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178 Background: Care coordination represents deliberate efforts to harmonize and organize patient care activities. This study examined sociodemographic and clinical predictors of patient-reported care coordination among Medicare beneficiaries older than 65 with a history of cancer. Methods: This study utilized the Surveillance, Epidemiology, and End Results-Consumer Assessment of Healthcare Providers and Systems (SEER-CAHPS) linked data, including SEER cancer registry data, Medicare CAHPS patient experience surveys, and Medicare claims. We identified Medicare beneficiaries who completed a CAHPS survey within ten years after their most recent cancer diagnosis and reported visiting a personal doctor within six months before their survey (n = 14,646). Multivariable regression models examined associations between cancer survivor characteristics and care coordination, with higher scores indicating better coordination (scale of 0-100). Results: Residing in a rural area at time of diagnosis (1.2-points greater score than urban; p= 0.04) and reporting > 4 visits with a personal doctor within 6 months (3.0-points greater than 1-2 visits; p< 0.001) were significantly associated with higher care coordination scores. Older age ( p< 0.001) and seeing more specialists ( p= 0.006) were associated with significantly lower care coordination scores. Patients with melanoma (women: 5.2-point difference, p< 0.001; men: 2.8 points, p= 0.01) and breast cancer (women: 2.4 points; p< 0.001) also reported significantly lower care coordination scores than did men with prostate cancer (reference group). Conclusions: Adult cancer survivors who are older, have a history of breast, lung, or melanoma cancers, or see more specialists report worse care coordination. Future research should explore and address the multilevel influences that lead to worse care coordination for older adult cancer survivors.

Cancer Medications Enquiry Database (CanMED) is comprised of two interactive, nomenclature-specific databases within the Observational Research in Oncology Toolbox: CanMED-Healthcare Common Procedure Coding System (HCPCS) and CanMED-National Drug Code (NDC), described through this study. CanMED includes medications with a) a US Food and Drug Administration-approved cancer treatment or treatment-related symptom management indication, b) inclusion in treatment guidelines, or c) an orphan drug designation. To demonstrate the joint utility of CanMED, medication codes associated with female breast cancer treatment were identified and utilization patterns were assessed within Surveillance Epidemiology and End Results-Medicare (SEER) data. CanMED-NDC (11_2018 v.1.2.4) includes 6860 NDC codes: chemotherapy (1870), immunotherapy (164), hormone therapy (3074), and ancillary therapy (1752). Treatment patterns among stage I–IIIA (20 701) and stage IIIB–IV (2381) breast cancer patients were accordant with guideline-recommended treatment by stage and molecular subtype. CanMED facilitates identification of medications from observational data (eg, claims and electronic health records), promoting more standardized and efficient treatment-related cancer research.

Purpose Health-care claims are of increasing utility as a rich, real-world data resource for conducting treatment-related cancer research. However, multiple dynamic coding nomenclatures exist, leading to study variability. To promote increased standardization and reproducibility, the National Cancer Institute (NCI) developed the Cancer Medications Enquiry Database (CanMED)-Healthcare Common Procedure Coding System (HCPCS) within the Observational Research in Oncology Toolbox. Methods The CanMED-HCPCS includes codes for oncology medications that a) have a US Food and Drug Administration-approved indication for cancer treatment or treatment-related symptom management; b) are present in National Comprehensive Cancer Network guidelines; or c) carry an orphan drug designation for treatment or management of cancer. Included medications and their HCPCS codes were primarily identified based on Center for Medicare and Medicaid Services annual HCPCS Indices (2012–2018). To demonstrate the utility of the CanMED-HCPCS, use of systemic treatment for stage II–IV colorectal cancer patients included in the Surveillance, Epidemiology, and End Results-Medicare data (2007–2013) was assessed. Results The CanMED-HCPCS (v2018) includes 332 HCPCS codes for cancer-related medications: chemotherapy (156), immunotherapy (74), hormonal therapy (54), and ancillary therapy (48). Observed treatment trends within the NCI Surveillance, Epidemiology, and End Results-Medicare data were as expected; utilization of each treatment type increased with stage, and immunotherapy was largely confined to use among stage IV patients. Conclusion The CanMED-HCPCS provides a comprehensive resource that can be used by the research community to facilitate systematic identification of medications within claims or electronic health data using the HCPCS nomenclature and greater reproducibility of cancer surveillance and health services research.

289 Background: For women diagnosed with early stage breast cancer, lumpectomy followed by radiation therapy is a guideline-recommended treatment. However, lumpectomy followed by hormonal therapy is also an approved treatment regimen for certain women. It is unclear what patient-driven factors are related to the decision to receive radiation therapy. This study examined the relationship between patient-reported experience of care, an important dimension of health care quality, and receipt of radiation therapy following lumpectomy among women with breast cancer. Methods: We used the SEER-CAHPS data resource (NCI Surveillance Epidemiology and End Results [SEER] data linked to Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey responses) to examine experiences of care among women diagnosed with local or regional stage breast cancer in 2000-2017 who received lumpectomy, were enrolled in fee-for-service Medicare, completed a CAHPS survey within 18 months of diagnosis, and survived for this study period. Experience of care was assessed by patient-provided numeric scores for overall care, health plan, physicians, customer service, doctor communication, care coordination, and other aspects of care. Multivariable logistic regression models assessed associations of receipt of radiation therapy with care experience and patient sociodemographic and clinical characteristics. Results: The study population included 825 women; 651 (79%) received radiation therapy. Approx. 84% were diagnosed with localized (vs. regional) breast cancer. Women with higher experience scores for their personal doctor or for care coordination were significantly more likely to have received any radiation therapy. In contrast, among women enrolled in Medicare Part D plans, those who reported higher scores for their prescription drug plan were significantly less likely to have received radiation therapy. Conclusions: Patient experience of care was significantly associated with receipt of radiation therapy following lumpectomy among women with breast cancer. While these results do not show causality, future quality improvement initiatives may want to explore the role of patient experience of care in facilitating patient decision making and improving quality of care.

Objective To clarify associations between metabolic syndrome, its components, and ovarian cancer risk. Methods Using a case-control study within the U.S.-based Surveillance, Epidemiology and End Results (SEER)–Medicare linked database, we examined metabolic syndrome, its components (obesity, impaired fasting glucose, hypertension, HDL cholesterol, triglycerides), and ovarian/fallopian tube cancer risk. Cases (n = 16,850) were diagnosed with cancer between age 68–89 from 1994 through 2013. Controls (n = 281,878) were Medicare enrollees without these cancers living in registry areas. We estimated adjusted odds ratios (OR) and 95% confidence intervals (CI) with logistic regression. Results Women with metabolic syndrome had reduced ovarian cancer risk compared to women not meeting the diagnostic criteria (OR 0.86, CI 0.82–0.89). Having one or two syndrome components was associated with increased risk, but having ≥3 was not, when compared to women without any components. Impaired fasting glucose, which was highly prevalent among those with metabolic syndrome, was associated with reduced risk (OR 0.90, CI 0.87–0.93). Hypertension and high triglycerides, the most prevalent components among women without metabolic syndrome, were associated with increased risks (OR 1.08, CI 1.04–1.12; OR 1.05, CI 1.01–1.08, respectively). Conclusions Specific metabolic syndrome components may have modest associations with ovarian cancer. These associations varied in direction and the prevalence of the components influenced the overall association between metabolic syndrome and ovarian cancer. Evaluating metabolic syndrome as a composite exposure could be misleading in ovarian cancer research, but further study of the syndrome components is warranted.

