Late-stage Cancer Diagnosis Research Articles

Cancer profiling in the littoral region of cameroon: Insights from a major health centre

Cancer remains a significant public health concern worldwide, necessitating ongoing efforts to understand its epidemiology and im- prove patient care. This cross-sectional epidemiological study, based on third-party statistics collected over a period of one and a half years (from October 2021 to March 2023), aimed to examine the sociodemographic characteristics and clinical profiles of cancer patients in the Littoral Region of Cameroon. Data were gathered through structured questionnaires, with strict adherence to ethical considerations. The study included 307 cancer patients.Key findings indicate a predominance of breast cancer, a significant proportion of patients aged 41-50 years, and a majority diagnosed at stage 4 of the disease. These results highlight the urgent need for early detection and targeted interventions in cancer care. Furthermore, the research explores factors contributing to the high rate of late-stage cancer diagnoses, such as lack of awareness, insufficient diagnostic facilities, and economic barriers that prevent many patients from seeking timely medical help. Based on these findings, the study recommends the development of comprehensive cancer management strategies, including enhancing public health education, improving diagnostic and treatment capacities, and implementing policy reforms aimed at making healthcare more accessible and affordable. Such measures are essential for reducing the burden of cancer in Cameroon and improving the overall health outcomes for its population.

Late Cancer Presentation and Increase Palliative Care Burden on Healthcare Delivery in Makurdi Benue State: A Need for Strategic Intervention

The study employed a narrative review design for the purpose of identifying statistical findings on late-stage cancer diagnosis from previously published studies to use as evidence to describe the prevailing incidence of patients’ presenting with late-stage cancer disease in Benue State. The data were searched from journals indexed in Google scholar, Semantic scholar, ResearchGate, Cross-references, PubMed, DOAJ, and Abstract journals. The statistical results obtained from the review shows that, late-stage cancer presentation among people who develop the disease is a common situation in Nigeria. Specifically, to Benue State one among the few published studies reported that patients who had presented with advanced clinical diseases as evidenced by fungating masses, palpable axillary nodes, are indications of histologically established metastatic disease. Another study applying the FIGO Staging method revealed that (81.8%) presented with advanced stage disease ranging from stage IIb–IV and stage III disease was the commonest with (42.9%) of cases. A recent study revealed that (46.7%) of patients were diagnosed with stage II disease. Whereas (49.1%) presented with advanced stage III and (1.3%) stage IV disease respectively. Based on these evidences, is the pertinent need to solicit for a strategic intervention by various stakeholders in the health system to establish a specialized palliative care service facility in Benue State. Late cancer presentation is an eligible condition for palliative care; early and routine referral of cancer patients for palliative care will accord patients the benefits of enjoying improved QOL and delay of early death from the disease.

The Efficacy of a Named Entity Recognition AI Model for Identifying Incidental Pulmonary Nodules in CT Reports.

Purpose: This study evaluates the efficacy of a commercial medical Named Entity Recognition (NER) model combined with a post-processing protocol in identifying incidental pulmonary nodules from CT reports. Methods: We analyzed 9165 anonymized CT reports and classified them into 3 categories: no nodules, nodules present, and nodules >6 mm. For each report, a generic medical NER model annotated entities and their relations, which were then filtered through inclusion/exclusion criteria selected to identify pulmonary nodules. Ground truth was established by manual review. To better understand the relationship between model performance and nodule prevalence, a subset of the data was programmatically balanced to equalize the number of reports in each class category. Results: In the unbalanced subset of the data, the model achieved a sensitivity of 97%, specificity of 99%, and accuracy of 99% in detecting pulmonary nodules mentioned in the reports. For nodules >6 mm, sensitivity was 95%, specificity was 100%, and accuracy was 100%. In the balanced subset of the data, sensitivity was 99%, specificity 96%, and accuracy 97% for nodule detection; for larger nodules, sensitivity was 94%, specificity 99%, and accuracy 98%. Conclusions: The NER model demonstrated high sensitivity and specificity in detecting pulmonary nodules reported in CT scans, including those >6 mm which are potentially clinically significant. The results were consistent across both unbalanced and balanced datasets indicating that the model performance is independent of nodule prevalence. Implementing this technology in hospital systems could automate the identification of at-risk patients, ensuring timely follow-up and potentially reducing missed or late-stage cancer diagnoses.

Cancer Prevention for Women Experiencing Homelessness: Onsite Mammography, Navigation, and Education.

