Search

Objectives/hypothesis Radiation-associated sarcomas of the head and neck (RASHN) are known but rare sequelae after radiation for squamous cell carcinoma. The purpose of this study was to characterize RASHN, estimate the risk of RASHN in head and neck squamous cell patients after therapeutic radiation, and compare their survival to that of patients with de novo sarcomas of the head and neck (dnSHN). Study design Retrospective database analysis. Methods RASHN and dnSHN cases were collected from the Surveillance, Epidemiology, and End Results Database to identify risk factors and calculate incidence and latency. Survival was compared between RASHN and dnSHN. Results The risk of RASHN was 20.0 per 100,000 person-years. The average latency period was 124.2 months (range 38-329). The cumulative incidence of RASHN at 20 years was 0.13%. Oral cavity and oropharynx primaries demonstrate increased risk. Five-year overall survival of RASHN was 22.4% compared to 64.5% for dnSHN. Conclusions RASHN are confirmed to be rare. RASHN have poor overall survival and worse survival compared to dnSHN. The impact of intensity-modulated radiation therapy protocols on this risk is unknown. Modifiable risk factors of smoking and alcohol consumption continue to dwarf radiation therapy as risk factors of second primary head and neck cancers. Level of evidence 3 Laryngoscope, 2021.

Non-directed living kidney donors (NDDs) are unique from the traditional directed living donors in terms of the circumstances that led NDDs to undergo a donation. The purpose of this study was to synthesize and discuss key similarities, differences, and existing gaps in the literature comparing their kidney donation process experiences and post-donation outcomes among directed and non-directed donors. A total of eight recent studies were reviewed as part of this study. These studies provided insights into the socioeconomic, physical, and mental health outcomes experienced by NDDs and directed donors throughout the various stages of the evaluation and donation process. Among the studies, NDDs were generally not found to demonstrate having substantial differences as compared to the traditional directed donor within the realms of physical and psychosocial health outcomes post-donation. However, NDDs did have fewer financial burdens as compared to directed donors, which may be related to the differences in demographic characteristics and the limited study sample sizes. Recent evidence on outcomes among non-directed living donors as compared with directed donors should inform efforts to enhance the evaluation and post-donation experiences for this special population. While future studies remain warranted, the current literature signals that further improvements can be made by revisiting the current evaluation screening protocols for living kidney donation as well as the donation system’s infrastructure to help yield enhanced outcomes and experiences among both directed and non-directed donors.

Purpose Privately insured patients with head and neck cancer (HNC) typically have better outcomes; however, differential outcome among Medicaid versus the uninsured is unclear. We aimed to describe outcome disparities among HNC patients uninsured versus on Medicaid. Methods A cohort of 18-64-year-old adults (n = 57 920) with index HNC from the Surveillance, Epidemiology, and End Results 18 database (2007-2015) was analyzed using Fine and Gray multivariable competing risks proportional hazards models for HNC-specific mortality. Results Medicaid (sdHR = 1.65, 95% CI 1.58, 1.72) and uninsured patients (sdHR = 1.55, 95% CI 1.46, 1.65) had significantly greater mortality hazard than non-Medicaid patients. Medicaid patients had increased HNC mortality hazard than those uninsured. Conclusion Compared with those uninsured, HNC patients on Medicaid did not have superior survival, suggesting that there may be underlying mechanisms/factors inherent in this patient population that could undermine access to care benefits from being on Medicaid.

Partial hospitalization programming (PHP) is a treatment option available for individuals with eating disorders (ED) who have made insufficient progress in outpatient settings or are behaviorally or medically unstable. Research demonstrates that this level of care yields efficacy for the majority of patients. However, not all patients achieve recovery in PHP and later admit to a higher level of care (HLOC) including residential treatment or inpatient hospitalization. Although PHP is an increasingly common treatment choice for ED, research concerning outcome predictors in outpatient, stepped levels of care remains limited. Thus, the current study sought to identify the predictors of patients first admitted to PHP that later enter residential or inpatient treatment. Participants were 788 patients (after exclusions) enrolled in adolescent or adult partial hospitalization programs in a specialized ED clinic. When compared to patients who maintained treatment in PHP, a significantly greater proportion of patients who discharged to a HLOC had previously received ED residential treatment. Moreover, patients who discharged to a HLOC were diagnosed with a comorbid anxiety disorder and reported greater anxious and depressive symptomatology. A logistic regression model predicting discharge from PHP to a HLOC was significant, and lower body mass index (BMI) was a significant predictor of necessitating a HLOC. Supplemental programming in partial hospitalization settings might benefit individuals with previous ED residential treatment experience, higher levels of anxiety and depression, and lower BMIs. Specialized intervention for these cases is both practically and economically advantageous, as it might reduce the risk of rehospitalization and at-risk patients needing to step up to a HLOC.

BACKGROUND The current study was conducted to determine whether the incidence of late-stage head and neck cancer (HNC) is decreasing and to estimate the risk of late-stage HNC diagnosis based on race and sex. METHODS Age-adjusted incidence rates for patients aged ≥18 years with stage IV HNC were abstracted from the Surveillance, Epidemiology, and End Results database (2004-2015). Rates were stratified by race, sex, and age. Joinpoint regression estimated annual percent changes (APCs) in rates over time, and logistic regression estimated adjusted odds ratios (aORs). RESULTS There were 57,118 patients with stage IV HNC in the current study cohort, with an average age of 61.9 years. From 2004 to 2015, the age-adjusted incidence rates for stage IV HNC significantly increased by 26.1% (6.11 per 100,000 person-years in 2004 to 7.70 per 100,000 person-years in 2015). White and Asian/Pacific Islander/American Indian/Alaska Native patients had significant increases in incidence (APC for white patients, 3.03 [P

OBJECTIVE To describe comorbidity burden and nonclinical factors associated with all-cause mortality of sinonasal cancer in the United States. METHODS The National Cancer Database (2004-2013) was queried for adult cases of sinonasal cancer (n = 10,518). Outcome of interest was all-cause mortality. Independent variables included comorbidity score and nonclinical factors such as age, gender, race, facility type, distance to facility, insurance, and income. Survival analysis was conducted via multivariable extended Cox regression with Heaviside adjustments. RESULTS Patients were mostly (79%), male (61%), and mean age of diagnosis was 63.5 years. Approximately one in five patients (18.7%) had a major comorbid condition (Charlson-Deyo score ≥ 1) at diagnosis. After adjusting for clinical factors, increasing comorbidity score was associated with a corresponding increase in hazard of mortality (aHR comorbidity score of 1 = 1.25; 95% CI, 1.16, 1.35), (aHR score of 2+ = 1.61; 95%, CI 1.41, 1.83). Hazard of mortality was also associated with being male (aHR = 1.11; 95% CI, 1.04, 1.17); black (aHR = 1.13, 95% CI, 1.03, 1.24); uninsured (aHR = 1.45; 95% CI, 1.25, 1.68) or on Medicaid (aHR = 1.50; 95% CI, 1.33, 1.69); residence in zip codes with lower median income quartile (aHR

Thirty-day (30-day) mortality, a common posttreatment quality metric, is yet to be described following surgery for head and neck squamous cell carcinoma (HNSCC). This study aimed to measure 30-day postoperative mortality in HNSCC and describe clinical/nonclinical factors associated with 30-day mortality.In this retrospective cohort study, the National Cancer Database (2004 to 2013) was queried for eligible cases of HNSCC (n=91,858). Adult patients were included who were treated surgically with curative intent for the primary HNSCC, not missing first treatment, survival, and follow-up information. The outcome of interest was all-cause mortality within 30 days of definitive surgery. Clinical and nonclinical factors associated with all-cause 30-day postoperative mortality were estimated using a fully adjusted, multivariable logistic regression, which accounted for time-varying nature of adjuvant therapy.A total of 775 patients died within 30 days of definitive surgery for HNSCC (30-day mortality rate of 0.84%). Thirty-day mortality rate was however up to 2.33% (95% confidence interval [CI], 1.91%-2.75%) depending on comorbidity. In the fully adjusted model, increasing severity of comorbidity was associated with greater odds of 30-day mortality (Charlson-Deyo comorbidity scores of 1: adjusted odds ratio [aOR], 1.43; 95% CI, 1.21-1.69, and of 2+ aOR, 2.55; 95% CI, 2.07-3.14). Odds of 30-day mortality were greater among Medicaid patients (aOR, 1.77; 95% CI, 1.30-2.41), and in patients in neighborhoods with little education (≥ 29% missing high school diploma: aOR, 1.35; 95% CI, 1.02-1.78).Patients with higher 30-day mortality were those with a greater burden of comorbidities, with little education, and covered by Medicaid.

Objectives Incidence trends and outcomes of head and neck cancer (HNC) among female patients are not well understood. The objective of this study was to estimate incidence trends and quantify the association between health insurance status, stage at presentation, and survival among females with HNC. Study design Retrospective cohort study. Methods The Surveillance, Epidemiology, and End Results database (2007-2014) was queried for females aged ≥18 years diagnosed with a malignant primary head and neck cancer (HNC) (n = 18,923). Incidence trends for stage at presentation were estimated using Joinpoint regression analysis. The association between health insurance status and stage at presentation on overall and disease-specific survival was estimated using Fine and Gray proportional hazards models. Results Incidence of stage IV HNC rose by 1.24% from 2007 to 2014 (annual percent change = 1.24, 95% CI 0.30, 2.20). Patients with Medicaid (adjusted odds ratio [aOR] = 1.59, 95% confidence interval [CI] 1.45, 1.74) and who were uninsured (aOR = 1.73, 95% CI 1.47, 2.04) were more likely to be diagnosed with advanced stage (stages III/IV) HNC. Similarly, patients with Medicaid (adjusted hazard ratio [aHR] = 1.47, 95% CI 1.38, 1.56) and who were uninsured (aHR =1.45, 95% CI 1.29, 1.63) were more likely to die from any cause compared to privately insured patients. Medicaid (aHR = 1.34, 95% CI 1.24, 1.44) and uninsured (aHR = 1.41, 95% CI 1.24, 1.60) patients also had a greater hazard of HNC-specific deaths compared to privately insured patients. Conclusions Incidence of advanced-stage presentation for female HNC patients in the United States has increased significantly since 2007, and patients who are uninsured or enrolled in Medicaid are more likely to present with late stage disease and die earlier. Level of evidence NA Laryngoscope, 130:385-391, 2020.