Background Although cervical cancer risk overall is elevated among women living with human immunodeficiency virus (HIV; WLH), it is unclear whether risks are similarly elevated across histologic subtypes. Methods Data from the HIV/AIDS Cancer Match Study, a linkage of 12 US HIV and cancer registries during 1996 -2016, were used. Cervical cancers were categorized as adenocarcinoma (AC), squamous cell carcinoma (SCC), or other histologic subtype. Standardized incidence ratios compared rates of AC and SCC in WLH to those in general population. For WLH, risk factors for AC and SCC were evaluated using Poisson regression. Five-year survival was estimated by HIV status and histology. Results Overall, 62 615 cervical cancers were identified, including 609 in WLH. Compared with the general population, incidence of AC was 1.47 times higher (95% confidence interval [CI]: 1.03–2.05) and SCC was 3.62 times higher among WLH (95% CI: 3.31–3.94). Among WLH, there was no difference in AC rates by race/ethnicity or HIV transmission group, although SCC rates were lower among White women (vs Black) and higher among women who inject drugs (vs heterosexual transmission). Among WLH, 5-year overall survival was similar for AC (46.2%) and SCC (43.8%) but notably lower than for women not living with HIV. Conclusions Among WLH, AC rates were modestly elevated, whereas SCC rates were greatly elevated compared with the general population. These findings suggest there may be differences in the impact of immunosuppression and HIV in the development of AC versus SCC, given their common etiology in human papillomavirus infection.

Purpose There are no nationally representative data on oncologists’ use of next-generation sequencing (NGS) testing in practice. The purpose of this study was to investigate how oncologists in the United States use NGS tests to evaluate patients with cancer and to inform treatment recommendations. Methods The study used data from the National Survey of Precision Medicine in Cancer Treatment, which was mailed to a nationally representative sample of oncologists in 2017 (N = 1,281; cooperation rate = 38%). Weighted percentages were calculated to describe NGS test use. Multivariable modeling was conducted to assess the association of test use with oncologist practice characteristics. Results Overall, 75.6% of oncologists reported using NGS tests to guide treatment decisions. Of these oncologists, 34.0% used them often to guide treatment decisions for patients with advanced refractory disease, 29.1% to determine eligibility for clinical trials, and 17.5% to decide on off-label use of Food and Drug Administration–approved drugs. NGS test results informed treatment recommendations often for 26.8%, sometimes for 52.4%, and never or rarely for 20.8% of oncologists. Oncologists younger than 50 years of age, holding a faculty appointment, having genomics training, seeing more than 50 unique patients per month, and having access to a molecular tumor board were more likely to use NGS tests. Conclusion In 2017, most oncologists in the United States were using NGS tests to guide treatment decisions for their patients. More research is needed to establish the clinical usefulness of these tests, to develop evidence-based clinical guidelines for their use in practice, and to ensure that patients who can benefit from these new technologies receive appropriate testing and treatment.

Background Rural cancer patients often have challenges in accessing quality care. This study examined associations between the place of residence at cancer diagnosis (urban vs rural) and patient ratings of access to care among older cancer survivors participating in Medicare-managed care. Methods Using Surveillance, Epidemiology, and End Results -Consumer Assessment of Healthcare Providers and Systems (SEER-CAHPS) linked data, which included SEER data and Medicare CAHPS patient experience surveys, this study identified urban (n = 6140) and rural Medicare beneficiaries (n = 686) aged ≥ 65 years with a breast, lung, colorectal, or prostate cancer diagnosis who had completed a Medicare CAHPS survey between 1998 and 2013. Multivariable models examined associations between survivor residence at the time of diagnosis and CAHPS measures of timeliness and ease of getting care. Results Respondents who resided in urban areas (vs rural) at the time of their cancer diagnosis rated their care significantly lower for Getting Care Quickly (b = -2.27; standard error = 0.95; P = .02). Although there were no overall significant differences for Getting Needed Care, there was a significant interaction between race/ethnicity and residence (P = .04): both non-Hispanic black and Hispanic respondents residing in rural areas rated Getting Needed Care lower than those respondents residing in urban areas. Conclusions In contrast to prior studies, these findings suggest that rural survivors report more timely care than those in urban areas, but accessing needed care may be more challenging for racial/ethnic minority rural survivors. Future examination of specific barriers for urban and racial/ethnic minority rural survivors is warranted to ensure equitable access to quality cancer care. Cancer 2018. © 2018 American Cancer Society.

BACKGROUND: We examined the longitudinal association between sociodemographic factors and an expanded definition of underemployment among those with and without cancer history in the United States. METHODS: Medical Expenditure Panel Survey data (2007–2013) were used in multivariable regression analyses to compare employment status between baseline and two-year follow-up among adults aged 25–62 years at baseline (n = 1,614 with and n = 39,324 without cancer). Underemployment was defined as becoming/staying unemployed, changing from full to part-time, or reducing part-time work significantly. Interaction effects between cancer history/time since diagnosis and predictors known to be associated with employment patterns, including age, gender/marital status, education, and health insurance status at baseline were modeled. RESULTS: Approximately 25% of cancer survivors and 21% of individuals without cancer reported underemployment at follow-up (p = 0.002). Multivariable analyses indicated that those with a cancer history report underemployment more frequently (24.7%) than those without cancer (21.4%, p = 0.002) with underemployment rates increasing with time since cancer diagnosis. A significant interaction between gender/marital status and cancer history and underemployment was found (p = 0.0004). There were no other significant interactions. Married female survivors diagnosed >10 years ago reported underemployment most commonly (38.7%), and married men without cancer reported underemployment most infrequently (14.0%). A wider absolute difference in underemployment reports for married versus unmarried women as compared to married versus unmarried men was evident, with the widest difference apparent for unmarried versus married women diagnosed >10 years ago (18.1% vs. 38.7%). CONCLUSION: Cancer survivors are more likely to experience underemployment than those without cancer. Longer time since cancer diagnosis and gender/marital status are critical factors in predicting those at greatest risk of underemployment. The impact of cancer on work should be systematically studied across sociodemographic groups and recognized as a component of comprehensive survivorship care.

Purpose: Although patient-provider communication is an essential component of health care delivery, little is known about the quality of these discussions among patients with cancer. Methods: Data are from the 2011 Medical Expenditure Panel Survey Experiences with Cancer survey among 1,202 adult cancer survivors. We evaluated discussions with any provider after a cancer diagnosis about: (1) follow-up care; (2) late or long-term treatment effects; (3) lifestyle recommendations, such as diet, exercise, and quitting smoking; and (4) emotional or social needs. Using a response scale ranging from “did not discuss” to “discussed in detail,” a summary score was constructed to define communication quality as high, medium, or low. Patient factors associated with the quality of provider discussions were examined using multivariable polytomous logistic regression analyses. Results: At the time of the survey, approximately one half of the patients (46%) were either within 1 year (24.1%) or between 1 and 5 years (22.0%) of treatment. More than one third of cancer survivors reported that they did not receive detailed communication about follow-up care, and more than one half reported that they did not receive detailed communication regarding late or long-term effects, lifestyle recommendations, or emotional and social needs. Only 24% reported high-quality communication for all four elements, indicating that the vast majority experienced suboptimal communication. In multivariable analysis, survivors reporting a high communication quality with providers included those who were within 1 year of treatment, between the ages of 18 and 64 years, non-Hispanic black or other ethnicity, and married. Conclusion: Study findings demonstrate gaps in the communication quality experienced by cancer survivors in the United States and help identify survivors for targeted interventions.

