Increase In Cancer Diagnoses Research Articles

Correlates of intention-to-attend and confirmed cervical screening attendance during the COVID-19 pandemic in Australia: Findings from Compass-PLUS, a prospective cohort study

ObjectiveThe coronavirus pandemic impacted health-seeking behaviour and access to primary care in Australia. We investigated factors associated with intention-to-attend and attendance of cervical screening during the pandemic, mainly in Victoria, Australia. MethodsWe used questionnaire and attendance data (Aug 2020-Nov 2022) from Compass-PLUS, a sub-study of the Compass randomized-controlled trial of Human Papillomavirus-based vs cytology-based screening. Data was restricted to the HPV-screening arm for comparability to the national program. We investigated associations overall and for younger (25–39 years) and older (≥40 years) cohorts, between intention-to-attend/attendance, and socio-demographics, anxiety-related scores, and agreement with beliefs about screening during the pandemic (e.g. importance of screening, increased workload, working from home, risk of infection). ResultsAmong 2,226 participants, positive intention to attend screening was more likely among those with a family history of cancer (p = 0.030) or living outside major cities (p = 0.024). Increased attendance was associated with increasing age (p < 0.001), prior regular cervical screening history [adjusted relative risk (aRR) for 2 screens in 6 years vs none: 1.23 (95 %CI 1.09,1.40); p < 0.001], and part-time employment or retirement compared to full-time employment [aRR:1.08 (1.02,1.14); aRR:1.12 (1.03, 1.22); respectively]. Lower attendance was related to increased agreement with statements indicating screening de-prioritisation (p-trend < 0.05) and higher recent anxiety, specifically in the older cohort (p-trend = 0.002). ConclusionsReduced priority of screening and heightened recent anxiety may partly explain indications of lower-than-expected cervical screening rates during the pandemic. It is important that catch-up of missed HPV screens is performed to prevent a possible increase in cancer diagnoses in the long term.

The incremental healthcare cost associated with cancer in Belgium: A registry-based data analysis.

Similar to many countries, Belgium experienced a rapid increase in cancer diagnoses in the last years. Considering that a large part of cancer types could be prevented, our study aimed to estimate the annual healthcare burden of cancer per site, and to compare cost with burden of disease estimates to have a better understanding of the impact of different cancer sites in Belgium. We used nationally available data sources to estimate the healthcare expenditure. We opted for a prevalence-based approach which measures the disease attributable costs that occur concurrently for 10-year prevalent cancer cases in 2018. Average attributable costs of cancer were computed via matching of cases (patients with cancer by site) and controls (patients without cancer). Years of life lost due to disability (YLD) were used to summarize the health impact of the selected cancers. The highest attributable cost in 2018 among the selected cancers was on average €15,867 per patient for bronchus and lung cancer, followed by liver cancer, pancreatic cancer, and mesothelioma. For the total cost, lung cancer was the most costly cancer site with almost €700 million spent in 2018. Lung cancer was followed by breast and colorectal cancer that costed more than €300 million each in 2018. In our study, the direct attributable cost of the most prevalent cancer sites in Belgium was estimated to provide useful guidance for cost containment policies. Many of these cancers could be prevented by tackling risk factors such as smoking, obesity, and environmental stressors.

The COVID-19 pandemic has revealed an increase in cancer diagnoses and a decrease in prehabilitation programs among patients in Transylvania

Introduction: The COVID-19 pandemic has brought significant disruptions to the landscape of oncological medicine, resulting in postponed cancer diagnoses and treatments, poor implementation of prehabilitation programmes, and an overall altered general care. Purpose: This paper aims to evaluate the impact of the COVID-19 pandemic on the profile of patients admitted to a clinical Hospital from Transylvania, and to evaluate its detrimental effect on the implementation of prehabilitation/rehabilitation programs for patients diagnosed with cancer. Material and methods: The study compared two groups of patients, the ones admitted to the hospital in the year before the pandemic (2019) and the others admitted in 2020. We recorded the number of new cancer diagnoses, the performed interventions of prehabilitation/rehabilitation and we compared the results. Results: The diagnosis of cancer was statistically significantly more frequent in the pandemic year 2020 compared to the same timeframe in 2019. Additionally, fewer interventions of physical prehabilitation or rehabilitation were applied during the pandemic period. Conclusions: The COVID-19 pandemic had a detrimental effect on the cancer patient´s benefit from prehabilitation/rehabilitation interventions

Combined Effect of Plasma-Activated Water and Topotecan in Glioblastoma Cells.

