Disparities In Survival Rates Research Articles

Impact of treatment setting on survival outcomes in undifferentiated pancreatic carcinoma: An analysis of the National Cancer Database.

e16333 Background: Undifferentiated carcinoma of the pancreas is a rare and highly aggressive form of pancreatic cancer, characterized by its low degree of cellular differentiation. The prognosis for this condition remains poor, with median survival times typically not exceeding one year. While existing research indicates that treatment at academic institutions may lead to improved survival outcomes compared to non-academic settings, there is scant research on this topic in the context of undifferentiated carcinoma of the pancreas. Addressing this research gap, this study analyzes data from the National Cancer Database (NCDB) to compare long-term survival rates between patients treated at academic institutions and those at other facilities. Methods: The National Cancer Database (NCDB) was used to identify patients diagnosed with undifferentiated carcinoma of the pancreas from 2004 to 2019 using the histology code 8020 as assigned by the Commission on Cancer Accreditation program. Kaplan-Meier, ANOVA, and Chi-Square tests were performed. Data was analyzed using SPSS version 27 and statistical significance was set at α = 0.05. Results: In this analysis of 284 patients, 124 (43.7%) received care at academic centers, while 160 (56.3%) were treated at non-academic institutions. Individuals treated at academic centers had a significantly extended mean overall survival of 27 months compared to 13.9 months for those treated elsewhere (p < 0.05). Additionally, patients at academic centers were more likely to be insured, undergo surgical interventions, receive chemotherapy, and be initially diagnosed at a different facility (p < 0.05). Conversely, patients at non-academic centers were more likely to be white, live closer to their care facility, and exhibit greater metastatic regional lymph nodes (p < 0.05). However, there was no significant association between treatment at academic centers and variables such as median income, cancer grade, and Charlson-Deyo Comorbidity Index (CDCI) (p > 0.05). Conclusions: This study revealed that individuals with undifferentiated carcinoma of the pancreas receiving treatment at academic centers exhibit a significantly improved overall survival rate compared to those treated at non-academic centers. This disparity in survival rates might be attributed to the higher prevalence of chemotherapeutic treatments and surgical interventions at academic institutions. While these observations are based on correlational data, they underscore the necessity for further investigation to establish causality.

Impact of treatment setting on survival outcomes in undifferentiated pancreatic carcinoma: An analysis of the National Cancer Database.

e16333 Background: Undifferentiated carcinoma of the pancreas is a rare and highly aggressive form of pancreatic cancer, characterized by its low degree of cellular differentiation. The prognosis for this condition remains poor, with median survival times typically not exceeding one year. While existing research indicates that treatment at academic institutions may lead to improved survival outcomes compared to non-academic settings, there is scant research on this topic in the context of undifferentiated carcinoma of the pancreas. Addressing this research gap, this study analyzes data from the National Cancer Database (NCDB) to compare long-term survival rates between patients treated at academic institutions and those at other facilities. Methods: The National Cancer Database (NCDB) was used to identify patients diagnosed with undifferentiated carcinoma of the pancreas from 2004 to 2019 using the histology code 8020 as assigned by the Commission on Cancer Accreditation program. Kaplan-Meier, ANOVA, and Chi-Square tests were performed. Data was analyzed using SPSS version 27 and statistical significance was set at α = 0.05. Results: In this analysis of 284 patients, 124 (43.7%) received care at academic centers, while 160 (56.3%) were treated at non-academic institutions. Individuals treated at academic centers had a significantly extended mean overall survival of 27 months compared to 13.9 months for those treated elsewhere (p < 0.05). Additionally, patients at academic centers were more likely to be insured, undergo surgical interventions, receive chemotherapy, and be initially diagnosed at a different facility (p < 0.05). Conversely, patients at non-academic centers were more likely to be white, live closer to their care facility, and exhibit greater metastatic regional lymph nodes (p < 0.05). However, there was no significant association between treatment at academic centers and variables such as median income, cancer grade, and Charlson-Deyo Comorbidity Index (CDCI) (p > 0.05). Conclusions: This study revealed that individuals with undifferentiated carcinoma of the pancreas receiving treatment at academic centers exhibit a significantly improved overall survival rate compared to those treated at non-academic centers. This disparity in survival rates might be attributed to the higher prevalence of chemotherapeutic treatments and surgical interventions at academic institutions. While these observations are based on correlational data, they underscore the necessity for further investigation to establish causality.

