NCI Comprehensive Cancer Centers Research Articles

The National Cancer Institute's Cancer Disparities Research Partnership Program: a unique funding model 20 years later.

The burden of cancer and access to effective treatment are not experienced equally by all in the United States. For underserved populations that often access the health-care system when their cancers are in advanced disease stages, radiation oncology services are essential. In 2001, the National Cancer Institute's (NCI's) Radiation Research Program created and implemented the Cancer Disparities Research Partnership Program (CDRP). CDRP was a pioneering funding model whose goal was to increase participation of medically underserved populations in NCI clinical trials. CDRP's Cooperative Agreement funding supported for awardees the planning, development, and conduct of radiation oncology clinical research in institutions not traditionally involved in NCI-sponsored research and cared for a disproportionate number of medically underserved, health-disparities populations. The awardee secured and provided support for mentorship from 1 of 2 NCI comprehensive cancer centers named in its application. Six CDRP awards were made over two 5-year funding periods ending in 2013, with the end-of-program accomplishments previously reported. With the current focus on addressing equity, diversity, and inclusion, the 6 principal investigators were surveyed, 5 of whom responded about the impact of CDRP on their institutions, communities, and personal career paths. The survey that was emailed included 10 questions on a 5-point Likert scale. It was not possible to collect patient data this long after completion of the program. This article provides a 20-year retrospective of the experiences and observations from those principal investigators that can inform those now planning, building, and implementing equity, diversity, and inclusion programs.

Race-Ethnic Enrollment Disparities over 15 Years of Alliance/CALGB Acute Myeloid Leukemia Clinical Trials, Biobanks, and Correlative Science Protocols