Cancer treatment studies commonly exclude patients with prior primary cancers due to difficulties in ascertaining for which site treatment is intended. Surveillance, Epidemiology, and End Results-Medicare patients 65 years and older diagnosed with an index colon or rectal cancer (CRC) or female breast cancer (BC) between 2004 and 2013 were included. Chemotherapy, defined as “any chemotherapy” and more restrictively as “chemotherapy with confirmatory diagnoses,” was ascertained based on claims data within 6 months of index cancer diagnosis by prior cancer history. Any chemotherapy use was slightly lower among patients with a prior cancer (CRC: no prior = 17.4%, prior = 16.1%; BC: no prior = 12.9%, prior = 12.0%). With confirmatory diagnoses required, estimates were lower, especially among patients with a prior cancer (CRC: no prior = 16.8%, prior = 13.6%; BC: no prior = 12.6%, prior = 11.0%). These findings suggest that patients with prior cancers can be included in studies of chemotherapy use; requiring confirmatory diagnoses can increase treatment assignment confidence.

Background A growing proportion of tobacco users in the United States use non-cigarette products including cigars, pipes, and smokeless tobacco. Studies examining the disease and mortality risks of these products are urgently needed. Methods We harmonized tobacco use data from 165 335 adults in the 1991, 1992, 1998, 2000, 2005, and 2010 National Health Interview Surveys. Hazard ratios (HRs) and 95% confidence intervals (CIs) for overall and cause-specific mortality occurring through December 31, 2015, were estimated by exclusive use of cigarettes, cigars, pipes, or smokeless tobacco using Cox proportional hazards regression with age as the underlying time metric and never tobacco users as the referent group. Results Current use of cigarettes (HR = 2.23, 95% CI = 2.13 to 2.33) and smokeless tobacco (HR = 1.36, 95% CI = 1.17 to 1.59) were each associated with overall mortality. Relative to never tobacco users, higher risks were observed both in daily (HR = 2.34, 95% CI = 2.24 to 2.44) and nondaily (HR = 1.69, 95% CI = 1.54 to 1.86) cigarette smokers, with associations also observed across major smoking-related causes of death. Daily use of smokeless tobacco was also associated with overall mortality (HR = 1.41, 95% CI = 1.20 to 1.66) as was daily use of cigars (HR = 1.52, 95% CI = 1.12 to 2.08). Current smokeless tobacco use was associated with a higher risk of mortality from heart disease and smoking-related cancer, with strong associations observed for cancers of the oral cavity and bladder. Conclusions Exclusive daily use of cigarettes, cigars, and smokeless tobacco was associated with higher mortality risk. Tobacco control efforts should include cigars and smokeless tobacco.

Background The optimal approach to biliary drainage for patients with supra-ampullary cholangiocarcinoma remains undetermined. Violation of sphincter of Oddi results in bacterial colonization of bile ducts and may increase postdrainage infectious complications. We sought to determine if rates of cholangitis are affected by the type of drainage procedure. Methods We examined the Surveillance, Epidemiology, and End Results-Medicare linked database from 1991 to 2013 for cholangiocarcinoma. Biliary drainage procedures were categorized as sphincter of Oddi violating (SOV) or sphincter of Oddi preserving (SOP). Patients were stratified by resection. Results A total of 1914 patients were included in the final analysis. A total of 1264 patients did not undergo a postdrainage resection (SOP 83, SOV 1181) while 650 did undergo a postdrainage resection (SOP 26, SOV 624). For those patients not undergoing a postdrainage resection, the rate of cholangitis 90 days after an SOP procedure was 19% compared with 34% in the SOV cohort (P = 0.007). For those patients undergoing a postdrainage resection, the rate of cholangitis 90 days after an SOP procedure was less than 42.3% compared with 30% in the SOV cohort (P = 0.66). Conclusion For patients with supra-ampullary cholangiocarcinoma that did not undergo resection, biliary drainage procedures that violated the sphincter of Oddi were associated with increased rates of cholangitis.

Previous research describing how informal cancer caregiving impacts employment has been conducted in small samples or a single disease site. This paper provides population-based estimates of the effect of informal cancer caregiving on employment and characterizes employment changes made by caregivers. The samples included cancer survivors with a friend or family caregiver, participating in either the Medical Expenditure Panel Survey Experiences with Cancer Survivorship Survey (ECSS) (n = 458) or the LIVESTRONG 2012 Survey for People Affected by Cancer (SPAC) (n = 4706). Descriptive statistics characterized the sample of survivors and their caregivers’ employment changes. Multivariable logistic regression identified predictors of caregivers’ extended employment changes, comprising time off and changes to hours, duties, or employment status. Among survivors with an informal caregiver, 25 % from the ECSS and 29 % from the SPAC reported that their caregivers made extended employment changes. Approximately 8 % of survivors had caregivers who took time off from work lasting ≥2 months. Caregivers who made extended employment changes were more likely to care for survivors: treated with chemotherapy or transplant; closer to diagnosis or end of treatment; who experienced functional limitations; and made work changes due to cancer themselves compared to caregivers who did not make extended employment changes. Many informal cancer caregivers make employment changes to provide care during survivors’ treatment and recovery. This study describes cancer caregiving in a prevalent sample of cancer survivors, thereby reflecting the experiences of individuals with many different cancer types and places in the cancer treatment trajectory.

Purpose: We sought to determine if there were racial/ethnic disparities in the receipt of initial, cure-intended treatment for localized prostate cancer. Methods: We analyzed prostate cancer cases reported in 2004-2013 to Surveillance, Epidemiology and End Results (SEER) cancer registries, linked with Medicare claims from 2003-2014. We focused on cases that were fee-for-service with continuous Part A and B Medicare from 12 months before first diagnosis to 6 months after diagnosis, and that had American Joint Committee on Cancer 6th Edition tumor extent T1 or T2 without metastatic disease. We used SEER race/ethnicity to categorize cases as non-Hispanic whites; non-Hispanic blacks; non-Hispanic Asian or Pacific Islanders; Hispanics of any race; and Other/Unknown. We defined initial treatment to include 1 month before to 6 months after first diagnosis; cure-intended radical prostatectomy to include radical prostatectomy with or without radiation therapy; cure-intended radiation therapy to include radiation therapy without a radical prostatectomy; and noncurative treatment to include other initial treatment or no treatment. We used multivariable logistic regression to calculate adjusted odds ratios (OR) and 95% confidence intervals (CI) for receipt of each category of initial treatment, compared with the remaining cases, and adjusting for race/ethnicity; life expectancy from the man's age at diagnosis; pretreatment prostate cancer disease recurrence risk category; Charlson comorbidity score; year of diagnosis; SEER registry region, census tract poverty; and metropolitan or nonmetropolitan county location. Results: Our final study cohort included a total of 125,072 men, with 95,763 non-Hispanic white, 13,616 non-Hispanic black, 4,658 non-Hispanic Asian or Pacific Islanders, 7,933 Hispanic any race, and 3,102 in the Other/Unknown category. After adjustment for multiple variables, non-Hispanic blacks were less likely than non-Hispanic whites to receive initial radical prostatectomy (with or without radiation therapy) (OR, 0.57; 95% CI, 0.53-0.61) or initial radiation therapy without radical prostatectomy (OR, 0.85; 95% CI, 0.82-0.88), and more likely to receive noncurative treatment (OR, 1.51; 95% CI, 1.45-1.57). Non-Hispanic Asian or Pacific Islanders were more likely than non-Hispanic whites to receive initial radiation therapy without radical prostatectomy (OR, 1.23; 95% CI, 1.16-1.31), and less likely to receive noncurative treatment (OR, 0.84; 95% CI, 0.78-0.89). The adjusted odds ratios for curative and noncurative initial treatment received by Hispanics of any race were similar to those for non-Hispanic whites. Conclusion: Compared with non-Hispanic whites, non-Hispanic black men were less likely to receive curative and more likely to receive noncurative initial treatment for localized prostate cancer during 2004-2013. Citation Format: Thomas B. Richards, David G. Stinchcomb, Timothy S. McNeel, Wilhelmina Ross, Diane Ng. Racial-ethnic disparities in the receipt of initial, cure-intended treatment for localized prostate cancer, SEER Medicare, 2004-2013 [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 B023.