Association between the stress-hyperglycemia ratio and all-cause mortality in community-dwelling populations: An analysis of the National Health and Nutrition Examination Survey (NHANES) 1999-2014.

Reportedly, the stress-hyperglycemia ratio (SHR) is closely associated with poor prognosis in patients with severe acute disease. However, the community-dwelling may also be in a state of stress due to environmental exposure. Our study aimed to explore the association between SHR and all-cause mortality in the community-dwelling population. A total of 18 480 participants were included out of 82 091 from the NHANES 1999-2014 survey. The Kaplan-Meier survival analyses were used to assess the disparities in survival rates based on SHR, and the log-rank test was employed to investigate the distinctions between groups. The multivariate Cox regression analysis and restricted cubic spline (RCS) analysis were performed to assess the association of SHR with all-cause mortality. A subgroup analysis was also conducted. A total of 3188 deaths occurred during a median follow-up period of 11.0 (7.7; 15.4) years. The highest risk for all-cause mortality was observed when SHR≤ 0.843 or SHR ≥0.986 (log-rank p < .001). After adjusting for the confounding factors, compared with subjects in the second SHR quartile (Q2), participants in the highest (Q4, adjusted hazard ratio [HR] 1.49, 95% confidence interval [CI] 1.28-1.73) and lowest quartiles (Q1, adjusted HR 1.37, 95% CI 1.16-1.60) have a higher probability of all-cause death. The RCS observed a dose-response U-shaped association between SHR and all-cause mortality. The U-shaped association between SHR and all-cause mortality was similar across subgroup analysis. The SHR was significantly associated with all-cause mortality in the community-dwelling population, and the relationship was U-shaped.

A Study on the Relationship between Social Support and Subjective Well being of Vocational College Students

The objective of this research is to examine the correlation between social support and subjective well-being among vocational college students using empirical surveys. The intention is to provide a foundation for increasing their mental health and improving their subjective well-being. A total of 375 students from vocational colleges were chosen as participants, and their levels of social support and subjective well-being were assessed by the administration of a questionnaire. The findings indicated a substantial positive correlation between subjective well-being and objective support, subjective support, usage of support, and the overall social support score. (2) Female vocational college students exhibit a notably greater degree of assistance use compared to their male counterparts. There exists a notable disparity in survival rates between students pursuing liberal arts and those studying science in terms of subjective well-being, with science students exhibiting much greater levels of subjective well-being compared to liberal arts students. There are notable variations seen across different grades in terms of objective support, subjective support, usage of support, overall social support score, and subjective well-being. Following the LSD post-test analysis, it was determined that freshman students exhibited significantly lower levels of objective support, subjective support, total social support score, and subjective well-being score compared to students in other grades. On the other hand, sophomore students scored significantly higher than students in other grades in terms of utilization of support. (3) A multiple regression analysis revealed that objective support, subjective support, and usage of support positively predict subjective well-being. This research examines the correlation between social support and subjective well-being and offers empirical evidence and theoretical direction to enhance the subjective well-being of vocational college students via more focused coaching.

Orthodontic adhesive loaded with different proportions of ZrO2 silver-doped nanoparticles: An in vitro μTBS, SEM, EDX, FTIR, and antimicrobial analysis.