IntroductionRace-ethnic disparities in clinical trial enrollment have the potential to bias findings, limit generalizability, misdirect drug development, and reduce equitable access to novel therapy. The degree to which such disparities exist within acute myeloid leukemia (AML) North American cooperative group trials, biobanks, and correlative studies remain unclear, as are the factors that influence biobank and correlative study participation among trial enrollees. In addition, the National Cancer Institute's (NCI) mandate for Comprehensive Cancer Centers (CCC) to designate catchment areas has not been explored as a mechanism through which AML enrollment disparities can be addressed.MethodsWe analyzed enrollment data from the 9 Alliance/CALGB AML treatment trials, 2 biobank protocols, and 2 correlative studies active from 1998-2013 and with published results. Trial enrollees could consent to biobank and/or correlative study participation. We compared participation rates of United States (US) enrollees for the mutually exclusive racial-ethnic groups of non-Hispanic (NH)-white, NH-Black, NH-Asian, NH-Native American, and Hispanic using X 2 testing, with NH-white as the comparator and reporting odds ratios (OR) and 95% confidence intervals (CI). Rates were adjusted by national incidence according to the Surveillance, Epidemiology, and End Results program and the US Census. Testing was repeated for the 55% of participants enrolled at 15 NCI CCCs recruiting ≥10 patients, where incidence was adjusted for catchment area size and demographics. Logistic regression models, clustered by trial, were performed to assess the following predictors for biobank and correlative study participation among trial enrollees: race-ethnicity (NH-white vs non-white), site type (CCC status), age (10-year increments), sex, neighborhood urbanity (urban vs rural) and poverty (<20% vs ≥20% below poverty line) by zip code, and distance from site (10-mile increments).ResultsThere were 3041 trial enrollees at US sites; participant characteristics and demographics by race-ethnicity are shown in Table 1. 93.9% of patients participated in a biobanking study and 60.0% in a correlative study. National incidence adjusted enrollment odds by race-ethnicity are shown in the Figure (top); NH-Black, NH-Asian, and Hispanic persons were enrolled at significantly lower rates than NH-whites; NH-Native American enrollment was significantly higher. Enrollment odds were even lower for NH-Black, NH-Asian, and Hispanic enrollees at CCC sites when adjusted by catchment area incidence (Figure; bottom). Among trial enrollees, there were no univariable predictors of biobank participation, however, male sex (OR 1.12; 95% CI 1.01, 1.37; p=0.04) and NH-white race-ethnicity (OR 1.33; 95% CI 1.12,1.57; p<0.001) were associated with correlative study participation. Multivariable models of correlative study participation, with predictors selected based on univariable significance, are shown in Table 2 for all trial enrollees and when restricted to biobank enrollees; in both cases, NH-white race predicted participation.ConclusionsAcross 15 years of AML cooperative group studies, there were several enrollment disparities by race-ethnicity, which were more pronounced at CCC sites. Over 90% of trial enrollees participated in biobanking, with no race-ethnic differences seen. However, correlative study participation among trial enrollees was higher for NH-whites. Taken together, these data suggest that efforts should focus on increasing trial and correlative study participant diversity-but not biobanking-within NCI-designated CCC catchment areas. Reasonable next steps include identifying key structural, provider, and patient-based barriers to trial and correlative study participation at CCC sites and developing inclusive, multilevel interventions to address them. [Display omitted] DisclosuresEisfeld: Karyopharm (spouse): Current Employment. Stock: Pfizer: Consultancy, Honoraria, Research Funding; amgen: Honoraria; agios: Honoraria; jazz: Honoraria; kura: Honoraria; kite: Honoraria; morphosys: Honoraria; servier: Honoraria; syndax: Consultancy, Honoraria; Pluristeem: Consultancy, Honoraria. Stone: AbbVie Inc, Actinium Pharmaceuticals Inc, Aprea Therapeutics, BerGenBio ASA, ElevateBio, Foghorn Therapeutics, GEMoaB, GlaxoSmithKline, Innate Pharma, Syndax Pharmaceuticals Inc, Syros Pharmaceuticals Inc, Takeda Oncology: Other: Advisory Committee; Agios Pharmaceuticals Inc, Novartis;: Research Funding; ACI Clinical, Syntrix Pharmaceuticals, Takeda Oncology: Other: Data Safety & Monitoring. DeAngelo: Abbvie: Research Funding; Blueprint: Research Funding; Takeda: Consultancy; Autolus: Consultancy; Forty-Seven: Consultancy; Incyte: Consultancy; Jazz: Consultancy; Novartis: Consultancy, Research Funding; Pfizer: Consultancy; Servier: Consultancy; Amgen: Consultancy; Agios: Consultancy; Glycomimetrics: Research Funding. Byrd: Newave: Membership on an entity's Board of Directors or advisory committees; Vincerx Pharmaceuticals: Current equity holder in publicly-traded company, Membership on an entity's Board of Directors or advisory committees; Novartis, Trillium, Astellas, AstraZeneca, Pharmacyclics, Syndax: Consultancy, Honoraria.

Abstract S3-06: Treatment outcomes in patients with invasive breast cancer treated with neoadjuvant systemic therapy and breast MR imaging: Results of a secondary analysis of TBCRC 017