Persons experiencing homelessness (PEHs) represent a medically underserved population with a disproportionately high rate of late-stage cancer diagnoses and cancer mortality. During mobile onsite mammography and breast health education events, we studied PEH's barriers to and uptake of cancer screenings. This study used patient surveys and review of the electronic health record. The main outcome measures included mammogram and diagnostic imaging (as needed) results. A questionnaire assessed patient's views and barriers related to social determinants of health. The study included women accessing community organization resources who were 40 years or older or who met criteria for screening mammography. Forty-six individuals completed mammograms and 41 individuals participated in the survey, for a response rate of 89%. Thirty-five participants (85%) held health insurance provided by a Medicaid managed plan. Thirty-six participants (87%) received a negative mammogram result, and five participants (12%) required follow-up for abnormal results. Of these five, two participants completed diagnostic follow-up with negative results, and three did not complete diagnostic follow-up. In addition to barriers related to housing insecurity, five patients (12%) reported transportation barriers. A majority (n = 28, 68%) disagreed or strongly disagreed with the statement, "I'm afraid the mammogram will be painful." A majority (n = 31, 76%) disagreed or strongly disagreed with the statement, "I'm busy and do not have time." Nearly all participants (n = 37, 90%) responded yes to the statement, "I believe in preventative care screenings." Eight participants (20%) completed at least one additional cancer screening. By creating enduring programs offering screening, navigation, and education, academic-community partnerships may begin to address the increased cancer mortality among PEHs by improving screening adherence.

Effects of Medicaid managed care on early detection of cancer: Evidence from mandatory Medicaid managed care program in Pennsylvania.

To examine changes in late- versus early-stage diagnosis of cancer associated with the introduction of mandatory Medicaid managed care (MMC) in Pennsylvania. We analyzed data from the Pennsylvania cancer registry (2010-2018) for adult Medicaid beneficiaries aged 21-64 newly diagnosed with a solid tumor. To ascertain Medicaid and managed care status around diagnosis, we linked the cancer registry to statewide hospital-based facility records collected by an independent state agency (Pennsylvania Health Care Cost Containment Council). We leveraged a natural experiment arising from county-level variation in mandatory MMC in Pennsylvania. Using a stacked difference-in-differences design, we compared changes in the probability of late-stage cancer diagnosis among those residing in counties that newly transitioned to mandatory managed care to contemporaneous changes among those in counties with mature MMC programs. N/A. Mandatory MMC was associated with a reduced probability of late-stage cancer diagnosis (-3.9 percentage points; 95% CI: -7.2, -0.5; p = 0.02), particularly for screening-amenable cancers (-5.5 percentage points; 95% CI: -10.4, -0.6; p = 0.03). We found no significant changes in late-stage diagnosis among non-screening amenable cancers. In Pennsylvania, the implementation of mandatory MMC for adult Medicaid beneficiaries was associated with earlier stage of diagnosis among newly diagnosed cancer patients with Medicaid, especially those diagnosed with screening-amenable cancers. Considering that over half of the sample was diagnosed with late-stage cancer even after the transition to mandatory MMC, Medicaid programs and managed care organizations should continue to carefully monitor receipt of cancer screening and design strategies to reduce barriers to guideline-concordant screening or diagnostic procedures.

Enhancing early detection of lung cancer: A strategic initiative to boost screening rates among patients.

e22512 Background: Lung cancer is the top cause of cancer death in the U.S. Despite LDCT screenings reducing mortality, uptake is low in Alabama and nationally (6% vs. 4.5%). The U.S. Preventive Services Task Force recommends annual LDCT for certain high-risk adults, but factors like awareness, access, and policy affect screening rates. Alabama's situation is worsened by rural disparities and socioeconomic issues. Infirmary Health is the largest private, not for profit health care system in the state of Alabama. This study focuses on evaluating LDCT screening in a selected clinic of our health care system, pinpointing obstacles to adherence, and seeking ways to boost screenings to lower lung cancer mortality through early detection. Methods: As part of the Summer 2023 ASCO Quality Training Program we adopted a QI approach to increase LDCT lung cancer screening. It began by assessing baseline screening rates and staff knowledge, then created problem and aim statements. The team conducted root cause analysis, used a Pareto chart for issue prioritization, and employed a Priority Pay-off Matrix to focus on impactful, feasible issues. The Plan-Do-Study-Act (PDSA) cycle was then used to develop, test, and implement interventions, ensuring strategic alignment and effective monitoring of outcomes to enhance screening rates. Results: From January to July 2023, the Infirmary Health -Hillcrest clinic had a low 10.53% LDCT screening rate (system wide 6%, this clinic was selected due to it's highest screening rate), leading to late-stage lung cancer diagnoses and higher mortality. To address this, a goal was set to triple the screening rate to 30% by December 2023. Key barriers identified were staff and patient knowledge about lung cancer screening and a cumbersome LDCT ordering process. A PDSA cycle initiated between September and December 2023, firstly focused on Patient/Clinic Education, increasing screening rates by simplifying the process—removing doctor signature requirements and enhancing staff knowledge through meetings and informative flyers. The subsequent phase introduced a Nurse Navigator, who further increased screenings through prescreening, staff reminders, and on-site visits. By December of 2023 the LDCT screening rate was increased from baseline 10.53% to 33.3%. Conclusions: Through identifying and addressing key issues like education, faulty process and nurse navigation we successfully elevated LDCT screening rates. This study highlights the benefit of participating in a structured quality training program. [Table: see text]