To quantify head and neck cancer (HNC) mortality rates and identify racial and socioeconomic factors associated with 90-day mortality.The National Cancer Database (2004-2014) was queried for eligible HNC cases (n = 260,011) among adults treated with curative intent. Outcome of interest was any-cause 90-day mortality. Kaplan-Meier curves (Log-rank tests) estimated crude survival differences. A Cox proportional hazards model with further adjustments using the Šidák multiple comparison method adjusted for racial, socioeconomic and clinical factors.There were 9771 deaths (90-day mortality rate = 3.8%). There were crude differences in sex, race/ethnicity, comorbidity, distance, income, and insurance (Log-rank p-value 0.0001). In the final model, blacks (aHR = 1.10, 95% CI 1.00, 1.21) and males (aHR = 1.07; 95% CI 1.00, 1.15) had greater 90-day mortality hazard, as did those uninsured (aHR = 1.72; 95% CI 1.48, 1.99), covered by Medicaid (aHR = 1.72; 95% CI 1.53, 1.93) or Medicare (aHR = 1.40; 95% CI 1.27, 1.53). Residence in lower median income zip code was associated with greater 90-day mortality [(aHR$30,000 = 1.30; 95% CI 1.18, 1.44); (aHR $30,000-$34,999 = 1.24; 95% CI 1.13, 1.36); (aHR $35,000-$45,999 = 1.18; 95% CI 1.08, 1.27)]; and farther travel distance for treatment was associated with decreased 90-day mortality [(aHR 50-249.9 miles = 0.86; 95% CI 0.77, 0.97); (aHR 250 miles = 0.70; 95% CI 50, 0.99)].There are significant race and socioeconomic disparities among patients with HNC, and these disparities impact mortality within 90 days of treatment.

While there are a growing number of cancer survivors, this population is at increased risk of developing second primary malignancies (SPMs). We described the incidence, most common tumor sites, and trends in burden of SPM among survivors of the most commonly diagnosed smoking-related cancers. The current study was a population-based study of patients diagnosed with a primary malignancy from the top 10 smoking-related cancer sites between 2000 and 2014 from Surveillance, Epidemiology, and End Results data. SPM risks were quantified using standardized incidence ratios (SIRs) and excess absolute risks (EARs) per 10,000 person-years at risk (PYR). Trends in the burden of SPM were assessed using Joinpoint regression models. A cohort of 1,608,607 patients was identified, 119,980 (7.5%) of whom developed SPM (76% of the SPMs were smoking-related). The overall SIR of developing second primary malignancies was 1.51 (95% CI, 1.50-1.52) and the EAR was 73.3 cases per 10,000 PYR compared to the general population. Survivors of head and neck cancer had the highest risk of developing a SPM (SIR = 2.06) and urinary bladder cancer had the highest excess burden (EAR = 151.4 per 10,000 PYR). The excess burden of SPM for all smoking-related cancers decreased between 2000 and 2003 (annual percentage change [APC] = -13.7%; p = 0.007) but increased slightly between 2003 and 2014 (APC = 1.6%, p = 0.032). We show that 1-in-12 survivors of smoking-related cancers developed an SPM. With the significant increase in the burden of SPM from smoking-related cancers in the last decade, clinicians should be cognizant of long-term smoking-related cancer risks among these patients as part of their survivorship care plans.

Right ventricular (RV) failure (RVF) is a serious disease with no effective treatment available. We recently reported a disease prevention study showing that chronic stimulation of α1A-adrenergic receptors (α1A-ARs), started at the time of RV injury, prevented the development of RVF. The present study used a clinically relevant disease reversal design to test if chronic α1A-AR stimulation, started after RVF was established, could reverse RVF. RVF was induced surgically by pulmonary artery constriction in mice. Two weeks after pulmonary artery constriction, in vivo RV fractional shortening as assessed by MRI was reduced by half relative to sham-operated controls (25 ± 2%, n = 27, vs. 52 ± 2%, n = 13, P < 10−11). Subsequent chronic treatment with the α1A-AR agonist A61603 for a further 2 wk resulted in a substantial recovery of RV fractional shortening (to 41 ± 2%, n = 17, P < 10−7 by a paired t-test) along with recovery of voluntary exercise capacity. Mechanistically, chronic A61603 treatment resulted in increased activation of the prosurvival kinase ERK, increased abundance of the antiapoptosis factor Bcl-2, and decreased myocyte necrosis evidenced by a decreased serum level of cardiac troponin. Moreover, A61603 treatment caused increased abundance of the antioxidant glutathione peroxidase-1, decreased level of reactive oxygen species, and decreased oxidative modification (carbonylation) of myofilament proteins. Consistent with these effects, A61603 treatment resulted in increased force development by cardiac myofilaments, which might have contributed to increased RV function. These findings suggest that the α1A-AR is a therapeutic target to reverse established RVF. NEW & NOTEWORTHY Currently, there are no effective therapies for right ventricular (RV) failure (RVF). This project evaluated a novel therapy for RVF. In a mouse model of RVF, chronic stimulation of α1A-adrenergic receptors with the agonist A61603 resulted in recovery of in vivo RV function, improved exercise capacity, reduced oxidative stress-related carbonylation of contractile proteins, and increased myofilament force generation. These results suggest that the α1A-adrenergic receptor is a therapeutic target to treat RVF.

α1-Adrenergic receptors (ARs) are catecholamine-activated G protein-coupled receptors (GPCRs) that are expressed in mouse and human myocardium and vasculature, and play essential roles in the regulation of cardiovascular physiology. Though α1-ARs are less abundant in the heart than β1-ARs, activation of cardiac α1-ARs results in important biologic processes such as hypertrophy, positive inotropy, ischemic preconditioning, and protection from cell death. Data from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) indicate that nonselectively blocking α1-ARs is associated with a twofold increase in adverse cardiac events, including heart failure and angina, suggesting that α1-AR activation might also be cardioprotective in humans. Mounting evidence implicates the α1A-AR subtype in these adaptive effects, including prevention and reversal of heart failure in animal models by α1A agonists. In this review, we summarize recent advances in our understanding of cardiac α1A-ARs.

BACKGROUND AND AIMS Estimates of racial disparity in cirrhosis have been limited by lack of large-scale, longitudinal data, which track patients from diagnosis to death and/or transplant. APPROACH AND RESULTS We analyzed a large, metropolitan, population-based electronic health record data set from seven large health systems linked to the state death registry and the national transplant database. Multivariate competing risk analyses, adjusted for sex, age, insurance status, Elixhauser score, etiology of cirrhosis, HCC, portal hypertensive complication, and Model for End-Stage Liver Disease-Sodium (MELD-Na), examined the relationship between race, transplant, and cause of death as defined by blinded death certificate review. During the study period, 11,277 patients met inclusion criteria, of whom 2,498 (22.2%) identified as Black. Compared to White patients, Black patients had similar age, sex, MELD-Na, and proportion of alcohol-associated liver disease, but higher comorbidity burden, lower rates of private insurance, and lower rates of portal hypertensive complications. Compared to White patients, Black patients had the highest rate all-cause mortality and non-liver-related death and were less likely to be listed or transplanted (P

OBJECTIVES/HYPOTHESIS To 1) examine the characteristics of patients who develop second primary malignancies (SPMs) from an index human papillomavirus (HPV)-related head and neck squamous cell carcinoma (HNSCC) and HPV-unrelated HNSCC and to 2) compare overall survival between those with HPV-related and HPV-unrelated index HNSCC among patients who develop SPM. STUDY DESIGN Retrospective cohort analysis. METHODS A retrospective study was conducted of 113,259 patients who were diagnosed with HNSCC from 2000 to 2014. SPM was defined as the first subsequent primary cancer occurring at least 2 months after index cancer diagnosis, and HPV-relatedness was based on whether patients' index HNSCC was potentially HPV-related or HPV-unrelated. Multivariable Fine and Gray (FG) competing-risks regression models were used to estimate factors associated with risk of SPM by HPV-relatedness. Among patients with SPM, an adjusted Cox proportional hazards (PH) regression model was used to assess the association between HPV-relatedness and survival. RESULTS Approximately 13,900 patients (12.3%) developed SPM. In the FG model, patients with HPV-unrelated HNSCC had a 15% higher risk of developing SPM (adjusted hazard ratio: 1.15, 95% confidence interval: 1.10-1.20) than those with potentially HPV-related HNSCC, but the same characteristics were associated with SPM development. In the Cox PH model, patients with SPM whose index HNSCC was HPV-unrelated had higher risk of death than those whose index HNSCC was potentially HPV-related (adjusted hazard ratio: 1.06; 95% confidence interval: 1.02-1.11). CONCLUSIONS Patients with HPV-unrelated HNSCC have a higher risk of SPM development than do those with HPV-related HNSCC. Effective secondary disease-prevention strategies should be established to improve long-term patient outcomes. LEVEL OF EVIDENCE NA Laryngoscope, 129:1828-1835, 2019.

Objective To determine if there are differences in mortality from oral cavity squamous cell carcinoma (OCSCC) based on oral cavity (OC) subsites. Methods Using the Surveillance, Epidemiology, and End Results Program (SEER) 9 database, patients with sequence number 0 or 1 squamous cell OCSCC were analyzed by OC subsite for 5-year cause-specific mortality (CSM) from OCSCC. Proportional hazards regression determined the association between 5-year CSM and OC subsites while controlling for treatment modality, stage, and demographic characteristics using hazard ratios. Significance was set at alpha = 0.05. Results 20,647 OC patients were included in the regression analysis. The most commonly diagnosed sites were floor of mouth (34.4%) and oral tongue (34.3%). Floor of mouth, upper gum, and retromolar trigone were associated with lower CSM compared to oral tongue. Not receiving surgery and receiving radiation were associated with increased CSM, and CSM increased with cancer staging when distant or regional disease was compared to localized disease. Also, patients diagnosed at 60 years or older and black patients had increased CSM. Conclusion Among OCSCC patients, those with oral tongue cancer are more likely to experience CSM than patients with floor of mouth, upper gum, and retromolar trigone cancer. It is important to understand these mortality related differences in the management of OCSCC patients. Understanding subsite-specific mortality may benefit prognosis counseling of OCSCC patients and elicit subsite-directed research as a means to improve outcomes. Level of evidence NA Laryngoscope, 129:1400-1406, 2019.

