Surveillance, Epidemiology, And End Results Areas Research Articles

Angiotensin-II stimulating vs. inhibiting antihypertensive drugs and the risk of Alzheimer's disease or related dementia in a large cohort of older patients with colorectal cancer.

Several previous studies showed that patients who received angiotensin II-stimulating antihypertensive medications had a lower incident dementia rate than those angiotensin II-inhibiting antihypertensive users, but no study has been conducted in long-term cancer survivors. To determine the risk of Alzheimer's disease (AD) and related dementia (ADRD) associated with the types of antihypertensive medications in a large cohort of survivors with colorectal cancer in 2007-2015 with follow-up from 2007 to 2016. We identified 58,699 men and women with colorectal cancer aged 65 or older from the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database in 17 SEER areas in 2007-2015 with follow-up to 2016, who were free of any diagnosed ADRD at the baseline (within 12 months prior to and 12 months after the date of diagnosis for colorectal cancer). All patients who were defined as having hypertension by ICD diagnosis code or received antihypertensive drugs during this baseline 2-year period were classified into 6 groups based on whether they received angiotensin-II stimulating or inhibiting antihypertensive drugs. Crude cumulative incidence rates of AD and ADRD were similar between those who received angiotensin II-stimulating antihypertensive medications (4.3% and 21.7%) and those receiving angiotensin II-inhibiting antihypertensive medications (4.2% and 23.5%). As compared to patients who received angiotensin II-stimulating antihypertensive drugs, those who received angiotensin II-inhibiting antihypertensives were significantly more likely to develop AD (adjusted hazard ratio: 1.15, 95% CI: 1.01-1.32), vascular dementias (1.27, 1.06-1.53), and total ADRD (1.21, 1.14-1.28) after adjusting for potential confounders. These results remained similar after adjusting for medication adherence and considering death as a competing risk. The risk of AD and ADRD in patients with hypertension who received angiotensin II-inhibiting antihypertensive medications was higher than in those receiving angiotensin II-stimulating antihypertensive drugs in patients with colorectal cancer.

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Tumor Necrosis Factor Inhibitors and the Risk of Cancer among Older Americans with Rheumatoid Arthritis.

TNF inhibitors (TNFi) effectively treat rheumatoid arthritis but may increase patient risk of some malignancies, particularly lymphomas or skin cancers. We used Surveillance, Epidemiology, and End Results (SEER)-Medicare data to conduct a case-control study in patients with rheumatoid arthritis (2007-2015). Cases were individuals with a first cancer diagnosed in SEER registries (ages 66-99, 22 cancer sites, N = 10,263). Skin cancer cases [nonmelanoma skin cancer (NMSC, N = 501), basal cell carcinoma (BCC, N = 161), squamous cell carcinoma (SCC, N = 150)] and cancer-free controls (N = 30,475) were selected from Medicare beneficiaries residing in SEER areas. Cases and controls had prior Medicare claims-based evidence for rheumatoid arthritis, and TNFi exposure was ascertained from part B and part D claims. Logistic regression was used to estimate adjusted odds ratios (aOR). TNFi exposure was present in 16.2% of controls and 12.8% to 33.7% of cancer cases, varying by site. TNFi use was associated with increased risk of NMSC overall (aOR 1.32, 95% confidence interval 1.06-1.63), non-Hodgkin lymphoma (NHL) overall (1.28, 1.06-1.56) and, specifically, follicular lymphoma (2.63, 1.63-4.24). TNFi exposure was not associated with other SEER cancer sites, BCC or SCC specifically, or other common NHL subtypes. Among older adults with rheumatoid arthritis, TNFi exposure was associated with elevated risk of NMSC and NHL, driven specifically by follicular lymphoma. Exposure was not associated with increased risk for other cancer sites. Our results support a role for TNF in lymphomagenesis. Given the association with NMSC, patients initiating TNFi therapy may benefit from skin cancer screening and sun protection measures.