The increase in cancer diagnoses and cancer deaths, severe side effects of existing treatments and resistance to traditional treatments have generated a need for new anticancer treatments. Glioblastoma multiforme (GBM) is the most common, malignant and aggressive brain cancer. Despite many innovations regarding GBM treatment, the final outcome is still very poor, making it necessary to develop new therapeutic approaches. Cold atmospheric plasma (CAP) as well as plasma-activated liquids (PAL) are being studied as new possible approaches against cancer. The anticancer activity of PAL such as "plasma-activated water" (PAW) is dependent on the reactive chemical compounds present in the solution. Possible combinatory effects with conventional therapies, such as chemotherapeutics, may expand the potential of PAL for cancer treatment. We aim to explore the therapeutic properties of a combination of PAW and topotecan (TPT), an antineoplastic agent with major cytotoxic effects during the S phase of the cell cycle, on a GBM cancer cell line (U-251mg). Combined treatments with PAW and TPT showed a reduction in the metabolic activity and cell mass, an increase in apoptotic cell death and a reduction in the long-term survival. Single applications of PAW+TPT treatments showed a cytotoxic effect in the short term and an antiproliferative effect in the long term, warranting future exploration of combining PAW with chemotherapeutic agents as new therapeutic approaches.

Utilidad de una unidad de diagnóstico rápido durante la pandemia por SARS-CoV-2 para el diagnóstico de cáncer

ObjectivesTo analyse changes in health care activity, time of referral and diagnosis intervals and the incidence of cancer during the first 2years of the SARS-CoV-2 pandemic in a quick diagnosis unit. Materials and methodsA retrospective observational study was carried out during the prepandemic year (March 1, 2019 to February 29, 2020) and the first 2years of the pandemic (March 1, 2020 to February 28, 2022). Demographic and clinical variables, the first visit interval, the diagnosis interval and the first visit-diagnosis interval were evaluated and compared. ResultsDuring the first pandemic wave, there was a reduction in referrals (−32.6%), which then increased 8.1% and 17.7% from the second wave until the end of the first pandemic year and the second pandemic year, respectively. An increase in referrals to primary care and a decrease in emergencies were identified. The increase in cancer diagnoses of 2.7% and 15.7% in the 2years of the pandemic was proportional to the increase in referrals. No changes were observed in benign processes or in cancer locations and stages. The first visit interval was higher for benign diseases (p < 0.0001). A prolongation of the diagnosis interval was observed in cancer patients, although during the 3years of the study the median was <15 days. ConclusionsThe impact of the pandemic affected the length of intervals and the origins of referrals. The quick diagnosis units constitute and urgent complementary cancer diagnostic route with a high diagnosis yield.

Utility of a quick diagnostic unit during the SARS-CoV-2 pandemic for the diagnosis of cancer

ObjectivesTo analyse changes in health care activity, time of referral and diagnosis intervals and the incidence of cancer during the first two years of the SARS-CoV-2 pandemic in a quick diagnosis unit. Materials and methodsA retrospective observational study was carried out during the prepandemic year (March 1, 2019, to February 29, 2020) and the first two years of the pandemic (March 1, 2020, to February 28, 2022). Demographic and clinical variables, the first visit interval, the diagnosis interval and the first visit-diagnosis interval were evaluated and compared. ResultsDuring the first pandemic wave, there was a reduction in referrals (−32.6%), which then increased 8.1% and 17.7% from the second wave until the end of the first pandemic year and the second pandemic year, respectively. An increase in referrals to primary care and a decrease in emergencies were identified. The increase in cancer diagnoses of 2.7% and 15.7% in the two years of the pandemic was proportional to the increase in referrals. No changes were observed in benign processes or in cancer locations and stages. The first visit interval was higher for benign diseases (p<0.0001). A prolongation of the diagnosis interval was observed in cancer patients, although during the three years of the study the median was <15 days. ConclusionsThe impact of the pandemic affected the length of intervals and the origins of referrals. The quick diagnosis units constitutes and urgent complementary cancer diagnostic route with a high diagnosis yield.

Newly diagnosed lung cancer in hospitalized patients during the COVID-19 pandemic: How well are LDCTs utilized?

