Florida Cancer Data System Research Articles

Health-related quality of life in Black breast cancer survivors with and without triple-negative breast cancer (TNBC).

Black women are more likely to develop early-onset (≤50years) breast cancer (BC) and have the lowest five-year, cause-specific survival rate of any United States (U.S.) racial or ethnic group. These disparities can be attributed partially to the higher rate of triple-negative BC (TNBC) in Blacks. Yet, little is known about health-related quality of life (HRQOL) among Black women with TNBC. Black women with invasive BC≤50years were recruited via the Florida Cancer Data System as part of a population-based case-only study of etiology and outcomes of early-onset invasive BC. Of 460 consented participants, a subset of 355 self-reported sociodemographic, clinical, and psychosocial variables. Descriptive analyses included participants with known TNBC (n=85) or non-TNBC (n=245) disease. Univariable and multivariable analyses were conducted to examine differences in factors associated with HRQOL. In unadjusted analyses, TNBC participants had significantly lower FACT-B total scores (90.1±27.9) compared to non-TNBC (98.5±27.6) participants (p<0.05). For the TNBC group, multivariable analyses indicated five individual-level, and three systemic-level factors explain 80% of the response variation in HRQOL. For the non-TNBC group, seven individual-level factors and three systemic-level factors account for 76% of the variation in HRQOL scores. Compared to Black women with non-TNBC, TNBC women have worse HRQOL. There are key individual and systemic-level factors that are unique to both groups. Findings can inform future HRQOL interventions to support young Black BC survivors.

Abstract A01: Socioeconomic and Survival Differences among Minorities With Hepatocellular Carcinoma in Florida

Abstract Purpose: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality with racial disparities in survival after its diagnosis. It has been suggested that racial disparities in survival reflect socioeconomic disparities. We aimed to determine associations between race, socioeconomic characteristics and survival in patients with HCC in Florida. Methods: We identified HCC cases diagnosed between 1/1/2004 - 12/31/2013 in the Florida Cancer Data System (FCDS). We linked FCDS to the 2010-2014 US Census American Community Survey by census tract and the 2013 Florida Behavioral Risk Factor Surveillance System by county to ascertain population-level characteristics. We performed univariate, bivariate and Cox proportional hazards regression analyses to describe the association between race and survival. Results: Of 10,852 patients with HCC, 77.4% were men, 13.4% were Black, 67.1% non-Hispanic White, 15.7% Hispanic, 3.2% Asian and &amp;lt;1% other. Blacks were younger at presentation, with a median age of 59 years compared to 64 years in Hispanics and 63 years in all other races, p&amp;lt;0.01. Median size of the largest tumor was greatest in Asians, 6.0 cm, followed by 5.4 cm in Blacks, 4.8 cm in Hispanics and 4.7 cm in Whites, p&amp;lt;0.01. Blacks were most likely to have distant disease, 18.1%, compared to 14.3% of Whites, 14.9% of Hispanics, 15.9% of Asians, and 10.4% of others, p&amp;lt;0.01. Only 16.3% of Blacks had surgery or radiofrequency ablation compared to 25.4% of Asians, 24.8% of Hispanics and 21.7% of Whites, p &amp;lt;0.01. Transplant was performed in 9.7% of Hispanics, 8% of Whites, 6.9% of Asians and 4.6% of Blacks, p&amp;lt;0.01. One-year survival was 45.6% in Blacks, 52.1% in Whites, 55.4% in Hispanics, 58.1% in Asians, and 57.3% in others, p&amp;lt;0.01. Five-year survival was 31.7% in Blacks, 36.5% in Whites, 36.9% in Hispanics 46.2% in Asians, and 51% in other, p&amp;lt;0.01.Median survival was 208 days in Hispanics, 171 days in Whites, 158 days in Asians and 136 days in Blacks, p&amp;lt;0.01. When adjusted for gender, age at diagnosis, payer, tumor size, stage, and surgical treatment, Hispanics had 16% reduced rate of death (hazard ratio (HR) 0.84, 95% confidence interval (CI) 0.77-0.92, p&amp;lt;0.01) and Whites had 7% reduced rate of death (HR 0.93, 95% CI 0.86-0.99, p 0.03) compared to Blacks. Hispanics had 9% adjusted reduced rate of death (HR 0. 91, 95% CI 0.85-0.97, p&amp;lt;0.01) compared to Whites. In our sample, Blacks and Asians were more frequently uninsured, 11.6%, compared to 8.1% of Hispanics and 6.3% of Whites, p&amp;lt;0.01. There were significant racial differences in population characteristics. For example, the census tracts where Hispanics live have the highest uninsured population and the highest percentage of participation in the supplemental nutrition assistance and/or food stamps program, compared to all other races, p &amp;lt;0.01. Also, Hispanics lived in census tracts where more families reported income below the federal poverty level and had lower mean household income, compared to Blacks, p&amp;lt;0.01 In regards to community health, in the counties where Blacks live, a higher percentage of adults have been diagnosed with diabetes, elevated cholesterol, cardiovascular disease and are obese than in the counties where Hispanic patients live, p&amp;lt;0.01. However, in the counties where Hispanics live, a higher percentage of adults have been told they are overweight, compared to Blacks, Whites or Others, p&amp;lt;0.01. In counties where Blacks lived, more adults reported having a colonoscopy, but fewer adults reported having a mammogram, compared to counties where Hispanic patients resided, p&amp;lt;0.01. Conclusions: Access to care and socioeconomic differences may help explain survival differences in some settings; however, despite living in areas with similar or worse socioeconomic features, Hispanics with HCC survive longer than Blacks and Whites in Florida. Although access to transplant may inform these findings, additional contributors must be identified. Citation Format: Patricia D. Jones, Valery Muenyi, Joselin Gonzalez-Diaz, Paul Martin, Erin Kobetz. Socioeconomic and Survival Differences among Minorities With Hepatocellular Carcinoma in Florida. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A01.