Background Cancer survivors face psychosocial issues that increase their risk of suicide. This study examined the risk of suicide across cancer sites, with a focus on survivors of head and neck cancer (HNC). Methods The Surveillance, Epidemiology, and End Results 18-registry database (from 2000 to 2014) was queried for the top 20 cancer sites in the database, including HNC. The outcome of interest was suicide as a cause of death. The mortality rate from suicide was estimated for HNC sites and was compared with rates for 19 other cancer sites that were included in the study. Poisson regression was used to estimate adjusted rate ratios (aRRs) and 95% confidence intervals (CIs) for 1) HNC versus non-HNC sites (the other 19 cancer sites combined), and 2) HNC versus each individual cancer site. Models were stratified by sex, controlling for race, marital status, age, year, and stage at diagnosis. Results There were 404 suicides among 151,167 HNC survivors from 2000 to 2014, yielding a suicide rate of 63.4 suicides per 100,000 person-years. In this timeframe, there were 4493 suicides observed among 4219,097 cancer survivors in the study sample, yielding an incidence rate of 23.6 suicides per 100,000 person-years. Compared with survivors of other cancers, survivors of HNC were almost 2 times more likely to die from suicide (aRR, 1.97; 95% CI, 1.77-2.19). There was a 27% increase in the risk of suicide among HNC survivors during the period from 2010 to 2014 (aRR, 1.27; 95% CI, 1.16-1.38) compared with the period from 2000 to 2004. Conclusions Although survival rates in cancer have improved because of improved treatments, the risk of death by suicide remains a problem for cancer survivors, particularly those with HNC.

Objectives/hypothesis Head and neck squamous cell carcinoma (HNSCC) prognosis strongly correlates with demographic factors. This study aimed to determine whether demographic predictors of HNSCC survival differ between age cohorts, with an emphasis on the growing elderly demographic. Study design Outcomes research. Methods Adults with squamous cell carcinoma of the upper aerodigestive tract were identified from the Surveillance, Epidemiology and End Results 18 database. Demographic and oncologic factors were compared between three age groups: 18 to 49, 50 to 74, and >75 years. Factors associated with cancer-specific survival were assessed in each cohort using subdistribution hazard ratio (sHR) and 95% confidence interval (CI) produced by multivariate competing risk models. Results A cohort of 69,098 patients included 10,588 (15.3%) 75 years or older and 9,882 (14.3%) less than 50 years old. Older patients were more often female (35.4% vs. 25.1% aged 18-49 years and 20.4% aged 50-74 years), white (78.7% vs. 69.4% and 75.9%), insured (63.5% vs. 46.5% and 56.8%), and married (56.6% vs. 53% and 51.1%), but received adequate treatment less often (72.0% vs. 86.3% and 82.7%). In the older cohort, male sex was associated with lower mortality (sHR: 0.92, 95% CI: 0.85-1.00), and unlike the younger cohorts, black race was no longer associated with mortality (sHR: 1.07, 95% CI: 0.94-1.22). Marriage was associated with lower mortality in all age groups but with diminishing effects (single sHR: young 1.52, middle 1.31, older 1.14). Conclusions Elderly HNSCC patients have distinct effects from demographic prognostic factors and should be considered a separate subgroup with unique epidemiology, risks, and preferences. Level of evidence 2c Laryngoscope, , 129:146-153, 2018.

Weight suppression (WS), the difference in one's highest and current adult weight excluding pregnancy, is associated with eating disorder (ED) symptom onset and maintenance. There is increasing evidence that WS is related to ED symptoms in non-clinical samples, but there are no known studies examining the interaction of WS and current body mass index (BMI) in this group. History of overweight is common in those with EDs, and higher weight status often delays identification and treatment. This study examined the interaction of WS and current BMI on body dissatisfaction and eating pathology in undergraduate men and women. Undergraduates (N = 476) completed online surveys assessing current height and weight, weight history, and eating attitudes and behaviors. In women (n = 333), both BMI and WS were positively associated with body dissatisfaction, restraint, and global ED symptoms. In men (n = 143), there were no significant associations with BMI, but WS was related to greater body dissatisfaction, restraint, global ED symptoms, and loss-of-control eating. Moderation analyses revealed that the effect of current BMI on shape concern (p = .005), weight concern (p = .002), global ED symptoms (p = .01), and purging behaviors (p = .04) in women and restraint (p = .03) in men weakened at the highest levels of WS. Results suggest that WS is salient in a non-clinical sample and underscore the need to evaluate both weight history and the presence of disordered eating in individuals across the BMI spectrum.

Aim. To describe the top five causes of preventable health conditions among Pacific children (Cook Island, Fijian, Niuean, Samoan, Tongan, Tokelauan) aged 0-4 years living in New Zealand (NZ), and to make comparisons of these rates with NZ’s population who were of neither Maori nor Pacific ethnicity (NMNP). Method. This study is a retrospective analysis of preschool Ambulatory Sensitive Hospitalisations (ASH) by ethnicity. The data, from 2010 to 2014, was extracted from The National Minimum Dataset. Results. The top five preventable health conditions among Pacific under 5’s were asthma and wheeze, gastroenteritis, dental, skin infections and pneumonia. Rates for all Pacific children with any of the ASH conditions were four to five times higher among Pacific, than among NMNP, from 2000 to 2014. Pacific children were also significantly more likely to present with bronchiectasis and rheumatic fever or rheumatic heart disease (RR 25.7 and 26.4 respectively). Conclusion. Pacific children aged 0-4 years are more likely to be exposed to health conditions that are considered preventable . The most common preventable health conditions experienced by Pacific children were asthma and wheeze, gastroenteritis, dental, skin infections and pneumonia. These findings highlight the importance of investing in effective prevention strategies to further investigate and address the underlying causes of these conditions.

To determine differences in oropharyngeal squamous cell carcinoma (OPSCC) incidence between 1975 and 2014 stratified by race, sex, and age.We obtained age-adjusted OPSCC incidence rates for race and sex groups from 1975 to 2014 using the Surveillance, Epidemiology, and End Results 9 database. We defined OPSCC as cancers of the base of tongue, lingual/palatine tonsil, oropharynx, soft palate, uvula, and Waldeyer's ring. We used Joinpoint analyses to determine incidence trends for race/sex/age groupings.There were 38,624 oropharyngeal primary tumors in the analyses. Males accounted for 74% of sample population, and whites accounted for 84% of tumors. Overall, there was a 57.3% increase in incidence of oropharyngeal between 1975 and 2014. For blacks and whites, average incidence was lower for females than males. Rates for black males aged ≥50years was highest for most of the follow-up time but decreased sharply around 1988 and were surpassed by the significant increase in incidence in white males aged 50-59 (1995-2014 APC=4.07, p0.001) and ≥60years (2002-2014 APC=4.25, p0.001). For males aged ≥60, whites had higher rates than blacks starting in 2010. OPSCC incidence in White males (10.99 per 100,000 person-years) surpassed rates in Blacks (10.14 per 100,000 person-years) beginning in 2008.OPSCC has significantly increased in the United States in the last 40 years. This overall increase in OPSCC can primarily be attributed to white males. OPSCC prevention and early detection efforts could target these demographic factors to decrease rising OPSCC incidence.

Objective A pattern of disordered eating involving a pathological fixation with healthy food consumption, labeled orthorexia nervosa (ON), has recently generated attention; however, research has not yet investigated perceptions of ON-related behaviors. This study examined potential stigmatization of ON, compared with DSM-5 ED diagnoses. Method Participants (N = 505) were randomly assigned to read a vignette depicting a woman with anorexia nervosa (AN), bulimia nervosa (BN), binge-eating disorder (BED), or ON. They then answered questions about the individual depicted in the vignette. A series of MANOVAs investigated whether opinions and beliefs about the person depicted varied as a function of the disorder described in the vignette. Results Individuals with ON were perceived as less likely to “improve with treatment” than individuals with BN, and less likely to “pull themselves together,” than individuals with BED. Individuals with ON and AN were viewed as “hard[er] to talk to” and more of a “danger to others” compared with individuals with BED. ON was viewed as less distressing, less likely to evoke sympathy, and more acceptable than the other disorders. Finally, “poor living choices” were perceived as contributing more substantially to ON. Participants' attributions of various personality characteristics did not differ based on ED diagnosis. Discussion Results suggest that ON is viewed as less severe, more desirable, and more often the result of personal life choices. However, findings also imply that ON is associated with stigma, similar to DSM-5 EDs. These negative attitudes might reinforce ON behaviors, and limit awareness of their potential complications.