10624 Background: Medicare covers the cost of lung cancer screening in individuals aged 50-77 years with a high-risk smoking history. The COVID-19 pandemic caused a decrease in outpatient visits and cancer screenings. The objective of this study was to provide a comparison between the multitude of lung cancer diagnoses upon presentation to the hospital predating and during the COVID-19 pandemic in patients with varying insurance types. Methods: We retrospectively reviewed fifteen hospitals in West Florida with newly diagnosed lung cancer during the pre-pandemic period from March 2019-August 2020 and the pandemic period from March 2020- August 2021. These patients were split into subcategories based on insurance type: private medical insurance; Medicare; Medicaid; no insurance; and other. The chi-square test was used for statistical analysis. Results: A total of 1409 inpatients, 676 during the pre-pandemic and 733 during the pandemic, were identified with a new diagnosis of lung cancer upon presentation to the hospital. 74% of the pandemic population and 77% of the pre-pandemic population were patients insured with Medicare. Hospitals without LDCT screening programs were found to have 317 lung cancer diagnoses during the pre-pandemic period and 292 during the pandemic period. Hospitals with LDCT screening programs were found to have 359 lung cancer diagnoses during the pre-pandemic period and 441 during the pandemic period. Chi-square tests comparing pre-pandemic to pandemic did not show a p-value of statistical significance. Conclusions: A substantial number of patients with Medicare were newly diagnosed with lung cancer during the pre-pandemic and pandemic periods compared to patients with other insurance types. Although Medicare provides LDCT screening for lung cancer in high-risk populations at no out-of-pocket cost, about 75% of West Florida’s patients were diagnosed with lung-cancer upon presentation to the hospital. Hospitals with LDCT screening programs had an increase in cancer diagnoses during the pandemic, consistent with prior research data. Instead, the pandemic did not seem to affect hospitals without LDCT screening programs. We need to address the barriers in implementation of LDCT hospital-based screening programs to increase early diagnoses and decrease hospitalization diagnoses, leading to improved lung cancer mortality. [Table: see text]

Kualitas Hidup Family Caregiver Pasien Kanker dan Faktor-Faktor yang Mempengaruhinya

Background: The increase of cancer diagnosis in Indonesia needs special attention because cancer causes crisis not only in patient’s life but also to family caregivers. Studies depict that a family caregiver’s quality of life (QOL) influences patient’s. Therefore, it is necessary to pay special attention to the caregiver’s QOL to generate a holistic approach for cancer patients.Objective: This study aimed to portray family caregivers of cancer patients’ QOL and its associated factors.Methods: In this analytical crossectional study, 60 family caregivers of cancer patients were recruited. The Caregiver Quality of Life Index-Cancer (CQOLC) was used to assess the QOL of family caregivers and then analyzed using descriptive statistics and linear regression.Results: The mean age of the family caregiver was 40±13.67, and 53% were male. The mean score of CQOLC was 43.95 (±17.83). Age was negatively associated with CQOLC score (β= -3.389, p=.034) which meant positively associated with QOL whereas duration of caregiving (β= 2.167, p=.021), cancer stage (β= 1.299, p=.046), and burden of family caregiver (β= 1.292, p=.000) were positively associated with CQOLC score which meant negatively associated with QOL.Conclusion: The study found that the duration of caregiving, cancer stage, and burden were negatively associated with the QOL of the family caregiver. Nursing intervention such as caregiver assistant is needed to decrease the burden to family caregivers, especially when caring for cancer patients with advanced stages.

The Impact of COVID-19 on Breast Cancer Treatment: A Systematic Review

Background: During the COVID-19 pandemic, health resources were stretched, access was impacted by lockdowns and there were concerns about exposure to the virus during visits to hospitals. The purpose of this study was to examine how breast cancer treatments (presentation, surgery, radiotherapy, chemotherapy and/or endocrine therapy) changed or were adapted during the early phase of the pandemic. Methods: A systematic review was conducted using PRISMA guidance. Eligible studies presented original data reporting changes to early breast cancer treatment by comparing ‘pandemic’ treatment to a ‘pre-pandemic’ cohort or to ‘ideal’ treatment of individual cases. Data were extracted into evidence tables and narrative synthesis was used to analyse results. Results: Fifteen studies with paired design were eligible. These reported outcomes for 6,353 people treated for early breast cancer (January 2020–June 2021). All studies reported some change to treatment due to the pandemic. The nature of reported changes was inconsistent. Changes included: tumours more advanced at presentation compared to pre-pandemic, increase in breast conserving surgery; increase in simple mastectomy (without breast reconstruction); trend towards increased wait times, delays to start of treatment, shorter post-operative hospital stay and hypofractionation or omission of radiotherapy. Centres used more or less neoadjuvant chemotherapy or endocrine therapy. Conclusion: In the early stage of the pandemic, fewer early-stage breast cancer cases were treated many centres. Treatment for breast cancer was impacted and various local solutions were developed. These included less complicated breast surgery, increased use of neoadjuvant therapy, and changes to radiotherapy regimens. Surgery was frequently delayed and breast reconstruction was often unavailable. These results have implications for breast cancer services during the pandemic recovery as a ‘catch-up’ increase in cancer diagnoses is expected. Women may wish to access breast reconstruction, unavailable due to COVID-19. The impact of changes to treatment on long-term quality of life should be evaluated.