Patterns of treatment and outcomes in elderly patients with non-metastatic, unresected gastric adenocarcinoma: A review of the Florida cancer data system.

146 Background: Concurrent chemoradiation is considered definitive treatment for unresected, localized gastric adenocarcinoma, but utilization in the elderly is complicated by increased toxicity risk and limited life expectancy. The benefit of concurrent chemoradiation in this population over non-definitive therapy is not well characterized. Methods: The Florida Cancer Data System was queried for patients ≥ 60 years old diagnosed with non-metastatic gastric adenocarcinoma between 2004 and 2010 who did not undergo primary surgery. Logistic regression was performed to evaluate variables independently associated with treatment and mortality hazard was evaluated using Cox-proportional modeling. The primary aim was to compare overall survival between groups. Results: A total of 1,729 patients were identified with a median and maximum age of 79 and 101 years respectively. The majority received no therapy (68.4%) followed by concurrent chemoradiation (12.0%), chemotherapy alone (10.5%), radiation alone (5.0%), and sequential chemoradiation (4.2%). Median survival with no treatment was 3.7 months (95% CI: 3.3-4.1) and no difference was seen with radiation alone (MS 5.4 months, p = 0.85). However, improved survival was seen with chemotherapy alone (9.1 months), and concurrent (10.5 months) and sequential (12.5 months) chemoradiation, all p &lt; 0.001 compared to no therapy. Despite a modest survival benefit with sequential chemoradiation compared to chemotherapy alone (p = 0.046), this was not seen with concurrent chemoradiation (p = 0.215) or between concurrent and sequential chemoradiation (p = 0.266). On multivariate analysis, age ≥ 80 (OR 0.41, p &lt; 0.001) and African-America race (OR 0.45, p = 0.004) were independently associated with no treatment compared to receiving any chemotherapy. Conclusions: Chemotherapy may improve survival over those not receiving systemic therapy, and the addition of radiation does not appear to provide any added benefit over chemotherapy alone. Advanced age and African-American race are strong predictors against chemotherapy use, however additional factors not accounted for such as performance status may contribute.

Racial Disparity in Localized Prostate Cancer Mortality

This study aims to examine racial differences in all-cause mortality between African American (AA) and non-African American localized prostate cancer patients. This study advances academic discussion by being among the first to use a sample more representative of the general population that is different from certain subpopulations examined in literature. This study adopted a retrospective cohort study design using the Florida Cancer Data System. The hierarchical logistic regression was employed to analyze mortality in 2004 among living patients with localized prostate cancer from baseline 2000. Among 9617 patients, the odds of mortality in AAs were 57.6% higher than the non-AAs (Adjusted OR = 1.576, 95% CI: 1.243–1.999). Among prostate cancer patients, AA, older age, unmarried status, conservative treatment, Medicaid, and tumor grade III diagnosis predicted higher mortality relative to the reference group. Screening programs at a younger age can be considered, family and community support and aggressive treatments are suggested to prevent AA against adverse health outcomes.

Mutational Frequency in Hispanic Vs. Non-Hispanic Patients with Acute Myeloid Leukemia (AML)

