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Objective(s): A subset of laryngeal squamous cell carcinoma (LSCC) patients undergoing larynx preserving treatment ultimately require total laryngectomy (TL) for oncologic or functional reasons. This study aims to identify TL risk factors in these patients. Methods: Retrospective cohort study using Veterans Affairs (VA) database. T1–T4 LSCC cases treated with primary radiotherapy (XRT) or chemoradiotherapy (CRT) were assessed for TL and recurrence. Binary logistic and Cox regression and Kaplan–Meier analyses were implemented. Results: Of 5390 cases, 863 (16.0%) underwent TL. On multivariable analysis, age (adjusted odds ratio: 0.97 [0.96–0.98]; p <.001) and N3 disease (0.42 [0.18–1.00]; p =.050) were associated with reduced risk of TL, whereas current alcohol use (1.22 [1.04–1.43]; p =.015) and >T1 disease (T2, 1.76 [1.44–2.17]; p <.001; T3, 2.06 [1.58–2.68]; p <.001; T4, 1.79 [1.26–2.53]; p =.001) were associated with increased risk of TL. However, N2 (adjusted hazard ratio: 1.30 [1.10–1.55]; p =.003) and N3 (2.02 [1.25–3.26]; p =.004) disease were associated with an increased risk for local recurrence. Compared to XRT, treatment with CRT was associated with reduced risk for local recurrence after adjusting for other factors (0.84 [0.70–0.99]; p =.044). Those who do not receive TL following local recurrence have poorer disease‐specific survival (log‐rank, p <.001). In patients without local recurrence, N2 disease was associated with a fourfold increase in risk of TL (4.24 [1.83–9.82]; p <.001). Conclusion: Advanced nodal stage was associated with reduced rates of salvage TL in the setting of local recurrence, and subsequent worse prognosis after recurrence. Conversely, advanced nodal stage may increase the risk for functional salvage TL in patients without recurrence. Level of Evidence: Level 3. [ABSTRACT FROM AUTHOR]

Background: Existing data on the impact of Hispanic ethnicity on outcomes for patients with renal cell carcinoma (RCC) is mixed. The authors investigated outcomes of Hispanic and non‐Hispanic White (NHW) patients with advanced RCC receiving systemic therapy at large academic cancer centers using the International Metastatic Renal Cell Carcinoma Database (IMDC). Methods: Eligible patients included non‐Black Hispanic and NHW patients with locally advanced or metastatic RCC initiating systemic therapy. Overall survival (OS) and time to first‐line treatment failure (TTF) were calculated using the Kaplan–Meier method. The effect of ethnicity on OS and TTF were estimated by Cox regression hazard ratios (HRs). Results: A total of 1563 patients (181 Hispanic and 1382 NHW) (mostly males [73.8%] with clear cell RCC [81.5%] treated with tyrosine kinase inhibitor [TKI] monotherapy [69.9%]) were included. IMDC risk groups were similar between groups. Hispanic patients were younger at initial diagnosis (median 57 vs. 59 years, p =.015) and less likely to have greater than one metastatic site (60.8% vs. 76.8%, p <.001) or bone metastases (23.8% vs. 33.4%, p =.009). Median OS and TTF was 38.0 months (95% confidence interval [CI], 28.1–59.2) versus 35.7 months (95% CI, 31.9–39.2) and 7.8 months (95% CI, 6.2–9.0) versus 7.5 months (95% CI, 6.9–8.1), respectively, in Hispanic versus NHW patients. In multivariable Cox regression analysis, no statistically significant differences were observed in OS (adjusted hazard ratio [HR], 1.07; 95% CI, 0.86–1.31, p =.56) or TTF (adjusted HR, 1.06; 95% CI, 0.89–1.26, p =.50). Conclusions: The authors did not observe statistically significant differences in OS or TTF between Hispanic and NHW patients with advanced RCC. Receiving treatment at tertiary cancer centers may mitigate observed disparities in cancer outcomes. The authors demonstrate that there were no statistically significant differences in overall survival or time to first‐line treatment failure between non‐Black Hispanic and non‐Hispanic White patients with advanced renal cell carcinoma (RCC) treated at these large academic cancer centers. Our findings suggest that receiving treatment at a tertiary cancer center may mitigate previously observed disparities in cancer outcomes for non‐Black Hispanic patients with advanced RCC. [ABSTRACT FROM AUTHOR]