Impact of the COVID-19 pandemic on stage at diagnosis of patients with breast cancer: An analysis of 11,752 patients from Oncoclínicas.

10559 Background: As a reaction to the COVID-19 pandemic, a nation-wide lockdown was enforced in Brazil in March 2020, cancer care was impacted, and cancer screening reduced. Therefore, an increase in cancer diagnoses at more advanced stages was expected. In this study, we extracted data from our nationwide real-world database to evaluate the impact of the COVID-19 pandemic on the stage at diagnosis of breast cancer (BC) cases. Methods: We explored curated electronic medical record data of female patients, over 18 years of age, diagnosed with BC and with established disease stage based on the AJCC 8th edition, who started treatment or follow-up in the Oncoclínicas (OC) between Jan 1, 2018, and Dec 31, 2021. The primary objective was to compare stage distribution at first visit during COVID-19 pandemic (2020-2021) with a historical control cohort from a period prior to the pandemic (2018-2019). We investigated stage distribution according to age at diagnosis and tumor ER/HER2 subtype in univariate models. Associations were considered significant if they had a minimum significance (P &lt; 0.1 in Chi-square test). The historical numbers of patients with BC at OC make it possible to identify differences in the prevalence of stages in the order of 5% comparing pre and post pandemic periods with a statistical power greater than 80%. Results: We collected data for 11,752 patients with initial diagnosis of BC, with 6,492 patients belonging to the pandemic (2020-2021) and 5,260 patients to the pre-pandemic period (2018-2019). For both ER+/ HER2- and HER2+ tumors, there was a lower percentage of patients with early-stage (defined as stage I-II) in the years 2020-2021 vs 2018-2019 and a considerable increase in advanced-stage disease (defined as stage IV). For triple negative BC (TNBC), there was a significant higher percentage of patients with advanced-stage disease in the pandemic vs pre-pandemic period (table 1). Age over 50 years was associated with a greater risk of advanced stage at diagnosis after the onset of the pandemic, with an absolute increase of 7% (P two-sided &lt;0.01) Conclusions: We observed a substantial increase in cases of advanced-stage BC in OC institutions as a result of delays in BC diagnoses due to the COVID-19 pandemic. The impact appeared greater in older adults, potentially because of stricter confinement in this group. [Table: see text]