Introduction: There is a paucity of data on the distribution of acute leukemia (AL) across ethnic groups. Historically, B-cell acute lymphoblastic leukemia (B-ALL) and acutepromyelocytic leukemia (APL) are over-represented in Hispanic patients, while acute myeloid leukemia (AML) is less frequent. We analyzed the ethnic distribution of AL in Florida based on incidence rates and nativity differences using Florida Cancer Data System (FCDS). In our study, B-ALL and APL were more common in Hispanics vs. non-Hispanics (IRR of 1.627 and 1.302, respectively); however, contrary to prior reports, AML was also more common (IRR 1.533) (Swords et al, BCJ 2016, in press). No nativity differences were observed. Given this novel finding of increased AML incidence in Hispanics in South Florida, we examined AML patients at Sylvester Comprehensive Cancer Center (SCCC) to look for ethnic differences in mutational frequency.Methods: We obtained molecular genetic data on AML patients treated from 2012-2015 across multiple centers.Genomic DNA from bone marrow or peripheral blood was sequenced for ASXL1, DNMT3A, FLT3 TKD, IDH1, IDH2, KIT, NPM1, PHF6, TET2 on the IlluminaMiSeq platform using a lower limit of detection of 5% and minimum coverage of 500X. Alignment and variant calling were performed usingNextGENe® software as previously described byGenoptix, Inc. MLL PTD, FLT3 ITD and CEBPA mutations were detected by PCR amplification followed by fragment analysis.For patients treated at SCCC, we obtained IRB approval to conduct retrospective chart reviews for clinical and pathologic data. Categorical data was analyzed by Fisher exact test or Chi-square test as appropriate. Continuous data was analyzed by independent t-test and Wilcoxon-Mann Whitney test for parametric and non-parametric data, respectively. Statistical analysis was performed using Stata (version 13.0).Circos plots were created usingCircos.Results: We examined the 11-gene mutational profile of 927 unique AML patients. The frequency of these mutations was consistent with previous reports (Park et al, NEJM 2012). DNMT3A, NPM1, and FLT3 were the most common abnormalities (Figure 1A). 75 of these 927 patients were treated at our center. Of these, median age was 60.2 years; 53.3% were female; 80% were white, 13.3% black,6.7% other. 68% (n=51) self-identified as non-Hispanic and 32% (n=24) as Hispanic (Table 1). Median WBC was 3.95 K/µL (1.4-100.7); 37% had antecedent MDS or MDS-related changes; 8% had favorable-, 69% intermediate-, and 23% poor-risk cytogenetics. There were no differences in WBC, MDS, or cytogenetic risk by ethnicity. In the 75 patient SCCC cohort, TET2 (n=14, 18.7%), CEBPA (n=14, 21.9%), and DNMT3A (n=11, 14.7%) were the most common mutations. 16 patients had an IDH mutation (10 IDH1 and 6 IDH2). We found no statistically significant difference in mutation frequency in Hispanic vs. non-Hispanic patients (Figure 1B); however, there was a non-significant increase in MLL-PTD mutations in Hispanic patients (15.8% vs. 9.3%, p=0.665) and IDH1 mutations in non-Hispanics (11.8% vs. 0%, p=0.168).Conclusions: We present one of the largest examinations to date (n=927 patients) of mutational frequency in AML. Our findings corroborate prior literature; however, we did note the rare co-occurrence of TET2 and IDH mutations-showing the 2 are not always mutually exclusive. We examined demographic data on a subset of these patients treated at SCCC, where we have a large Hispanic population, and assessed for ethnic differences in mutational frequency. We found a suggestion of increased MLL PTD mutations, a poor-risk abnormality, in Hispanic patients, and increased IDH1 mutations in non-Hispanics, but found no significant differences. This may be due to our relatively small sample size. We are now examining the full 927 patient cohort for demographic data and updated results will be presented. If certain AML mutations cluster by ethnicity, this might explain differing incidence rates and outcomes in Hispanics, and examination of predisposing heritable or environmental factors should be pursued.Table 1. Distribution of mutations in an 11-gene AML molecular profile by ethnicity in 75 patients with AML.Figure 1.Circosplots characterizing the distribution of concomitant mutations in 927 patients with AML (A); and the incidence of mutations by ethnicity in 75 patients with AML (B). [Display omitted] [Display omitted] [Display omitted] DisclosuresVaupel:Genoptix, a Novartis Company: Employment. Hall:Genoptix, a Novartis Company: Employment.

PD10-11 COMPARISON OF SURVIVAL OUTCOMES FOR AFRICAN-AMERICAN AND CAUCASIAN MEN WITH ADVANCED PENILE CANCER IN FLORIDA

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality Improvement & Patient Safety III1 Apr 2016PD10-11 COMPARISON OF SURVIVAL OUTCOMES FOR AFRICAN-AMERICAN AND CAUCASIAN MEN WITH ADVANCED PENILE CANCER IN FLORIDA Chad R. Ritch, Nicola Pavan, Samarpit Ray, Nachiketh Soodana-Prakash, Raymond R. Balise, Dipen J. Parekh, and Mark L. Gonzalgo Chad R. RitchChad R. Ritch More articles by this author , Nicola PavanNicola Pavan More articles by this author , Samarpit RaySamarpit Ray More articles by this author , Nachiketh Soodana-PrakashNachiketh Soodana-Prakash More articles by this author , Raymond R. BaliseRaymond R. Balise More articles by this author , Dipen J. ParekhDipen J. Parekh More articles by this author , and Mark L. GonzalgoMark L. Gonzalgo More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2919AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Studies suggest that there may be disparity in clinical outcomes for African American men (AAM) compared to Caucasian men (CM) with penile squamous cell carcinoma (SCC). We sought to determine whether there was a survival difference for African American versus Caucasian men, particularly in locally advanced and metastatic cases of penile SCC where disease mortality is highest. METHODS Using the Florida Cancer Data System, we identified men diagnosed with penile SCC, from 2004 to 2014. We excluded men who were diagnosed on autopsy or at the time of death and with < 6 months of follow up. Demographic variables including: age, follow up, stage, race and treatment type were compared between AAM and CM. Treatment type was categorized as surgery alone or surgery plus additional therapy (chemotherapy and/or radiation). For locally advanced and metastatic disease, we compared treatment type and overall survival (OS) between AAM and CM. A multivariable model was developed to determine significant predictors of OS. RESULTS Of the 653 men with penile SCC, 198 [38 (19%) AAM and 160 (81%) CM] had locally advanced and/or metastatic disease. Median follow up for the entire cohort was 12.5 mos. For all stages, AAM demonstrated a significantly decreased median OS compared to CM (26 vs. 37 mos, p=0.03). For locally advanced and metastatic disease, there was a persistent, but non-significant, trend toward disparity in median OS between AAM and CM (17 vs. 23 mos, p=0.06). Fewer AAM compared to CM received surgery plus additional therapy for locally advanced and/or metastatic disease [8 (21%) vs. 42 (26%)], but this difference was not statistically significant. After adjusting for age, stage, and treatment type, AAM had increased likelihood of death from penile SCC (HR 1.63, p=0.015). CONCLUSIONS Mortality rates from penile SCC remain high in contemporary series. For AAM in Florida, advanced stage at presentation, along with treatment disparity, may partially explain decreased survival rates. Further studies are needed to determine the additional socioeconomic, as well as potential biologic, factors that may predict the relatively poor outcome observed in AA men with penile SCC. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e243-e244 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Chad R. Ritch More articles by this author Nicola Pavan More articles by this author Samarpit Ray More articles by this author Nachiketh Soodana-Prakash More articles by this author Raymond R. Balise More articles by this author Dipen J. Parekh More articles by this author Mark L. Gonzalgo More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Abstract A40: Untangling the ethnic differences among black men relative to prostate cancer burden: The Florida CaPCaS study