215 Background: Over 161,000 new prostate cancer patients diagnosed annually, with 75% diagnosed at early stages. Limited evidence exists supporting choice of treatment (including radical prostatectomy, radiation therapy, hormonal therapy, active surveillance or watchful waiting) for localized prostate cancer. Treatments have varying side effects associated with impaired functional status and health-related quality of life. Patient care experiences are important quality indicators, but research examining patient experiences by prostate cancer treatment is limited. The purpose of this study was to examine the association between treatment received (surgery, radiation, or no treatment) and CAHPS ratings of overall care over the prior six months. Methods: This study used data from SEER-CAHPS, which links Surveillance, Epidemiology, and End Results (SEER) data with Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) patient experience survey and Medicare claims data. Medicare Fee-for-Service beneficiaries ≥65 years with a National Comprehensive Cancer Network (NCCN) low- or intermediate-risk prostate cancer diagnosis were assigned to surgery only, radiation only, and no treatment received groups for analysis. The outcome variable was a CAHPS rating of overall care (0 = worst; 10 = best). The analysis adjusted for case mix and other cancer-specific variables. Results: The final cohort included 507 prostate cancer survivors (surgery n = 109 [21%]; radiation n = 197 [39%]; no treatment n = 201 [40%]). Respondents who received radiation rated their overall care higher than those not receiving treatment (adjusted mean 8.9 vs 8.3; p= 0.02). Ratings did not differ significantly between the surgery and no treatment groups. Conclusions: This study represents a first look at patient experiences among localized prostate cancer survivors receiving surgery, radiation, or no treatment. It is not clear whether those who did not receive treatment chose active surveillance or watchful waiting, or whether they did not have access to care, which could have affected results. Future research should explore associations between receipt of treatment and patient care experiences in an adequately powered sample to inform future interventions.

BACKGROUND Cancer survivors may experience long-term and late effects from treatment that adversely affect health and limit functioning. Few studies examine lost productivity and disease burden in cancer survivors compared with individuals who have other chronic conditions or by cancer type. METHODS We identified 4960 cancer survivors and 64,431 other individuals from the 2008-2010 Medical Expenditure Panel Survey and compared multiple measures of disease burden, including health status and lost productivity, between conditions and by cancer site for cancer survivors. All analyses controlled for the effects of age, sex, race/ethnicity, and number of comorbid conditions. RESULTS Overall, in adjusted analyses in multiple models, cancer survivors with another chronic disease (heart disease or diabetes) experienced higher levels of burden compared with individuals with a history of cancer only, chronic disease only, and neither cancer, heart disease, nor diabetes across multiple measures (P

Two selective estrogen receptor modulators, tamoxifen and raloxifene, have been shown in randomized clinical trials to reduce the risk of developing primary invasive breast cancer in high-risk women. In 1998, the U.S. Food and Drug Administration (FDA) used these studies as a basis for approving tamoxifen for primary breast chemoprevention in both premenopausal and postmenopausal women at high risk. In 2007, the FDA approved raloxifene for primary breast cancer chemoprevention for postmenopausal women. Data from the year 2010 National Health Interview Survey were analyzed to estimate the prevalence of tamoxifen and raloxifene use for chemoprevention of primary breast cancers among U.S. women. Prevalence of use of chemopreventive agents for primary tumors was 20,598 (95 % CI, 518-114,864) for U.S. women aged 35-79 for tamoxifen. Prevalence was 96,890 (95 % CI, 41,277-192,391) for U.S. women aged 50-79 for raloxifene. Use of tamoxifen and raloxifene for prevention of primary breast cancers continues to be low. In 2010, women reporting medication use for breast cancer chemoprevention were primarily using the more recently FDA approved drug raloxifene. Multiple possible explanations for the low use exist, including lack of awareness and/or concern about side effects among primary care physicians and patients.

Purpose To estimate the prevalence of financial hardship associated with cancer in the United States and identify characteristics of cancer survivors associated with financial hardship. Methods We identified 1,202 adult cancer survivors diagnosed or treated at ≥ 18 years of age from the 2011 Medical Expenditure Panel Survey Experiences With Cancer questionnaire. Material financial hardship was measured by ever (1) borrowing money or going into debt, (2) filing for bankruptcy, (3) being unable to cover one’s share of medical care costs, or (4) making other financial sacrifices because of cancer, its treatment, and lasting effects of treatment. Psychological financial hardship was measured as ever worrying about paying large medical bills. We examined factors associated with any material or psychological financial hardship using separate multivariable logistic regression models stratified by age group (18 to 64 and ≥ 65 years). Results Material financial hardship was more common in cancer survivors age 18 to 64 years than in those ≥ 65 years of age (28.4% v 13.8%; P < .001), as was psychological financial hardship (31.9% v 14.7%, P < .001). In adjusted analyses, cancer survivors age 18 to 64 years who were younger, female, nonwhite, and treated more recently and who had changed employment because of cancer were significantly more likely to report any material financial hardship. Cancer survivors who were uninsured, had lower family income, and were treated more recently were more likely to report psychological financial hardship. Among cancer survivors ≥ 65 years of age, those who were younger were more likely to report any financial hardship. Conclusion Cancer survivors, especially the working-age population, commonly experience material and psychological financial hardship.

BACKGROUND: In 2005, mammography rates in the United States dropped nationally for the first time among age-eligible women. An increased risk of breast cancer related to hormone therapy (HT) use reported in 2002 led to a dramatic drop in its use by 2005. Because current users of HT also tend to have higher mammography rates, the authors examined whether concurrent drops in HT and mammography use were associated. METHODS: Multivariate logistic regression was used to test for an interaction between HT use and survey year, controlling for a range of measurable factors in data from the 2000 and 2005 National Health Interview Surveys (NHIS). RESULTS: Women ages 50 to 64 years were more likely to report a recent mammogram if they also reported more education, a usual source of care, private health insurance, any race except non-Hispanic Asian, talking with an obstetrician/gynecologist or other physician in the past 12 months, or were currently taking HT. Women aged ≥65 years were more likely to report a recent mammogram if they also reported younger age (ages 65-74 years), more education, a usual source of care, having Medicare Part B or other supplemental Medicare insurance, excellent health, any race except non-Hispanic Asian, talking with an obstetrician/gynecologist or other physician in the past 12 months, or were currently taking HT. CONCLUSIONS: The change in HT use was associated with the drop in mammography use for women ages 50 to 64 years but not for women aged ≥65 years. NHIS data explained 70% to 80% of the change in mammography use. Cancer 2011;. © 2011 American Cancer Society.