Factors associated with surgical intervention in Native American patients with hepatocellular carcinoma.

e16279 Background: Hepatocellular carcinoma (HCC) is the prevailing type of primary liver cancer, exhibited at a higher frequency in individuals afflicted by chronic liver conditions. Past literature has demonstrated the impact certain socioeconomic factors have on the prognosis of HCC. Native American patients often face late-stage cancer diagnoses and have the lowest survival rates among racial and ethnic groups. While surgery offers potential for cure, factors related to surgical interventions in liver cancer for Native American patients remain largely unexplored. Through the NCDB, this study analyzed factors associated with surgical intervention and survival trends in Native American patients with HCC. Methods: The National Cancer Database (NCDB) was used to identify Native American patients diagnosed with Hepatocellular Carcinoma from 2004 to 2019 using the histology code 8170 and race code 03 as assigned by the Commission on Cancer Accreditation program. Kaplan-Meier, ANOVA Chi-Square, and Cox Proportional Hazards tests were performed. Data was analyzed using SPSS version 27, and statistical significance was set at α = 0.05. Results: Of 1193 Native American patients included in this sample, 172 (14.4%) patients received surgical treatment for HCC, while 1021 (85.6%) patients did not receive surgical treatment for HCC. Native American patients who received surgery for HCC experienced a greater mean overall survival (90 months) when compared to the mean overall survival (24 months) in HCC Native American patients who did not receive surgical treatments (p < 0.001). When controlling for age, year of diagnosis, stage, grade, facility type and income status, receiving surgery showed an independent decrease in hazard (HR = 0.245; p < 0.05). HCC Native American patients who received surgery were more likely to be treated an at academic facility, have stage I disease, and have less aggressive tumors (grade) (p < 0.05). Native American patients who did not receive surgery were more likely to be older (62 vs 60 years old), have larger tumors, and have brain, bone, lung, and liver metastases (p < 0.05). No associations of surgical versus non-surgical treatment were seen in Charlson-Deyo score, urban or rural residence, and primary payor at diagnosis. Conclusions: Native American patients with HCC who received surgical intervention experienced improved overall survival compared to non-surgical treatment groups. Native American patients undergoing surgical intervention more often received care at academic or private institutions and had lower stages of HCC. These results follow previous trends, where cancer patients receiving adequate surgical intervention generally survive longer. Further research is needed to examine other treatment differences among Native American patients and how these findings compare across other disadvantaged groups.

Disparities in Cancer Stage Outcomes by Catchment Areas for a Comprehensive Cancer Center

The National Cancer Institute comprehensive cancer centers (CCCs) lack spatial and temporal evaluation of their self-designated catchment areas. To identify disparities in cancer stage at diagnosis within and outside a CCC's catchment area across a 10-year period using spatial and statistical analyses. This cross-sectional, population-based study conducted between 2010 and 2019 utilized cancer registry data for the Johns Hopkins Sidney Kimmel CCC (SKCCC). Eligible participants included patients with cancer in the contiguous US who received treatment for cancer, a diagnosis of cancer, or both at SKCCC. Patients were geocoded to zip code tabulation areas (ZCTAs). Individual-level variables included sociodemographic characteristics, smoking and alcohol use, treatment type, cancer site, and insurance type. Data analysis was performed between March and July 2023. Distance between SKCCC and ZCTAs were computed to generate a catchment area of the closest 75% of patients and outer zones in 5% increments for comparison. The primary outcome was cancer stage at diagnosis, defined as early-stage, late-stage, or unknown stage. Multinomial logistic regression was used to determine associations of catchment area with stage at diagnosis. This study had a total of 94 007 participants (46 009 male [48.94%] and 47 998 female [51.06%]; 30 195 aged 22-45 years [32.12%]; 4209 Asian [4.48%]; 2408 Hispanic [2.56%]; 16 004 non-Hispanic Black [17.02%]; 69 052 non-Hispanic White [73.45%]; and 2334 with other or unknown race or ethnicity [2.48%]), including 47 245 patients (50.26%) who received a diagnosis of early-stage cancer, 19 491 (20.73%) who received a diagnosis of late-stage cancer , and 27 271 (29.01%) with unknown stage. Living outside the main catchment area was associated with higher odds of late-stage cancers for those who received only a diagnosis (odds ratio [OR], 1.50; 95% CI, 1.10-2.05) or only treatment (OR, 1.44; 95% CI, 1.28-1.61) at SKCCC. Non-Hispanic Black patients (OR, 1.16; 95% CI, 1.10-1.23) and those with Medicaid (OR, 1.65; 95% CI, 1.46-1.86) and no insurance at time of treatment (OR, 2.12; 95% CI, 1.79-2.51) also had higher odds of receiving a late-stage cancer diagnosis. In this cross-sectional study of CCC data from 2010 to 2019, patients residing outside the main catchment area, non-Hispanic Black patients, and patients with Medicaid or no insurance had higher odds of late-stage diagnoses. These findings suggest that disadvantaged populations and those living outside of the main catchment area of a CCC may face barriers to screening and treatment. Care-sharing agreements among CCCs could address these issues.