Abstract Background and Objective: Without a doubt, foreign-born Blacks continue to transform the ethnic composition of the Black population in the US. Unfortunately, native-born and foreign-born Blacks are often grouped together in health disparities research. This practice limits our ability to effectively address health disparities, especially with respect to prostate cancer (CaP). One of the goals of the Florida Prostate Cancer Disparity group is to untangle the ethnic differences in CaP disparities. As part of a large-scale study to develop a model of CaP care and survivorship (CaPCaS model) for Black men (BM), the primary objective of this study is to explore the ethnic differences in CaP incidence/morbidity among BM. Research Strategy: The study population is Florida BM diagnosed with CaP in 2010. Our primary objective is to estimate the ethnic differences in the incidence of CaP among Native-born BM (NBBM), Caribbean-born BM (CBBM) and African-born BM (ABBM). Following appropriate Human Subjects approvals, participants (only BM) were identified through the Florida Cancer Data System (FCDS). The FCDS has collected the number of new cancer cancers diagnosed in the state of Florida annually since 1981. Since the country of birth is not collected as part of cancer registry data, the primary strategy was to contact all the men identified through the FCDS database. Using the published standard procedure by FCDS for recruitment, all BM diagnosed with CaP were contacted to participate in the study. Participant recruitment included: (i) initial patient contact mailing with patient response form; (ii) second mailing with telephone opt-out card; and (iii) telephone call. Following the Florida Department of Health standard procedure, we did not disclose that the patient is being contacted for a study specific to cancer on the cover of study mailings. For participants who agreed to participate in the study, structured telephone survey was employed to collect data on their demographics, including ethnicity and country of birth. Trained Community Health Workers who were African Americans conducted the phone survey. An incentive of $5 Walmart card was sent to all participants. Results: The FCDS provided a database of 1,813 participants identified as BM diagnosed with CaP in 2010 (most recent completed database). The FCDS does not extract data on patients with a death certificate, thus quite a number of the men were reported to be deceased. In addition, there were bad addresses. A total of 212 completed responses were obtained by phone. Majority of the participants were between 60 and 69 years (48.2%), had only high school diploma (26.1%), and currently married (65.3%). Relative to ethnicity, 67% of participants classified themselves as African-American of American origin (born and grew up in America), 20% as African-American of Caribbean origin (born in one of the Caribbean Islands but now American), 4% as Caribbean, 3.5% as African-American of African origin (born in Africa but now American), 0% as African, and 5.5% as Other/Don't know/Refused. For the CBBM, the most common country of birth are Jamaica, Haiti and Guyana, respectively. For Africa, the most common country of birth is Nigeria. Conclusion: This study explored the ethnic differences among BM relative to CaP diagnosis in Florida. The findings suggest that the burden of CaP may be lowest among African-born BM compared to CBBM and NBBM. This conclusion is similar to our previously published review of the global burden of CaP in BM. Given the fact that Black populations of African ancestry share ancestral genetic factors that increase their susceptibility to CaP, the question of exogenous factors in the origin, cause, recurrence and survivorship of CaP among Blacks need to be further explored, especially through migration and global studies. Another implication of this study is the importance of studying CaP in US immigrants, especially immigrants from Jamaica, Haiti and Nigeria. Citation Format: Folakemi Odedina, Mary Ellen Young, Getachew Dagne, Christopher Williams, Deidre Pereira, Lauren Gilbert, Eva Egensteiner, Kenneth Stokes, Christopher Hill, Community Advisory Board CaPCaS. Untangling the ethnic differences among black men relative to prostate cancer burden: The Florida CaPCaS study. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr A40.

Factors Associated With Receipt of Radiation Therapy for Rectal Cancer.

Appropriate treatment for cancer is vital to increasing the likelihood of survival; however, for rectal cancer, there are demonstrated disparities in receipt of treatment by race/ethnicity and socioeconomic status. We evaluated factors associated with receipt of appropriate radiation therapy for rectal cancer using data from the Florida Cancer Data System that had been previously enriched with detailed treatment information collected from a Centers for Disease Control and Prevention Comparative Effectiveness Research study. This treatment information is not routinely available in cancer registry data and represents a unique data resource. Using multivariable regression, we evaluated factors associated with receiving radiation therapy among rectal cancer cases stage II/III. Our sample (n=403) included cases diagnosed in Florida in 2011 who were 18 years and older. Cases clinically staged as 0/I/IV were excluded. Older age (odds ratio=0.96; 95% confidence interval, 0.94-0.97), the presence of one or more comorbidities (0.61; 0.39-0.96), and receipt of surgical intervention (0.44; 0.22-0.90) were associated with lack of radiation. In this cohort of patients, sociodemographic factors such as race/ethnicity, insurance status, and socioeconomic status, did not influence the receipt of radiation. Further research is needed, however, to understand why aging, greater comorbidity, and having surgery present a barrier to radiation therapy, particularly given that it is a well-tolerated treatment in most patients.