Increase in survival for patients with mantle cell lymphoma in the era of novel agents in 1995–2013: Findings from Texas and national SEER areas

BackgroundOver the past 20 years, many novel agents and treatment regimens have been developed to treat mantle cell lymphoma (MCL). This study aimed to determine the impact of these new regimens on the survival of MCL patients from 1995 to 2013. MethodsAll newly diagnosed adult MCL patients in the Surveillance, Epidemiology, and End Results (SEER) and Texas Cancer Registry (TCR) databases were included. Patients were grouped into 4 calendar periods based on the time when new novel agents became available: chemotherapy-only (1995–1998, P1), rituximab + chemotherapy (1999–2004, P2), bortezomib and HyperCVAD (2005–2008, P3), bendamustine and Nordic regimen (2009–2013, P4). Associations between these time periods and survival outcomes were analyzed using the Kaplan-Meier method and Cox proportional hazard regressions. ResultsA total of 7,555 SEER patients and 2,055 TCR patients were identified. All-cause mortality rates decreased significantly from 1995 to 2013 (SEER, P < 0.001; TCR, P = 0.03). Multivariable analysis of SEER data showed that the risk of MCL-specific death decreased significantly over the study period with hazard ratios of 0.82 (P2 vs. P1), 0.66 (P3 vs. P1), and 0.58 (P4 vs. P1) (P < 0.0001). Similar results were observed for TCR data (P < 0.0001). In an analysis stratified by tumor stage, only patients with advanced- stage tumors showed a significantly decreased risk of death in both SEER (P < 0.0001) and TCR (P = 0.002) datasets. ConclusionSurvival outcome for MCL patients improved from 1995 to 2013, especially for patients with advanced-stage tumors, potentially reflecting the impact of the introduction of novel agents and new therapeutic regimens.

Increase in Survival for Patients with Mantle Cell Lymphoma in the Era of Novel Agents in 1995-2013: Findings from Texas and National SEER Areas

Abstract Background Over the past 20 years, many novel agents and treatment regimens have been developed to treat mantle cell lymphoma (MCL). This study aimed to determine the impact of these new regimens on the survival of MCL patients from 1995 to 2013. Methods All newly diagnosed adult MCL patients in the Surveillance, Epidemiology, and End Results (SEER) and Texas Cancer Registry (TCR) databases were included. Patients were grouped into 4 calendar periods based on the time when new novel agents became available: chemotherapy-only (1995–1998, P1), rituximab + chemotherapy (1999–2004, P2), bortezomib and HyperCVAD (2005–2008, P3), bendamustine and Nordic regimen (2009–2013, P4). Associations between these time periods and survival outcomes were analyzed using the Kaplan-Meier method and Cox proportional hazard regressions. Results A total of 7,555 SEER patients and 2,055 TCR patients were identified. All-cause mortality rates decreased significantly from 1995 to 2013 (SEER, P Conclusion Survival outcome for MCL patients improved from 1995 to 2013, especially for patients with advanced-stage tumors, potentially reflecting the impact of the introduction of novel agents and new therapeutic regimens.

Racial, Socioeconomic, and Geographic Disparities in the Receipt, Timing to Initiation, and Duration of Adjuvant Androgen Deprivation Therapy in Men with Prostate Cancer.

This retrospective cohort study aims to examine the receipt, timing to initiation, and duration of androgen deprivation therapy (ADT) in men with prostate cancer by race/ethnicity, socioeconomic status, and geographic location. The study population are patients from Surveillance, Epidemiology, and End Results (SEER)-Medicare linked database, who were 66years or older and newly diagnosed with stage III and IV prostate cancer in 1992-2009 and underwent radiation therapy, where ADT was proven to be highly beneficial and its use was considered as most appropriate (n = 12,170). We use logistic regression to examine the receipt of ADT and linear regression to study factors associated with time to ADT initiation while controlling for baseline characteristics. Overall, 77% of eligible patients received at least one form of ADT in combination with radiation therapy, of which 12% underwent orchiectomy and the rest received ADT, and 77.2% of non-Hispanic white and 80.7% of Hispanic patients received ADT compared to 73.8% of non-Hispanic black. After adjustment for demographic and tumor characteristics, black men and men of other races are less likely to receive ADT compared to white counterparts (OR = 0.64 and 0.74, respectively). The median time from cancer diagnosis to ADT initiation is 2months. Once initiated, men received a median of seven drug injections. After controlling for covariates, race/ethnicity and geographic location (SEER areas) are associated with early initiation of therapy. White, Hispanic men and men living in the South initiate ADT earlier. Significant racial disparities exist in the receipt and use of this highly beneficial therapy, and there are geographic variations in the utilization of this therapy.

Differences in cancer survival among white and black cancer patients by presence of diabetes mellitus: Estimations based on SEER-Medicare-linked data resource.