Machine Learning as a Tool for Early Detection: A Focus on Late-Stage Colorectal Cancer across Socioeconomic Spectrums

Purpose: To assess the efficacy of various machine learning (ML) algorithms in predicting late-stage colorectal cancer (CRC) diagnoses against the backdrop of socio-economic and regional healthcare disparities. Methods: An innovative theoretical framework was developed to integrate individual- and census tract-level social determinants of health (SDOH) with sociodemographic factors. A comparative analysis of the ML models was conducted using key performance metrics such as AUC-ROC to evaluate their predictive accuracy. Spatio-temporal analysis was used to identify disparities in late-stage CRC diagnosis probabilities. Results: Gradient boosting emerged as the superior model, with the top predictors for late-stage CRC diagnosis being anatomic site, year of diagnosis, age, proximity to superfund sites, and primary payer. Spatio-temporal clusters highlighted geographic areas with a statistically significant high probability of late-stage diagnoses, emphasizing the need for targeted healthcare interventions. Conclusions: This research underlines the potential of ML in enhancing the prognostic predictions in oncology, particularly in CRC. The gradient boosting model, with its robust performance, holds promise for deployment in healthcare systems to aid early detection and formulate localized cancer prevention strategies. The study’s methodology demonstrates a significant step toward utilizing AI in public health to mitigate disparities and improve cancer care outcomes.

Clinician Awareness of Patient-Reported Health-Related Social Needs: There's Room for Improvement.

People experiencing health-related social needs (HRSNs), such as transportation insecurity, are less likely to undergo preventive health screenings. They are more likely to have worse health outcomes overall, including a higher rate of late-stage cancer diagnoses. If primary care clinicians are aware of HRSNs, they can tailor preventive care, including cancer screening approaches. Accordingly, recent guidelines recommend that clinicians "adjust" care based on HRSNs. This study assessed the level of clinician awareness of patient-reported HRSNs and congruence between clinician perception and patient-reported HRSNs. We surveyed patients aged 50 to 85 years and their clinicians in 3 primary care clinics that routinely screen patients for HRSNs. Patients and clinicians reported the presence/absence of 6 HRSNs, including food, transportation, housing and financial insecurity for medications/healthcare, financial insecurity for utilities, and social isolation. Kappa statistics assessed the concordance of reported HRSNs between patients and clinicians. Across 237 paired patient-clinician surveys, mean patient age was 65 years, and 62% and 13% of patients were female and Latinx/Hispanic, respectively. Concordance between clinician- and patient-reported HRSNs varied by HRSN, with the lowest agreement for food insecurity (kappa = .08; 95% CI: 0.00, 0.17; P = .01) and highest agreement for transportation insecurity (kappa = .39; 95% CI: 0.18, 0.59; P < .001). The other HRSNs assessed were housing insecurity (kappa = .30; 95% CI: 0.05, 0.55; P < .001), social isolation (kappa = .24; 95% CI: 0.03, 0.45; P < .001), financial insecurity for utilities (kappa = .21; 95% CI: -0.02, 0.45; P < .001), and financial insecurity for healthcare/medications (kappa = .12; 95% CI: -0.02, 0.27; P < .001). In particular, discrepancies were noted in food insecurity prevalence: patient-reported food insecurity was 29% whereas clinician-reported food insecurity was only 3%. Clinician awareness of patients' social needs was only modest to fair, and varied by specific HRSN. In order to adjust care for HRSNs, clinics need processes for increased sharing of patient-reported HRSNs screening information with the entire clinical team. Future research should explore options for sharing HRSN data across teams and evaluate whether better HRSN data-sharing impacts outcomes.