The Medicare Effect on Head and Neck Cancer Diagnosis and Survival

<h3>Purpose/Objective(s)</h3> Medicare provides health insurance benefits to over 63 million Americans. Up to 25% of near elderly adults are uninsured or have a gap in insurance coverage prior to Medicare eligibility. A "Medicare effect" has been proposed to account for increased healthcare utilization at age 65 and has been associated with more cancer diagnoses and lower cancer-specific mortality in lung, breast, colon, and prostate cancers. The existence of such an effect in head and neck squamous cell carcinoma (HNSCC) has not been studied. We sought to investigate whether an increase in cancer diagnoses occurs with Medicare eligibility and whether this affects cancer stage at diagnosis and survival. <h3>Materials/Methods</h3> Patients were queried from the SEER database. Incidence rates of HNSCC among patients diagnosed in 2000-2016 were calculated for patients ages 60-64, 65, and 66-70. Multivariable Poisson regression compared incidence among age 65 to 60-64 and 66-70. For patients with first primary HNSCC diagnosed from 2007-2016, multivariable logistic regression compared odds of late-stage diagnosis (stages III/IV, and a multivariable competing risks proportional hazards model compared hazard of cancer-specific mortality of age 65 to 60-64 by insurance. <h3>Results</h3> There were 57,953 HNSCCs diagnosed from 2000-2016, with 48.6% among age 60-64 (incidence rate (IR) 41.2 per 100,000 persons), 9.6% age 65 (IR 46.9 per 100,000 persons), and 41.9% age 66-70 (IR 48.1 per 100,000 persons). Controlling for covariates, incidence among age 65 was 14% higher than for 60-64 (incidence rate ratio (IRR) = 1.14, 95% confidence interval (CI) 1.10 – 1.19), but incidence among age 66-70 compared to 65 was not significantly different (IRR = 1.03, 95% CI 0.99 – 1.07). Compared to patients age 65, ages 60-64 with Medicaid (odds ratio (OR) = 1.85, 95% CI 1.61 – 2.13) or who were uninsured (OR = 2.02, 95% CI 1.63 – 2.49) had increased odds of being diagnosed with late-stage HNSCC. Compared to patients age 65, ages 60-64 with Medicaid (sub-distribution hazard ratio (sdHR) = 1.26, 95% CI 1.14 – 1.40) or who were uninsured (sdHR = 1.17, 95% CI 1.02 – 1.35) had increased hazard of cancer-specific mortality, while ages 60-64 with private insurance had decreased hazard of cancer-specific mortality (sdHR = 0.84, 95% CI 0.77 – 0.91). <h3>Conclusion</h3> Medicare eligibility is associated with a significant increase in incidence of HNSCC. In the population studied, patients ages 60-64 had were more likely to be diagnosed with late-stage HNSCC and have increased cancer-specific mortality compared to their Medicare-insured counterparts. Collectively, this supports the notion of a "Medicare effect" in HNSCC wherein patients defer initiating cancer-related treatment until they are Medicare eligible.

Abstract P2-10-05: The estimated impact of COVID-19 on population breast cancer screening outcomes, and options for risk-based recovery

Abstract OBJECTIVES AND RATIONALE Estimating the impact of COVID-19 on cancer screening programs and related outcomes can help health services prepare for potential delays in diagnoses and different demands on treatment services and plan for best approaches to recovery. Simulation modelling enables estimation of outcomes for a range of scenarios. In this study, we estimate the impact of various disruptions and recovery strategies for the Australian biennial mammographic breast screening program (BreastScreen). METHOD Policy1-Breast is a continuous-time, multiple-cohort micro-simulation model that simulates the whole Australian female population, incorporating breast cancer risk and natural history, breast density, menopause, hormone therapy use and breast cancer screening. Firstly, in the early stages of the COVID pandemic we used Policy1-Breast to evaluate how 3, 6, 9 and 12-month pauses to BreastScreen would impact on population-level breast cancer diagnoses, tumour staging, and breast cancer survival, compared to business-as-usual (BAU) outcomes. Secondly, to explore options for recovery after an actual one-month screening pause in April 2020, we evaluated a range of assumed throughput levels following screening resumption (50% or 80% up to December, then 100% to 120% from Jan 2021), comparing various protocols where specific sub-groups of clients were prioritised for screening during the recovery period. Outcomes are reported for the target age range for the BreastScreen program (50-74 years). RESULTS For 3- to 12-month pauses, we estimated a slight reduction in 5-year survival following diagnosis for women directly affected by a pause, but no discernible changes to population-level breast cancer mortality rates up to 2023. We estimated marked fluctuations in population rates of invasive breast cancer diagnoses with a 10% increase in cancer diagnoses between 2020-2021 and 2022-2023. For a 12-month pause to screening we estimate that population-level breast cancers would increase in size (with an additional 4% &amp;gt;15mm at diagnosis) and be more likely to involve the nodes (increasing from 26% to 30% of all cancers). We estimate that median screening intervals during 2020-2021 would increase from 104 weeks under BAU up to 130 weeks with a 12-month pause, and BreastScreen recall rates and false positive recall rates would fluctuate markedly over time. For the second evaluation of a one-month pause followed by various throughput and prioritisation scenarios, we estimated that screen-detected cancer rates would vary markedly with throughput but interval cancer rates would not, leading to fluctuations in program sensitivity of up to 6%. Reflecting the periodic nature of screening participation, we estimated the extent to which longer-term future screening participation rates are expected echo the peaks and troughs in participation due to the impacts of the COVID pandemic in 2020. We estimate that for a given throughput assumption, client prioritisation could lead to different rescreening rates, screening intervals, and time required for prioritisation protocols, with little change to cancer outcomes. CONCLUSION These modelled evaluations estimate short and longer-term effects of COVID-19 on the impact of population breast cancer screening in Australia. The estimated changes in breast cancer rates and characteristics would be expected to have a flow-on effect on the demand for treatment services in terms of throughput and case-mix. Preparing for such outcomes is critical given that treatment services are also directly impacted by the pandemic. The modelled outcomes are likely to be relevant to other high-income settings with established population breast cancer screening programs. Citation Format: Pietro Procopio, Sabine Deij, Louiza S Velentzis, Amanda Tattam, Lara Petelin, Carolyn Nickson. The estimated impact of COVID-19 on population breast cancer screening outcomes, and options for risk-based recovery [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P2-10-05.