Zirconium dioxide silver-doped nanoparticles (ZrO2AgDNPs) impacts the adhesive material in terms of its physical characteristics, antimicrobial properties, degree of conversion (DC), and micro-tensile bond strength (μTBS) of orthodontic brackets to the enamel surface. A comprehensive methodological analysis utilizing a range of analytical techniques, including scanning electron microscopy coupled with energy-dispersive x-ray spectroscopy (EDX), Fourier-transform infrared (FTIR) spectroscopy, DC analysis, and μTBS testing. A light-curable orthodontic adhesive, specifically Transbond XT, was combined with ZrO2AgDNPs at 2.5% and 5%. As a control, an adhesive with no incorporation of ZrO2AgDNPs was also prepared. The tooth samples were divided into three groups based on the weightage of NPs: group 1: 0% ZrO2AgDNPs (control), group 2: 2.5 wt% ZrO2AgDNPs, and group 3: 5 wt% ZrO2AgDNPs. EDX graph demonstrated silver (Ag), Zirconium (Zr), and Oxygen (O2), The antibacterial efficacy of adhesives with different concentrations of NPs (0%, 2.5%, and 5%) was assessed using the pour plate method. The FTIR spectra were analyzed to identify peaks at 1607 cm-1 corresponding to aromatic CC bonds and the peaks at 1638 cm-1 indicating the presence of aliphatic CC bonds. The μTBS was assessed using universal testing machine (UTM) and bond failure of orthodontic brackets was seen using adhesive remanent index (ARI) analysis. Kruskal-Wallis test assessed the disparities in survival rates of Streptococcus mutans. Analysis of variance (ANOVA) and post hoc Tukey multiple comparisons test calculated μTBS values. The lowest μTBS was observed in group 1 adhesive loaded with 0% ZrO2AgDNPs (21.25 ± 1.22 MPa). Whereas, the highest μTBS was found in group 3 (26.19 ± 1.07 MPa) adhesive loaded with 5% ZrO2AgDNPs. ZrO2AgDNPs in orthodontic adhesive improved μTBS and has acceptable antibacterial activity against S mutans. ZrO2AgDNPs at 5% by weight can be used in orthodontic adhesive alternative to the conventional method of orthodontic adhesive for bracket bonding. RESEARCH HIGHLIGHTS: The highest μTBS was found in orthodontic adhesive loaded with 5% ZrO2AgDNPs. ARI analysis indicates that the majority of the failures fell between 0 and 1 among all investigated groups. The colony-forming unit count of S. mutans was significantly less in orthodontic adhesive loaded with nanoparticles compared with control. The 0% ZrO2AgDNPs adhesive showed the highest DC.

Breast cancer survival in India across 11 geographic areas under the National Cancer Registry Programme.

Population-based cancer survival is a key indicator for assessing the effectiveness of cancer control by a health care system in a specific geographic area. Breast cancer is the most common cancer among women in India, accounting for over one quarter of all female cancers. The objective of this study was to estimate the 5-year survival of female patients who were diagnosed with breast cancer between 2012 and 2015 from the existing Population-Based Cancer Registries (PBCRs) in India. In total, 17,331 patients who had breast cancer diagnosed between 2012 and 2015 from 11 PBCRs were followed until June 30, 2021. Active methods were used to track the vital status of registered breast cancer cases. The study conducted survival analysis by calculating the difference between the date of first diagnosis and the date of death or censoring to estimate observed survival and relative survival using the actuarial survival approach and the Ederer-II approach, respectively. The 5-year age-standardized relative survival (95% confidence interval [CI]) of patients with breast cancer was 66.4% (95% CI, 65.5%-67.3%). Mizoram (74.9%; 95% CI, 68.1%-80.8%), Ahmedabad urban (72.7%; 95% CI, 70.3%-74.9%), Kollam (71.5%; 95% CI, 69.2%-73.6%), and Thiruvananthapuram (69.1%; 95% CI, 67.0%-71.2%) had higher survival rates than the national average. Conversely, Pasighat had the lowest survival rate (41.9%; 95% CI, 14.7%-68.6%). The 5-year observed survival rates for localized, regional, and distant metastasis in the pooled PBCRs were 81.0%, 65.5%, and 18.3%, respectively. The overall disparity in survival rates was observed across 11 PBCRs, with lower survival rates reported in Manipur, Tripura, and Pasighat. Therefore, it is imperative to implement comprehensive cancer control strategies widely throughout the country.

Geographical disparities in survival rates for urological cancers in Poland from 2000 to 2015

Geographical disparities in survival rates for urological cancers in Poland from 2000 to 2015

Comparative Outcome Analysis of Nodular Lymphocyte-Predominant Hodgkin Lymphoma Vs Classical Hodgkin's Lymphoma - a SEER Based Study