Purpose: Family history guides cancer prevention and genetic testing. We sought to estimate the population prevalence of increased familial risk for breast, ovarian, endometrial, prostate, and colorectal cancers and hereditary cancer syndromes that include these cancers. Methods: Using the 2005 California Health Interview Survey data, a weak, moderate, or strong familial cancer risk was assigned to 33,187 respondents. Guidelines were applied to identify individuals with hereditary breast-ovarian cancer and hereditary nonpolyposis colon cancer. Results: Among respondents without a personal history of cancer, familial breast cancer was most prevalent; 7% had a moderate and 5% a strong familial risk. Older individuals and women were more likely to report family history of cancer. Generally, whites had the highest prevalence, and Asians and Latinos had the lowest prevalence. Among women without a personal history of breast or ovarian cancer, 2.5% met criteria for hereditary breast-ovarian cancer, and among individuals without a personal history of colorectal, endometrial or ovarian cancer, 1.1% met criteria for hereditary nonpolyposis colon cancer. Conclusions: We provide population-based prevalence estimates for moderate and strong familial risk for five common cancers and hereditary breast-ovarian cancer and hereditary nonpolyposis colon cancer. Such estimates are helpful in planning and evaluation of genetic services and prevention programs, and assessment of cancer surveillance and prevention strategies.

14 Background: Cancer patients often have multiple chronic conditions and require complex care coordination. We compared older (ages 66+) cancer patients’ reports of their healthcare experiences based on level of multimorbidity. Methods: Data from the SEER-CAHPS combines cancer registry (Surveillance, Epidemiology, and End Results; SEER), patient experiences (Consumer Assessment of Healthcare Providers and Systems; CAHPS) and Medicare claims data. Multimorbidity was captured as: (1) the National Cancer Institute-Combined Comorbidity Index (NCCI, 16 Charlson conditions diagnosed ≤12 months prior to cancer); and (2) a Multimorbidity Burden Index (MBI), which categorizes conditions based on the impact to cancer treatment (no comorbidity, low/medium, and high). Outcomes were CAHPS patient experience measures: Doctor Communication, Getting Care Quickly, Getting Needed Care, Obtaining Prescription Drugs, Customer Service, and ratings of Overall Care, Personal Doctor, and Specialist. Multivariable linear regression provided associations of each multimorbidity measure with CAHPS measures controlling for standard case mix adjustors, years from diagnosis to survey and diagnostic stage. Results: The study cohort included 9305 cancer patients (53% male, 84% Non-Hispanic White, average age 77, average time from diagnosis 29 months), with a distribution of NCCI conditions as: 0 (cancer only), 73%; 1, 17%; ≥2, 10%. Cancer patients with NCCI = 0 and those with MBI = no comorbidity rated their Personal Doctor more negatively than those with any comorbidities ( p < 0.02). Those with NCCI ≥ 2 or MBI = low/medium reported better Doctor Communication ( p < 0.04). Those with high MBI rated their specialist physician better than those with no multimorbidity ( p = 0.04), and those with low/medium MBI reported better experiences Getting Care Quickly ( p = 0.02). No other associations were significant. Conclusions: Cancer patients with multimorbidity report better communication with their doctor and care = by = personal doctors and specialists. Increased attention to the care experiences of cancer patients with multimorbidity may lead to insights and interventions that benefit all cancer patients.

BACKGROUND: Cancer diagnosis and treatment of a parent has considerable impact on the lives of their minor children, family caregivers, and patients themselves. Understanding the number and characteristics of the population of cancer survivors with children younger than 18 years of age would help to better target services for these survivors and their children and to stimulate and inform research on these understudied families. METHODS: This study identified adults with a history of cancer (n = 13,385) who participated in the United States National Health Interview Survey (NHIS) between 2000 and 2007. The authors examined the prevalence and characteristics of survivors residing with their minor children, both in the total sample and among survivors diagnosed within the last 2 years. RESULTS: Among these adult survivors, 18.3% (95%CI, 16.3-20.5) of those recently diagnosed and 14.0% (95%CI 13.3-14.8) of the total sample reported living with a minor child. Most of these survivors were female (78.9%), married (69.8%), and younger than age 50 years (85.8%). Of the 3193 identified children of survivors, 30.5% were younger than age 6 years at the time of their parent's cancer diagnosis; 33.4% were born after the diagnosis. By using population-based weights, the authors estimated that 1.58 million US cancer survivors reside with their minor children, representing 2.85 million children. Furthermore, an estimated 562,000 US minor children are living with a parent in the early phases of cancer treatment and recovery. CONCLUSIONS: There is a large population of families for whom cancer may pose special challenges and for whom assessment of needs and referral to resources are essential. Cancer 2010. Published 2010 by the American Cancer Society.

BACKGROUND: This paper examines the prevalence of cancer screening use as reported in 2005 among US adults, focusing on differences among historically underserved subgroups. We also examine trends from 1992 through 2005 to determine whether differences in screening use are increasing, staying the same, or decreasing. METHODS: Data from the National Health Interview Surveys between 1992 and 2005 were analyzed to describe patterns and trends in cancer screening practices, including Papanicolaou test, mammography, prostate-specific antigen, and colorectal screening. Logistic regression was used to report 2005 data for population subgroups defined by several demographic and socioeconomic characteristics. RESULTS: Rates of use for cancer tests are rising only for colorectal cancer, due largely to the increase in colorectal endoscopy screening. Use of all the modalities was strongly influenced by contact with a physician and by having health insurance coverage. CONCLUSIONS: There remain large gaps in use for all screening modalities by education, income, usual source of care, health insurance, and recent physician contact. These specific populations would benefit from interventions to overcome these barriers to screening. Cancer 2010. Published 2010 by the American Cancer Society.

Background: In the United States, prostate cancer incidence is higher among black than among white males, with a higher proportion of blacks diagnosed with advanced-stage cancer. Methods: Prostate cancer incidence (1999-2001) and census tract data were obtained for 66,468 cases in four states that account for 20% of U.S. blacks: Georgia, Florida, Alabama, and Tennessee. Spatial clusters of localized-stage prostate cancer incidence were detected by spatial scan. Clusters were examined by relative risk, population density, and socioeconomic and racial attributes. Results: Overall prostate cancer incidence rates were higher in black than in white men, and a lower proportion of black cases were diagnosed with localized-stage cancer. Strong associations were seen between urban residence and high relative risk of localized-stage cancer. The highest relative risks generally occurred in clusters with a lower percent black population than the national average. Conversely, of eight nonurban clusters with significantly elevated relative risk of localized-disease, seven had a higher proportion of blacks than the national average. Furthermore, positive correlations between percent black population and relative risk of localized-stage cancer were seen in Alabama and Georgia. Conclusion: Association between urban residence and high relative risk of localized-stage disease (favorable prognosis) persisted after spatial clusters were stratified by percent black population. Unexpectedly, seven of eight nonurban clusters with high relative risk of localized-stage disease had a higher percentage of blacks than the U.S. population. Impact: Although evidence of racial disparity in prostate cancer was found, there were some encouraging findings. Studies of community-level factors that might contribute to these findings are recommended. Cancer Epidemiol Biomarkers Prev; 19(6); 1460–7. ©2010 AACR.

6529Background: The proliferation of next-generation sequencing (NGS) tests provides an opportunity to advance oncology care. However, there are limited data about when and how NGS tests are used a...