Abstract Background:Neoadjuvant chemotherapy (NCT) is used frequently to downstage locally advanced tumors and facilitate breast conservation. However, we have previously reported that achievement of radiographic complete response (rCR) or pathologic complete response (pCR) does not impact choice of surgery for many patients. This secondary analysis reports treatment outcomes across 9 NCI comprehensive cancer centers in women receiving both NCT and breast MR imaging to assess whether treatment outcomes among women receiving NCT differs according to choice of locoregional treatment. Methods:1077 women from 9 institutions were retrospectively identified as having undergone NCT with MR imaging obtained both before and after systemic treatment. Systemic treatment regimen was not prespecified, but receipt of at least 80% of all planned cycles was required prior to final MR imaging. We performed a univariate analysis as well as a multivariable Cox proportional hazard regression to identify covariates associated with overall survival (OS), disease-free survival (DFS) and time to recurrence (TTR). rCR was defined as no residual enhancement on post-treatment breast MRI. Results:1077 patients diagnosed and treated with NCT for stage I-III invasive breast cancer from January 1, 2002 to June 16, 2014 were analyzed for all endpoints. Median follow-up was 4.2 years, (range 0.1 to 13 years). Median age of the cohort was 50 years, (range 19-87 years). 473 (43.9%) had ER(+) and/or PR(+)/HER2(-) disease, 348 (32.3%) had HER2(+) disease, and 256 (23.8%) had ER(-)/PR(-)/HER2(-) (triple negative) disease. Mastectomy or breast conserving therapy (BCT) was recorded as the definitive surgery in 675 (62.7%) and 402 (37.3%) of patients, respectively. Radiation receipt was confirmed in 84.1% of BCT and 68.3% of mastectomy patients. Overall there were 134 recurrences, 168 disease events and 89 deaths. Among patients with pCR, there were 7/161 (7.2%) recurrences in those undergoing mastectomy and 6/143 (5.1%) in those undergoing lumpectomy (p=0.81). Among patients who achieved an rCR, there were recurrences in 5% of those undergoing mastectomy and 2.9% in those undergoing lumpectomy (p=0.53). In multivariable analysis of the entire cohort, only clinical stage, ER status and pCR remained independently associated with DFS. Notably, subset analysis showed that lumpectomy was independently associated with improved TTR (HR 0.40; 95% CI 0.17-0.97) in the triple negative group only, but this did not translate into improved DFS with lumpectomy in this group. Radiographic CR as determined by breast MRI accurately predicted presence or absence of pCR in 74% of cases, but was not independently associated with DFS, OS or TTP. Conclusions:Among a contemporary cohort of women receiving neoadjuvant systemic therapy and breast MR imaging at 9 NCI designated cancer centers, type of surgery did not impact DFS, OS or TTP. The only exception was found in the triple negative group in which the lumpectomy group had a more favorable TTP compared to the mastectomy group. These findings provide additional evidence that in women who are appropriate candidates for lumpectomy after NCT, BCT does not compromise long-term cancer outcomes. Citation Format: De Los Santos J, Hyslop T, Alvarado M, Forero A, Golshan M, Hieken T, Horton J, Hudis C, McGuire K, Meric-Bernstam F, Nanda R, Zagar T, Hwang S. Treatment outcomes in patients with invasive breast cancer treated with neoadjuvant systemic therapy and breast MR imaging: Results of a secondary analysis of TBCRC 017. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr S3-06.

Impact of care at NCI Comprehensive Cancer Centers (NCICCC) and payor status on outcomes in osteosarcoma (OS), Ewing sarcoma (ES) and rhabdomyosarcoma (RMS).

e17537 Background: Effective management of ES/OS/RMS requires a multidisciplinary approach. Whether care at specialized centers (e.g., NCICCCs) affords a survival advantage across socioeconomic strata remains unstudied. Methods: We constructed a population-based cohort of 629 patients with newly diagnosed (dxed) ES/OS/RMS reported to Los Angeles cancer registry between 1998 and 2008. Multivariable Cox regression was used to determine impact of care at NCI sites (NCICCCs [all ages]; Children’s Oncology Group [COG] sites [<21y]) on overall survival adjusting for dx, stage, age, SES, payor. Logistic regression was used to determine likelihood of care at NCI sites, adjusting for above variables and distance to nearest center (using GIS). Results: Clinical characteristics in Table.Median age at dx was 17y (0-65y). Survival: Multivariable analysis revealed payor as a risk factor for survival (uninsured: HR=1.7, 95%CI 1.0-2.8, p=0.04; ref: private insurance). A significant NCI/payor interaction (p=0.01) was obse...

Impact of NCI Comprehensive Cancer Centers on ovarian cancer treatment and survival

Impact of NCI Comprehensive Cancer Centers on ovarian cancer treatment and survival

Impact of Care at NCI Comprehensive Cancer Centers (NCICCC) on Outcomes in Children, Adolescents and Young Adults (AYA) with Hematologic Malignancies