Determinants of late-stage cervical cancer presentation in Ethiopia: a systematic review and meta-analysis

IntroductionBehind breast, colorectal, and lung cancers, cervical cancer is the fourth most common cancer affecting females. Despite, it is a preventable form of cancer both the incidence and mortality figures reflect it as a major reproductive health problem. Late-stage cervical cancer diagnosis is associated with complicated clinical presentation which can result in short survival time and increased mortality. Several factors contribute to the late-stage presentation of cervical cancer patients. In Ethiopia nationally summarized evidence on the level and the factors contributing to late-stage cervical cancer diagnosis is scarce. Therefore, this systematic review and meta-analysis aimed to assess the pooled prevalence of late-stage cervical cancer diagnosis and its determinants in Ethiopia.MethodA systematic review and meta-analysis were conducted using PRISMA guidelines. Comprehensive literature was searched in PubMed, Embase, Google Scholar, and African Online Journal to retrieve eligible articles. A weighted inverse variance random effect model was used to estimate pooled prevalence. Cochrane Q-test and I2 statistics were computed to assess heterogeneity among studies. Funnel plot and Egger’s regression test were done to assess publication bias.ResultOverall, 726 articles were retrieved and finally 10 articles were included in this review. The pooled prevalence of late-stage cervical cancer diagnosis in Ethiopia was 60.45% (95%CI; 53.04%-67.85%). Poor awareness about cervical cancer and its treatment (AOR = 1.55, 95% CI: (1.03 – 2.33, longer delay to seek care (AOR = 1.02, 95% CI: (1.01 – 1.03)) and rural residence (AOR = 2.07, 95% CI:( 1.56 – 2.75)) were significantly associated to late-stage diagnosis.ConclusionIn Ethiopia, six in every ten cervical cancer cases are diagnosed at the late stage of the disease. Poor awareness about cervical cancer and its treatment, long patient delay to seek care, and rural residence were positively associated with late–stage diagnosis. Therefore intervention efforts should be made to improve public awareness about cervical cancer, minimize patient delay to seek care, and expand screening services specifically in the rural residing segment of the population to detect the disease early and improve survival.

Abstract C008: Associations of county-level structural racism indices with cancer mortality disparities in Florida

Abstract Existing multidimensional measures of structural racism are largely measured on the state level, which may mask underlying heterogeneity on smaller levels of geography. This study pilots an empirical approach to operationalizing structural racism in cancer equity research by introducing an association-sensitive inequality index developed to capture county-level structural racism, utilizing the state of Florida as an empirical case study. Three structural racism indices per county were constructed, incorporating comparisons between (a) non-Hispanic/Latinx Blacks and non-Hispanic/Latinx whites, (b) Hispanics/Latinx and non-Hispanic/Latinx whites, and (c) non-Hispanic/Latinx Blacks and Hispanics/Latinx. Unadjusted and adjusted regression models were fit to assess the ecological association between the structural racism indices and race/ethnicity-specific measures of (1) age-adjusted all-cause mortality, (2) age-adjusted overall cancer mortality, (3) age-adjusted lung cancer mortality, (4) age-adjusted breast cancer mortality, and (5) prevalence of late stage cancer diagnosis. Unadjusted and adjusted Poisson regression models were fit to assess the ecological association between the structural racism indices and race/ethnicity-specific measures of (1) age-adjusted all-cause mortality, (2) age-adjusted overall cancer mortality, (3) age-adjusted lung cancer mortality, (4) age-adjusted breast cancer mortality, and (5) prevalence of late stage cancer diagnosis. In fully adjusted models, county-level Black-white structural racism was associated with higher levels of all-cause, overall cancer, lung cancer, and breast cancer mortality rates among Black residents (p&amp;lt;0·0001), higher levels of all-cause mortality in white residents (p&amp;lt;0·0001). County- level Latinx-white structural racism was associated with lower levels of all-cause and overall cancer mortality and slightly higher lung cancer mortality among Hispanic/Latinx residents, and higher levels of all-cause mortality and lower levels of overall cancer mortality among white residents. This study provides evidence of structural racism impacts among cancer disparities within Black and Hispanic/Latinx communities, an understudied population in empirical structural racism literature. Study findings demonstrate that the relationship between the Black-white structural racism index and the health outcomes of interest correspond best with a “universal harm” relationship, whereby both Black and white Floridians experienced increased negative health outcomes associated with increasing levels of structural racism. Citation Format: Zinzi D. Bailey, Marlene Camacho-Rivera, Kasim Ortiz. Associations of county-level structural racism indices with cancer mortality disparities in Florida [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C008.