BACKGROUND: The number of adult survivors of childhood cancer in the United States is increasing because of effective treatments and improved survival. The purpose of this study was to use a national, population-based sample to estimate the burden of illness in adult survivors of childhood cancer. METHODS: A total of 410 adult survivors of childhood cancer and 294,641 individuals without cancer were identified from multiple years of the National Health Interview Survey. Multiple measures of burden, general health, and lost productivity were compared using multivariate regression analyses including: logistic, polytomous logit, proportional odds, and linear models. RESULTS: Controlling for the effects of age, sex, race/ethnicity, and survey year, adult survivors of childhood cancer reported poorer outcomes across the majority of general health measures and productivity measures than individuals without cancer. Survivors were more likely to report their health status as fair or poor (24.3% vs 10.9%; P < .001); having any health limitation in any way (12.9% vs 3.4%; P < .001); being unable to work because of health problems (20.9% vs 6.3%; P < .001); and being limited in the amount/kind of work because of health problems (30.9% vs 10.6%; P < .001). When categorized by time since diagnosis, cancer survivors had poor health outcomes in every time interval, with the greatest limitations in the initial 4 years after diagnosis and 30 or more years after diagnosis. CONCLUSIONS: Across multiple measures, adult survivors of childhood cancers have poorer health outcomes and more health limitations than similar individuals without cancer. Cancer 2010. Published 2010 by the American Cancer Society.

Background: Although family history of cancer is widely ascertained in research and clinical care, little is known about assessment methods, accuracy, or other quality measures. Given its widespread use in cancer screening and surveillance, better information is needed about the clarity and accuracy of family history information reported in the general population. Methods: This telephone survey in Connecticut examined coherence and completeness of reports from 1,019 respondents about 20,504 biological relatives. Results: Of 2,657 cancer reports, 97.7% were judged consistent with malignancy (versus benign or indeterminate conditions); 79% were site specific, 10.1% had unspecified cancer sites, and 8.6% had “ill-defined” sites. Only 6.1% of relatives had unknown histories. Unknown histories and ambiguous sites were significantly higher for second-degree relatives. The adjusted percentage of first-degree relative reports with ambiguous sites increased with decreasing education and African-American race of survey respondents, and with deceased vital status of relatives. Ambiguous second-degree relative reports were also associated with deceased vital status and with male gender of respondents. Conclusions: These findings suggest that family history of cancer reports from the general population are generally complete and coherent. Impact: Strategies are needed to improve site specificity and thus maximize the utility of such information in primary care settings. Cancer Epidemiol Biomarkers Prev; 19(3); 799–810

Data are limited regarding cancer risk in human immunodeficiency virus (HIV)-infected persons with modest immunosuppression, before the onset of acquired immunodeficiency syndrome (AIDS). For some cancers, risk may be affected by highly active antiretroviral therapy (HAART) widely available since 1996. We linked HIV/AIDS and cancer registries in Colorado, Florida and New Jersey. Standardized incidence ratios (SIRs) compared cancer risk in HIV-infected persons (initially AIDS-free) during the 5-year period after registration with the general population. Poisson regression was used to compare incidence across subgroups, adjusting for demographic factors. Among 57,350 HIV-infected persons registered during 1991-2002 (median CD4 count 491 cells/mm(3)), 871 cancers occurred during follow-up. Risk was elevated for Kaposi sarcoma (KS, SIR 1,300 [n = 173 cases]), non-Hodgkin lymphoma (NHL, 7.3 [n = 203]), cervical cancer (2.9 [n = 28]) and several non-AIDS-defining malignancies, including Hodgkin lymphoma (5.6 [n = 36]) and cancers of the lung (2.6 [n = 109]) and liver (2.7 [n = 14]). KS and NHL incidence declined over time but nonetheless remained elevated in 1996-2002. Incidence increased in 1996-2002 compared to 1991-1995 for Hodgkin lymphoma (relative risk 2.7, 95%CI 1.0-7.1) and liver cancer (relative risk infinite, one-sided 95%CI 1.1-infinity). Non-AIDS-defining cancers comprised 31.4% of cancers in 1991-1995, versus 58.0% in 1996-2002. For KS and NHL, risk was inversely related to CD4 count, but these associations attenuated after 1996. We conclude that KS and NHL incidence declined markedly in recent years, likely reflecting HAART-related improvements in immunity, while incidence of some non-AIDS-defining cancers increased. These trends have led to a shift in the spectrum of cancer among HIV-infected persons.

BACKGROUND Timely screening with mammography can prevent a substantial number of deaths from breast cancer. The objective of this brief was to ascertain whether recent use of mammography has dropped nationally. METHODS The authors assessed the trend in mammography rates from 1987 through 2005. Then, they used the 2000 and 2005 National Health Interview Survey (NHIS) estimates to characterize trends and current patterns in mammography use. RESULTS After robust, rapid increases in reported use of mammography by women in the U.S. since 1987, estimates from the 2005 NHIS showed a decline compared with 2000 (from 70% to 66%). Although it was small, this decline may be cause for concern, because it signals a change in direction. CONCLUSIONS This report establishes for the nation what already has been observed in some local data. The results confirmed that the use of mammography may be falling. This change needs to be monitored carefully and also may call for intervention. Cancer 2007. Published 2007 by the American Cancer Society

Purpose: Anatomic pulmonary resection includes surgical procedures such as pneumonectomy, lobectomy, and segmentectomy, in contrast to non-anatomic pulmonary surgical procedures such as wedge resection. National Comprehensive Cancer Network guidelines for non-small cell lung cancer (NSCLC) indicate that anatomic pulmonary resection is preferred when surgery is indicated. The purpose of the current study is to describe racial-ethnic disparities in the receipt of anatomic pulmonary resection among NSCLC patients. Methods: We analyzed Surveillance, Epidemiology, and End Results (SEER) patients linked with Medicare claims, first diagnosed in 2000-2011. We required patients to have NSCLC as their first malignancy and covered by fee-for-service with continuous Part A and B Medicare from 12 months before to 4 months after first diagnosis. We categorized stage using American Joint Committee on Cancer 6th Edition. We excluded patients who were age ≤65 years; diagnosed at occult stage or stage 0; diagnosed at death; had unknown race, census tract poverty, urban-rural status, month of diagnosis, or month of death; or were enrolled in a health maintenance organization at any time from 12 months before to 4 months after diagnosis. We used SEER race to classify cases as: non-Hispanic whites; non-Hispanic blacks; Hispanics of white or black race (hereafter referred to as Hispanics), and Asian or Pacific Islanders. We reserved cases with American Indian or Alaska Native race for a future, separate analysis because numbers were smaller compared to other racial-ethnic groups. We defined anatomic pulmonary resection to include pneumonectomy, lobectomy, and segmentectomy. We identified receipt of anatomic pulmonary resection from the month of diagnosis to 4 months after first NSCLC diagnosis using Healthcare Common Procedure Coding System and International Classification of Disease 9th edition Clinical Modification codes. We used multiple variable logistic regression to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for receipt of anatomic pulmonary resection by males, and separately by females, adjusting for age at diagnosis, racial-ethnic group, mediastinal exploration, stage, histology, census tract poverty, SEER region, year of diagnosis, and comorbidity. Results: Our study cohort included 99,766 NSCLC cases, with similar proportions of males (51.2%) and females (48.8%). Overall, 23.2% (n=23,105) received anatomic pulmonary resection, but receipt varied by racial-ethnic group. Compared to non-Hispanic black men, anatomic resection procedures were more commonly received by men who were non-Hispanic white (aOR, 1.93; 95% CI, 1.70-2.19), Hispanic (aOR, 1.82; 95% CI, 1.49-2.22), or Asian or Pacific Islander (aOR, 2.06; 95% CI, 1.71-2.49). Compared to non-Hispanic black females, anatomic resection procedures also were more commonly received by females who were non-Hispanic white (aOR, 1.39; 95% CI, 1.23-1.57), Hispanic (aOR, 1.46; 95% CI, 1.20-1.79) or Asian or Pacific Islander (aOR, 1.42; 95% CI, 1.16-1.73). Conclusions: Non-Hispanic black men diagnosed with NSCLC from 2000-2011 were less likely to receive anatomic pulmonary resection than non-Hispanic white, Hispanic, or Asian or Pacific Islander men. Non-Hispanic black females also were less likely to receive anatomic pulmonary resection, but the differences in aORs by race were smaller among females than among males. Citation Format: Thomas B. Richards, Serban Negoita, Timothy S. McNeel, Dylan L. Holt, Marie Topor, S Jane Henley, Arica White, Jun Li, Chunyu Li. Racial-ethnic disparities in receipt of anatomic pulmonary resection in non-small cell lung cancer, SEER Medicare, 2000-2011. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr PR06.