Background:AYA (15-39y) diagnosed with hematologic malignancies have inferior survival and have not seen the same survival improvement in comparison with those diagnosed during childhood (0-14y) leaving an AYA Gap. Treatment on pediatric trials is associated with superior survival in 15-21y diagnosed with acute lymphoblastic leukemia (ALL). However, impact of care at National Cancer Institute-designated Comprehensive Cancer Centers (NCICCC) for AYA of all ages or Children’s Oncology Group sites (COG) for AYA aged 15-21y remains unstudied.Methods:We constructed a population-based cohort of 1,388 children (1-14y), 673 young AYA (15-21y) and 2,275 older AYA (22-39y) with newly diagnosed ALL, acute myeloid leukemia (AML), Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) reported to the LA County cancer registry between 1998-2008. We sought to determine the impact of care at NCICCC/COG (NCICCC+COG: n=3, COG: n=3) on overall survival (OS) and barriers to access to care at NCICCC/COG in AYA with hematologic malignancies. Multivariable Cox regression was used to derive hazard ratios (HR) for mortality, adjusting for gender, race/ethnicity, socioeconomic status (SES) [and stage in lymphomas]. Multivariable logistic regression was used to derive odds ratios (OR) for likelihood of care at NCICCC/COG, adjusting for above variables plus insurance and distance to the nearest NCICCC/COG. Distance to NCICCC/COG was derived using Geographic Information Systems.Results:AYA experienced inferior 5y OS as compared to children across diagnoses (Figure: ALL [n=1,380]: 72% [10-14y] vs 44% [15-21y] vs 38% [22-39y], p<0.01; AML [n=490]: 63% [1-14y] vs 49% [15-21y] vs 49% [22-39y], p<0.01; NHL [n=1,379] : 86% [1-14y] vs 78% [15-21y] vs 68% [22-39y], p<0.01; HL [n=1,087]: 96% [1-14y] vs 95% [15-21y] vs 90% [22-39y], p=0.04). AYA with ALL treated at community sites had worse outcome when compared with children (15-21y vs 10-14y: HR=2.9, p<0.01; 22-39y vs 10-14y: HR=4.7, p<0.01). This difference in outcome between young AYA and children with ALL was abrogated by care at NCICCC/COG (HR=1.3, p=0.2) and greatly diminished in older AYA by care at NCICCC (HR=2.5, p<0.01). Similarly, AYA with AML treated at community sites had worse outcome when compared with children (15-21y vs 1-14y: HR=2.3, p<0.01; 22-39y vs 1-14y: 1.8, p=0.07). The difference in outcome was abrogated by care at NCICCC/COG (young AYA vs children with AML: HR=1.1, p=0.07; older AYA vs children: HR=1.5, p=0.2). AYA with NHL treated at community sites had worse outcome as compared to children (15-21y vs 1-14y: HR=2.4, p=0.04; 22-39y vs 1-14y: HR=3.9, p<0.01). The difference in outcome was diminished by care at NCICCC/COG (young AYA vs children with NHL: HR=2.0, p=0.06; older AYA vs children: HR=1.6, p=0.2). Compared to children and young AYA (1-21y) with HL, older AYA cared for at community sites had poor outcome (HR=2.2, p<0.01). The difference between older AYA and younger patients (1-21y) was mitigated by care at NCICCC (HR=1.2, p=0.6).While 69% of children were treated at one of NCICCC/COG sites in LA County, only 38% of young AYA were seen at NCICCC/COG and merely 10% of older AYA were seen at NCICCCs. Compared with children (0-14y), young AYA (15-21y) were less likely to receive care at NCICCC/COG (ALL: OR=0.5; AML: OR=0.2; NHL: OR=0.3; HL: OR=0.2; all p<0.01), irrespective of SES, distance to care, insurance status. In analyses restricted to older AYA (22-39y), public or no insurance (ALL: OR=0.1; AML: OR=0.2; NHL: OR=0.3, all p<0.01), African-American or Hispanic background (HL: OR=0.3, p<0.01), low SES (NHL: OR=0.5, p<0.01) and distance from the nearest NCICCC (NHL: OR=0.5; HL: OR=0.5, all p<0.01) reduced likelihood of receiving care at NCICCC.Conclusions:Population-based data reveal that receipt of care at NCICCC/COG greatly diminishes the inferior outcome in AYA with hematologic malignancies. The role that cancer biology, therapeutic strategy and treating physician specialty (pediatric vs adult) each play in this dynamic is currently under investigation. Irrespective of all sociodemographic variables, young AYA are less likely to use NCICCC/COG than children. Among older AYA, patients without private insurance, from low SES, African-American/ Hispanic backgrounds or living >9 miles from the nearest NCICCC are less likely to receive treatment at NCICCC. Barriers to care at COG/NCICCC are currently being explored. [Display omitted] DisclosuresStock:Jazz Pharmaceuticals: Consultancy; Amgen: Consultancy; Seattle Genetics: Consultancy; Sigma Tau: Consultancy; Sigma Tau: Research Funding.