EPH244 Late-Stage Cancer Diagnosis and Systemic Therapy in England Since 2018

EPH244 Late-Stage Cancer Diagnosis and Systemic Therapy in England Since 2018

Geographic Variation in Late-Stage Cervical Cancer Diagnosis

There are stark disparities in cervical cancer burden in the United States, notably by race and ethnicity and geography. Late-stage diagnosis is an indicator of inadequate access to and utilization of screening. To identify geospatial clusters of late-stage cervical cancer at time of diagnosis in Texas. This population-based cross-sectional study used incident cervical cancer data from the Texas Cancer Registry from 2014 to 2018 of female patients aged 18 years or older. Late-stage cervical cancer cases were geocoded at the census tract level (n = 5265) using their residential coordinates (latitude and longitude) at the time of diagnosis. Statistical analysis was performed from April to September 2023. Census tract of residence at diagnosis. Late-stage cervical cancer diagnosis (ie, cases classified by the National Cancer Institute Surveillance, Epidemiology and End Results summary stages 2 to 4 [regional spread] or 7 [distant metastasis]). A Poisson probability-based model of the SaTScan purely spatial scan statistics was applied at the census tract-level to identify geographic clusters of higher (hot spots) or lower (cold spots) proportions than expected of late-stage cervical cancer diagnosis and adjusted for age. Among a total of 6484 female patients with incident cervical cancer cases (mean [SD] age, 48.7 [14.7] years), 2300 (35.5%) were Hispanic, 798 (12.3%) were non-Hispanic Black, 3090 (47.6%) were non-Hispanic White, and 296 (4.6%) were other race or ethnicity. Of the 6484 patients, 2892 with late-stage diagnosis (mean [SD] age, 51.8 [14.4] years were analyzed. Among patients with late-stage diagnosis, 1069 (37.0%) were Hispanic, 417 (14.4%) were non-Hispanic Black, 1307 (45.2%) were non-Hispanic White, and 99 (3.4%) were other race or ethnicity. SaTScan spatial analysis identified 7 statistically significant clusters of late-stage cervical cancer diagnosis in Texas, of which 4 were hot spots and 3 were cold spots. Hot spots included 1128 census tracts, predominantly in the South Texas Plains, Gulf Coast, and Prairies and Lakes (North Texas) regions. Of the 2892 patients with late-stage cervical cancer, 880 (30.4%) were observed within hot spots. Census tract-level comparison of characteristics of clusters suggested that hot spots differed significantly from cold spots and the rest of Texas by proportions of racial and ethnic groups, non-US born persons, and socioeconomic status. In this cross-sectional study examining geospatial clusters of late-stage cervical cancer diagnosis, place-based disparities were found in late-stage cervical cancer diagnosis in Texas. These findings suggest that these communities may benefit from aggressive cervical cancer interventions.

Association of federal and state policies regulating short-term limited duration insurance (STLD) plans and later cancer stage at diagnosis.

197 Background: Most short-term limited duration (STLD) insurance plans do not cover essential health services, such as cancer screenings, which may delay cancer diagnoses. STLD plans can disrupt individual insurance markets, leading to higher costs and delays in care for comprehensive plan enrollees. In October 2018, federal regulations extended the allowable duration of STLD plans to up to 36 months. States have taken varying approaches to expand, restrict, or eliminate the sale or terms of STLD plans, both prior to 2018 and following its enactment. Our study examined associations of state-level policies regarding STLD plans and late-stage cancer diagnosis before and after the 2018 change. Methods: We identified 1,289,366 adults aged 18-64 years newly diagnosed with cancer in 01/2016-02/2020 in 47 states and DC from the National Cancer Database, with a “washout” period +/- 3 months of the 2018 regulation. Patients were categorized into 4 groups according to their states’ STLD plans policies: (1) states prohibiting STLD plans prior to 2016; (2) states banning STLD plans or strict regulations leading insurers to stop offering STLD plans after 2018; (3) states restricting STLD plans; (4) states with no STLD regulation. We conducted difference-in-differences (DiD) analyses to evaluate changes in late-stage diagnoses (stages III/IV) pre- (01/2016-06/2018) and post- (01/2019-02/2020) STLD plan expansion between groups 2, 3, 4 vs group 1 for all cancers combined and 2 common cancers with effective screening tests: female breast and colorectal. We adjusted for age group, sex, race/ethnicity, rurality, area-level poverty, and state random effects to account for other state-level variations. Results: Percentages of late-stage diagnosis decreased since 2018 in all state groups (Table). Compared to patients in group 1 states (prohibited STLD plans prior to 2016), group 4 (no STLD regulations) had a net increase of 0.8 (95%CI = 0.2-1.3) percentage points (ppt) in late-stage diagnosis and group 3 (some STLD regulations) had a net increase of 0.9 (95%CI = 0.3-1.4) ppt in late-stage diagnoses (Table). Similar patterns were observed for female breast and colorectal cancers. Conclusions: The federal policy on STLD plan expansion was associated with an increase in late-stage cancer diagnoses, underscoring the importance of individual state policies banning or restricting STLD plans.[Table: see text]

Spatial access to screening centers and late-stage lung cancer in Alabama.