Comparison of survival outcomes for African American and Caucasian men with advanced penile cancer in Florida.

490 Background: Studies suggest that there may be disparity in clinical outcomes for African−American men (AAM) compared to Caucasian men (CM) with penile squamous cell carcinoma (SCC). We sought to determine whether there was a survival difference for African American versus Caucasian men, particularly in locally advanced and metastatic cases of penile SCC where disease mortality is highest. Methods: Using the Florida Cancer Data System, we identified men diagnosed with penile SCC, from 2004 to 2014. We excluded men who were diagnosed on autopsy or at the time of death and with &lt; 6 months of follow up. Demographic variables including: age, follow−up, stage, race and treatment type were compared between AAM and CM. Treatment type was categorized as surgery alone or surgery plus additional therapy (chemotherapy and/or radiation). For locally advanced and metastatic disease, we compared treatment type and overall survival (OS) between AAM and CM. A multivariable model was developed to determine significant predictors of OS. Results: Of the 653 men with penile SCC, 198 [38 (19%) AAM and 160 (81%) CM] had locally advanced and/or metastatic disease. Median follow up for the entire cohort was 12.5 mos. For all stages, AAM demonstrated a significantly decreased median OS compared to CM (26 vs. 37 mos, p=0.03). For locally advanced and metastatic disease, there was a persistent, but non−significant, trend toward disparity in median OS between AAM and CM (17 vs. 23 mos, p=0.06). Fewer AAM compared to CM received surgery plus additional therapy for locally advanced and/or metastatic disease [8 (21%) vs. 42 (26%)], but this difference was not statistically significant. After adjusting for age, stage, and treatment type, AAM had increased likelihood of death from penile SCC (HR 1.63, p=0.015). Conclusions: Mortality rates from penile SCC remain high in contemporary series. For AAM in Florida, advanced stage at presentation, along with treatment disparity, may partially explain decreased survival rates. Further studies are needed to determine the additional socioeconomic, as well as potential biologic, factors that may predict the relatively poor outcome observed in AA men with penile SCC.

Effects of Obesity and Smoking on Survival in Non-Small Cell Lung Cancer

Background: Obesity is an emerging leading cause of morbidity and mortality in the US and the relationship between obesity, tobacco, and survival in NSCLC is unclear. Methods: Data (n = 87,631) were obtained from linkage of the 1996-2007 Florida Cancer Data System to the Agency for Health Care Administration database providing procedure and diagnoses codes. Survival time was calculated from date of diagnosis to date of death. Smoking status was categorized as never, current, and former. Obesity (yes/no) = ICD9 code BMI > 30 kg/m2, cachexia = ICD9 code “wasting syndrome”, & non-obese = non-obese & non cachectic. Cox proportional regression models used to predict survival; demographic, clinical, treatment factors, & comorbidities were included in adjusted models with smoking status and obesity as the main factors. Results: The majority of patients (pts) were either former (49%) or current (40%) smokers, & non-obese (88%). 6.8% of pts were obese & 4.8% of pts were cachectic. There were significant differences between survival curves and median survival (months) for obese vs. non-obese vs. cachectic pts. (20 vs 10 vs. 7.9; P < 0.001). Former and current smokers had shorter median survival than never smokers (10.8 & 9.2 vs. 11.9; P < 0.001). Survival rates (%) at 1-yr (60.1 vs. 45.2 vs. 37.7; P < 0.001), 5-yr (30.3 vs. 15.4 vs. 9.5; P < 0.001), 10-yr (18.1 vs. 7.6 vs. 2.7; P < 0.001) were better for obese vs. non-obese and cachectic pts respectively. Independent predictor of worse survival in the unadjusted model was former (HR 1.08; P < 0.001) and current (HR 1.20; P < 0.001) smokers compared to never. Obese and non-obese pts had better survival vs. cachexia pts. (HR 0.52; P < 0.001 and HR 0.80, p < 0.001 respectively) and obese had better survival than Non-obese pts (HR 0.65, p < 0.001). In the adjusted model, controlling for extensive variables and comorbidities, former (HR 1.11; P < 0.001) and current (HR 1.19; P < 0.001) smokers still had significantly worse survival vs. never smokers. Obese patients still had better survival (HR 0.87; P < 0.001, and HR 0.88, p < 0.001) vs. cachexia patients and non-obese respectively, survival rate was not significantly different compare non-obese with cachexia. Conclusions: Our results show that being a former or current smoker worsens survival while obesity improved survival when compared with cachexia patients or Non-obese.