AACR Report on the Impact of COVID-19 on Cancer Research and Patient Care

<i>AACR Report on the Impact of COVID-19 on Cancer Research and Patient Care</i>

The association between heart failure and incident cancer in women: an analysis of the Women's Health Initiative.

There is conflicting evidence whether heart failure (HF) is a risk factor for incident cancer. Despite population-based cohorts demonstrating this association, an analysis of the Physician's Health Study found no association in a cohort of mostly healthy males. We investigated the association of HF with incident cancer among a large cohort of post-menopausal women. A prospective cohort study of 146 817 post-menopausal women age 50 to 79 years enrolled in the Women's Health Initiative from 1993-1998, and followed through 2015. The primary exposure was adjudicated incident HF diagnosis, including preserved and reduced ejection fraction in a sub-cohort. The primary outcome was adjudicated incident total and site-specific cancers. Hazard ratios were calculated using multivariable-adjusted Cox proportional hazard regression models. Over a median follow-up of 8.4 years, 3272 and 17 474 women developed HF and cancer, respectively. HF developed in 235 women prior to cancer. HF was associated with subsequent incident cancer [hazard ratio (HR) 1.28, 95% confidence interval (CI) 1.11-1.48]. Associations were observed for obesity-related cancers (HR 1.24, 95% CI 1.02-1.51), as well as lung and colorectal cancers (HR 1.58, 95% CI 1.09-2.30 and HR 1.52, 95% CI 1.02-2.27, respectively). HF with preserved ejection fraction (HR 1.34, 95% CI 1.06-1.67), but not HF reduced ejection fraction (HR 0.99, 95% CI 0.74-1.34), was associated with total cancer. Heart failure was associated with an increase in cancer diagnoses in post-menopausal women. This association was strongest for lung cancer. Further research is needed to appreciate the underlying mechanisms responsible for this association.

COVID-19 effect on cancer diagnosis: A retrospective comparative analysis.

e18506 Background: In response to the COVID-19 pandemic, many health systems postponed routine screening and care to conserve resources and reduce patient exposure. As a result, several studies have shown a decline in the diagnosis of new cancer cases, a process that relies heavily on the use of screening tools and modalities. The Washington D.C. area is home to a heterogeneous patient population and one of the highest income gaps in the United States. Patterns in healthcare inequality in the area mirror these disparities. This study aims to identify the impact of the COVID-19 pandemic on cancer diagnosis rates compared to prior years and analyze whether vulnerable populations in the D.C. area were disproportionately affected. Methods: Data was collected from the George Washington University (GWU) Cancer Registry. The study population included patients age 18 and up residing in D.C., Maryland or Virginia who were diagnosed with any cancer at the GWU Health System within the following date ranges: April 1 to September 30 of 2018, 2019, 2020 and September 1, 2019 to February 29, 2020. Data collected included age at diagnosis, race, ethnicity, cancer site, stage at diagnosis, and patient zip code as a proxy for socioeconomic status (SES). Median income by zip code was labeled as low, middle or high. Chi square analysis was used to compare changes in each of these demographic and SES categories between each time frame. Results: There were 372 new cancer diagnoses during the COVID-19 period, April 1 2020 to September 30 2020. During this time period in 2018 and 2019, there were 525 and 539 new cancer diagnoses, respectively. Immediately prior to the COVID-19 period, September 1 2019 to February 29 2020, there were 588 new cancer diagnoses. Patterns of cancer type, age at diagnosis, sex, clinical stage, pathological stage and SES did not significantly differ between the COVID-19 period and any other time period (p &gt; 0.05 for all categories). However, ethnicity did change significantly with a slight increase in the number of Hispanic patients diagnosed during the COVID-19 period as compared to the 2018 and 2019 time periods (p = 0.041) and the September 2019 to February 2020 time period (p = 0.0005). Conclusions: Through this retrospective analysis, we observed a decrease in new cancer diagnoses during the COVID-19 period with no significant differences in patient age, sex, cancer type, cancer stage or SES. There was a slight increase in cancer diagnoses among Hispanic patients during the COVID-19 period. These results suggest that most groups were equally impacted by the COVID-19 pandemic with respect to cancer diagnosis. However, this may be specific to the region we studied and limited by the population size and our means of collecting data about patient SES. Further studies comparing early and late impacts of COVID-19 on cancer care will be important to identify specific communities for targeted outreach and intervention.