Introduction Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a slower-growing variant of Hodgkin lymphoma that is uniquely characterized by its growth pattern and cellular appearance. While patients with NLPHL tend to demonstrate more promising prognoses than their counterparts with classical Hodgkin lymphoma (CHL), recent comparative studies remain limited. The objective of this study was to investigate the disparities in survival rates between NLPHL and CHL patients, accounting for variations in patient demographics and disease attributes. Methodology We utilized Surveillance, Epidemiology, and End Results (SEER) 17 registries database to identify patients diagnosed with NLPHL and CHL between 2000 - 2020. Univariate survival analysis was done using a Kaplan Meir plot with a log-rank test, and the Cox proportion hazard regression model was used for multivariate survival analysis. Results A total of 2,723 NLPHL cases and 42,581 CHL cases were included in the study. The median age of NLPHL patients stood at 44 years, whereas for CHL patients it was observed to be 38 years. Over an 83-month median follow-up, NLPHL demonstrated superior 5-year (92.2%) and 10-year (83.84%) survival rates compared to CHL (82.45% and 75.45%, respectively). When controlled for all available characteristics, NLPHL showed a significantly higher overall survival (HR: 2.373; 95% CI, 2.131 - 2.644; P&amp;lt;.001) than CHL. For those diagnosed with NLPHL, our data indicated that patients who underwent radiation therapy had better survival rate (HR: 1.98; 95% CI, 1.55 - 2.53; p&amp;lt;.001). Additionally, younger age and male gender were associated with a more favorable prognosis. Conclusion Our analysis highlights the superior survival outcomes for NLPHL patients as compared to those with CHL, even when accounting for available patient and disease characteristics. The further enhanced survival rates observed in NLPHL patients undergoing radiation therapy suggests potential for more tailored therapeutic approaches. Factors such as younger age and male gender were also identified as indicative of a more favorable prognosis, underscoring the need for further exploration of demographic and clinical influences on survival outcomes in Hodgkin lymphomas.

Breast Cancer in the Arabian Gulf Countries.

Breast cancer stands as the prevailing malignancy across all six Gulf Cooperation Council (GCC) nations. In this literature review, we highlighted the incidence and trend of breast cancer in the GCC. Most of the studies reported a consistent increase in breast cancer incidence over the past decades, which was particularly attributed to the adoption of a Westernized lifestyle in the region and the implications of emerging risk factors and other environmental and societal factors, the increase in screening uptake, as well as the improvement in data collection and reporting in the GCC. The data on breast cancer risk factors in the GCC were limited. In this geographic region, breast cancer frequently manifests with distinctive characteristics, including an early onset, typically occurring before the age of 50; an advanced stage at presentation; and a higher pathological grade. Additionally, it often exhibits more aggressive features such as human epidermal growth factor receptor 2 (HER2) positivity or the presence of triple-negative (TN) attributes, particularly among younger patients. Despite the growing body of literature on breast cancer in the GCC, data pertaining to survival rates are, regrettably, meager. Reports on breast cancer survival rates emanating from the GCC region are largely confined to Saudi Arabia and the United Arab Emirates (UAE). In the UAE, predictive modeling reveals 2-year and 5-year survival rates of 97% and 89%, respectively, for the same period under scrutiny. These rates, when compared to Western counterparts such as Australia (89.5%) and Canada (88.2%), fall within the expected range. Conversely, Saudi Arabia reports a notably lower 5-year survival rate, standing at 72%. This disparity in survival rates underscores the need for further research directed toward elucidating risk factors and barriers that hinder early detection and screening. Additionally, there is a pressing need for expanded data reporting on survival outcomes within the GCC. In sum, a more comprehensive and nuanced understanding of breast cancer dynamics in this region is imperative to inform effective strategies for prevention, early detection, and improved patient outcomes.

A prognostic nomogram and risk classification system of elderly patients with extraosseous plasmacytoma: a SEER database analysis.

The survival trends and prognostic factors of patients with extraosseous plasmacytoma (EOP) or extramedullary plasmacytoma (EMP) have not been reported in recent years. The objective of this study was to develop a novel nomogram and risk stratification system for predicting the overall survival (OS) of elderly patients with EOP based on the Surveillance, Epidemiology, and End Results (SEER) database. The demographic characteristics of 900 patients aged 60years and above, diagnosed with EOP between 2000 and 2019, were extracted from the SEER database. The patient population was randomly divided into a training cohort and an internal validation cohort in a ratio of 7:3. Univariate and multivariate Cox regression analyses were conducted to identify independent predictors of prognosis in elderly EOP patients, followed by developing a nomogram for prognostic assessment. The performance of the model was evaluated through receiver-operating characteristic (ROC) curves, C-index, calibration curves for calibration accuracy assessment, and decision curve analysis (DCA) to assess its clinical utility. All elderly EOP patients were stratified into three risk subgroups by cutoff value utilizing X-tile software based on their total OS scores for comparative analysis purposes. Kaplan-Meier (K-M) survival curve analysis was employed to validate any observed differences in OS among these three risk groups. Six factors including age, year of diagnosis, marital status, primary site, surgery, and prior tumor history were identified to be independently predictive of the OS of elderly patients with EOP, and these predictors were included in the construction of the nomogram. The 1-, 3-, and 5-year area under the curves (AUCs) for OS were 0.717, 0.754, and 0.734 in the training cohort and 0.740, 0.730, and 0.765 in the validation cohort, respectively. The C-index values in the two cohorts were 0.695 and 0.690. The calibration curves and DCA exhibit commendable consistency and validity, respectively, thereby demonstrating their robust performance. The training set was stratified into low-, medium-, and high-risk subgroups based on the optimal cutoff points (167.8 and 264.8) identified. The K-M curve and cumulative risk curve exhibited statistically significant disparities in survival rates among the groups. We developed a nomogram and risk classification system, which can serve as an intuitive and effective tool for clinicians to enhance the prediction of OS in elderly EOP patients, thereby facilitating the formulation of more rational and personalized treatment strategies.