Distance to Radiation Facility and Treatment Choice in Early-Stage Breast Cancer

Breast-conserving therapy (BCT) is a recommended alternative to mastectomy (MT) for early-stage breast cancer. Limited access to radiation therapy (RT) may result in higher rates of MT. We assessed the association between distance to the nearest RT facility and the use of MT, in a modern cohort of women. Women with stage 0-II breast cancer eligible for BCT diagnosed from 2004 to 2010 were identified from the Florida Cancer Data System (FCDS). Distances from patient census tracts to the nearest RT facility census tract were calculated. Multivariate logistic regression was used to identify explanatory variables that influenced MT use. Of the 27,489 eligible women, 32.1% (n=8841) underwent MT, and 67.8% (n=18,648) underwent BCS. Thirty-two percent of patients lived in a census tract that was >5 miles from an RT facility. MT use increased with increasing distance to RT facility (31.1% at ≤5 miles, 33.8% at >5 to <15 miles, 34.9% at 15 to <40 miles, and 51% at ≥40 miles, P<.001). The likelihood was that MT was independently associated with increasing distance to RT facility on multivariate analysis (P<.001). Compared to patients living <5 miles away from an RT facility, patients living 15 to <40 miles away were 1.2 times more likely to be treated with MT (odds ratio [OR]: 1.19, 95% confidence interval [CI]: 1.05-1.35, P<.01), and those living ≥40 miles away were more than twice as likely to be treated with MT (OR: 2.17, 95% CI: 1.48-3.17, P<.001). However, in patients younger than 50years (n=5179), MT use was not associated with distance to RT facility (P=.235). MT use in a modern cohort of women is independently associated with distance to RT facility. However, for young patients, distance to RT is not a significant explanatory variable for MT use.

Racial and Ethnic Disparities in the Pediatric Hodgkin Lymphoma Population.

Little is known about the association between race/ethnicity and survival in pediatric Hodgkin lymphoma (HL) patients. In a state-wide pediatric cohort diagnosed with HL, we assessed demographic, disease, and treatment characteristics associated with overall survival (OS). We then attempted to validate these findings and assess disease-specific survival (DSS) in a national Surveillance, Epidemiology, and End Results (SEER) cohort. HL patients of 0.1-21 years diagnosed from 1981 to 2010 were evaluated using the Florida Cancer Data System (FCDS). Kaplan-Meier curves estimated OS from 5 to 25 years based on race/ethnicity, treatment, decade of diagnosis, and sex. Multivariate Cox proportional hazard regressions tested independent factors associated with differences in OS. These methods were replicated in the SEER with additional assessment of DSS. A total of 1,778 patients were identified in the FCDS and 6,027 in the SEER. Median diagnosis age was 17 years in both cohorts. In the FCDS, Blacks had worse OS than Whites and Hispanics at 25 years (33% vs. 49.2% vs. 44.7%, respectively; P = 0.0005), and Black race was associated with inferior OS on multivariate regression (hazard ratio [HR]: 1.81, P = 0.0003). In the SEER, Blacks had inferior OS (Blacks 74.2% vs. Whites 82% vs. Hispanics 82%; P = 0.0005) and DSS (85.7% vs. 90.8% vs. 88.1%, respectively; P = 0.0002) at 25 years. Hispanic males had inferior DSS compared to White males (84.8% vs. 90.6%; P = 0.0478), and Hispanic race was a predictor for inferior DSS on multivariate analysis (HR: 1.238; P < 0.0001). Racial/ethnic disparities persist in the pediatric HL population despite modern treatment; underlying causes of these disparities are complex and need further examination.

The utilization of chemotherapy and radiation at the end of life in individuals with metastatic non-small cell lung cancer.

143 Background: Advancements in the diagnosis and treatment of metastatic non-small cell lung cancer (NSCLC) have contributed to improved quality of life and survival. However, these successes are matched with rising healthcare costs and a growing debate over the appropriate utilization of medical resources near the end of life. To date, the majority of utilization studies report outcomes based on single institution or Medicare models. This may lead to significant bias due to individual physician preferences, narrow age groups or single payer systems. The purpose of this study is to analyze the broader trends and variables impacting the use of chemotherapy (CHT) and radiation (XRT) in the final months of life. Methods: The Florida Cancer Data System (FCDS) was used to evaluate patients with Stage IV (M1) NCLC from 1995 to 2010. Logistic Regression was used to determine the association between insurance types, census-based socioeconomic status (SES) and demographic variables with XRT received or CHT received. Results: 48,858 patients were identified within the FCDS and eligible for this study. The median age was 69 years. The median survival was 4.8 months. The overall use of XRT decreased between 1995 and 2010 from 52% to 37%, while the use of CHT increased from 35% to 49%. The utilization of treatment during the final 60, 30 and 14 days of death was 28%, 13% and 5% respectively for XRT, and 18%, 8% and 4% for CHT. Neither insurance status (OR, 0.852; 95% CI, 0.721 -1.174) nor poverty status (OR, 1.026; 95% CI, 0.950 -1.109) was predictive for XRT received. Those classified as low SES (OR, 0.685, 95% CI, 0.633-0.741) or not insured (OR, 0.678, 95% CI, 0.572-0.804) were less likely to receive CHT. Older-unmarried-females were less likely to receive CHT and XRT compared to their younger-married-male counterparts. Conclusions: When examining a broader demographic and insurance mix, the utilization of XRT and CHT in the final 30 and 14 days of death remain low at 13% and 5% for radiation and 8% and 4% for chemotherapy consistent with previously reported studies. Younger-married-males were more likely to receive palliative treatments. Insurance and SES did not influence the delivery of XRT while they did impact the use of CHT.