Summary: Alpha-1 adrenergic receptors (α1-ARs) play adaptive and protective roles in the heart. Dabuzalgron is an oral selective α1A-AR agonist that was well tolerated in multiple clinical trials of treatment for urinary incontinence, but has never been used to treat heart disease in humans or animal models. In this study, the authors administered dabuzalgron to mice treated with doxorubicin (DOX), a widely used chemotherapeutic agent with dose-limiting cardiotoxicity that can lead to heart failure (HF). Dabuzalgron protected against DOX-induced cardiotoxicity, likely by preserving mitochondrial function. These results suggest that activating cardiac α1A-ARs with dabuzalgron, a well-tolerated oral agent, might represent a novel approach to treating HF. Key Words: alpha adrenergic receptors, anthracyclines, cardioprotection, catecholamines, heart failure

BACKGROUND To describe sociodemographic factors associated with head and neck cancer (HNC) survival among patients with distant metastatic disease. METHODS We retrospectively analyzed national data for 2889 adult patients with metastatic HNC (2007-2015). We used Fine and Gray competing risks proportional hazard models, stratified by oropharyngeal cancer status, controlled for sociodemographic factors (age, sex, race/ethnicity, marital status, and insurance status), and accounted for multiple testing. RESULTS Median survival time was 11 months (15 months for patients married/partnered; 13 months for patients with non-Medicaid insurance; P

Importance Melanoma is one of the most common cancers worldwide, typically diagnosed in older adults. There is an increasing incidence in the younger population (age ≤40 years) in America. In addition, approximately 1 in 5 cases of melanoma affect the head and neck. However, there are limited data on the incidence of head and neck melanoma in the pediatric, adolescent, and young adult population in North America (United States and Canada). Objective To assess 20-year demographic and incidence changes associated with head and neck melanoma in the pediatric, adolescent, and young adult population in North America. Design, Setting, and Participants A descriptive analysis of retrospective data on head and neck melanoma from the North American Association of Central Cancer Registries’ Cancer in North America public use data set from 1995 to 2014 was conducted. The data set currently includes 93% of the United States and 64% of the Canadian populations. Eligible data were from 12 462 pediatric, adolescent, and young adult patients (aged 0-39 years) with a confirmed diagnosis of melanoma (International Classification of Diseases–Oncology 3histologic types 8720-8790) in primary head and neck sites: skin of lip, not otherwise specified (C44.0); eyelid (C44.1); external ear (C44.2); skin of other/unspecified parts of face (C44.3); and skin of scalp and neck (C44.4). The study was conducted from January 26 to July 21, 2019. Main Outcomes and Measures Log-linear regression was used to estimate annual percentage change in age-adjusted incidence rates (AAIRs) of head and neck melanoma. Results Of the 12 462 patients with head and neck melanoma included in the study, 6810 were male (54.6%). The AAIR was 0.51 per 100 000 persons (95% CI, 0.50-0.52 per 100 000 persons). In North America, the incidence of head and neck melanoma increased by 51.1% from 1995 to 2014. The rate was higher in the United States (AAIR, 0.52; 95% CI, 0.51-0.53 per 100 000 person-years) than Canada (AAIR, 0.43; 95% CI, 0.40-0.45 per 100 000 persons). In the United States, the incidence increased 4.68% yearly from 1995 to 2000 and 1.15% yearly from 2000 to 2014. In Canada, the incidence increased 2.18% yearly from 1995 to 2014. Male sex (AAIR, 0.55; 95% CI, 0.54-0.57 per 100 000 persons), older age (AAIR, 0.79; 95% CI, 0.79-0.80 per 100 000 persons), and non-Hispanic white race/ethnicity (AAIR, 0.79; 95% CI, 0.77-0.80 per 100 000 persons) were associated with an increased incidence of head and neck melanoma. Conclusions and Relevance The incidence of pediatric, adolescent, and young adult head and neck melanoma in North America appears to have increased by 51.1% in the past 2 decades, with males aged 15 to 39 years the main cohort associated with the increase.

The hereditary spastic paraplegias (HSPs) are a group of inherited neurodegenerative conditions whose characteristic feature is degeneration of the longest axons within the corticospinal tract which leads to progressive spasticity and weakness of the lower limbs. Though highly genetically heterogeneous, the majority of HSP cases are caused by mutations in genes encoding proteins that are responsible for generating and organizing the tubular endoplasmic reticulum (ER). Despite this, the role of the ER within neurons, particularly the long axons affected in HSP, is not well understood. Throughout axons, ER tubules make extensive contacts with other organelles, the cytoskeleton and the plasma membrane. At these ER contacts, protein complexes work in concert to perform specialized functions including organelle shaping, calcium homeostasis and lipid biogenesis, all of which are vital for neuronal survival and may be disrupted by HSP-causing mutations. In this article we summarize the proteins which mediate ER contacts, review the functions these contacts are known to carry out within neurons, and discuss the potential contribution of disruption of ER contacts to axonopathy in HSP.

Three dogs who were presented with cutaneous lesions and had histopathologic findings consistent with pemphigus foliaceus were treated with injectable polysulfated glycosaminoglycan as an adjunctive to systemic immune-modulatory therapy. These patients were not adequately controlled with oral glucocorticoids in conjunction with cyclosporine, azathioprine, and/or mycophenolate. Polysulfated glycosaminoglycan contributed to induction of remission and reduced glucocorticoid doses in all dogs.

Background Since the number of cancer survivors is increasing, it is imperative that we better understand the long-term consequences of these survivors. We assessed the risk of developing a second primary malignant neoplasm (SPMN) after an index potentially-HPV-associated cancers (P-HPV-AC). Methods We constructed a population-based cohort of patients with P-HPV-AC using Surveillance, Epidemiology, and End Results registry data (2000–2015). We limited patients to those with invasive P-HPV-AC [cervical, vagina, vulva, penile, anal, and oropharynx] based on the International Classification of Diseases for Oncology, 3rd edition. Excess SPMN risks were calculated based on standardized incidence ratios (SIRs) and excess absolute risks (EARs) per 10,000 person-years at risk (PYR). Results A total of 105,644 patients with an index P-HPV-AC were identified, and 7.8 % developed a SPMN. In all P-HPV-AC patients, the overall SIR was 1.73 (95 % CI: 1.69–1.77) and EAR of 70.72 per 10,000 PYR. All index P-HPV-AC sites showed statistically significant increases in the risk of SPMN, except for anal cancer among men, compared with the general population. The greatest increase in risk of SPMN was observed among patients diagnosed with an index P-HPV-oropharyngeal cancer (SIR = 1.83; 95 % CI, 1.70–1.82 and SIR = 2.29; 95 % CI, 2.12–2.47 for men and women, respectively). Men developed SPMN mostly in aero-digestive tract whiles women developed SPMN both in aero-digestive tract and other HPV-associated cancer sites. Conclusions P-HPV-AC survivors experienced excess risk of SPMN. These findings have the potential to affect future surveillance practices and improve preventive healthcare for survivors of P-HPV-ACs.

Hyperbaric oxygen therapy (HBOT) has been beneficial in treating people with nocardiosis. This report describes Nocardia spp. affecting a cat, with lesions confined to the skin. To the best of the authors' knowledge, this is the first report of HBOT, combined with amikacin, used to successfully treat feline cutaneous nocardiosis.

Objective This study aimed to determine the incremental validity of the Minnesota Multiphasic Personality Inventory, Second Edition (MMPI-2), relative to the Beck Depression Inventory-Second Edition (BDI-II) in the detection of depressive symptoms in neurological patients. An additional aim was to determine whether over-reporting and under-reporting as measured by the MMPI-2 validity scales, predicted BDI-II scores. Method The sample comprised 406 consecutive participants seen for neuropsychological assessment. The sample was divided into two subsamples for analysis, a heterogeneous neurosciences sample and a seizure disorders sample. Rates of elevated scores were compared and the prevalence of over-reporting and under-reporting by subsample was also examined. Results A total of 31.8% participants were classified as depressed by both the BDI-II and the MMPI-2 Scale 2 and 38.2% participants were classified as not depressed by both tools. However, the BDI-II missed a total of 24.4% cases of elevated depressive symptoms detected by MMPI-2 Scale 2, whereas Scale 2 only missed 5.7% of depressed cases detected by the BDI-II. Depression rates did not vary significantly by subsample. Over-reporting and under-reporting rates were similar for both subsamples. Multiple linear regression showed MMPI-2 depression (Scale 2) and over-reporting of symptoms (scale Fb) predicted BDI-II scores in both subsamples. Under-reporting of symptoms (scales L) was found to be a significant predictor of BDI-II scores in the seizure disorders sample. Conclusions If only the BDI-II is used to screen for depression, there is a risk of misclassification errors as BDI-II scores are influenced by over-reporting and under-reporting of symptoms.

Background There is limited evidence whether being on fludrocortisone prevents vasovagal syncope. Objectives The authors sought to determine whether treatment with fludrocortisone reduces the proportion of patients with recurrent vasovagal syncope by at least 40%, representing a pre-specified minimal clinically important relative risk reduction. Methods The multicenter POST 2 (Prevention of Syncope Trial 2) was a randomized, placebo-controlled, double-blind trial that assessed the effects of fludrocortisone in vasovagal syncope over a 1-year treatment period. All patients had >2 syncopal spells and a Calgary Syncope Symptom Score >−3. Patients received either fludrocortisone or matching placebo at highest tolerated doses from 0.05 mg to 0.2 mg daily. The main outcome measure was the first recurrence of syncope. Results The authors randomized 210 patients (71% female, median age 30 years) with a median 15 syncopal spells over a median of 9 years equally to fludrocortisone or placebo. Of these, 96 patients had ≥1 syncope recurrences, and only 14 patients were lost to follow-up before syncope recurrence. There was a marginally nonsignificant reduction in syncope in the fludrocortisone group (hazard ratio [HR]: 0.69: 95% confidence interval [CI]: 0.46 to 1.03; p = 0.069). In a multivariable model, fludrocortisone significantly reduced the likelihood of syncope (HR: 0.63; 95% CI: 0.42 to 0.94; p = 0.024). When the analysis was restricted to outcomes after 2 weeks of dose stabilization, there was a significant benefit due to fludrocortisone (HR: 0.51; 95% CI: 0.28 to 0.89; p = 0.019). Conclusions The study did not meet its primary objective of demonstrating that fludrocortisone reduced the likelihood of vasovagal syncope by the specified risk reduction of 40%. The study demonstrated a significant effect after dose stabilization, and there were significant findings in post hoc multivariable and on-treatment analyses. (A randomised clinical trial of fludrocortisone for the prevention of vasovagal syncope; ISRCTN51802652 ; Prevention of Syncope Trial 2 [POST 2]; NCT00118482 )

Fitspiration is a relatively new social media trend nominally intended to promote health and fitness. Fitspiration messages are presented as encouraging; however, they might also engender body dissatisfaction and compulsive exercise. This study analyzed fitspiration content (n = 1050) on the image-based social media platform Pinterest. Independent raters coded the images and text present in the posts. Messages were categorized as appearance- or health-related, and coded for Social Cognitive Theory constructs: standards, behaviors, and outcome expectancies. Messages encouraged appearance-related body image standards and weight management behaviors more frequently than health-related standards and behaviors, and emphasized attractiveness as motivation to partake in such behaviors. Results also indicated that fitspiration messages include a comparable amount of fit praise (i.e., emphasis on toned/defined muscles) and thin praise (i.e., emphasis on slenderness), suggesting that women are not only supposed to be thin but also fit. Considering the negative outcomes associated with both exposure to idealized body images and exercising for appearance reasons, findings suggest that fitspiration messages are problematic, especially for viewers with high risk of eating disorders and related issues.