Exploring international differences in ovarian cancer care: a survey report on global patterns of care, current practices, and barriers

ObjectiveAlthough global disparities in survival rates for patients with ovarian cancer have been described, variation in care has not been assessed globally. This study aimed to evaluate global ovarian cancer...

Association of ethnicity with overall survival in patients with T-cell acute lymphoblastic leukemia/lymphoblastic lymphoma

e18557 Background: T-cell acute lymphoblastic leukemia/lymphoblastic lymphoma (T-ALL/T-LBL) is a rare and aggressive form of malignancy of immature T-Cells. Despite advancements in treatment, disparities in survival rates among different racial/ethnic groups have been reported. While there is some data available comparing survival outcomes in children with ALL based on ethnicity, there is limited data on comparison of survival outcomes in patients specifically with T-ALL. Here we compared the survival outcomes of T-ALL patients from a minority rich cohort including both children and adults. Methods: This is a single center observational retrospective study analyzing T-ALL patients from 2004-2022 who were followed up at our center. We collected and analyzed data on demographics, race, immunophenotype, treatment regimens, and survival outcomes. Race (used here interchangeably with ethnicity) was categorized as Hispanic, Black, White and other races. Immunophenotype was classified as Pro-TALL, Pre-TALL, Cortical TALL, Medullary TALL and Early T cell precursor-ALL. Univariate and multivariate Cox regression models were used for analysis. Overall survival (OS) was compared using the Kaplan-Meier curve and log-rank test. P-values &lt; / = 0.05 were considered as statistically significant. All analyses were done using R statistical software. Results: We included 59 patients with T-ALL (78% males and 22% females) for analysis. The median age at diagnosis was 20 years (range 1-48 years). Thirty two percent were Black, 29% Hispanic, 17% White and 14% were of other races (8%-not reported). Median follow up duration was 30 months. We compared OS based on sex, race, and immunophenotype. Univariate analysis showed significant difference in OS only for race (p value 0.006). Hispanic patients had the worse outcomes with lower OS compared to White (p = 0.02), and other ethnicities (p = 0.04). The difference was still significant (p = 0.016 and 0.01 respectively) after correction for age using multivariate analysis (age groups: &lt; 15 and = / &gt; 15 years; 15 years being the median age for Hispanic population). There was no difference in OS between remaining races. Median overall survival was not reached in any group. Conclusions: Although sample size is small, our study showed that the OS in Hispanics was lower than in White and other races in a minority rich population including adults and children with T-ALL. Whether this difference is due to systemic barriers in accessing care and/or due to inherent characteristics affecting disease severity/response to treatment remains to be explored. Interestingly, we didn’t find any difference in survival outcomes for black race and for different immunophenotypes. This study adds to the literature demonstrating disparities in survival among different racial groups with T-ALL and the need to address these disparities through targeted interventions.

Healthcare access dimensions and uterine cancer survival: A National Cancer Database study.