Diabetes prevalence and racial health disparities in the diabetic population are increasing in the US. Population‐based cancer‐specific survival estimates for cancer patients with diabetes have not been assessed. The Surveillance, Epidemiology, and End Results (SEER)‐Medicare linkage provided data on cancer‐specific deaths and diabetes prevalence among 14 separate cohorts representing 1 068 098 cancer patients ages 66 + years diagnosed between 2000 and 2011 in 17 SEER areas. Cancer‐specific survival estimates were calculated by diabetes status adjusted by age, stage, comorbidities, and cancer treatment, and stratified by cancer site and sex with whites without diabetes as the reference group. Black patients had the highest diabetes prevalence particularly among women. Risks of cancer deaths were increased across most cancer sites for patients with diabetes regardless of race. Among men the largest effect of having diabetes on cancer‐specific deaths were observed for black men diagnosed with Non‐Hodgkin lymphoma (NHL) (HR = 1.53, 95%CI = 1.33‐1.76) and prostate cancer (HR = 1.37, 95%CI = 1.32‐1.42). Diabetes prevalence was higher for black females compared to white females across all 14 cancer sites and higher for most sites when compared to white and black males. Among women the largest effect of having diabetes on cancer‐specific deaths were observed for black women diagnosed with corpus/uterus cancer (HR = 1.66, 95%CI = 1.54‐1.79), Hodgkin lymphoma (HR = 1.62, 95%CI = 1.02‐2.56) and breast ER+ (HR = 1.39, 95%CI = 1.32‐1.47). The co‐occurrence of diabetes and cancer significantly increases the risk of cancer death. Our study suggests that these risks may vary by cancer site, and indicates the need for future research to address racial and sex disparities and enhance understanding how prevalent diabetes may affect cancer deaths.

Trends and variations in mantle cell lymphoma incidence from 1995 to 2013: A comparative study between Texas and National SEER areas.

BackgroundFew studies have assessed mantle cell lymphoma (MCL) incidence trends in the U.S. National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) areas. Previous studies were 5 to 9 years old and MCL incidence in Texas remains unknown. This study updated the temporal trends and variations of MCL incidence in the SEER areas and compared them with counterpart data in Texas.ResultsFrom 1995 to 2013, there were 2, 435 and 5, 193 newly diagnosed MCL patients in Texas and SEER areas. Age-adjusted MCL incidence was 0.91 per 100,000 persons per year in Texas and 1.01 in SEER areas. MCL incidence increased steadily with an annual percent change (APC) of 2.56% in SEER areas and an APC of 2.16% in Texas. In SEER areas, APCs for MCL incidence were significantly different from zero in patients with advanced stage tumor (3.33%), male (2.71%), elderly patients ≥ 80 years old (4.21%) and non-Hispanic white patients (2.83%) (all P < 0.05). Similar patterns were found in Texas for both incidence rates and APCs.Materials and methodsWe identified all adult patients with newly diagnosed MCL in Texas Cancer Registry and SEER databases from 1995 to 2013. Age-adjusted incidence rates were calculated and negative binomial regression model was used to assess the factors associated with MCL incidence.ConclusionsMCL incidence rates increased over time in both Texas and SEER areas, with increases being greater in male, non-Hispanic white, and elderly patient ≥70 years with advanced stage tumors. Texas has similar MCL incidence trends and disparities as the national SEER areas.

Abstract 259: A case series of vitreoretinal lymphoma in New York City with exposure to Chernobyl nuclear disaster decades earlier