Abstract A60: Full-length transcripts identification from deep transcriptomic analysis of Bothrops jararaca venom gland

Abstract Introduction: Head and neck cancer is a collective term defined by topographic and anatomic features to describe malignant tumors of the upper aerodigestive tract. Despite the different strategies used in the treatment of head and neck squamous cell carcinoma (HNSCC), the overall survival rate is around 50% and the main reason for treatment failure is the frequent development of loco-regional recurrences, which affect around 30% of HNSCC patients. The increase in cancer diagnosis makes it necessary to search for alternative sources to inhibit tumor progression, as well as the development of more efficient drugs. Identification of natural resources as therapeutic potential may lead to the development of new antitumor treatments. Objectives: The aim was to identify transcripts expressed in venom glands of the Bothrops jararaca snake with therapeutic potential for head and neck squamous cell carcinoma (HNSCC) tumors. Materials and Methods: The mRNA library from B. jararaca was sequenced using Illumina NextSeq 500 platform (76 bp unpaired-end) and NextSeq 500/550 Mid Output v2 kit (150 cycles). Library was constructed using TruSeq Stranded mRNA LT Sample Prep Kit (Illumina). De novo assembly of the B. jararaca transcriptome was performed using Velvet software to assemble the transcriptome contigs. Results: The RNA-seq of B. jararaca venom gland generated 4,401,692 raw reads. The de novo Velvet assembly produced 3,498,133 contigs, which matched against NCBI-Blastn transcripts. From these contigs were identified 3,638 full-length transcripts, from which were selected two potential therapeutic genes, Fosfolipases A2 1 and Fosfolipases A2 2. Conclusions: In conclusion, this transcriptome sequencing identified two potential therapeutic transcripts, Fosfolipases A2 1 and Fosfolipases A2 2, which will be analyzed in HNSCC cell lines. Citation Format: Elisa Alves Messias, Flavia Coltri Eguchi, Bruna Pereira Sorroche, Angela Das Neves Oliveira, Lidia Maria Rebolho Batista Arantes, Ana Carolina De Carvalho, Anita mitico tanaka Azevedo, Kathleen Fernandes Grego, Matias Eliseo Melendez, Andre Lopes Carvalho. Full-length transcripts identification from deep transcriptomic analysis of Bothrops jararaca venom gland [abstract]. In: Proceedings of the AACR International Conference held in cooperation with the Latin American Cooperative Oncology Group (LACOG) on Translational Cancer Medicine; May 4-6, 2017; São Paulo, Brazil. Philadelphia (PA): AACR; Clin Cancer Res 2018;24(1_Suppl):Abstract nr A60.

Effect of Medicaid Expansions of 2014 on Overall and Early-Stage Cancer Diagnoses.

To determine whether the 2014 Medicaid expansions facilitated by the Affordable Care Act affected overall and early-stage cancer diagnosis for nonelderly adults. We used Surveillance, Epidemiology, and End Results Cancer Registry data from 2010 through 2014 to estimate a difference-in-differences model of cancer diagnosis rates, both overall and by stage, comparing changes in county-level diagnosis rates in US states that expanded Medicaid in 2014 with those that did not expand Medicaid. Among the 611 counties in this study, Medicaid expansion was associated with an increase in overall cancer diagnoses of 13.8 per 100 000 population (95% confidence interval [CI] = 0.7, 26.9), or 3.4%. Medicaid expansion was also associated with an increase in early-stage diagnoses of 15.4 per 100 000 population (95% CI = 5.4, 25.3), or 6.4%. There was no detectable impact on late-stage diagnoses. In their first year, the 2014 Medicaid expansions were associated with an increase in cancer diagnosis, particularly at the early stage, in the working-age population. Public Health Implications. Expanding public health insurance may be an avenue for improving cancer detection, which is associated with improved patient outcomes, including reduced mortality.