130 Background: Cancer stage at diagnosis has a tremendous influence on type of treatment, recovery and survival. This study examined the impact of spatial access to healthcare services on late-stage lung cancer diagnosis in Alabama, taking into account access and travel time to the nearest Screening Center of Excellence (SCOE). Methods: A cross-sectional retrospective study of lung cancer incidence in the state of Alabama was employed, using zipcode as unit of analysis. Data on individual lung cancer diagnosis between 2013 and 2018 was obtained from Alabama State Cancer Registry. Geographic information system (GIS) network analysis was used to calculate distance to the nearest SCOE. Descriptive statistics were used to compare distribution of independent variables including residential status, age, race, gender and insurance across lung cancer diagnosis stage. Multi-variable logistic regression assessed odds ratio and 95% confidence intervals to evaluate the relationship between residential status and late-stage diagnosis. Results: 14,556 individuals were diagnosed with lung cancer in Alabama from 2013 - 2018. Late-stage diagnosis accounted for 72.7% of cases, predominantly among males (56.5%) and Whites (79.8%). Late-stage vs. early-stage cases differed significantly in sex (males: 59.2% vs. 50.9%) and race (Whites: 78.6% vs. 83.4%) (p &lt; 0.0001). Multivariable logistic regression analyses found that Alabamians were more likely to be diagnosed with late stage lung cancer if they were Black (p &lt; 0.0001); male (p &lt; 0.0001); uninsured (p &lt; 0.0001); and/or insured via Medicaid (p &lt; 0.0001). Alabamians were less likely to be diagnosed with late stage lung cancer if they were within 60 miles of a SCOE (p &lt; 0.0001). Living in a persistent poverty census tract was associated with a lower OR for late-stage lung cancer occurrence (adjusted OR = 0.88, 95% CI =0.78-0.99, p=0.0341). Neighborhood Deprivation Index did not significantly correlate with late-stage lung cancer (p = 0.8280). Conclusions: Proximity to screening centers within 60 miles is associated with a reduced likelihood of late-stage lung cancer. Additionally, race, sex, insurance status, and age are significant factors. These findings underscore the importance of access to screening centers and the influence of demographic and socioeconomic factors on lung cancer stage at diagnosis.

Association between pre-diagnosis financial strain and later stage cancer presentation.

127 Background: Poverty and community-level deprivation have been shown to be associated with later stage cancer diagnosis. However, few studies have used objective financial data to study the link between individual financial strain and cancer stage at diagnosis. Our goal was to assess the associations between pre-diagnosis financial strain (FS) as measured by credit reports and later stage cancer diagnosis. Methods: Records from cancer patients diagnosed with solid tumors between 2014 and 2018 from the Western Washington SEER cancer registry and quarterly credit report data from a large credit-reporting agency TransUnion were linked and deidentified. Patients diagnosed with late-stage cancer (stages III and IV) were matched 1:1 to patients diagnosed with early-stage cancer (stages I and II) by age, year of diagnosis, cancer type, and insurance status. We assessed the association between FS (defined as any records of third-party collections, charge-offs, delinquent mortgage payments, tax liens, foreclosures, repossessions, and bankruptcies within 2 years prior to diagnosis) and late-stage diagnosis using conditional logistic regression to account for matching, adjusting for race, sex, marital status, area deprivation, and rurality. We performed stratified analyses by insurance enrollment. Separately, among a subset of unmatched insured breast cancer patients eligible for cancer screening (ages 50-74), we used multivariable logistic regressions to exam how the nonreceipt of screening mammography within 2 years of diagnosis mediated the relationship between FS and late-stage diagnosis. Results: After matching, 27916 patients were included in the analysis (mean age 66, 47% female, 84% White race, 7% Asian or Pacific Islander, 4% Black, and 3% Hispanic). Almost one in three patients (32%) had experienced FS before diagnosis. FS was associated with higher odds of late-stage cancer diagnosis (adjusted OR, aOR 1.18, 95%CI 1.1-1.3), and this association remained significant among insured patients (aOR 1.13, 95%CI 1.03-1.2). Among a subset of insured breast cancer patients (n=6934), FS was associated with nonreceipt of mammography (aOR 1.88, 95%CI 1.5-2.4). The association between FS and late-stage diagnosis became insignificant after we accounted for nonreceipt of mammography (aOR reduced from 1.65 (95%CI 1.4-1.9) to 1.04 (95%CI 0.8-1.4)). Conclusions: FS is associated with a later stage cancer diagnosis, which could in turn lead to adverse cancer outcomes. Among breast cancer patients, this association can be largely explained by nonreceipt of mammography. Our findings suggest that even with insurance coverage, individual’s financial stress may create an additional barrier to timely medical attention for suspicious cancer symptoms or routine screening, further exacerbating cancer disparities. This research highlights the need to develop strategies to improve access to care for these individuals.