Abstract Background: Vitreoretinal lymphoma (VRL) is an unusual presentation of primary central nervous system lymphoma and a subcategory of intraocular lymphoma (IOL). The etiology and epidemiology of this rare malignancy is unknown. Methods: We diagnosed 10 subjects with VRL in our clinical practices in New York City (NYC) during 2010-2013. Upon systematic collection of demographic and exposure history, 6 patients reported residence in regions proximal to the Chernobyl nuclear disaster (4 Ukraine, 1 Poland, 1 Moldova). We studied clinical variables including presentation, diagnostic parameters, therapies and survival of this case series. To provide context, we examined population-based incidence data from the Surveillance, Epidemiology and End Results (SEER) program to determine age-adjusted incidence rates of IOL (there is no unique code for VRL) per 100,000 person-years in the United States (US) during 1992-2013. New York State (NYS) rates are not reported to SEER and were examined separately using NYS Cancer Registry (NYSCR). Incidence trends using 10-year intervals (1992-2002 and 2003-2013) were also analyzed. Results: All six subjects (5 females) were diagnosed with diffuse large B-cell lymphoma with bilateral presentation. Diagnosis in all cases was made by immunohistochemical analysis on tumor specimen obtained by vitreous fine needle aspiration, vitreous biopsy or stereotactic brain biopsy. Median age at diagnosis was 76 years (range, 62-84 years). Median interval from Chernobyl accident (1986) to diagnosis was 26 years (range, 24-27 years). We identified no other common exposure or environmental risk factor. There were 68 cases of primary IOL during 1992-2013 in the 13 SEER areas. IOL rates per 100,000 person-years for both sexes were highest among Asian/Pacific Islanders (0.010 for males and 0.014 for females) followed by whites (0.009 for males and 0.008 for females) and (based on small numbers) by blacks. Analysis of incidence trends showed an increase in rates among Asian/Pacific Islander females from 0.005 in 1992-2002 to 0.018 in 2003-2013 and among males from 0.006 to 0.013. Rates among whites increased for both genders. Analysis of NYSCR data revealed 44 cases of primary IOL. IOL rates per 100,000 person-years for both genders were highest among whites (0.010 for males and 0.012 for females) followed by Asian/Pacific Islanders (0.007 for males and females). Analysis of trends revealed increase in rates for both genders and racial groups. Conclusions: Our analyses highlight the rarity of VRL and reveal an increase in incidence, particularly among Asian/Pacific Islanders where IOL rates tripled within two decades. Based on incidence rates, 8 cases of IOL (with a subset being VRL) are expected in 4 years in NYS. Our observation of 10 cases of VRL in 4 years in our practices in NYC is unanticipated. The sole common environmental factor we identified was residence in regions proximal to the Chernobyl nuclear disaster. Citation Format: Sanford Kempin, Paul Finger, Robert Gale, John Rescigno, Jeffrey Rubin, Walter Choi, Rebecca Fisher, Alexander Aizman, Ilona Genis, Roxana Moslehi* (Corresponding Author). A case series of vitreoretinal lymphoma in New York City with exposure to Chernobyl nuclear disaster decades earlier [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 259. doi:10.1158/1538-7445.AM2017-259

Utilization of preoperative endoscopic ultrasound for pancreatic adenocarcinoma

BackgroundEndoscopic ultrasound (EUS) is used for pancreatic adenocarcinoma staging and obtaining a tissue diagnosis. The objective was to determine patterns of preoperative EUS and the impact on downstream treatment. MethodsThe Surveillance, Epidemiology, and End Results (SEER) Medicare-linked database was used to identify patients with pancreatic adenocarcinoma. The staging period was the first staging procedure within 6 months of surgery until surgery. Logistic regression was used to determine factors associated with preoperative EUS. The main outcome was EUS in the staging period, with secondary outcomes including number of staging tests and time to surgery. Results2782 patients were included, 56% were treated at an academic hospital (n = 1563). 1204 patients underwent EUS (43.3%). The factors most associated with receipt of EUS were: earlier year of diagnosis, SEER area, and a NCI or academic hospital (all p < 0.0001). EUS was associated with a longer time to surgery (17.8 days; p < 0.0001), and a higher number of staging tests (40 tests/100 patients; p < 0.0001). ConclusionsFactors most associated with receipt of EUS are geographic, temporal, and institutional, rather than clinical/disease factors. EUS is associated with a longer time to surgery and more preoperative testing, and additional study is needed to determine if EUS is overused.