Abstract A01: Prism regression: A new statistical tool for understanding determinants of cancer health disparities

Abstract As part of our ongoing collaboration with community stakeholders throughout the Miami metropolitan area, we have become increasingly aware of the limitations imposed by current measurements of race. Our stakeholders uphold that the categorical variable (black vs. white) most commonly used to approximate this social construct lacks necessary dimension for understanding its significance and contribution to persistent health disparity. In response to this input, we introduce a class of generalized regression models for cancer outcomes, which allow the coefficient of race to vary as a function of other variables. These other variables involve factors that typically interact with the race focus variable. Existing varying coefficient models (VCMs) have been limited in a number of ways: they do not easily extend to allow multiple effect modifiers at once, and they do not allow interactions between the effect modifier variables. We developed “prism regression” to overcome these limitations in a data-adaptive, non-parametric manner. Joint modeling of the effect modifiers can be viewed as a prism through which the overall race coefficient is “refracted” in different directions (the variables defining the prism are what we term prism variables). This allows one to delineate patterns of racial differences in cancer outcomes that were previously hidden or masked. Our particular implementation of prism regression uses a rule-based decision tree structure, which is extremely intuitive to understand. Importantly, these tree-like structures can be extended in elegant ways to allow for much more complex effect modification. One such example, which we term hierarchical prism regression, allows the effect of race to vary as a function of layered, directional effect modifiers (i.e. prism variables and hierarchical variables together). This cannot be accomplished by existing methods such as multiway interactions, mediation or moderation. We detail the prism regression methodology and demonstrate some optimality properties based on a new constrained parameter estimation algorithm called “prism fusion” that provides not only more accurate predictions due to shrinkage, but also evidence for or against the presence of effect modification. We compare prism regression to existing methods using a series of simulation studies and show significant gains in predictive accuracy. In addition, we analyzed data from the cancer registry of Florida to search for complex effect modification of racial disparity. The Florida Cancer Data System is Florida's legislatively mandated, population-based, statewide cancer registry. It is the second largest population based, cancer incidence registry in the nation processing over 180,000 new cases are from patient medical records annually, corresponding to 1155,000 newly diagnosed tumors since 1981. Cancer cases are submitted by hospitals, freestanding ambulatory surgical facilities, radiation therapy facilities, private physicians and death certificates. Information includes routine personal and demographic data, includes diagnosis, stage of disease, tissue pathology, and first course of medical treatment as well as passive death certificate linkage information. We illustrate the usefulness of prism regression focusing on breast cancer patients from the FCDS registry to investigate the individual and contextual level factors that lead to differential effects of race in relation to stage of disease at diagnosis. Individual level variables obtained from the FCDS registry are linked by geocode to obtain contextual variables from census data. We consider the individual level information as prism variables, and the geocode linked contextual level variables as hierarchical variables. Citation Format: Shari Messinger, Erin Kobetz, J Sunil Rao. Prism regression: A new statistical tool for understanding determinants of cancer health disparities. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr A01.

Smoking and survival in male breast cancer patients

The purpose of the article was to assess whether smoking affects survival in male breast cancer patients for the overall population and when stratified by race, ethnicity, and socioeconomic status. Data were obtained by linking the 1996-2007 Florida Cancer Data System, the Florida Agency for Health Care Administration, and the US Census. Inclusion criteria were males ≥18 years, diagnosed with breast cancer and residing in Florida (n = 1573). To analyze the association between smoking and survival, we performed sequential multivariate Cox proportional hazards regression models with progressive adjustment for main confounders. Compared to never smokers, worse survival was found in current (hazard ratio = 1.63; 95 % CI = 1.23-2.16) but not in former smokers (1.26; 0.99-1.59). Those who smoked ≥1 packs/day had worse survival (2.48; 1.59-3.87) than never smokers with a significant dose-response (P for linear trend <0.001). Race-ethnic stratified models comparing current and former smokers with never smokers found significant differences among Whites [(1.88; 1.44-2.44) and (1.31; 1.04-1.65, respectively)] and non-Hispanics, [(1.73; 1.31-2.28) and (1.31; 1.04-1.66, respectively)]. Overall, current smokers were found to have significantly reduced survival, which was worse by intensity of smoking. Also, any smoking history is associated with worse survival in White and non-Hispanic male breast cancer patients compared to never smokers. Thus, male breast cancer patients should be advised to quit smoking.

The relationships among individual and regional smoking, socioeconomic status, and oral and pharyngeal cancer survival: a mediation analysis.

Poorer survival from oral and pharyngeal cancer (OPC) has been reported for populations of lower socioeconomic status (SES), adjusting for risk factors such as patient and clinical characteristics. Beyond these risk factors, higher rates of tobacco use may be a mediator for the observed poorer OPC survival for low SES populations. In this study, we aimed to examine the impact of the relationships among SES, individual smoking status, and living in a region with a higher smoking rate on OPC survival. We obtained Florida Cancer Data System data from 1996 to 2010 and merged the data with US Census data and Behavioral Risk Factor Surveillance System data from 1996 to 2010. We built multivariable survival models to quantify the mediational effect of individual smoking on overall and OPC-specific survival, adjusting for regional smoking, demographics, and clinical characteristics. We found that lower SES, individual smoking, and living in a region with a higher smoking rate were all strongly associated with poorer survival. We estimated that the indirect effect of individual smoking accounted for a large part (ranged from 13.3% to 30.2%) of the total effect of SES on overall and OPC-specific survival. In conclusion, individual and regional smoking are both significant and independent predictors of poor cancer survival. Higher rate of individual smoking is partially responsible for poorer cancer survival in low SES populations. Results of this study provide rationale for considering a multi-level approach that simultaneously targets both individual and contextual factors for future smoking cessation interventions.