Participants are often asked to replicate their diet before each trial to control dietary intake. However, little is known about the reproducibility of the diet using different approaches. The aim was to assess the reproducibility of a diet when a controlled diet (Cdiet), food record (Frecord) and 24-h dietary recall (Drecall) were used as dietary standardisation techniques.Thirty athletes completed six visits to the laboratory. On the first occasion, a Drecall was performed and subjects were asked to replicate exactly the same diet on the day before visit 2, when another Drecall was performed. The day before the third visit, subjects completed a Frecord, which was presented at visit 3 and assessed using Drecall to ensure comparability between methods. Subjects were asked to replicate this Frecord before visit 4, which was assessed using Drecall. Finally, subjects were provided with a Cdiet of known composition, which they consumed for 24 h before visits 5 and 6. For each method, the difference in energy and macronutrient intakes between both occasions was measured.Despite finding no differences in mean energy and macronutrient intakes between visits for any technique, important within-subject differences were apparent. The range of percentage coefficient of variation for all variables was between 2.7 and 5.8% for Cdiet, 10.1 and 18.6% for Frecord and 7.1 and 11.7% for Drecall.This study has shown that Cdiet is the best approach to standardise dietary intake, especially when the expected effect of an intervention is small and an enhanced reliability is required.

The emergence of the human papillomavirus (HPV) as the primary etiology of oropharyngeal cancer has changed head and neck cancer (HNC) epidemiology. This study described change in the age at diagnosis of oropharyngeal and non-oropharyngeal HNC in the United States in the last four decades. Using a retrospective cohort analysis, the Surveillance, Epidemiology, and End Results dataset from 1975 to 2016 was queried for eligible adult cases of HNC, grouped as oropharyngeal (n = 31,702) versus non-oropharyngeal (n = 87,108). Age at diagnosis was compared by gender (female, male) using independent t-test, and by race/ethnicity (Hispanic, non-Hispanic black, non-Hispanic white, non-Hispanic other) using analysis of variance. Joinpoint regression estimated yearly increases/decreases in age of diagnosis by sex and race/ethnicity through annual percent changes (APC), which were summarized with average annual percent changes (AAPC). Mean age at diagnosis for oropharyngeal cancer was 60.3 years. While there was initially a decrease in age at diagnosis, a 0.37% annual increase occurred from 2002 to 2016 (APC = 0.37, 95% confidence interval (CI) 0.28, 0.45). For non-oropharyngeal cancer, mean age at diagnosis was 63.2 years, with a continuous increase in age at diagnosis throughout the study period (1975&ndash, 2016 AAPC = 0.08, 95% CI 0.04, 0.12). Females had higher average age at diagnosis than males for both sites, while blacks (57.4 years for oropharyngeal cancer, 59.0 years for non-oropharyngeal) had the lowest age at diagnosis of all races/ethnicity. Age at diagnosis of oropharyngeal cancer has increased significantly since 2002, while non-oropharyngeal HNC has increased significantly in the last four decades.

Background:Cognitive reserve, or the extent to which brain can cope with damage, is associated with extended healthy aging and with slow age-related cognitive decline, as well as a lower number of dementia-associated clinical cognitive signs. Thus, understanding how cognitive reserve might affect different cognitive abilities is important. This study aims at investigating the associations between cognitive reserve and linguistic abilities in a group of Spanish older adults with Alzheimer’s disease.Method:The sample comprised 25 older adults with a clinical diagnostic of AD with mild to moderate dementia, and 25 controls who were residing in care homes from the province of Granada and with ages between 52 and 92 years old (M= 83.40, SD= 7.18). The Mini Mental State Examination (MMSE), the Global Deterioration Scale, the Cognitive Reserve Questionnaire, and the Short Form of the Boston Naming Test for Individuals with Aphasia were used to collect data. Correlations and regression analysis were performed.Results:Results showed that cognitive reserve positively and significantly correlated with naming and with phonological fluency but not with semantic fluency word or sentence repetitions or with the global cognitive functioning and the severity of cognitive impairment. The regression analysis showed that cognitive reserve explained 24.7% of the variance in spontaneous naming (F=3.764, p=.039). On the contrary cognitive reserve did not predict verbal fluency.Conclusions:People with higher cognitive reserve score obtained higher scores in phonological fluency and in spontaneous naming and in naming after a semantic clue. Thus, cognitive reserve is linked with better linguistic abilities in AD patients and therefore it should be considered when designing speech therapy interventions for these patients.

Patients with metastatic solid tumors frequently develop central nervous system (CNS) metastases as part of their disease course. Radiation therapy (RT) is an effective treatment for disease control and symptom management of CNS metastases. Genomic predictors of poor CNS disease control include patients whose tumors harbor PI3K pathway alterations. Hyperactivation of the phosphatidylinositol-3-kinase/protein kinase b (PI3K-Akt) pathway has been associated with radioresistance. GDC-0084 (paxalisib) is a potent, oral, selective, CNS-penetrant small molecule inhibitor of phosphoinositide 3-kinase and of mammalian target of rapamycin (PI3K/mTOR) that has been specifically designed for treatment of CNS tumors. It is active against all four isoforms of PI3K (α, β, γ, and δ) and has moderate activity against mTOR. While PI3K inhibitors usually elicit cytostatic activity, they are thought to enhance radiation-induced DNA damage, G2/M arrest and apoptosis when combined with radiation. The synergistic effect is due to the abrogation of RT-induced phosphorylation of Akt with PI3K-Akt inhibition and therefore downregulation of the prosurvival pathways. In addition, PI3K inhibitors have been found to cause significant decrease in glycolysis at the step catalyzed by aldolase, and the inhibition of aldolase leads to the reduction of its product, Ga3P, which is the source for nucleotide synthesis. This has significant implication in a cell's ability to undergo efficient DNA repair and causes DNA damage through nucleoside depletion. This is a single institution, open label, prospective phase I clinical trial for patients with metastatic solid tumors harboring PI3K pathway mutations with parenchymal brain metastases or leptomeningeal metastases. Our primary aim is to assess the toxicity and safety of concurrent GDC-0084 administration with RT (30Gy in 10 fractions) to the brain (NCT04192981). Efficacy (local control per Response Assessment in Neuro-Oncology, intracranial progression-free survival, overall survival) will be evaluated as a secondary objectives. Pre- and post-treatment cerebrospinal fluid (CSF) biomarkers including circulating tumor cells, mutated allelic burden in cell-free DNA, cytokines, RNA and protein analysis of the cellular component will also be investigated as exploratory objectives. The starting dose of GDC-0084 is 45mg daily and a maximum of 24 patients will be required to establish the maximum-tolerated dose (MTD). Once the MTD is determined, an expansion cohort of 12 patients will be treated. Citation Format: T. Jonathan Yang, Zhigang Zhang, Robert Young, James S. Garner, Jeremy Simpson, Adrienne Boire, Michael Offin, Eli Diamond. A dose escalation phase I study of concurrent GDC-0084 with radiation therapy for patients with solid tumor brain metastases or leptomeningeal metastases harboring PI3K pathway mutations [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr CT252.

Objective/Hypothesis Early diagnosis and stage at presentation, two prognostic factors for survival among patients with head and neck cancer (HNC), are significantly impacted by a patient’s health insurance status. We aimed to assess the impact of the Patient Protection and Affordable Care Act (ACA) on stage at presentation across socioeconomic and demographic subpopulations of HNC patients in the United States. Study Design Retrospective data analysis. Methods The National Cancer Database, a hospital-based cancer database (2011–2015), was queried for adults aged 18–64 years and diagnosed with a malignant primary HNC. The outcome of interest was change in early-stage diagnoses between 2011–2013 (pre-ACA) and 2014–2015 (post-ACA) using logistic regression models. Results A total of 91,137 HNC cases were identified in the pre-ACA (n = 53,726) and post-ACA (n = 37,411) years. Overall, the odds of early-stage diagnoses did not change significantly post-ACA (aOR = 0.97, 95 % CI 0.94, 1.00; p = 0.081). However, based on health insurance status, HNC patients with Medicaid were significantly more likely to present with early-stage disease post-ACA (aOR = 1.12, 95 % CI 1.03, 1.21; p = 0.007). We did not observe increased odds of early-stage presentation for other insurance types. Males were less likely to present with early-stage disease, pre- or post-ACA. Conclusions We demonstrate a significant association between ACA implementation and increased early-stage presentation among Medicaid-enrolled HNC patients. This suggests that coverage expansions through the ACA may be associated with increased access to care and may yield greater benefits among low-income HNC patients.

Background Cannabidiol (CBD) in hemp oil has become a widely used product in veterinary medicine. To date, there have been no reports of cutaneous adverse events associated with CBD-containing oil in the veterinary literature. Clinical summary A 4-year-old castrated male Labrador retriever presented with pad sloughing and rapidly progressive cutaneous and mucosal ulceration within five days of administering an oral CBD oil product. Histopathological findings in combination with cutaneous signs were consistent with Stevens-Johnson syndrome. All lesions completely resolved after discontinuation of the hemp oil in addition to a 12 day course of cephalexin and prednisone. Given the lack of alternative causes including other medications, an adverse drug event was deemed probable according to the Naranjo algorithm. Conclusions and clinical importance To the best of the authors' knowledge, this is the first report of suspected cutaneous adverse drug reaction to a CBD-containing hemp oil product.