Chronic Sinusitis and Risk of Head and Neck Cancer in the US Elderly Population

Chronic sinusitis may be involved in the etiology of certain head and neck cancers (HNCs), due to immunodeficiency or inflammation. However, the risk of specific HNCs among people with chronic sinusitis is largely unknown. To evaluate the associations of chronic sinusitis with subsequent HNC, including nasopharyngeal cancer (NPC), human papillomavirus-related oropharyngeal cancer (HPV-OPC), and nasal cavity and paranasal sinus cancer (NCPSC), in an elderly US population. We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database to conduct a case-cohort study of US individuals aged 65 years or older during 2004 through 2011. The study included 483 546 Medicare beneficiaries from SEER areas in a 5% random subcohort, and 826 436 from the entire source population who developed cancer (including 21 716 with HNC). Incidence of HNCs including NPC, HPV-OPC, and NCPSC. Most individuals were female (57.7%), and the mean (SD) age at entry was 72.6 (8.0) years. Chronic sinusitis was associated with risk of developing HNC (adjusted hazard ratio [aHR], 1.37; 95% CI, 1.27-1.48), particularly NPC (aHR, 3.71; 95% CI, 2.75-5.02), HPV-OPC (aHR, 1.33; 95% CI, 1.13-1.57), and NCPSC (aHR, 5.49; 95% CI, 4.56-6.62). Most of this increased risk was limited to risk within 1 year of the chronic sinusitis diagnosis, as associations were largely attenuated 1 year or more after chronic sinusitis (NPC: aHR, 1.60; 95% CI, 0.96-2.65; HPV-OPC: aHR, 1.07; 95% CI, 0.86-1.32; NCPSC: aHR, 2.47; 95% CI, 1.84-3.31). All 3 HNC subtypes had cumulative incidence of less than 0.07% 8 years after chronic sinusitis diagnosis. Chronic sinusitis is associated with certain HNCs, particularly NPC and NCPSC. These HNCs are rare, and most of the increased HNC risk is limited to within 1 year of chronic sinusitis diagnosis, consistent with surveillance or detection bias. The associations were weaker over longer intervals, suggesting at most a modest role for sinusitis-related inflammation and/or immunodeficiency.

Abstract 5212: A comparative descriptive study of cutaneous malignant melanoma

Abstract Objectives: Incidence of cutaneous malignant melanoma has increased worldwide in the past several decades, particularly in developed countries. Melanoma is believed to be a multifactorial condition, with exposure to ultraviolet radiation (UVR) as a major environmental risk factor. We matched five provinces in Iran with five states in the United States (US) based on measurements of solar UVB exposure and conducted a comparison of population-based incidence rates of melanoma in each province and state. Methods: Solar UVB exposure was measured using data from NASA's Total Ozone Mapping Spectrometer (TOMS) for the period between January 1, 1997 and December 31, 2000 at a geographic resolution of one degree. UV exposures (in mW/m2) for each state and province were calculated by averaging the values of the grid points within each state and province. Population-based incidence data for five Iranian provinces (Ardabil, Golestan, Mazandaran, Gilan and Kerman) were obtained from their respective cancer registries. Incidence rates among white non-Hispanic individuals in the five US states (Kentucky, Utah, Texas, Oklahoma, and Hawaii) with matching average UVB exposure to the Iranian provinces were obtained from the North American Association of Central Cancer Registries. Furthermore, population-based incidence rates of melanoma for the overall U.S. population were obtained from the Surveillance, Epidemiology, and End Results (SEER) program for the 13 SEER areas (1996-2000). All incidence rates were calculated per 100,000 person-years and were age-adjusted using the 2000 standard populations. Results: Annual UVB exposure from 1996-2000 ranged from an average of 138.52 in Ardabil to 227.44 in Kerman. The exposures of the corresponding US states ranged from 124.95 in Kentucky to 246.34 in Hawaii during the same period. The overall male and female rates of melanoma were 0.59 and 0.46, respectively, for Iran and 14.9 (95%CI: 14.7-15.2) and 10.5 (95%CI: 10.4-10.7), respectively, for the US. Age-standardized rates (ASR) of melanoma among males for the five Iranian provinces in comparison to their UVR-matched US states were as follows: 0.30 (22.6) for Ardabil (Kentucky), 1.20 (26.6) for Golestan (Utah), 0.73 (18.1) for Mazandaran (Texas), 0.17 (15.8) for Gilan (Oklahoma), and 0.90 (75.3) for Kerman (Hawaii). ASR of melanoma among females were as follows: 0.20 (16.0) for Ardabil (Kentucky), 0.60 (17.5) for Golestan (Utah), 0.47 (10.6) for Mazandaran (Texas), 0.17 (8.9) for Gilan (Oklahoma), and 0.90 (36.5) for Kerman (Hawaii). Conclusion: The markedly higher incidence rates of melanoma in selected US states compared to Iranian provinces with similar UVR exposure patterns may be due to differences in lifestyle, pigmentation, or genetic profiles, as well as under-reporting in Iran compared to the US. Our findings underscore the need for additional studies to decipher the multitude of extrinsic and intrinsic factors involved in the etiology of this multifactorial condition. Citation Format: Roxana Moslehi, Francis B. Boscoe, Nur Zeinomar. A comparative descriptive study of cutaneous malignant melanoma. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 5212.

