of NSC patients were analyzed using the National Cancer Database (NCBD). Methods: Data from NCDB was queried and patients with a confirmed diagnosis of NSC between 2004 and 2020 were identified for a retrospective cohort analysis (N = 1,130). Yearly diagnosis rates were analyzed using regression analysis. Factors including patient age, sex, race, insurance status, urban/rural residence, surgical treatment approach, treatment facility type, and 90-day mortality were identified and evaluated via descriptive statistics. Results: The NCDB contained a total of 1,130 patients with a confirmed diagnosis of NSC from 2004 – 2020. The incidence rate of new diagnoses remained stable over this time (R2 = 0.0). Women were much more likely to be diagnosed (78.5%) compared to men (21.5%) with an average age at diagnosis of 44.0 years (SD = 18.7, range = 6 – 90 years). Most patients were White (86.0%), lived in metropolitan areas with a greater than 1 million population (56.5%), and were privately insured (68.9%). The vast majority of patients were treated surgically (99.9%). A complete thyroidectomy was the most common surgical approach (89.3%), more so than subtotal thyroidectomy or lobectomy. For the patients with valid data, the most common treatment facility type was an academic/research program (42.6%) followed by comprehensive community cancer programs (33.8%). Most patients survived at least ninety days after their primary surgery (98.2%) and were still alive at the date of last contact (88.4%). Conclusions: NSC is an aggressive subtype of PTC, but it generally has a good prognosis with initiation of aggressive treatment. The findings of this research corroborated previous studies showing that NSC is much more common in females than males, is most commonly treated with complete thyroidectomy, and has high 90-day survival rates. In examining the demographic features of this patient population, it was found that the majority of patients were White, lived in large metropolitan areas, and were privately insured. This may suggest that a relative ease of access to healthcare aided in their diagnosis. Future research should focus on understanding how demographic and socioeconomic factors may contribute to the timing of diagnosis, chosen treatments, and overall mortality rates of patients with NSC.

Adenocarcinoma in villous adenoma: Demographics analysis.

e18024 Background: Adenocarcinoma in Villous Adenoma (AVA) is a metastatic disease that arises from villous adenomas. These adenocarcinomas can arise from different tissues, particularly this analysis looked at AVA arising from the head and neck region. Treatment for otolaryngological AVA varied depending on grade, but the majority of patients received surgery or radiation. Despite its rarity, 16.7% of patients pass within 90 days after receiving surgery for this cancer. Given the rarity, data analysis of demographic findings could provide important information regarding its occurrence and distribution in the population. Methods: Patients from the National Cancer Database (NCDB) with a confirmed diagnosis of otolaryngological AVA from 2004–2017 were used in a retrospective cohort analysis (N = 33). Factors analyzed by descriptive statistics and regression analysis include sex, race, average household income, Charlson-Deyo score, palliative care obtained, and year of diagnosis. Results: A total of 33 patients were identified in the database with a confirmed diagnosis of AVA in the head and neck between 2004 – 2017 with a steady incidence of patients diagnosed per year (R2 = 0.0). The average age of diagnosis was 69 years (SD = 9.7, range = 51-85 years). The top primary site was the esophagus (90.9%). Most individuals (60.6%) had Charlson/Deyo comorbidity scores of 0. The majority of the patients were Non-Hispanic and White (97.0%). There was an equal distribution of income earners in the first and second quartile (33.3% and 33.3%) compared to those in the third or fourth quartiles (upper and middle quartiles are defined as over $74,063 and $57,857 to $74,062, respectively). A higher percentage of patients were insured by Medicare (57.0%) or privately insured (36.4%), compared to those who were uninsured. Most patients lived in metropolitan counties with a population greater than 1 million (51.6%). The majority of patients were treated in a comprehensive community cancer program (54.5%). Most patients did not receive palliative care (97.0%) and 16.7% of patients died within 90 days of receiving surgical treatment. Conclusions: With most data showing extensive data analysis on AVA stemming from the colon, this is the only analysis of demographic data from this cancer originating from the head and neck region. From the NCDB data, the majority of patients are non-Hispanic and White with a primary-site diagnosis presenting in the esophagus. This is the first time that specific AVA socio-economic data has been analyzed: patients with this cancer tend to be in upper or middle income brackets, live in crowded metropolitan areas, and have Medicare as their insurance coverage. To further our understanding of otolaryngological AVA, it would be necessary to examine the relationship between demographic and socioeconomic factors, and the diagnosis, treatment options, and survival rates for individuals with AVA.