Objectives: Ovarian cancer is rare in children, accounting for 1% of childhood cancers. However, it is the most common cancer of the female genital tract in adolescents. Due to the rarity of the disease and the histologic and prognostic differences between pediatric and adult cases, there is a paucity of data describing incidence trends of pediatric ovarian cancer in the United States. It is unknown whether pediatric ovarian cancer has increased in incidence over time. The aim of the current study was to examine incidence and trends in pediatric ovarian cancer in the last four decades in the United States. Methods: We queried the Surveillance, Epidemiology, and End Results 9 database from 1975-2016 for age-adjusted ovarian cancer incidence rates for pediatric cases, aged 0 to 19 years. We used Joinpoint regression analyses to examine incidence trends stratified by race (white, blacks, and others, which included Hispanics, American Indians/Alaskan Natives, and Asian Pacific Islanders), histology (carcinoma, germ cell tumor, others), and age groups (0-14, and 15-19 years). Results: There were 897 pediatric ovarian cancer cases in the study. Whites accounted for 71.3% of tumors, and 75.6% of tumors were germ cell. Overall, there was a 46% increase in the incidence of pediatric ovarian tumors in (12.59 per 100,000 in 1975 vs. 18.38 per 100,000 in 2016). Average annual percent change (AAPC) was 0.9 (p < 0.05), and APC from 1975 to 1977 was 5.1 (p = 0.5), from 1977 to 2006 APC was 0.5 (p < 0.05), and from 2006 to 2016, APC was 1.3 (p < 0.05). There was an upward trend in tumor incidence in all racial groups, and age-adjusted incidence rate was highest among whites (18.95 per 100,000). Among whites, APC changed significantly between 1981 and 2016 (APC = 0.8, p < 0.05); however, among blacks, APC increased between 1997 and 2016 (APC = 1.3, p < 0.05); and among other races, it increased between 1975 and 1997 (APC=1.1, p Conclusions: In the past four decades, there has been a steady increase in the age-adjusted incidence rate of pediatric ovarian tumors, and while overall incidence is highest among whites, there has been a sharp increase in incidence among blacks and other minority populations, especially in the last two decades. This surveillance information may be relevant to issues germane to survivors of pediatric cancers, such as oncofertility issues. Citation Format: Kara M. Christopher, Eric Adjei Boakye, Justin M. Barnes, Matthew C. Simpson, Brittany J. Kline, Katherine Mass, Theresa L. Schwartz, Shannon Grabosch, Nosayaba Osazuwa-Peters. Pediatric ovarian cancer in the United States: Incidence trends over four decades [abstract]. In: Proceedings of the AACR Special Conference on the Advances in Pediatric Cancer Research; 2019 Sep 17-20; Montreal, QC, Canada. Philadelphia (PA): AACR; Cancer Res 2020;80(14 Suppl):Abstract nr A02.

Objectives: In 2009, there were 48,010 new cases of head and neck cancer in the United States. A decade later, it is projected that there will be 65,410 new cases in 2019, a 36% increase in new cases of the disease. While this number represents the general head and neck cancer population in the United States, only a few studies have described incidence and trends in head and neck cancer in the pediatric, adolescent, and young adult population—individuals who may have to live with the effects of cancer treatment due to a younger than average age of diagnosis. This study aimed to estimate head and neck cancer incidence and trends in the United States’ pediatric, adolescent, and young adult population. Methods: Using the Surveillance, Epidemiology, and End Results (SEER) 9 database from 1975-2016, we analyzed age-adjusted head and neck cancer incidence rates for pediatric cases (aged 0 to 14 years) and young adult cases (aged 15-39 years). We used Joinpoint regression analyses to examine incidence trends stratified by sex (male, female), race (white, blacks, and Others), and age groups (0-14, and 15-39 years). Results: There were 424 pediatric HNC cases and 6,936 adolescent and young adult cases in the study. Whites accounted for 70.6% of cancers, and 57.6% of cancers occurred in males. Overall, there was a 14.7% decrease in the incidence of HNC (1.32 per 100,000 in 1975 vs. 1.12 per 100,000 in 2016). For pediatric cases, there was a 51.2% decrease in incidence of HNC (0.18 per 100,000 in 1975 vs. 0.09 per 100,000 in 2016); in young adults, there was a 12.8% decrease in incidence of HNC (2.01 per 100,000 in 1975 vs. 1.75 per 100,000 in 2016). While there was overall decrease in incidence, we found differences based on sex. Among young adult males, the annual percent change (APC) from 1975 to 2016 was -0.46 (p < 0.05) while among young adult females, it significantly increased by 0.50 (p < 0.05). This difference in young adult male vs. female head and neck cancer incidence may have been driven by race: as stratified by race, the APC for white young adult males was -0.29 (ns) while white females had an APC of 0.55 (p < 0.05); and among black young adults, APC for males was -2.24 (p < 0.05) and APC for females was -0.82 (p < 0.05). Conclusions: Among pediatric, adolescent, and young adults in the United States, head and neck cancer has decreased markedly in all groups in the last four decades, except among white female adolescents and young adults where there has been a significant increase in the time period of the study. As this trend differs from the adult head and neck cancer population, it is critical that further investigations provide more insight into the epidemiology of head and neck cancer among white adolescent and young adult females. Note: This abstract was not presented at the conference. Citation Format: Nosayaba Osazuwa-Peters, Kara M. Christopher, Matthew C. Simpson, Premal B. Desai, Rebecca L. Rohde, Sai D. Challapalli, Adnan S. Hussaini, Neelima Panth, Eric Adjei Boakye. Incidence and trends in head and neck cancer among United States’ pediatric, adolescent, and young adult population [abstract]. In: Proceedings of the AACR Special Conference on the Advances in Pediatric Cancer Research; 2019 Sep 17-20; Montreal, QC, Canada. Philadelphia (PA): AACR; Cancer Res 2020;80(14 Suppl):Abstract nr A05.

Introduction: Head and neck cancer epidemiology has historically focused on the burden of disease among males. Despite a concerning increase in the incidence of certain types of head and neck cancer among females, females with head and neck cancer continue to represent an understudied and overlooked patient population. While previous studies have established that health insurance status is associated with mortality and stage at presentation among patients with head and neck cancer, the impact of health insurance on female patients with head and neck cancer is not well understood. This study describes incidence trends in stage at presentation and investigates the association between health insurance status, stage at presentation and survival among female patients with head and neck cancer. Methods: This retrospective cohort study included 18,923 female patients from the Surveillance, Epidemiology, and End Results (SEER) database (2007 - 2014), aged ≥ 18 years, and diagnosed with a malignant primary head and neck cancer. Incidence trends for stage at presentation was estimated using Joinpoint regression analysis. Binary logistic regression estimated odds of presenting with late-stage disease. The association between health insurance status (private insurance, uninsured and Medicaid), and stage of presentation (AJCC stages I-IV) on the outcomes of interest (overall and disease-specific survival) was estimated using Fine and Gray proportional hazards models, while adjusting for covariates, including age at diagnosis, race/ethnicity, marital status, and tumor site. Results: The incidence of stage IV head and neck cancer in this subpopulation rose by 1.24% from 2007-2014 (APC=1.24, 95% CI 0.30, 2.20). Patients with Medicaid (aOR=1.59, 95% CI 1.45, 1.74) and who were uninsured (aOR=1.73, 95% CI 1.47, 2.04) were more likely to be diagnosed with advanced-stage (stages III/IV) head and neck cancer. Cancers of the hypopharynx (81%) and oropharynx (83%) were most likely to be diagnosed at an advanced stage. Female patients with Medicaid (aHR=1.47, 95% CI 1.38, 1.56) and who were uninsured (aHR=1.45, 95% CI 1.29, 1.63) were more likely to die from any cause compared to privately insured patients. Medicaid (aHR=1.34, 95% CI 1.24, 1.44) and uninsured (aHR=1.41, 95% CI 1.24, 1.60) patients also had a greater hazard of death from head and neck cancer compared to privately insured patients. Conclusions: There has been a significant increase in the incidence of advanced-stage presentation for female head and neck cancer patients in the United States since 2007. Patients who are either uninsured or are on Medicaid are more likely to present with late-stage disease and die earlier than those with private insurance. This study illustrates the need to evaluate and address the unique burden of head and neck cancer among females. It is critical that physicians are aware of the trends in head and neck cancer among females and the need for further evaluation or referral of their high-risk patients when concerned. Citation Format: Neelima Panth, Matthew C. Simpson, Rosh K.V. Sethi, Mark A. Varvares, Nosayaba Osazuwa-Peters. Health insurance status, stage at presentation and survival among female patients with head and neck cancer [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B088.