Bone Morphogenetic Protein Use and Cancer Risk Among Patients Undergoing Lumbar Arthrodesis: A Case-Cohort Study Using the SEER-Medicare Database.

Recombinant bone morphogenetic proteins (BMPs) are growth factors utilized in lumbar arthrodeses. Limited data from randomized trials suggest that BMP may increase cancer risk. We sought to evaluate cancer risk and mortality following the use of BMP in lumbar arthrodesis. Within the linked Surveillance, Epidemiology, and End Results (SEER) Program-Medicare cohort, we conducted a case-cohort study of 7,278 individuals who were ≥65 years of age and had undergone a lumbar arthrodesis from 2004 to 2011. Of these patients, 3,627 were individuals in a 5% random subcohort of Medicare enrollees in SEER areas including 191 who developed cancer, and there were 3,651 individuals outside the subcohort who developed cancer. Weighted Cox proportional-hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for cancer on the basis of exposure to BMP. In the SEER-Medicare subcohort, 30.7% of individuals who underwent a lumbar arthrodesis received BMP. BMP was not associated with overall cancer risk in univariate analyses (HR, 0.92 [95% CI, 0.82 to 1.02]) or after adjustment for demographic characteristics, comorbidities, hospital size, history of cancer, and calendar year (adjusted HR, 0.94 [95% CI, 0.84 to 1.05]). Individual cancer types were also not significantly elevated (p > 0.05 for all) in BMP users compared with nonusers. In addition, BMP use was not associated with a new cancer in people who had cancer prior to undergoing lumbar arthrodesis (adjusted HR, 1.04 [95% CI, 0.71 to 1.52]) or with mortality after a cancer diagnosis (adjusted HR, 1.05 [95% CI, 0.93 to 1.19]). In a large population of elderly U.S. adults undergoing lumbar arthrodesis, BMP use was not associated with cancer risk or mortality. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

The effect of marriage on stage at diagnosis and survival in women with cervical cancer.

This study assessed the effect of marital status on stage at diagnosis and survival in women with cervical cancer. Cervical cancer cases diagnosed between 2000 and 2010 were identified from the Surveillance, Epidemiology and End Results (SEER) program. Patient demographic and clinical characteristics were compared by marital status. Multivariate logistic and Cox proportional hazard regression models were performed to calculate odds ratios of advanced stage at diagnosis and hazard ratios of death risk respectively. Among 31425 women, 46% of cases were married at the time of diagnosis. Married women were more commonly diagnosed at a localized stage (55%) compared to other non-marital groups (47% of singles, 42% of separated/divorced, and 28% of widowers, p < 0.001). After controlling for age, race/ethnicity, period of diagnosis, histology, and SEER area, single [adjusted odds ratio (aOR) 1.41; 95% Confidence Interval (CI) 1.33-1.49], separated/divorced [aOR 1.44; 95% CI 1.34-1.55], and widowed women [aOR 1.43; 95% CI 1.31-1.58] were all more likely to be diagnosed at an advanced stage compared to married women. In terms of prognosis, single (adjusted hazard ratio (aHR) 1.35; 95% CI 1.28-1.43), separated/divorced (aHR 1.22; 95% CI 1.15-1.29), and widowed women (aHR 1.28; 95% CI 1.19-1.36) had significant increased risk of death compared to married women. Adjusting for insurance status did not change the findings. Being married is associated with earlier diagnosis and a more favorable prognosis for cervical cancer among US women. Interventions to improve prognosis for unmarried women, including increasing use of cervical cancer screenings, are warranted.

No differences in cervical cancer stage at diagnosis for Blacks and Whites in the Mountain West.

This study assesses cervical cancer disparities between Blacks and Whites in terms of stage at diagnosis in a Mountain West state. A total of 1,408 women diagnosed with cervical cancer between 1995 and 2010 were identified from the Nevada Central Cancer Registry. Logistic regression modeling examined the effect of race on stage at diagnosis in both Nevada and the Surveillance, Epidemiology and End Results (SEER) population. After controlling for the main confounders, no significant differences in stage at diagnosis were observed between Black and White females in Nevada (aOR 0.91; 95% CI 0.57-1.43). In contrast, Black women in SEER areas had a 21% higher odds of being diagnosed at an advanced stage compared to Whites. Our findings suggest a favorable disparity balance for cervical cancer in Nevada where Blacks are largely recent arrivals in relation to the remaining US, where Blacks have long been established.