Impact of care at NCI Comprehensive Cancer Centers (NCICCC) on cancer outcome: Results from a population-based study.

188 Background: Despite advances in therapy and supportive care, prognosis for certain cancers remains poor. Rigorous processes ensure quality of research, clinical care and education at NCICCC. However, impact of site of care on survival and access to NCICCC for vulnerable subpopulations (race/ethnicity, payor) remains unstudied. Methods: We constructed a population-based cohort of 53,618 patients diagnosed between 22y-65y with adult-onset cancers and reported to LA County cancer registry between 1998-2008. Geographic Information Systems (ArcGIS) was used for geospatial analysis. Results: Across multiple diagnoses, patients at NCICCC showed superior 5y overall survival (OS) as compared to those at community sites (Breast [n=31,770]: 89% vs. 86%, p&lt;0.01; Lung [n=10,855]: 28% vs. 17%, p&lt;0.01; Hepatobiliary [n=4,296]: 34% vs. 19%, p&lt;0.01; Gastric [n=2,678] 32% vs. 22%, p&lt;0.01; Pancreas [n=2,326]: 13% vs. 6%, p&lt;0.01; Oral [n=1,838]: 68% vs. 59%, p=0.01). Adjusting for clinical (age, stage, gender) and sociodemographic (race/ ethnicity, payor, socioeconomic status [SES]) characteristics, multivariable Cox regression revealed an increased risk of mortality in patients receiving care at non-NCICCC sites: Breast: hazard ratio (HR)=1.2, p&lt;0.01; Lung: HR=1.5, p&lt;0.01; Hepatobiliary: HR=1.4, p&lt;0.01; Gastric: HR=1.4, p&lt;0.01; Pancreas (n=2,326), HR=1.5, p&lt;0.01; Oral: HR=1.3, p=0.05. Overall 7% of patients were seen at NCICCC (range 4-16%, p&lt;0.01). Multivariable logistic regression adjusting for clinical characteristics revealed that low SES (OR range across diagnoses: 0.4-0.5, p&lt;0.01), public (OR 0.4-0.9, p&lt;0.03) or no (OR 0.1-0.7, p&lt;0.04) insurance, African-American race (OR 0.4-0.6, p&lt;0.03) or Hispanic ethnicity (OR 0.5-0.7, p&lt;0.02), and residing &gt; 9 miles from nearest NCICCC (OR 0.5-0.9, p&lt;0.01) decreased likelihood of care at NCICCC. Conclusions: Population-based data reveal superior OS among adult-onset cancer patients receiving care at NCICCC. Patients without private insurance, from low SES, African-American and Hispanic backgrounds or living more than 9 miles from an NCICCC, are less likely to use NCICCC. Barriers to care at NCICCC are currently being explored.

Impact of care at NCI comprehensive cancer centers (NCICCC) on cancer outcome: Results from a population-based study.

6541 Background: Despite advances in therapy and supportive care, prognosis for certain cancers remains poor. Rigorous processes ensure quality of research, clinical care and education at NCICCC. H...

Abstract P1-01-04: Nodal patterns of care in patients with invasive breast cancer treated with neoadjuvant systemic therapy: Results of a secondary analysis of TBCRC 017