Disparities in the recommendation, acceptance, and performance of surgery as treatment modality for patients with stage 0-III breast cancer.

e18509 Background: National data to identify disparities in breast cancer focus on the receipt of standard therapies, although receipt of those treatments is predicated upon three factors: provider recommendation, patient acceptance, and administration or performance of those therapies. We aim to determine whether surgical disparities exist for each of these three factors in patients diagnosed with stage 0-III breast cancer patients. Methods: The National Cancer Database (NCDB) was queried for females 40 to 70 years of age treated from 2010 to 2019 for stage 0-III breast cancer. Covariates of interest included race/ethnicity, socioeconomic status, and patient, facility, and tumor characteristics. Exclusion criteria were applied to mitigate biases in treatment variabilities. Outcomes of interest included whether surgery was recommended, whether the recommended surgery was accepted, and ultimately performed. Multivariable logistic regression models were fit to assess the outcomes of interest controlling for patient and tumor characteristics. Predictive margins were calculated, and chi-square tests were used to assess the differences between subgroups of interest. Results: Among 440,828 patients, unadjusted rates of recommendation, acceptance, and performance of surgery were 98.5%, 99.7%, and 99.6% respectively. After confounder adjustment, compared to White patients, the probabilities of having surgery recommended, accepted, and performed for Black patients were 0.6, 0.46, and 0.49 percentage points (ppt) lower respectively (all p &lt; 0.0001). The probabilities of accepting and having surgery performed were both 0.14 ppt lower (p = 0.0012 and p = 0.0041) for Asian patients compared to White patients. Insurance status was a predictor for all outcomes, with the probabilities being 1.19, 0.78, and 0.78 ppt lower respectively when uninsured patients were compared to patients with private insurance (all p &lt; 0.0001). Similarly, probabilities for all three factors were 0.92, 0.11, and 0.17 ppt lower respectively for patients treated at Academic/Research Programs compared to Comprehensive Community Cancer Programs (p &lt; 0.0001, p = 0.001, and p = 0.0002). Income and Hispanic ethnicity had no significant association with the studied outcomes. Conclusions: Concern is justified about recommendation and differences in the performance of surgery as cause of breast cancer disparities by race and socioeconomic status, but acceptance of recommendations is also lower. Differences in understanding and a sense of trust may contribute to the lower likelihood of accepting surgical recommendations seen here. Further exploration is needed to ensure that patients of all backgrounds are equally clear regarding the reasons for surgical recommendations, and to foster trust. Such a focus on acceptance may help narrow disparities that have proven resistant to change so far.

MP38-14 UNITED STATES INSTITUTIONAL VARIATION IN THE USE OF ACTIVE SURVEILLANCE FOR LOW-RISK PROSTATE CANCER

You have accessJournal of UrologyCME1 Apr 2023MP38-14 UNITED STATES INSTITUTIONAL VARIATION IN THE USE OF ACTIVE SURVEILLANCE FOR LOW-RISK PROSTATE CANCER Shu Wang, Amir Khan, Kathryn Hughes Barry, Michael Naslund, and M. Minhaj Siddiqui Shu WangShu Wang More articles by this author , Amir KhanAmir Khan More articles by this author , Kathryn Hughes BarryKathryn Hughes Barry More articles by this author , Michael NaslundMichael Naslund More articles by this author , and M. Minhaj SiddiquiM. Minhaj Siddiqui More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003276.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Active surveillance (AS) has been recommended as the initial management for low-risk prostate cancer (PCa). Even though we have witnessed a dramatic increase in the use of AS recently, significant variation still exists. This study aimed to investigate the use of AS for low-risk prostate cancer at the institutional level. METHODS: The National Cancer Database was used to identify patients diagnosed with low-risk prostate adenocarcinoma (NCCN criteria: cT1-cT2a, PSA<10, Gleason Score 3+3) as the only malignancy from 2015 to 2019. Patients aged 40-75 were included. Information on the initial management was accessed. The AS rate on the institute level was calculated as the number of patients on AS divided by the total number of patients with low-risk PCa reported by a specific institute. We only included institutions with a cohort of no less than ten patients. RESULTS: 1,010 institutions with 85,026 low-risk PCa patients were included in this study. The mean AS rates on the institutional level were 38% (IQR 15-55%), 36% (IQR 8-63%), 27% (IQR 5-44%), and 26% (IQR 3-45%), among Academic/Research Programs, Community Cancer Programs, Integrated Network Cancer Programs, and Comprehensive Community Cancer Programs, respectively (p<0.001). When stratifying centers based on the AS uptake rates, we found that 35% (350/1010) of institutions reported a very low AS rate (<10%), 28% (287/1010) reported a low AS rate (10-40%), 33% reported a suboptimal AS rate (40-80%) and only 4% achieved an optimal AS rate (>80%). The percentages of each institutional type stratified by AS rates are shown in Figure 1. Comprehensive Community Cancer Programs had the highest percentage (42%) of institutions with very low AS rates, and Community Cancer Programs had the highest percentage meeting an optimal AS rate (10%). CONCLUSIONS: Significant variations of AS for low-risk PCa were observed at the institutional level. A substantial number of institutions still demonstrate very low rates of <10% of AS for management of low-risk PCa. Source of Funding: N/A © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e529 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shu Wang More articles by this author Amir Khan More articles by this author Kathryn Hughes Barry More articles by this author Michael Naslund More articles by this author M. Minhaj Siddiqui More articles by this author Expand All Advertisement PDF downloadLoading ...