Intraperitoneal chemotherapy among women in the Medicare population with epithelial ovarian cancer

BackgroundIntraperitoneal combined with intravenous chemotherapy (IV/IP) for primary treatment of epithelial ovarian cancer results in a substantial survival advantage for women who are optimally debulked surgically, compared with standard IV only therapy (IV). Little is known about the use of this therapy in the Medicare population. MethodsWe used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database to identify 4665 women aged 66 and older with epithelial ovarian cancer diagnosed between 2005–2009, with their Medicare claims. We defined receipt of any IV/IP chemotherapy when there was claims evidence of any receipt of such treatment within 12months of the date of diagnosis. We used descriptive statistics to examine factors associated with treatment and health services use. ResultsAmong 3561 women with Stage III or IV epithelial ovarian cancer who received any chemotherapy, only 124 (3.5%) received IV/IP chemotherapy. The use of IV/IP chemotherapy did not increase over the period of the study. In this cohort, younger women, those with fewer comorbidities, whites, and those living in Census tracts with higher income were more likely to receive IV/IP chemotherapy. Among women who received any IV/IP chemotherapy, we did not find an increase in acute care services (hospitalizations, emergency department visits, or ICU stays). ConclusionDuring the period between 2005 and 2009, few women in the Medicare population living within observed SEER areas received IV/IP chemotherapy, and the use of this therapy did not increase. We observed marked racial and sociodemographic differences in access to this therapy.

The risk of amyotrophic lateral sclerosis after cancer in U.S. elderly adults: A population‐based prospective study

Although epidemiologic studies have examined the risk of amyotrophic lateral sclerosis (ALS) in relation to cancer, none have been large population-based studies using incident ALS and adjusting for medical surveillance. Addressing those limitations, all first primary cancer cases from the Surveillance, Epidemiology and End Results (SEER) Program (1992-2005), linked to Medicare claims data were used. Cases were followed from cancer diagnosis until the earliest date of ALS diagnosis, a break in Medicare claims data, death, age 85 or December 31, 2005. A comparison group from a 5% random Medicare sample in the SEER areas who were cancer-free and censored as above, or until a cancer diagnosis were selected. ALS outcomes were derived from medical claims. The proportional hazards models to estimate ALS hazard ratios (HRs), using age as the time scale, adjusting for sex, race and physician visits, and stratifying the baseline hazard on birth year and SEER registry were used. A total of 303 ALS cases were ascertained in cancer patients (2,154,062 person-years) compared with 246 ALS cases (2,467,634 person-years) in the reference population. There was no overall relationship between cancer and ALS (HR = 0.99; 95% CI = 0.81-1.22), nor by gender or race. Except for an elevated ALS risk in the first year after a leukemia diagnosis, the relationship between site-specific cancers and ALS was null after correcting for multiple comparisons. Having a cancer diagnosis was not associated with an overall risk of incident ALS. The short-term ALS risk after leukemia may reflect screening or reporting errors.

Regional Variation in Spending and Survival for Older Adults With Advanced Cancer

Medicare spending varies substantially across the United States. We evaluated the association between mean regional spending and survival in advanced cancer. We identified 116 523 subjects with advanced cancer from 2002 to 2007, using Surveillance, Epidemiology and End Results (SEER)-Medicare linked data. Subjects were aged 65 years and older with non-small cell lung, colon, breast, prostate, or pancreas cancer. Of these subjects, 61 083 had incident advanced-stage cancer (incident cohort) and 98 935 had death from cancer (decedent cohort); 37% of subjects were included in both cohorts. Subjects were linked to one of 80 hospital referral regions within SEER areas. We estimated mean regional spending in both cohorts. We assessed the primary outcome, survival, in the incident cohort; the exposure measure was the quintile of regional spending in the decedent cohort. Survival in quintiles 2 through 5 was compared with that in quintile 1 (lowest spending quintile) using Cox regression models. From quintile 1 to 5, mean regional spending increased by 32% and 41% in the incident and decedent cohorts (incident cohort: $28 854 to $37 971; decedent cohort: $27 446 to $38 630). The association between spending and survival varied by cancer site and quintile; hazard ratios ranged from 0.92 (95% confidence interval [CI] = 0.82 to 1.04, pancreas cancer quintile 5) to 1.24 (95% CI = 1.11 to 1.39, breast cancer quintile 3). In most cases, differences in survival between quintile 1 and quintiles 2 through 5 were not statistically significant. There is substantial regional variation in Medicare spending for advanced cancer, yet no consistent association between mean regional spending and survival.