Abstract Background: Neoadjuvant chemotherapy (NCT) to downstage locally advanced tumors and potentially allow breast conservation has increased. In parallel, the use of sentinel lymph node biopsy (SNB) and axillary node dissection has evolved. This analysis reports patterns of care for axillary evaluation at 8 NCI Comprehensive Cancer Centers in women receiving NCT. Methods: Between 2002 and 2010, 770 women were retrospectively identified as having received NCT, 758 of who had nodal imaging either before or after NCT. Clinical, pathologic, and treatment data were collected. Univariate and multivariate analyses of covariates associated with axillary management were performed using logistic regression (SAS 9.2, Proc Logistic). Results: Between 2002 and 2010, the odds of receiving a post-NCT SNB increased by 8% per year (p&amp;lt;0.001). Rates of post-NCT SNB were significantly different in only one of eight institutions (p&amp;lt;0.001), where pre-NCT nodal evaluation was made by SNB. The remainder of institutions used SNB following NCT. Of those who underwent post-NCT SNB, regardless of nodal status pre-NCT, 55% (171/314) had axillary lymph node dissection (ALND). Prior to NCT, 74% (564/758) of patients exhibited at least one abnormal lymph node on pretreatment imaging. Imaging modalities used pretreatment to assess axillary lymph nodes Suspicious Nodes N (%)Ultrasound24 (4.3)Ultrasound+MRI218 (38.7)Ultrasound +MRI+CT103 (18.3)Ultrasound+MRI+CT+PET39 (6.9)Ultrasound+MRI+PET9 (1.6)Ultrasound+CT12 (2.1)Ultrasound+CT+PET8 (1.4)Ultrasound+PET3 (0.5)MRI36 (6.4)MRI+CT58 (10.3)MRI+CT+PET21 (3.7)MRI+PET9 (1.6)CT18 (3.2)CT+PET3 (0.5)CT+PET3 (0.5)TOTAL564 (100) Of those, 52% (291/564) of the lymph nodes were sampled using fine needle aspiration (FNA) and 27% (149/564) were sampled with CNB. Odds of undergoing a core needle biopsy (CNB) at presentation for radiographically or clinically suspicious lymph nodes increased by 27% per year (p&amp;lt;0.001). 57% (322/564) of all sampled lymph nodes were positive for malignant cells by either FNA or CNB. Of those with confirmed positive nodes at diagnosis, 26% (83/322) had nodal sampling with SNB after NCT. Of the 462 patients with pretreatment MRI suggesting an abnormal lymph node, 155 (33.5%) had a complete imaging response in the lymph nodes by MRI. Of those patients 32% (49/155) had SNB as their initial axillary evaluation after NCT, of which 45% (22/49) of those exhibited persistently positive nodes and underwent completion axillary node dissection. Conclusions: Among a contemporary cohort of women receiving NCT, a significant trend was observed towards increased use of needle biopsy for patients with abnormal pretreatment nodal imaging at presentation and sentinel lymph node biopsy after NCT nodal evaluation. A trend was also observed over time towards greater use of post-NCT SNB in patients with confirmed pathologic positive nodes at presentation. These data demonstrate a trend towards less invasive assessment of suspicious lymph nodes both before and after NCT. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-01-04.

Impact of care at NCI comprehensive cancer centers (NCICCC) on outcomes in children, adolescents, and young adults (AYA) with central nervous system tumors (CNSt).

123 Background: AYA (15-39yo) have not seen the same survival improvement as younger cancer patients with similar diagnoses (dx), leaving an AYA Gap. Treatment on pediatric trials is associated with superior survival in 15-21yo. However, impact of care at NCICCC for complex diseases with poor prognosis that require evidence-based care available at NCICCC (e.g. CNSt), remain unstudied. Methods: We constructed a cohort of 560 children (0-14yo) and 785 AYA with newly-dx CNSt, reported to the LA County (LAC) cancer registry between 1998 and 2008. While 82% of children (0-14y) and 65% of young AYA (15-18y) were treated at one of 3 NCICCC or 3 COG sites in LAC, only 17% of older AYA (19-39y) were treated at one of 3 NCICCC. We sought to determine the impact of NCICCC/COG on overall survival (OS) and barriers to access to care at NCICCC/COG in AYA with CNSt. Since distance to NCICCC/COG could serve as a barrier to accessing care, Geographic Information Systems were used to derive distance between patient’s residence to the nearest NCICCC/COG. Results: OS rates were uniformly good for children and AYA with grade 1 CNSt (96 vs. 89% at 5y, p=0.2) and uniformly poor for children and AYA with grade 3/4 CNSt (43 vs. 43% at 5y, p=0.6). Among patients with WHO grade 2 CNSt, AYA had worse outcome (HR=1.9, p&lt;0.01) after adjustment for race/ ethnicity, SES, and gender. This difference in outcome between AYA and children was abrogated by care at NCICCC (HR 1.4, p=0.2). Furthermore, patients cared at non-NCICCC saw worse outcome (HR=1.6, p=0.04). Compared with children, young AYA (15-18yo) were less likely to receive care at NCICCC (OR=0.3, p=0.02); race/ ethnicity, SES and distance to NCICCC did not influence care at NCICCC. Among older AYA (19-39yo), low SES (OR 0.4, p=0.01), public/ no insurance (OR 0.3, p&lt;0.01) and longer distance to NCICCC (5-12mi: OR=0.3 , p&lt;0.01; &gt;12mi OR 0.5 , p=0.05) reduced likelihood to receive care at NCICCC. Conclusions: Population-based data reveal that receipt of care at NCICCC abrogates the inferior outcome in AYA with WHO grade 2 CNSt. Young AYA are less likely to use NCICCC than children, as are older AYA with low SES, public/ no insurance, or living &gt; 5 miles from an NCICCC.