Background: The United States and other industrialized nations are experiencing what is known as the thyroid cancer epidemic. While there are studies of incidence trends among adult thyroid cancer patients in the United States, there is a paucity of data examining the relative contributions of different races/ethnicities and age groups, especially among the pediatric, adolescent, and young adult (AYA) population. This study aimed to identify which racial/ethnic groups may be driving the incidence trends of thyroid cancer among the pediatric and AYA population in the United States. Methods: We used data from the joint National Program of Cancer Registries/Surveillance, Epidemiology, and End Results databases from 2001 - 2015 (n = 149,578), which covered the entire United States (50 states and the District of Columbia). We calculated age-adjusted incidence rates of thyroid cancer for patients from 0 - 39 years, and rates were stratified by age, race/ethnicity, and sex and presented per 100,000 person-years (PY). Overall rates for the entire study period, rate ratios (RR) with 95% confidence intervals (CI), and annual percent changes (APC) comparing the 2001 rate and 2015 rate were calculated for each group. Joinpoint regression estimated increases/decreases in age-adjusted incidence over time for each group through average annual percent changes (AAPC). Results: The majority of thyroid cancer patients in this study were females (83%), white (60%), and between 15 - 39 years (98%). The overall incidence was 6.17 per 100,000 PY with an AAPC of 4.22 (p < 0.01). From 2001 to 2015, there was a 79% increase in age-adjusted incidence rate of thyroid cancer pediatric and AYAs in the United States (4.29 per 100,000 PY in 2001 vs. 7.69 per 100,000 PY in 2015). Both pediatric (0-14 years) and AYA (15 - 39 years) groups experienced significant increase in incidence of thyroid cancer in this time period (AAPC for 0 - 14 years = 4.38; AAPC for 15 - 39 years = 4.22; p < 0.01). The AYA population was 34 times as likely to develop thyroid cancer than the pediatric population (RR = 34.55, 95% CI 33.23, 35.94). Also, both males and females experienced significant rate increases from 2001-2015, but females were almost five times (RR = 4.81, 95% CI 4.74, 4.87) as likely to develop thyroid cancer than males (2.13 per 100,000 PY for males vs. 10.26 per 100,000 PY for females). Whites had the highest overall incidence rate (6.87 per 100,000 PY), while blacks had the lowest overall rate (2.89 per 100,000). Compared to whites, all other race/ethnicity groups were significantly less likely to develop thyroid cancer (RR range 0.42 - 0.90). All race/ethnicity groups had significant rate increases from 2001-2015 (AAPC range = 3.69 - 5.70). Conclusion: Incidence of thyroid cancer increased in both the pediatric and AYA population over the last 15 years, and white females aged 15 - 39 years accounted for most of this increase. These findings can inform future directed screening and reveal unaddressed health disparities. Citation Format: Katherine M. Polednik, Matthew C. Simpson, Aleksandr R. Bukatko, Matthew E. Gaubatz, Eric Adjei Boakye, Mark A. Vavaras, Nosayaba Osazuwa-Peters. Thyroid cancer incidence trends among pediatrics, adolescents, and young adults in the United States 2001-2015 [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A117.

Objective: The last three decades in the United States have seen oropharyngeal cancer emerge as an important human papillomavirus (HPV)-associated cancer, with about three-quarters of cases thought to be positive for HPV. It has dramatically increased in incidence and recently surpassed cervical cancer as the leading HPV-associated cancer. While positive HPV tumor status generally portends better survival probability compared with non-HPV related head and neck cancer, there is a paucity of data describing mortality trends. This study aimed to describe trends in oropharyngeal cancer incidence-based mortality in the United States in the last three decades. Methods: We estimated age-adjusted incidence-based mortality rates (AAMR) from first primary oropharyngeal squamous cell carcinoma (OPSCC), using the Surveillance, Epidemiology, and End Results (SEER) 9 database from 1985-2016. To prevent later years from having a cumulatively larger set of patients diagnosed in the past, we only included OPSCC patients who died within 10 years of diagnosis. AAMRs were stratified by race, sex, and age at death and were presented per 100,000 person-years. Rate ratios (RRs) determined which groups had significantly different AAMRs, and Joinpoint regression calculated which groups had significant increases/decreases in annual AAMRs over time through annual percentage changes (APCs) and average APCs (AAPCs). We used 95% confidence intervals (CIs) to determine significant RRs, APCs, and AAPCs. Results: This study included 12,102 patients who died from first primary OPSCC from 1985-2016 with an AAMR of 1.16 per 100,000 person-years. AAMRs among males were 3.58 times higher than for females (RR = 3.58, 95% CI 3.43, 3.73). AAMRs among blacks were about 2 times higher than for whites (RR = 2.06, 95% CI 1.96, 2.16) but were about 60% lower for other race than whites (RR = 0.37, 95% CI 0.34, 0.42). From 1985-2009, AAMRs for first primary OPSCC decreased approximately 1.92% annually (APC = -1.92, 95% CI -2.27, -1.56) but remained stable from 2009-2016, which resulted in an average annual decrease of -1.31% from 1985-2016 (AAPC = -1.31, 95% CI -1.84, -0.78). When stratified by race or sex, all groups exhibited significant mortality rates decrease, however decrease was significantly greater among whites than blacks (white AAPC1985-2016 = -0.76; 95% CI -1.33, -0.17 vs black AAPC1985-2016 = -3.36; 95% CI -3.85, -2.87). AAMRs significantly decreased among 65+ year olds (AAPC = -0.88, 95% CI -1.63, -0.13), while AAMRs for 15-39 and 40-64-year olds exhibited non-significant decreases. Conclusions: While there has been significant decrease in oropharyngeal cancer mortality in the last three decades in the United States across age groups, races/ethnicity, and gender, there remained a significant mortality gap between blacks and whites, highlighting the persistent cancer-related disparity in the United States. Citation Format: Nosayaba Osazuwa-Peters, Matthew C Simpson, Sean T Massa, Eric Adjei Boakye, Kara M Christopher, Sai D Challapalli, Katherine M Polednik, Haley N Bray, Greg M Ward, Mark A Varvares. Oropharyngeal cancer incidence-based mortality trends in the United States, 1985-2016 [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D128.

Introduction: Suicide is a threat to cancer survivorship, and a known non-cancer competing cause of death among cancer survivors. In fact, the risk of suicide among cancer survivors is more than double that of the general population, depending on the cancer site. While several factors like age, gender, race, and cancer site are associated with suicide, studies on the potential impact of marriage, a marker for social support, on the risk of suicide among cancer survivors have been inconclusive. This study aimed to examine the impact of marital status on the risk of suicide, and to determine whether there are differences in the effect of marital status on suicide risk based on cancer sites. Methods: Patients with head and neck (n=162,701), pancreatic (n=127,831), stomach (n=80,839), and lung/bronchus cancer (n=605,274) from the Surveillance, Epidemiology, and End Results (SEER) 18 database diagnosed from 2007-2015 were included (total n=976,645). These cancer sites were selected as they have the highest suicide rates of all cancers. Competing risks proportional hazards models estimated the association between marital status and death from suicide for each of the four cancer sites while controlling for sociodemographic and clinical covariates. These models yielded adjusted hazard ratios (aHR) and 95% confidence intervals (CI). Results: The patient cohort was mostly male (57%), non-Hispanic white (74%), married/partnered (51%), and had a mean age of 67 years. For stomach cancer, marital status was not associated with death from suicide. For pancreatic, lung, and HNC, divorced/separated patients were more likely to commit suicide than married/partnered patients (aHR range 1.59-2.92). For lung (aHR=1.47, 95% CI 1.14, 1.92) and HNC (aHR=1.31, 95% CI 1.01, 1.70), never-married patients were more likely to commit suicide than married/partnered patients. Conclusions: Being married was protective against suicide among the cancer survivors in our study, except for stomach cancer survivors. However, the effect of marital status on suicide risk was greater among head and neck cancer survivors than lung, pancreatic, and stomach cancer survivors. It is critical that survivors receive as much support as possible to mitigate suicide risks. Citation Format: Nosayaba Osazuwa-Peters, Matthew C. Simpson, Eric Adjei Boakye. Differences in the impact of marital status on risk of suicide among cancer survivors based on cancer sites [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B014.

Introduction: Factors such as anatomic complexity and extensive surgical procedures increase the risk of serious, sometimes fatal complications post-surgical treatment for head and neck cancer squamous cell carcinoma (HNSCC). Thirty-day (30-day) mortality is a common quality metric that evaluates short-term survival; however, no study has described disparities associated with 30-day mortality following surgery in HNSCC United States population. The aim of this study was to identify disparities and factors (clinical and nonclinical) associated with 30-day postoperative mortality in patients with HNSCC treated with and without adjuvant therapy. Methods: In this retrospective study, we utilized a patient cohort of 102,877 confirmed HNSCC cases from the National Cancer Database (2004-2013) who were treated surgically with curative intent for the primary head and neck cancer. The effects of adjuvant therapy and other clinical and nonclinical factors on 30-day postoperative mortality were estimated via multivariate logistic regression with adjustment for time-varying nature of adjuvant therapy. Outcome was defined as any-cause-death within 30 days after definitive surgery of primary cancer. We controlled for several clinical and nonclinical covariates, including age, race, sex, health insurance status, primary tumor site, stage of presentation, and Charlson-Deyo comorbidity score. Results: There were 859 patients who died within 30 days of definitive surgery for cancer, yielding a 30-day mortality rate of 0.83%. Treatment differences were associated with mortality, and patients who received adjuvant therapy had were significantly more likely to die within 30 days compared with those treated with surgery alone (aOR: 3.51; 95% CI 1.85, 6.66). Increasing number of comorbidities was also associated with greater odds of 30-day mortality (Charlson-Deyo comorbidity scores of 1: aOR: 1.45; 95% CI 1.23, 1.71, and Charlson-Deyo comorbidity scores of 2+ aOR: 2.52; 95% CI 2.05, 3.09). There were also sociodemographic disparities associated with 30-day mortality. Odds of 30-day mortality were significantly increased among patients with Medicaid insurance (aOR: 1.99; 95% CI 1.48, 2.68), as well as those who lived in neighborhoods with little education (≥ 29% missing high school diploma: aOR: 1.43; 95% CI 1.08, 1.88). Conclusions: Disparities impact short-term mortality in the head and neck cancer population. Patients that were significantly more likely to die within 30 days of surgical treatment were those treated with adjuvant therapy, those with greater burden of comorbidities, those with little education, and those covered by Medicaid. To our knowledge, this is the largest study to document short term (30-day) mortality disparities among patients with head and neck cancer post-surgery in the United States. To improve short-term survival among head and neck cancer patients, it is important to account for these disparities found in this study. Citation Format: Aleksandr R. Bukatko, Parth Patel, Vindhya Kakarla, Matthew C. Simpson, Eric A. Boakye, Katherine A. Stamatakis, Nosayaba Osazuwa-Peters. Disparities and factors associated with 30-day mortality following surgical treatment for squamous cell head and neck cancer with or without adjuvant therapy [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B085.