Purpose: Analyses of racial disparities in survival and treatment trends may be confounded by changes over time in cancer staging systems. For Surveillance, Epidemiology, and End Results (SEER) data linked with Medicare claims, non-small cell lung cancer (NSCLC) is available with American Joint Committee on Cancer (AJCC) 3rd edition stage from 2000–2003, and with AJCC 6th edition (AJCC6) stage from 2004–2011. We wanted to maximize the number of years that AJCC6 stage was available for analysis of trends. In this study, we describe the results of our methods to assign all NSCLC cases from 2000–2011 with stage group equivalent to AJCC6, and our assessment of black-white differences by stage and year following the stage reclassification. Methods: We focused on SEER-Medicare linked NSCLS cases, diagnosed 2000–2011, enrolled in Medicare during the month of diagnosis, and with SEER race coded as white or black. We used SEER Extent of Disease 1988 (10 digit) codes to assign AJCC6 to cases diagnosed 2000–2003, Collaborative Stage version 1 to assign AJCC6 to cases diagnosed 2004–2009, and Collaborative Stage version 2 to assign AJCC6 to cases diagnosed 2010–2011. To evaluate our adjusted AJCC6, we calculated the percentage point (pp) differences in the proportions of cases by stage and race between 2003 and 2004, and also for the 2000–2003, 2004–2009, and 2010–2011 sub-cohorts. In addition, we used SEER Joinpoint regression analysis to calculate annual percentage change (APC) by stage and race, including coincident and parallel pairwise comparisons by race. We defined statistical significance as p Results: Our final study cohort included 156,125 white and 16,594 black NSCLC cases. Overall from 2000 to 2011, the proportion of cases by stage was: IA (12.4%), IB (11.8%), IIA (1.2%), IIB (4.5%), IIIA (9.9%), IIIB (18.0%), and IV (41.0%); the remaining 1.2% were categorized Occult Carcinoma or Stage 0. The mean difference in proportions for stages I to IV between 2003 and 2004 was 0.3 pp, but the difference by specific stage varied up to 4.1 pp. The proportion Stage IA was higher in whites than in blacks (3.1 pp in 2000–2003; 3.7 pp in 2004–2009; and 3.5 pp in 2010–2011). The proportion Stage IV was higher in blacks than in whites (2.6 pp in 2000–2003; 3.2 pp in 2004–2009; and 3.5 pp in 2010–2011). Differences in proportions between whites and blacks for Stage IIA, IIB, and Stage IIIA were less than 1 pp for each of the three time periods. Proportions by stage for whites were greater than those for blacks for Stage IA to Stage IIB, and proportions by stage for blacks exceeded those for whites for Stage IIIB and Stage IV. The predicted proportions of white and black cases diagnosed at Stage IIIA were statistically identical. Significant changes in APCs were present among whites in Stage IA (at 2004), Stage IB (at 2006 and 2009), and Stage IV (at 2004). No statistically significant changes in APCs were detected among blacks. Conclusion: Our methods to reclassify NSCLC cases according to AJCC6 appear reasonable to support analyses that require cancer stage and race of all cohort patients diagnosed between 2000 and 2011. Some year-to-year differences are present, but they appear at most 4.1 pp between 2003 and 2004. Following the stage reclassification, our results suggest that whites were more likely to be diagnosed at a favorable stage (IA, IB, IIA, and IIB) compared with blacks, while blacks were more likely to be diagnosed at a less favorable stage (IIIB and IV) compared with whites. Citation Format: Thomas B. Richards, Serban Negoita, Timothy S. McNeel, Dylan L. Holt, Marie Topor, S Jane Henley, Arica White, Jun Li, Chunyu Li. Adjusted American Joint Committee on Cancer 6th edition stage for analysis of trends in black-white disparities in non-small cell lung cancer, SEER Medicare, 2000-2011. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B44.

Knowledge of family cancer history is essential for estimating an individual's cancer risk and making clinical recommendations regarding screening and referral to a specialty cancer genetics clinic. However, it is not clear if reported family cancer history is sufficiently accurate for this purpose.In the population-based 2001 Connecticut Family Health Study, 1019 participants reported on 20 578 first-degree relatives (FDR) and second-degree relatives (SDR). Of those, 2605 relatives were sampled for confirmation of cancer reports on breast, colorectal, prostate, and lung cancer. Confirmation sources included state cancer registries, Medicare databases, the National Death Index, death certificates, and health-care facility records. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated for reports on lung, colorectal, breast, and prostate cancer and after stratification by sex, age, education, and degree of relatedness and used to estimate report accuracy. Pairwise t tests were used to evaluate differences between the two strata in each stratified analysis. All statistical tests were two-sided.Overall, sensitivity and positive predictive value were low to moderate and varied by cancer type: 60.2% and 40.0%, respectively, for lung cancer reports, 27.3% and 53.5% for colorectal cancer reports, 61.1% and 61.3% for breast cancer reports, and 32.0% and 53.4% for prostate cancer reports. Specificity and negative predictive value were more than 95% for all four cancer types. Cancer history reports on FDR were more accurate than reports on SDR, with reports on FDR having statistically significantly higher sensitivity for prostate cancer than reports on SDR (58.9% vs 21.5%, P = .002) and higher positive predictive value for lung (78.1% vs 31.7%, P.001), colorectal (85.8% vs 43.5%, P = .004), and breast cancer (79.9% vs 53.6%, P = .02).General population reports on family history for the four major adult cancers were not highly accurate. Efforts to improve accuracy are needed in primary care and other health-care settings in which family history is collected to ensure appropriate risk assessment and clinical care recommendations.

Despite its benefit, about 30% of women report that they did not have a recent mammogram. We examine impact of distance, rural-urban residence, and other characteristics on mammography screening rates.We linked data on 33,938 women aged 40-84 years from the 2003 and 2005 California Health Interview Survey with FDA data on the location of mammography facilities in California, and with socioeconomic and geographic variables from the 2000 Census. We use logistic regression models to estimate the impact of selected variables on a woman's probability of having had a recent mammogram and developed a new mapping scheme to help visualize differences in mammography use across California.Though distance to a facility did not impact a woman's probability of having had a recent mammogram, women who resided in urban areas had somewhat higher screening rates than those living in more rural areas, as displayed on our map.Our findings suggest that more research is needed on possible disparities in access to mammography between rural and non-rural areas in California. Therefore, data adequately powered to examine rural populations and to compare them with urban populations are needed.