Impact of age, race and socio-economic status on temporal trends in late-stage prostate cancer diagnosis in Florida

Individual-level data from the Florida Cancer Data System (1981–2007) were analyzed to explore temporal trends of prostate cancer late-stage diagnosis, and how they vary based on race, income and age. Annual census-tract rates were computed for two races (white and black) and two age categories (40–65, >65) before being aggregated according to census tract median household incomes. Joinpoint regression and a new disparity statistic were applied to model temporal trends and detect potential racial and socio-economic differences. Multi-dimensional scaling was used as an innovative way to visualize similarities among temporal trends in a 2-D space. Analysis of time-series indicated that late-stage diagnosis was generally more prevalent among blacks, for age category 40–64 compared to older patients covered by Medicare, and among classes of lower socio-economic status. Joinpoint regression also showed that the rate of decline in late-stage diagnosis was similar among older patients. For younger patients, the decline occurred at a faster pace for blacks with rates becoming similar to whites in the late 1990s, in particular for higher incomes. Both races displayed distinct spatial patterns with higher rates of late-stage diagnosis in the Florida Panhandle for whites whereas high rates clustered in South-eastern Florida for blacks.

Smoking and survival in female breast cancer patients.

The purpose of this study was to determine if smoking affects survival in female breast cancer patients, both overall and stratified by race, ethnicity, and socioeconomic status. We linked data from the 1996-2007 Florida cancer data system, the Florida Agency for Health Care Administration, and the U.S. census. Inclusion criteria were females ≥18 years, diagnosed with breast cancer, and residing in Florida (n = 127,754). To analyze the association between smoking and survival, we performed sequential multivariate Cox proportional hazard regression models with progressive adjustment for main confounders. Compared to never smokers, worse survival was found in current (hazard ratio 1.33; 95 % CI 1.28-1.38) and former smokers (1.09; 1.06-1.13). Those who smoked <1, 1-2, and >2 packs/day had worse survival (HR 1.28; 1.20-1.36; HR 1.40; 1.33-1.47 and 1.70; 1.45-1.99, respectively) (p for linear trend <0.001), than never smokers. Among Whites, current and former smokers had worse survival (HR 1.38; 1.33-1.44 and HR 1.11; 1.07-1.15, respectively) than never smokers. Worse survival was also found for current and former smokers (HR 1.34; 1.29-1.40 and HR 1.10; 1.06-1.15, respectively) compared with never smokers among non-Hispanics; similarly, worse survival was found among current Hispanic smokers (HR 1.13; 1.01-1.26). The association was not significant for Blacks. Current smoking is associated with worse survival in White breast cancer patients and through all socioeconomic status categories and ethnicities compared to never smoking. Former smoking is associated with worse survival in White and non-Hispanic females. Blacks had similar survival regardless of smoking status. Nonetheless, all female breast cancer patients should be advised to quit smoking.

Factors associated with overall survival prostate cancer in Florida: a multilevel analysis.

To investigate individual and contextual factors contributing to overall prostate cancer (PCa) survival in Florida. A random sample of 6,457 PCa cases diagnosed between 10/1/2001 and 12/31/2007 was extracted from Florida Cancer Data System. Comorbidity was computed following Elixhauser Index. Survival probability curve was generated using Kaplan-Meier method. The Wei, Lin, and Weissfel model was used for the multivariate analysis. Older age at diagnosis was associated with shorter time to death. Current smokers had a higher hazard rate than non-current smokers. Higher hazard of overall mortality was associated with being diagnosed with advanced stage compared with localized stage and having poorly-differentiated tumor compared with well-moderately differentiated tumor. No definitive treatment, radiation alone, and hormone alone were significantly associated with elevated hazard rate compared with surgery. Fifteen comorbidities were significantly associated with shorter time-to-death. Effective control of comorbidity in PCa patients should help improve life expectancy and lead to prolonged survival.

Factors associated with receipt of radiation therapy for rectal cancer.

747 Background: Appropriate treatment for rectal cancer is vital to increasing the likelihood of survival. Disparities in receipt of appropriate radiation treatment have been observed with respect to race/ethnicity and socioeconomic status. We used enriched cancer registry data to identify alternative factors associated with receipt of appropriate radiation therapy for rectal cancer. Methods: Data were obtained from the Florida Cancer Data System and were enriched with detailed treatment information collected from a Centers for Disease Control and Prevention Comparative Effectiveness Research study. Using multivariable regression, we evaluated factors associated with receipt of radiation therapy among rectal cancer cases summary stage II/III. Our sample (n=403) included cases diagnosed in Florida in 2011 who were 18 years and older. Cases clinically staged as 0/1/4 were excluded. Though patients over age 80 years (n=67) and those with stage IIA disease (n=185) may not routinely be prescribed radiation, these cases were included in order to maximize the sample size. Results: Our sample was an average of 64 years-old, more often male (59%), NH White (56%), diagnosed with stage III disease (54%), insured (92%), had received surgical intervention (87%), chemotherapy (68%), or radiation (57%), were in the highest SES quartile (56%), and had one or more comorbid condition (57%). Older age (OR=0.96; 95%CI=0.94-0.97), the presence of more than one comorbidity (0.61; 0.39-0.96), and receipt of surgical intervention (0.44; 0.22-0.90) were predictors of not receiving radiation. Conclusions: Contrary to our hypothesis, socio-demographic factors such as race/ethnicity, insurance status, and socioeconomic status, did not influence the receipt of radiation. Further research is needed, however, to understand why age, comorbidity, and surgery present a barrier to radiation, particularly given that radiotherapy is a well-tolerated modality.