Disparities Contributing to Late-Stage Diagnosis of Lung, Colorectal, Breast, and Cervical Cancers: Rural and Urban Poverty in Florida.

Despite advances in cancer screening, late-stage cancer diagnosis is still a major cause of morbidity and mortality in the United States. In this study, we aim to understand demographic and geographic factors associated with receiving a late-stage diagnosis (LSD) of lung, colorectal, breast, or cervical cancer. (1) Methods: We analyzed data of patients with a cancer diagnosis between 2016 and 2020 from the Florida Cancer Data System (FCDS), a statewide population-based registry. To investigate correlates of LSD, we estimated multi-variable logistic regression models for each cancer while controlling for age, sex, race, insurance, and census tract rurality and poverty. (2) Results: Patients from high-poverty rural areas had higher odds for LSD of lung (OR = 1.23, 95% CI (1.10, 1.37)) and breast cancer (OR = 1.31, 95% CI (1.17,1.47)) than patients from low-poverty urban areas. Patients in high-poverty urban areas saw higher odds of LSD for lung (OR = 1.05 95% CI (1.00, 1.09)), breast (OR = 1.10, 95% CI (1.06, 1.14)), and cervical cancer (OR = 1.19, 95% CI (1.03, 1.37)). (3) Conclusions: Financial barriers contributing to decreased access to care likely drive LSD for cancer in rural and urban communities of Florida.

Gastric Cancer Risk Factors ina Veteran Population.

Risk factors for gastric cancer in the United States are not well understood, especially in populations with a low proportion of immigrants. We conducted a matched case-control study in a Veteran Affairs Medical Center to identify risk factors for gastric cancer. Gastric cancer patients and age- and sex-matched controls were identified in a 1:4 ratio from January 1, 1997 to October 31, 2018. Demographic, medical, endoscopic, and histologic data were extracted. We performed conditional logistic regression to estimate odds ratios and 95% CIs for associations between potential risk factors and gastric cancer. Most gastric cancer cases were diagnosed on initial endoscopy (71.4%). Of these, the most common presenting stage was stage IV (40.8%). Risk factors for gastric cancer included Black and Asian race and never or current (compared to former) drinkers, although Helicobacter pylori eradication and pernicious anemia were associated with decreased risk. The high proportion of late-stage gastric cancer diagnoses highlights the need for improved risk stratification as well as screening and surveillance protocols in the U.S. population. Racial disparities among veterans in an equal-access system necessitate further investigation into the etiology of these disparities.

Factors associated with late-stage diagnosis and overall survival for lung cancer: An analysis of patients treated in a Brazilian hospital and a US-hospital from 2009 to 2019

BackgroundLung cancer is a major public health problem due to its high incidence and mortality rates worldwide. Histology, socioeconomic conditions, access, quality of healthcare, and regional aspects are associated with lung cancer stages at diagnosis and survival outcomes. This paper aims to examine and contrast the factors associated with late-stage diagnosis of lung cancer and overall survival rates in two different settings: a Brazilian hospital and a US hospital, spanning from 2009 to 2019. MethodsThis is a retrospective cohort study of the incidence of lung cancer cases at the institution’s cancer registry from a Brazilian and a US-based cohort. Descriptive analyses are presented using either the mean and standard deviation or the median and interquartile interval. Frequency is used to present categorical variables. Factors associated with late-stage lung cancer diagnosis were identified through bivariate and multivariable forward stepwise logistic regression. One-year overall survival and its associated factors were identified by Kaplan–Meier curves and Cox's proportional hazards model. ResultsBetween January 2009 and December 2019, a total of 5286 individuals were diagnosed with LC in the Brazilian cohort, and out of these cases, 85.6% were diagnosed with late-stage disease.The US-cohort consisted of 3594 individuals, of whom 60.3% were diagnosed with late-stage disease in lung cancer. The one-year overall survival was 8.6 months for the US cohort and 6.4 months for the Brazilian cohort. In both cohorts, late-stage diagnosis emerged as the most significant factor influencing overall survival. However, the factors associated with late-stage diagnosis differed between the US and Brazilian cohorts. In the Brazilian cohort, being male and belonging to black or brown ethnic groups, along with having a lower education level, were linked to late-stage diagnosis. On the other hand, in the US-based cohort, the factors related to late-stage diagnosis were being male, having been diagnosed before 2015, and possessing private insurance coverage. ConclusionLate-stage diagnosis was associated with the worst survival in both the US and Brazilian cohorts. This study provides valuable information on inequities and barriers to access for lung patients with cancer from upper-middle-income and high-income countries.