Despite differences in prostate cancer risk across ancestry groups, relative performance of prostate cancer genetic risks scores (GRS) for positive biopsy prediction in different ancestry groups is unknown. This cross-sectional retrospective analysis examines the association between a polygenic hazard score (PHS290) and risk of prostate cancer diagnosis upon first biopsy in male veterans using 2-sided tests. Our analysis included 36 717 veterans (10 297 of African ancestry). Unadjusted rates of positive first prostate biopsy increased with higher genetic risk (low risk: 34%, high risk: 58%; P  < .001). Among men of African ancestry, higher genetic risk was associated with increased prostate cancer detection on first biopsy (odds ratio = 2.18, 95% confidence interval = 1.93 to 2.47), but the effect was stronger among men of European descent (odds ratio = 3.89, 95% confidence interval = 3.62 to 4.18). These findings suggest that incorporating genetic risk into prediction models could better personalize biopsy decisions, although further study is needed to achieve equitable genetic risk stratification among ancestry groups. [ABSTRACT FROM AUTHOR]

Background Opioid tapering in the general population is linked to increases in hospitalizations or emergency department visits related to psychiatric or drug-related diagnoses. Cancer survivors represent a unique population with different opioid indications, prescription patterns, and more frequent follow-up care. This study sought to describe patterns of opioid tapering among older cancer survivors and to test the hypothesis of whether older cancer survivors face increased risks of adverse events with opioid tapering. Methods Using the Surveillance, Epidemiology and End Results Medicare–linked database, we identified 15 002 Medicare-beneficiary cancer survivors diagnosed between 2010 and 2017 prescribed opioids consistently for at least 6 months after their cancer diagnosis. Tapering was defined as a binary time-varying event occurring with any monthly oral morphine equivalent reduction of 15% or more from the previous month. Primary diagnostic billing codes associated with emergency room or hospital admissions were used for the composite endpoint of psychiatric- or drug-related event(s). Results There were 3.86 events per 100 patient-months, with 97.8% events being mental health emergencies, 1.91% events being overdose emergencies, and 0.25% involving both. Using a generalized estimating equation for repeated measure time-based analysis, opioid tapering was not statistically associated with acute events in the 3-month posttaper period (odds ratio [OR] = 1.02; P  = .62) or at any point in the future (OR = 0.96; P  = .46). Conclusions Opioid tapering in older cancer survivors does not appear to be linked to a higher risk of acute psychiatric- or drug-related events, in contrast to prior research in the general population. [ABSTRACT FROM AUTHOR]

Background: Although Black men are more likely than non‐Hispanic White men to develop and die from prostate cancer, limited data exist to guide prostate‐specific antigen (PSA) screening protocols in Black men. This study investigated whether the risk for prostate cancer was higher than expected among self‐identified Black than White veterans based on prebiopsy PSA level. Methods: Multivariable logistic regression models were estimated to predict the likelihood of prostate cancer diagnosis on first biopsy for 75,295 Black and 207,658 White male veterans. Self‐identified race, age at first PSA test, prebiopsy PSA, age at first biopsy, smoking status, statin use, and socioeconomic factors were used as predictors. The adjusted predicted probabilities of cancer detection on first prostate biopsy from the logistic models at different PSA levels were calculated. Results: After controlling for PSA and other covariates, Black veterans were 50% more likely to receive a prostate cancer diagnosis on their first prostate biopsy than White veterans (odds ratio [OR], 1.50; 95% CI, 1.47‐1.53; p <.001). At a PSA level of 4.0 ng/mL, the probability of prostate cancer for a Black man was 49% compared with 39% for a White man. This model indicated that Black veterans with a PSA of 4.0 ng/mL have an equivalent risk of prostate cancer as White veterans with a PSA of 13.4 ng/mL. Conclusions: The findings indicate that, at any given PSA level, Black men are more likely to harbor prostate cancer than White men. Prospective studies are needed to better evaluate risks and benefits of PSA screening in Black men and other high‐risk populations. At any given prostate‐specific antigen level, Black men have substantially higher risk of prostate cancer detection on their first biopsy compared with White men after accounting for socioeconomic factors, age, and prebiopsy prostate‐specific antigen. This difference was more pronounced among younger men. [ABSTRACT FROM AUTHOR]

Black Veterans have higher a incidence of localized and metastatic prostate cancer compared to White Veterans yet are underrepresented in reports of frequencies of somatic and germline alterations. This retrospective analysis of somatic and putative germline alterations was conducted in a large cohort of Veterans with prostate cancer (N = 835 Black, 1613 White) who underwent next generation sequencing through the VA Precision Oncology Program, which facilitates molecular testing for Veterans with metastatic cancer. No differences were observed in gene alterations for FDA approved targetable therapies (13.5% in Black Veterans vs. 15.5% in White Veterans, P =.21), nor in any potentially actionable alterations (25.5% vs. 28.7%, P =.1). Black Veterans had higher rates of BRAF (5.5% vs. 2.6%, P <.001) alterations, White Veterans TMPRSS2 fusions (27.2% vs. 11.7%, P <.0001). Putative germline alteration rates were higher in White Veterans (12.0% vs. 6.1%, P <.0001). Racial disparities in outcome are unlikely attributable to acquired somatic alterations in actionable pathways. [ABSTRACT FROM AUTHOR]