5594 Background: Racial disparities persist throughout the continuum of care for Black patients with uterine cancer. Few studies have evaluated how multiple dimensions of healthcare access (HCA) contribute to these disparities in patients who present at an advanced stage and meet criteria for adjuvant therapy. Methods: Patients with Stage III-IV uterine cancer between 2004-2015 who received adjuvant therapy with complete sociodemographic and other relevant covariate data were identified in the National Cancer Database (NCDB). Race and ethnicity were defined as non-Hispanic (NH)-Black, Hispanic, and NH-White. Healthcare access dimensions of affordability, availability and accessibility were measured using variables defined in the NCDB. Overall survival was analyzed using Kaplan-Meier curves, log-rank test, and multivariable Cox proportional hazard models. Results: The study cohort included 43,134 patients: 78.8% NH-White, 15.3% NH-Black, and 5.9% Hispanic. Compared to NH-White and Hispanic patients, NH-Black patients were more likely to have Type II (75.6% vs. 53.9% and 55.4%) and Stage IV disease (40.8% vs. 30.7% and 32.3%). NH-Black patients were more likely to receive chemotherapy alone (53.5% vs. 43.1% and 46.2%) compared to NH-White and Hispanic patients. NH-Black patients were the most likely to have government funded insurance (58.6% vs. 50.3% and 50.4%) and live in the lowest income quartile (46.4% vs. 14.2% and 29.9%) compared to NH-White and Hispanic patients. NH-Black patients had a significantly higher risk of death than NH-White patients when adjusting for demographic/clinical characteristics and all three healthcare access dimensions (HR 1.29; 95% CI 1.24, 1.34). Conclusions: Healthcare access affordability predicts survival but does not fully explain racial disparities in survival rates of patients with advanced stage uterine cancer. NH-Black patients are more likely to have aggressive disease, receive chemotherapy alone, and have worse survival than NH-White patients regardless of pathogenic subtype. Investigating additional healthcare access dimensions may be critical to addressing disparities in uterine cancer.

The Landmark Series-Addressing Disparities in Breast Cancer Screening: New Recommendations for Black Women.

Randomized, clinical trials have established the efficacy of screening mammography in improving survival from breast cancer for women through detection of early, asymptomatic disease. However, disparities in survival rates between black women and women from other racial and ethnic groups following breast cancer diagnosis persist. Various professional groups have different, somewhat conflicting, guidelines with regards to recommended age for commencing screening as well as recommended frequency of screening exams, but the trials upon which these recommendations are based were not specifically designed to examine benefit among black women. Furthermore, these recommendations do not appear to incorporate the unique epidemiological circumstances of breast cancer among black women, including higher rates of diagnosis before age 40 years and greater likelihood of advanced stage at diagnosis, into their formulation. In this review, we examined the epidemiologic and socioeconomic factors that are associated with breast cancer among black women and assess the implications of these factors for screening in this population. Specifically, we recommend that by no later than age 25 years, all black women should undergo baseline assessment for future risk of breast cancer utilizing a model that incorporates race (e.g., Breast Cancer Risk Assessment Tool [BCRAT], formerly the Gail model) and that this assessment should be conducted by a breast specialist or a healthcare provider (e.g., primary care physician or gynecologist) who is trained to assess breast cancer risk and is aware of the increased risks of early (i.e., premenopausal) and biologically aggressive (e.g., late-stage, triple-negative) breast cancer among black women.

International Society of Paediatric Surgical Oncology (IPSO) Surgical Practice Guidelines.

Most children with tumors will require one or more surgical interventions as part of the care and treatment, including making a diagnosis, obtaining adequate venous access, performing a surgical resection for solid tumors (with staging and reconstruction), performing procedures for cancer prevention and its late effects, and managing complications of treatment; all with the goal of improving survival and quality of life. It is important for surgeons to adhere to sound pediatric surgical oncology principles, as they are closely associated with improved local control and survival. Unfortunately, there is a significant disparity in survival rates in low and middle income countries, when compared to those from high income countries.The International Society of Paediatric Surgical Oncology (IPSO) is the leading organization that deals with pediatric surgical oncology worldwide. This organization allows experts in the field from around the globe to gather and address the surgical needs of children with cancer. IPSO has been invited to contribute surgical guidance as part of the World Health Organization Initiative for Childhood Cancer. One of our goals is to provide surgical guidance for different scenarios, including those experienced in High- (HICs) and Low- and Middle-Income Countries (LMICs). With this in mind, the following guidelines have been developed by authors from both HICs and LMICs. These have been further validated by experts with the aim of providing evidence-based information for surgeons who care for children with cancer.We hope that this initiative will benefit children worldwide in the best way possible.Simone Abib, IPSO PresidentJustin T Gerstle, IPSO Education Committee ChairChan Hon Chui, IPSO Secretary

Global pattern and trends of colorectal cancer survival: a systematic review of population-based registration data.