Pediatric Thyroid Carcinoma Incidence and Temporal Trends in the USA (1973–2007): Race or Shifting Diagnostic Paradigm?

Pediatric thyroid carcinoma is relatively uncommon. But variability in incidence rate by race, sex, age at onset/diagnosis, and geographic local had been observed in adult thyroid carcinoma in the USA. We aimed to examine the patterns, rates, and temporal trends of thyroid carcinoma among pediatric patients (0–19 years) between 1973 and 2007. The Surveillance, Epidemiology, and End Results (SEER) data of the National Cancer Institute were utilized. Data were available on sex, age at diagnosis, race/ethnicity, and geographic locale (9 SEER registries) and were used for rates and trends computation. The frequency and percentage, percent changes (PCs) were calculated by using 1 year of each endpoint. Similarly, the annual percent changes (APCs) were calculated as well, with APCs estimated using weighted least square methods. Between 1973 and 2007, 1,360 thyroid cancer cases were ascertained in the 9 SEER areas (n = 247,638,734) in the USA. The percent change was 47.9, while the APC was significantly different from 0, 1.0 (95% CI: 0.5–1.6, P < 0.0001). The rate ratio (RR) was significantly lower in 1975 (RR: 0.62, 95% CI: 0.38–0.98, P = 0.03) relative to the rate between 1973 and 2007 (RR: 1.60, per 100,000, 95% CI: 1.50–1.70), but higher in 2007 (RR: 2.3 per 100,000, 95% CI: 1.70–3.10; RR: 1.44, 95% CI: 1.05–1.93, P = 0.02). The rate was significantly higher in whites relative to blacks, highest among age group of 15–19 years and girls, and in some SEER registries, with some significant PC in Connecticut. This temporal trend study of pediatric thyroid carcinoma indicates increase in the rate of this malignancy given the percent change and the annual percent change between 1973 and 2007. In addition, the incidence was higher among girls, lower among blacks, highest in age group of 15–19 years, and relatively higher in SEER registries with predominantly white or Hispanic populations.

Medical Care Costs and Survival Associated With Hepatocellular Carcinoma Among the Elderly

We assessed the burden of hepatocellular carcinoma (HCC), in terms of mortality and medical care costs, based on analysis of the Surveillance, Epidemiology and End Results (SEER)-Medicare database. We analyzed data from the SEER-Medicare database on patients 66 years or older who were diagnosed with primary HCC from 1991 to 2007, entitled for Medicare Parts A and B, and not enrolled in health maintenance organizations (n = 5712). Controls were individuals without HCC, identified from a 5% sample of Medicare beneficiaries residing in SEER areas; they were matched 1:1 with individuals with HCC (cases) for age, sex, race, and geographic region (average age, 75 y; 34.7% female). Kaplan-Meier analysis was used to estimate survival distributions. Costs were reported in 2009 dollars; per-patient-per-month (PPPM) costs were compared between cases and controls using the Wilcoxon rank sum test. The largest proportion of cases had localized disease (38.2%), followed by regional (24.0%), unstaged (20.4%), and distant (17.3%) disease. The median survival times were 5 months for cases and 60 months for controls; they were 3 months for patients with distant disease, 4 months for patients with regional disease, and 9 months for those with localized disease. The mean PPPM costs were $7863 for cases and $1243 for controls (P < .001). These costs were primarily driven by inpatient (mean, $5439 vs $682 without HCC; P < .001) and hospice (mean $554 vs $42 without HCC; P < .001) care. Mean PPPM costs by stage were $7265 for localized disease, $8072 for regional disease, and $9585 for distant disease (P < .001 for trend). Based on analysis of the SEER-Medicare database, costs for patients with HCC are approximately 6- to 8-fold higher than for those without this cancer. Patients with distant HCC had the greatest costs. These findings highlight that HCC is a substantial medical cost burden for elderly patients.