Background Genetic scores may provide an objective measure of prostate cancer risk and thus inform screening decisions. We evaluated whether a polygenic hazard score based on 290 genetic variants (PHS290) is associated with prostate cancer risk in a diverse population, including Black men, who have higher average risk of prostate cancer death but are often treated as a homogeneously high-risk group. Methods This was a retrospective analysis of the Million Veteran Program, a national, population-based cohort study of US military veterans conducted 2011-2021. Cox proportional hazards analyses tested for association of genetic and other risk factors (including self-reported race and ethnicity and family history) with age at death from prostate cancer, age at diagnosis of metastatic (nodal or distant) prostate cancer, and age at diagnosis of any prostate cancer. Results A total of 590 750 male participants were included. Median age at last follow-up was 69 years. PHS290 was associated with fatal prostate cancer in the full cohort and for each racial and ethnic group (P  <  .001). Comparing men in the highest 20% of PHS290 with those in the lowest 20% (based on percentiles from an independent training cohort), the hazard ratio for fatal prostate cancer was 4.42 (95% confidence interval = 3.91 to 5.02). When accounting for guideline-recommended risk factors (family history, race, and ethnicity), PHS290 remained a strong independent predictor of any, metastatic, and fatal prostate cancer. Conclusions PHS290 stratified US veterans of diverse ancestry for lifetime risk of prostate cancer, including metastatic and fatal cancer. Predicting genetic risk of lethal prostate cancer with PHS290 might inform individualized decisions about prostate cancer screening. [ABSTRACT FROM AUTHOR]

The COVID‐19 pandemic disrupted prostate‐specific antigen (PSA) screening and prostate biopsy procedures. We sought to determine whether delayed screening and diagnostic workup of prostate cancer (PCa) was associated with increased subsequent rates of incident PCa and advanced PCa and whether the rates differed by race. We analyzed data from the Veterans Health Administration to assess the changes in the rates of PSA screening, prostate biopsy procedure, incident PCa, PCa with high‐grade Gleason score, and incident metastatic prostate cancer (mPCa) before and after January 2020. While the late pandemic mPCa rate among White Veterans was comparable to the pre‐pandemic rate (5.4 pre‐pandemic vs 5.2 late‐pandemic, p = 0.67), we observed a significant increase in incident mPCa cases among Black Veterans in the late pandemic period (8.1 pre‐pandemic vs 11.3 late‐pandemic, p < 0.001). Further investigation is warranted to fully understand the impact of the COVID‐19 pandemic on the diagnosis of advanced prostate cancer. [ABSTRACT FROM AUTHOR]

Background: The 2018 US Preventive Services Task Force guidelines recommend individualizing prostate cancer screening in 55‐ to 69‐year‐old men. Given the higher incidence of prostate cancer in African American (AA) compared to non‐Hispanic White (NHW) men, this study compared reported rates of prostate‐specific antigen (PSA) screening hypothesizing that it would not be commensurate with the relative risk between these two groups. Methods: Using the 2020 Behavioral Risk Factor Surveillance System, we identified 43,685 men (40,301 NHW and 3384 AA) interviewed about PSA screening. Results: AA men had an odds ratio (OR) of 0.80 (95% confidence interval [CI], 0.69–0.93; p =.004) of reporting PSA screening; sequentially correcting for access to care, smoking, and age had minimal effect on this finding, but when correcting for income significantly attenuated this difference (OR, 0.95; 95% CI, 0.81–1.12). Further adding education level eliminated the effect size of AA race entirely with OR, 0.99 (95% CI, 0.84–1.17; p =.91). Further analysis found significant interaction between education and race, with college‐educated AA men having 1.42 OR of receiving screening compared to college‐educated NHW men. Conclusions: Despite prostate cancer being more common and having higher population‐level mortality in AA than NHW men, PSA screening and education patterns do not reflect this increased risk even when adjusting for health access disparities. The authors' findings of significant effect from both income and education suggest that systemic racism is an important factor in the observed difference in PSA screening between AA men and NHW men. Lay summary: In the United States, prostate cancer is more common in African American menNew guidelines from 2018 encourage physicians to consider risk factors in deciding whether or not to recommend screening, but overall African American men continue to be screened at a lower rate than non‐Hispanic White menThis effect disappears when correcting for income and education level, suggesting that several factors including systemic racism, medical mistrust, and self‐advocacy may impact this observed difference African American men continue to report lower rates of PSA screening compared to non‐Hispanic White men in a nationwide survey. This effect appears to be mediated by income and education, suggesting that systemic racism as well as self‐advocacy and medical mistrust may be responsible for this observed difference. [ABSTRACT FROM AUTHOR]