This review will describe the global patterns and trends of colorectal cancer survival, using data from the population-based studies or cancer registration. We performed a systematic search of China National Knowledge Infrastructure (CNKI), Wanfang Data, PubMed, Web of Science, EMBASE, and SEER and collected all population-based survival studies of colorectal cancer (up to June 2020). Estimates of observed and relative survival rates of colorectal cancer by sex, period, and country were extracted from original studies to describe the temporal patterns and trends from the late 1990s to the early 21st century. Globally, 5-year observed survival rates were higher in Seoul, Republic of Korea (1993–1997; 56.8% and 54.3% for colon and rectum cancers, respectively), Zhejiang province (2005–2010; 52.9% for colon cancer), Tianjin (1991–1999; 52.5% for colon cancer), Shanghai (2002–2006; 50.0% for rectum cancer) of China, and in Japan (1993–1996, 59.6% for colorectal cancer). Five-year relative survival rates of colorectal cancer in the Republic of Korea (2010–2014), Queensland, Australia (2005–2012), and the USA (2005–2009) ranked at relatively higher positions compared to other countries. In general, colorectal cancer survival rates are improving over time worldwide. Sex disparities in survival rates were also observed in the colon, rectum, and colorectal cancers in most countries or regions. The poorest age-specific 5-year relative survival rate was observed in patients > 75 years of age. In conclusion, over the past 3 decades, colorectal cancer survival has gradually improved. Geographic variations, sex differences, and age gradients were also observed globally in colorectal cancer survival. Further studies are therefore warranted to investigate the prognostic factors of colorectal cancer.

Perspective: Creating the Evidence Base for Nutritional Support in Childhood Cancer in Low- and Middle-Income Countries: Priorities for Body Composition Research

ABSTRACTThere is a striking disparity in survival rates for children in low- and middle-income countries (LMICs) compared with high-income countries (HICs). Many of the contributing factors are preventable, including the comorbidity of malnutrition. There are emerging data that malnutrition, as reflected in body composition changes, impacts survival of cancer. However, not enough priority is given to nutrition management of children with cancer, particularly in LMICs. The primary purpose of this article is to review the current knowledge on childhood cancer and body composition in LMICs and identify priorities for future research into the interlinking associations between cancer, body composition, and clinical outcomes for childhood cancer patients. Evidence will ensure feasible and effective nutrition management is prioritized in childhood cancer centers in LMICs and contribute to improving outcomes for children with cancer.

Impact of Insurance Status on Survival Outcomes in Adults with Acute Lymphoblastic Leukemia (ALL): A Single Center Experience

INTRODUCTION Five year survival for adults diagnosed with Acute Lymphoblastic Leukemia (ALL) is approximately 30-40% and decreases with older age at diagnosis. Although survival rates have improved over the last few decades, identifying risk factors for worse survival remains critical to improving outcomes. Previous studies in Acute Myeloblastic Leukemia (AML) and ALL have demonstrated disparities in survival rates based on race, ethnicity and poverty level. Lack of health insurance may also negatively impact survival in acute leukemias by impeding access to therapy and delaying treatment initiation. These issues are particularly problematic for hematologic malignancies where the costs of multidrug chemotherapy, prophylactic drugs and allogeneic stem cell transplant (ASCT) are significant. Our study investigates survival outcomes in uninsured vs. insured adult patients with ALL at a single comprehensive cancer center. METHODS This study was an IRB-approved retrospective chart review of patients diagnosed with B-lineage ALL between January 1, 2007 and October 31, 2017 and treated on the adult leukemia service at our institution. Charts were reviewed for demographic, diagnostic, cytogenetic and molecular data, as well as treatment history and response. A total of 136 patients were included and follow up extended through January 19, 2018. Insurance status was determined at time of diagnosis and defined as any insurance (including public) versus no insurance. Differences between the two groups were assessed using chi-square tests. Cox proportional hazard regression methods were used for univariate and multivariate analyses for overall survival (OS) and progression-free survival (PFS). RESULTS A total of 136 patients were included, 29 without insurance at time of diagnosis and 107 with insurance. Of the patients without insurance, 6.9% were ≥60 years old at time of diagnosis compared to 45.8% of the patients with insurance (p=0.0001). Patients without insurance were also more likely to be Hispanic or Latino compared to patients with insurance (72.4% vs 10.3%, p= &lt;0.0001). There was no statistically significant difference in baseline white count (≥30,000 or &lt;30,000 x 109/L), Philadelphia chromosome status, receipt of ASCT or achievement of complete remission (CR) between the 2 groups. In univariate analyses, insurance status was not associated with OS or PFS. Only achievement of CR was associated with better OS and PFS. In multivariate analyses, achievement of CR and Hispanic or Latino ethnicity were associated with better OS and PFS. However, insurance status also became a statistically significant factor associated with better PFS. CONCLUSIONS In this study, we found no significant difference in OS between ALL patients based on insurance status. However, when controlling for other variables, lack of health insurance was associated with worse PFS. These results suggest that uninsured patients may be at a disadvantage in terms of their leukemia outcomes. Patients with health insurance may have fewer obstacles to timely, effective therapy, which decreases their chance of relapse. Our finding that Hispanic or Latino patients had better OS and PFS was surprising and may be explained by the generally younger age of these patients in our population. Further research is needed to investigate how lack of insurance specifically affects leukemia management and patient outcomes. Disclosures Bannerji: Regeneron Pharmaceuticals, Inc.: Consultancy, Other: travel support, Research Funding; AbbVie, Inc: Consultancy, travel support; Celgene: Consultancy; Pharmacyclics: Other: travel support; Pharmacyclics: Other: travel support; Gilead: Other: travel support; Gilead: Other: travel support; AbbVie, Inc: Consultancy; Merck: Other: travel support, Patents &amp; Royalties: IP rights; Regeneron Pharmaceuticals, Inc.: Consultancy, Other: travel support, Research Funding; Celgene: Consultancy; Merck: Other: travel support, Patents &amp; Royalties: IP rights.