The effect of care at NCI comprehensive cancer centers on disparities in outcome in adolescents and young adults (AYAs) with cancer.

217 Background: AYAs (15-39y at diagnosis) with cancer have not seen the survival improvement evidenced by younger and older age groups with similar diagnoses, leaving an AYA Gap. While treatment on pediatric protocols is associated with superior survival in 15-21y, impact of site of care on survival for vulnerable AYA subpopulations (race/ethnicity) between 22-39y at diagnosis remains unstudied. Methods: Utilizing a cohort of 10,602 AYAs newly diagnosed between 22-39y with lymphoma, leukemia, brain tumors, melanoma, thyroid and GU cancers, and reported to the Los Angeles County cancer registry between 1998 and 2008, we aimed to determine the impact of receiving care at NCI Comprehensive Cancer Centers (NCICCC) on overall survival for AYAs, and disparities in survival by race/ethnicity. We further aimed to understand the role of SES and insurance status in accessing care at NCICCC. Multivariable analyses included race/ethnicity, age at diagnosis, SES, insurance status, primary cancer diagnosis and diagnosis year in the model. Results: A total of 904 (9%) patients received treatment at the 3 NCICCC (City of Hope, Jonsson Cancer Center, and Norris Cancer Center) in LA County. Ten-year overall survival (10y OS) was significantly worse for patients treated at non-NCICCC (81%) when compared with those treated at NCICCC (83%, p=0.02). Also, 10y OS was worse for African Americans (AA) (68%) vs. non-Hispanic whites (86%, p&lt;0.0001). Multivariable analysis adjusting for SES, insurance status, diagnosis and diagnosis year revealed that AA (HR=1.5, p=0.0001) were at an increased risk of death. Among patients treated at NCICCC, the difference in risk of death due to race (HR=0.9, p=0.84) was abrogated. However, among patients treated at non-NCICCC, these differences in outcome persisted (HR=1.48, p&lt;0.0001). Independent of SES, insurance and tumor factors, AA (OR=0.44, p&lt;0.001) were less likely to use NCICCC. Conclusions: Population-based data reveal that receipt of care at an NCICCC abrogates the inferior outcome observed among AA with cancer. AA are less likely to use NCICCC for treatment. Barriers to accessing care at NCICCC are currently being explored.

Evaluation of the effect of care at NCI comprehensive cancer centers (NCICCCs) on disparities in outcome within adolescents and young adults (AYAs) with cancer.