Process evaluation of treatment times in a large radiotherapy department

Purpose/objectiveThe Department of Health (DH) recognises access to appropriate and timely radiotherapy (RT) services as crucial in improving cancer patient outcomes, especially when facing a predicted increase in cancer diagnosis. There is a lack of ‘real-time’ data regarding daily demand of a linear accelerator, the impact of increasingly complex techniques on treatment times, and whether current scheduling reflects time needed for RT delivery, which would be valuable in highlighting current RT provision. Material/methodsA systematic quantitative process evaluation was undertaken in a large regional cancer centre, including a satellite centre, between January and April 2014. Data collected included treatment room-occupancy time, RT site, RT and verification technique and patient mobility status. Data was analysed descriptively; average room-occupancy times were calculated for RT techniques and compared to historical standardised treatment times within the department. ResultsRoom-occupancy was recorded for over 1300 fractions, over 50% of which overran their allotted treatment time. In a focused sample of 16 common techniques, 10 overran their allocated timeslots. Verification increased room-occupancy by six minutes (50%) over non-imaging. Treatments for patients requiring mobility assistance took four minutes (29%) longer. ConclusionThe majority of treatments overran their standardised timeslots. Although technique advancement has reduced RT delivery time, room-occupancy has not necessarily decreased. Verification increases room-occupancy and needs to be considered when moving towards adaptive techniques. Mobility affects room-occupancy and will become increasingly significant in an ageing population. This evaluation assesses validity of current treatment times in this department, and can be modified and repeated as necessary.

Being a Cancer Caregiver for an Older, Active, and Able Woman

P health care experiences often propel individuals to pursue careers in health care. For me, it was the experience of caring for my father who had early-onset neurodegenerative dementia that set the stage for my current work. Now, with an advanced degree in health policy with a focus on caregiving policy and research, I am part of a research team studying the information needs of cancer caregivers. Interest in family caregiving in the cancer context has grown over the past several years and is driven largely by the bubbling volcano that is older population growth in the United States. Due to a projected increase in the U.S. older adult population, a corresponding increase in cancer diagnoses is anticipated. A 67% increase in cancer diagnoses among adults 65 and older is anticipated between 2010 and 2030 (Smith, Smith, Hurria, Hortobagyi, & Buchholz, 2009). Meanwhile, a variety of factors contribute to the burden of care being shifted onto family caregivers, including a move toward more outpatient cancer care, advances in home-care technologies, and financial constraints (e.g., the cost of financing home aides or nurses). Caregiving research is vital as it is the scientific story of many caregivers. Yet, the story of one still holds value. The following is my commentary on being a cancer caregiver for an 87-year-old woman. This woman is a nonbiological “grandmother” to me. She was never married and never had children. Thus, I formally fit within the family caregiver spectrum as a “friend.” My official tenure as a cancer caregiver began when my pseudo-grandmother, Betty, noticed a large lump on her left breast. She immediately called her gynecologist and scheduled a mammogram. A mammogram was a test she had not had in years, which, unfortunately, is not uncommon of someone of her age and background. The mammogram verified what she knew—an abnormal growth. She moved on in the assembly line of good care and was scheduled for a biopsy. I, along with others, urged her to have patience and wait for the laboratory result. “It may be cancer, but it also may not be,” I offered in an attempt to be calm but not overly optimistic. The biopsy result indicated cancer, a diagnosis that numerous other older women likely received that same day. Despite sharing a similar diagnosis with many other older women, Betty is no typical 87-year-old. Most notable is her number of prescription medications compared to the average adult 60 or older. A 2008 report indicated that nearly 9 of 10 adults 60 or older were taking at least one prescription medication, whereas nearly 4 of 10 were taking five or more (Gu, Dillon, & Burt, 2010). Betty’s number of prescription medications was zero. Her prescription card showed only a daily multivitamin and garlic pill. My pseudo-grandmother also owns her own car and, importantly, is exceptional at driving. On several occasions, she has driven my kindergarten daughter from school to home. Among her friends at the long-term care facility where she has an apartment, she is the designated driver (not that kind!) of many

Sa1108 A National Bowel Cancer Awareness Campaign Did Not Lead to an Increase in Cancer Diagnosis Locally

Sa1108 A National Bowel Cancer Awareness Campaign Did Not Lead to an Increase in Cancer Diagnosis Locally