309 Changing Characteristics and Survival in Early Onset Colorectal Cancer in an Asian American County Population From 1990 to 2016

INTRODUCTION: The incidence of early onset colorectal cancer has been rising, but we have limited understanding of this pattern. Some groups have noticed racial disparities in survival rates, but we still have little data on ethnic differences. We sought to analyze the characteristics of early onset colorectal cancer in a county population and discovered changes in staging and survival in the Asian subgroup over time. METHODS: We performed a retrospective study involving all patients less than 50 years old that were newly diagnosed with colorectal cancer at a county hospital. We collected data from the hospital’s electronic medical system and existing databases from 1991 to 2016, and analyzed the demographics, staging, survival and follow up rates for patients of Asian descent. We divided the time frame into 2 equal periods (1991-2003 and 2004-2016) and performed chi-square analysis to assess for changes in colorectal cancer diagnoses between these two groups. RESULTS: A total of 182 patients under the age of 50 years old were diagnosed with colorectal cancer during this 26 year period. 69 patients were diagnosed from 1991-2003, of which 17 were of Asian descent. 113 patients were diagnosed from 2004-2016, of which 36 were of Asian descent. Among the Asian population, there was 1 case of Stage 2 (6%), and 16 cases of Stage III and IV (94%) in 1991-2003. Meanwhile, there were 15 cases of Stage 1 and 2 (42%), and 21 cases of Stage 3 and 4 (58%) in 2004-2016. Chi-square analysis of early (Stage 1 and 2) vs late (Stage 3 and 4) staging revealed a significantly higher proportion of early stage colorectal cancer in 2004-2016 compared to 1991-2003 (P-val 0.02). This coincides with a significantly higher 3 year-survival and follow up in 2004-2016 than in 1991-2003 (58% vs 24%, P-val 0.038). There were no significant differences in staging or survival for the non-asian population between these time periods. CONCLUSION: Our findings support that there is a rising incidence of early onset colorectal cancer in general, and within the Asian population. Interestingly, there is an increasing proportion of early stage colon cancer associated with a higher 3-year survival rate in the Asian population that was not found in other ethnicities. While our study is limited to one county population, our findings show the rising incidence is associated with ethnic disparities. Additional investigation into these disparities may help shed light on the driving factors behind the increasing incidence of early colon cancer.

Skin cancer awareness and sunscreen use among outpatients of a South African hospital: need for vigorous public education

Background: Melanoma incidence among white South Africans is increasing. Among black individuals, melanoma is associated with advanced stage at presentation and significant mortality.Objectives: A study was undertaken to assess the perception of skin cancer risk, knowledge of skin cancer, and understanding of the importance and use of sunscreens among South Africans.Methods: A cross-sectional survey was conducted in general outpatients over four months at a large central hospital in Durban, South Africa.Results: Only half the white respondents reported regular use of a sunscreen. Among black and Indian respondents, the number was substantially lower. Less than 20% of white respondents had ever checked their skin for suspicious moles. Most black patients were not aware that they are at risk of skin cancer, and only 10% were aware of the risk of developing skin cancers on acral sites and nails.Conclusions: There is a worrying lack of knowledge about skin cancer and sun protection behaviours among all South Africans. Given the increase in melanoma incidence and racial disparities in survival rates, it is imperative to target each population with effective, culturally sensitive educational programmes.