Background: There are previous studies on the impact of socioeconomic status on head and neck cancer outcomes, but it is not clear whether these factors are associated with short-term mortality as most studies on risk factors for mortality have focused on long-term mortality and clinical factors. This study aimed to quantify 90-day mortality rates and identify socioeconomic factors associated with 90-day mortality among patients with head and neck cancer. Methods: This retrospective cohort study included 260,011 patients from the National Cancer Database (2004 to 2014) ≥ 18 years with a diagnosis of head and neck cancer and treated with curative intent with a combination of either surgery, radiation, and/or chemotherapy. Our outcome of interest was any-cause mortality within 90 days of first treatment. The effects of socioeconomic factors on 90-day mortality were estimated using the Cox proportional hazards model with the following adjustments: Heaviside function for time-varying effects and Šidák correction for familywise error (multiple comparisons). A multinomial cumulative logit model estimated the likelihood of higher comorbidity scores in variables of interest. Results: There were 9,771 deaths within 90 days of treatment, yielding a 90-day mortality rate of 3.8%. Several socioeconomic factors were associated with 90-day mortality. Blacks (aHR = 1.10, 95% CI 1.00, 1.21) and males (aHR = 1.07; 95% CI 1.00, 1.15) were marginally more likely to die within 90 days of treatment. Hazard of 90-day mortality was significantly greater among patients who were uninsured (aHR = 1.71; 95% CI 1.48, 1.99) or insured by Medicaid (aHR = 1.72; 95% CI 1.53, 1.93) or Medicare (aHR = 1.40; 95% CI 1.27, 1.53), compared to those with private insurance. Residence in a zip-code with lower median income was associated with greater hazard of 90-day mortality [(aHR 250 miles = 0.70; 95% CI 50, 0.99)]. In addition, farther travel distance for treatment was associated with lower comorbidity scores [(aOR 50 - 249.9 miles = 0.91; 99% CI 0.86, 0.97); (aOR >250 miles = 0.78; 99% CI 0.67, 0.92)]. Conclusions: While the 90-day mortality rate was low among this national cohort of patients with head and neck cancer, there were significant sociodemographic disparities observed. Males, blacks, those uninsured, those with Medicaid or Medicare, and those living in poorer zip codes were more likely to die within 90 days of treatment, highlighting issues associated with access to care. To improve short-term head and neck cancer outcomes, these socioeconomic disparities associated with differing mortality rates among this cancer patient population need to be addressed. Citation Format: Matthew E. Gaubatz, Aleksandr R. Bukatko, Matthew C. Simpson, Katherine M. Polednik, Eric A. Boakye, Mark A. Varvares, Nosayaba Osazuwa-Peters. Socioeconomic disparities associated with 90-day mortality among patients with head and neck cancer in the United States [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A115.

7035 Background: Medicaid expansion has been associated with increased access to care and earlier stage at diagnosis among patients with head and neck cancer (HNC). However, it is unclear whether Medicaid expansion has impacted HNC mortality rates. We examined the associations between early Medicaid expansions (2010-2011) with mortality rates for HNC in the United States. Methods: Data were obtained from the Surveillance, Epidemiology, and End Results (SEER) program. SEER*Stat was utilized to obtain mortality rates for early expansion (CA, CT, DC, MN, NJ, and WA) and non-early expansion states (all others) in the year ranges as available in SEER: 2005-2007 (pre-expansion) and 2012-2016 (post-expansion). Deaths in 2008-2011 were excluded as a phase-in/washout period. Difference-in-differences analyses were utilized to compare mortality rates pre- and post-early expansion in early expansion vs. non-early expansion states. The parallel trends assumption was tested comparing changes in HNC mortality rates between early expansion and non-early expansion states from 2002-2004 to 2005-2007 and from 2005-2007 to 2008-2011. Results: There were 6882 and 35459 deaths due to HNC in early expansion and non-early expansion states, respectively. HNC mortality rates (deaths per 100,000) decreased from 2005-2007 to 2012-2016 in both early expansion (2.17 to 1.85, difference = -0.32, 95% CI = -0.42 to -0.22) and non-expansion states (2.59 to 2.43, difference = -0.16, 95% CI = -0.22 to -0.11). Relative to non-expansion states, there was a reduction of 0.16 deaths per 100,000 (95% CI = 0.05 to 0.27, p = 0.007) after early Medicaid expansion in expansion states. However, in parallel trends testing, there was no difference in the change in mortality rates between early expansion and non-expansion states from 2002-2011 (p > 0.37). Conclusions: In this quasi-experimental analysis, there was an association between early Medicaid expansion with decreased HNC mortality. Thus, Medicaid expansion might help decrease disparities associated with access to care among HNC survivors. As longer-term data emerges, additional follow-up will be necessary to understand the mechanisms that underlie the HNC mortality benefits seen in early Medicaid expansion.

e19113 Background: The risk of suicide among cancer survivors more than double that of the general population, highlighting the need to mitigating risk factors for suicide. While several studies have described marital status, a surrogate for social support, as associated with cancer mortality, it is inconclusive whether marital status impacts suicide as a competing cause of cancer mortality. We tested this hypothesis by describing the association of marital status and suicide among survivors of four cancer sites with the highest suicide mortality rates in the United States. Methods: Adult cancer patients were identified from the Surveillance, Epidemiology and End Results database from 2004 to 2016 for four index cancer sites previously identified with highest suicide mortality rates: pancreas, head and neck, lung/bronchus and stomach ( n = 800,798). Cumulative incidence curves stratified by marital status (divorced/separated, widowed, never unmarried, and married/partnered) estimated unadjusted probability of suicide (outcome of interest). A multivariable competing risk proportional hazards model yielded sub-distribution hazard ratios (sdHRs) and 95% confidence intervals (CI) to estimate the association of marital status with suicide for each cancer site, while controlling for clinical and nonclinical factors. Results: Half (50.7%) of the cohort were married/partnered, males (56.8%), and non-Hispanic whites (71.0%). Mean age at diagnosis was 67.3 years. Most patients (60.9%) had cancer in the lung/bronchus, 17.9% head and neck, 13.8% pancreas, and 8.3% stomach. Unadjusted probability of suicide was highest among head and neck cancer survivors (0.3%). In the fully adjusted model, mortality by suicide was more likely among divorced/separated patients vs. married/partnered patients across cancer sites (sdHRhead and neck = 1.81; 95% CI 1.38, 2.37; sdHRlung/bronchus = 1.68; 95% CI 1.28, 2.19; sdHRpancreas = 2.19; 95% CI 1.27, 3.78; and sdHRstomach = 2.38; 95% CI 1.17, 4.58). Additionally, for lung/bronchus cancer, patients who were never married patients were more likely to die by suicide than those married/partnered (sdHRlung/bronchus = 1.47; 95% CI 1.09, 1.98). Conclusions: Marital status is associated with suicide mortality among cancer survivors, and divorced/separated survivors may have greater suicide mortality risks, independent of cancer site. As overall probability of suicide remains low, these findings might help identify cancer survivors who may be candidates for ongoing surveillance and psychosocial support to mitigate suicide mortality risks.

OBJECTIVES/HYPOTHESIS Radiation is thought to increase risk of developing second primary thyroid cancer (SPTC). This study estimated the rate of SPTC following index head and neck cancer (HNC) and determined whether radiation treatment among HNC survivors increased SPTC risk. STUDY DESIGN Retrospective data analysis. METHOD The Surveillance, Epidemiology, and End Results database (1975-2014) was queried for cases of index HNC (N = 127,563) that developed SPTC. Adjusted multivariable competing risk proportional hazards model tested risk of developing a SPTC following index HNC. Sensitivity analyses using proportional hazards models were also performed restricting data to patients who 1) received both radiation and chemotherapy and 2) radiation alone. RESULTS Only 0.2% of index HNC survivors (n = 229) developed SPTC, yielding a rate of 26.1 per 100,000 person-years. For every increasing year of age at diagnosis, patients were 3% less likely to develop an SPTC (adjusted hazard ratio [aHR] = 0.97, 95% CI: 0.96-0.98). Males were also less likely to develop an SPTC (aHR = 0.73, 95% CI: 0.55-0.96). Radiation (aHR = 0.92, 95% CI: 0.68-1.25), surgery (aHR = 0.79, 95% CI: 0.56-1.11), and chemotherapy (aHR = 1.13, 95% CI: 0.76-1.69) were not significantly associated with developing SPTC. The sensitivity models also did not find an association between treatment and risk of SPTC. CONCLUSIONS Rate of developing SPTC following index HNC was very low, and previous exposure to radiation did not significantly increase risk in our study population. More studies are needed to understand the increasing incidence of thyroid cancer across the United States. LEVEL OF EVIDENCE NA Laryngoscope, 129:1014-1020, 2019.

To determine whether the impact of marital status on head and neck cancer (HNC) outcomes vary by gender.The Surveillance, Epidemiology, and End Results 18 database from 2007 to 2014 was queried for eligible cases of HNC (n = 71,799). An interaction term (gender*marital status) was tested for each outcome of interest (cancer-specific survival, stage of presentation, adequate treatment), and when significant (p 0.05), the model was stratified by gender. A competing risks proportional hazards (subdistribution [sd]) model estimated the interaction effect on cancer-specific survival. Logistic regression estimated effect on stage of presentation and treatment type.There was significant gender*marital status interaction for cancer-specific survival and stage of presentation. While married/partnered patients had the highest survival among both genders, males benefitted more: widowed (male sdHR = 1.41, 95% CI 1.31, 1.52; female sdHR = 1.15, 95% CI 1.06, 1.26), divorced/separated (males: sdHR = 1.39, 95% CI 1.32, 1.46; females: sdHR = 1.17, 95% CI 1.06, 1.28), or never married (males: sdHR = 1.42, 95% CI 1.36, 1.49; females: sdHR = 1.15, 95% CI 1.05, 1.26). When stratified by oropharyngeal cancer vs. non-oropharyngeal HNC, unmarried males had 50-60% increased hazard of death, while no difference was found for females. Unmarried males also had greater odds of presenting with late-stage disease compared with females. No gender*marital status interaction was observed for adequate treatment, although married/partnered survivors had greater odds of receiving adequate treatment.While there are survival benefits for married patients with HNC, married/partnered males, especially those with oropharyngeal cancer, may benefit more than females.