9512 Background: AYAs (15-39y at diagnosis) with cancer have not seen the survival improvement evidenced by younger and older age groups with similar diagnoses, leaving an AYA Gap. While treatment on pediatric protocols is associated with superior survival in 15-21 year-olds, the impact of site of care on survival for vulnerable AYA subpopulations (age at diagnosis or race/ ethnicity) between 22-and 39y at diagnosis remains unstudied. Methods: We constructed a cohort of 10,727 patients newly diagnosed between the ages of 22- and 39y with lymphoma, leukemia, brain tumors, melanoma, thyroid and GU cancers, and reported to the LA County cancer registry between 1998 and 2008. Multivariable Cox regression analysis was conducted, and included race/ethnicity, age at diagnosis, SES, insurance status, primary cancer diagnosis and diagnosis year in the model; the analysis was stratified by site of care (NCICCC vs. non-NCICCC). Results: A total of 928 (9%) patients received treatment at the 3 NCICCCs (City of Hope, Jonsson Cancer Center and Norris Cancer Center) in LA County, and 9,799 received care elsewhere. Five-year overall survival (5y OS) was significantly worse for patients treated at non-NCICCC (87%) when compared with those treated at NCICCC (84%, p=0.02). In addition, 5y OS was worse for African Americans (71%) vs. non-Hispanic whites (89%, p&lt;0.0001) and for older patients (31-39yo: 84%, vs. 22-30yo: 86%, p=0.0004). Multivariable analysis adjusting for SES, insurance status, diagnosis and diagnosis year revealed that African Americans (HR=1.4, p=0.0002) and older AYAs (31-39y: HR=1.24, p&lt;0.0001) were at an increased risk of death. Among patients treated at NCICCC, the difference in risk of death due to race (African Americans: HR=0.8, p=0.7) and age (31-39yo: HR=1.1, p=0.6) was abrogated. On the other hand, among patients treated at non-NCICCC, these differences in outcome persisted (African Americans: HR=1.45, p =0.0002; 31-39yo: HR=1.25, p&lt;.0001). Conclusions: Population-based data reveal that receipt of care at an NCICCC abrogates the effects of race and older age on mortality in AYAs with cancer. Barriers to accessing care at NCICCCs are being explored.

P2-15-01: Surgical Patterns of Care after Magnetic Resonance Imaging in the Academic Setting in Patients with Operable Breast Cancer Treated with Neoadjuvant Systemic Therapy: A Secondary Analysis of TBCRC 017.

Abstract Background: Neoadjuvant chemotherapy is increasingly used to downstage locally advanced tumors, test new regimens, and improve chances of breast conservation. In parallel, use of breast MRI for surgical planning and as a potential response biomarker has also increased along with an observed increase in mastectomy rates. This secondary analysis reports surgical patterns of care across 8 NCI comprehensive cancer centers in women receiving both neoadjuvant therapy and breast MRIs. Methods: 770 women from 8 institutions were retrospectively identified as having received neoadjuvant systemic therapy with MRI done before and after systemic treatment. Univariate and multivariate analyses of covariates associated with surgical management were performed. Within MRI complete response or not, the Jonckheere-Terpstra Test (JTT) was used to test for a trend in mastectomy rate by T stage. Results: Surgical data was available on 763/770 patients. Table 1 lists MRI response by pretreatment imaging size and final breast surgery. Distribution of pretreatment imaging-defined T stage was as follows: T1 66 (8%), T2 436 (57%), T3 230 (30%), and T4 36 (5%). 347/763 (45%) patients received breast conserving surgery and 416/763 (55%) had a mastectomy. 58% vs 43% (p=0.0003) of those with an incomplete vs complete MRI response had a mastectomy, respectively. Univariate logistic regression analysis of covariates significantly associated with use of mastectomy included ER- status (p=0.01), incomplete MRI response (p=0.0003), higher T stage (p&amp;lt;0.0001), chemotherapy regimen (p=0.006), younger age (p&amp;lt;0.0001), and institution (p=0.002); all except chemotherapy regimen and institution remained independent predictors of mastectomy on multivariate analysis. Patients with larger baseline T stage and an incomplete response on MRI (P&amp;lt;0.001) were more likely to undergo mastectomy. Overall, breast conservation was low (262/495, 53%) of all T1-T2 patients, especially in the T1 subset (26/65, 40%). Conclusions: In a contemporary group of women treated with preoperative chemotherapy at NCI designated cancer centers and with available pre/post MRI, we observed a lower frequency of breast conservation as compared to historical data from prospective randomized trials. Larger tumor size at baseline was associated with higher mastectomy rates. However, even among those with a complete MRI response, 43% had a mastectomy. In addition to clinical response and MRI findings, factors not examined here (e.g., BRCA status, education level, and patient/provider preference) may influence the decision-making process and deserve further evaluation. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-15-01.