Background: Men with HIV/acquired immunodeficiency syndrome (AIDS) are reported to be at increased risk for germ cell tumors (GCT), particularly testicular seminoma. We investigated correlates of this association to improve understanding of GCTs. Methods: Testicular and extratesticular seminoma and nonseminoma cases were found by linking population-based cancer and HIV/AIDS registry data for 268,950 men who developed AIDS in 1980 to 2003. Standardized incidence ratios (SIR) with 95% confidence intervals (95% CI) were used to compare these cases with the number of cases expected in the demographically matched population. Results: Overall, seminoma risk (161 cases: SIR, 1.9; 95% CI, 1.6-2.2) was increased significantly with HIV/AIDS, whereas nonseminoma risk was not (56 cases: SIR, 1.3; 95% CI, 0.96-1.7). Extratesticular GCT risk also was increased (11 cases: SIR, 2.1; 95% CI, 1.1-3.7). Seminoma risk was elevated regardless of age, race, or HIV/AIDS transmission group. It was highest for disseminated disease (SIR, 4.7; 95% CI, 2.9-7.2) and within 9 months of AIDS onset (SIR, 7.6; 95% CI, 5.8-9.6), but it was unrelated to CD4 count and duration of HIV/AIDS. The excess risk of seminoma declined in more recent calendar periods, and it was no longer elevated (SIR, 1.4; 95% CI, 0.9-1.9) in the highly active antiretroviral treatment era. Conclusions: Men with HIV/AIDS had an increased risk of seminoma, but this risk may have attenuated with improving anti-HIV/AIDS treatments. Although detection bias could partly explain the excess of this cancer, various lines of evidence support a causal relationship. Possible mechanisms underlying this association include impaired tumor immunosurveillance or AIDS-related testicular atrophy. (Cancer Epidemiol Biomarkers Prev 2007;16(6):1266–9)

The remarkable success achieved in cervical cancer prevention is largely attributable to cervical cytology screening, also known as the Papanicolaou (Pap) test. The American Cancer Society (ACS) revised screening guidelines for Pap testing in 2002. The impact of these changes on future numbers of Pap tests has not been assessed. Using National Health Interview Survey (NHIS) data to determine historical screening patterns, we extrapolate the numbers of Pap tests that would be performed through 2010, under 5 different scenarios of implementation of screening guidelines. From 1993 to 2003, there was a steady increase in the number of Pap tests, with an estimated 65.6 million Pap tests performed in 2003. Approximately two thirds of women born after 1930 reported having been screened within the previous year, and 85% within the previous 3 years. Fifteen percent of Pap tests were performed in hysterectomized women, most of whom, according to current guidelines, should not be screened. Based on population projections, if screening behavior remains unchanged, 75 million Pap tests will be performed in 2010. Full compliance with ACS guidelines would approximately halve the total number of tests to 34 million. Potentially, with more appropriate allocation of resources according to guidelines, all women could be screened and the total number of Pap tests reduced, despite projected increases in the population.

Proceedings: AACR 106th Annual Meeting 2015; April 18-22, 2015; Philadelphia, PA Background: Primary liver cancer is the sixth most common cancer worldwide, with HCC representing the majority of the cases. In the U.S., HCC rates are higher among Hispanics, Asians and blacks than among whites. Whether the higher risks are due to different distributions of risk factors is not clear. Thus, we conducted an analysis of HCC risk factors by race/ethnicity in the SEER-Medicare database for the years 2000-2009. Methods: HCC cases (n = 8,116), identified by ICD-O morphology codes 8170-8175, were compared to a 5% random sample of cancer-free persons in the SEER areas (n = 313,525). Risk factors examined included type II diabetes (DM II), obesity, hepatitis B virus (HBV), hepatitis C virus (HCV), alcohol-related disorders. Multivariate logistic regression analyses, which adjusted for age, location, gender, income and date of diagnosis as well as the other risk factors were used to compare risk factors by racial/ethnic group. Results: Risk factors by race/ethnicity | Risk factor | White | Black | Asians | Hispanics | |:----------------- | ------- | ---------------- | ------ | ---------------- | ---- | | | N 6,120 | N 668 | N 971 | N 357 | | | % | OR (95% CI) | % | OR (95% CI) | % | OR (95% CI) | % | OR (95% CI) | | Obesity | 6.3 | 1.06 (0.9-1.2) | 5.5 | 1.0 (0.7-1.5) | 0.7 | 0.2 (0.1-0.8) | 7.8 | 1.2 (0.7-1.9) | | DM II | 44.5 | 2.9 (2.8-3.1) | 41.8 | 1.3 (1.1-1.6) | 38.1 | 1.8 (1.5-2.1) | 54.6 | 2.0 (1.5-2.7) | | HBV | 1.8 | 3.8 (2.6-5.7) | 3.6 | 1.6 (0.7-3.7) | 17.7 | 17.1 (11.8-25.0) | 2.0 | 1.4 (0.2-11.1) | | HCV | 16.8 | 19.7 (17.1-22.6) | 34.0 | 36.8 (28.0-48.6) | 31.1 | 21.4 (15.4-29.9) | 22.7 | 16.0 (9.2-28.1) | | Alcohol cirrhosis | 11.4 | 4.7 (3.7-5.8) | 7.6 | 4.5 (2.4-8.5) | 4.0 | 3.8 (1.3-11.7) | 17.1 | 3.3 (1.7-6.8) | | Alcohol NOS | 13.1 | 2.7 (2.2-2.9) | 13.2 | 1.6 (1.1-2.4) | 3.7 | 2.0 (1.0-4.1) | 14.8 | 1.6 (0.8-3.0) | | Cirrhosis NOS | 33.3 | 45.5 (41.2-50.4) | 24.1 | 17.9 (12.3-25.9) | 36.8 | 36.9 (26.2-52.0) | 44.8 | 27.6 (18.9-40.3) | NOS not otherwise specified. Conclusion: Major HCC risk factor profile is differ across race/ethnical groups. While diabetes is most common risk factor overall, it is most prevalent in Hispanics. HCC related to HCV is more common in blacks and Asians, and to HBV in Asians. Citation Format: Oxana V. Makarova-Rusher, Sean F. Altekruse, Timothy S. McNeel, Barry I. Graubard, Austin G. Duffy, Susanna V. Ulahannan, Tim F. Greten, Katherine A. McGlynn. Risk factors for hepatocellular carcinoma (HCC) by race/ ethnicity in the United States. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 875. doi:10.1158/1538-7445.AM2015-875

6608 Background: Expenditures associated with cancer, its treatment, and lasting effects of treatment are increasing in the US. The purpose of this study is to estimate the prevalence of financial ...

BACKGROUND People with AIDS have heightened cancer risk from immunosuppression. HAART has been available since 1996 and has reduced AIDS-related mortality, but there are few large-scale studies on cancer trends. METHODS AIDS and cancer registries in 11 US regions (1980-2002) were used to identify cancers in 375 933 people with AIDS. Cancer risk relative to the general population was measured using the standardized incidence ratio (SIR), focusing on the 2 years after AIDS onset for those with AIDS in 1990-1995 and 1996-2002 (HAART era). Time trends were assessed with Poisson regression. RESULTS Between 1990-1995 and 1996-2002, risk declined for the two major AIDS-defining cancers: Kaposi sarcoma [(KS) n = 5131; SIR, 22 100 and 3640, respectively; P < 0.0001] and non-Hodgkin lymphoma [(NHL) n = 3412; SIR, 53.2 and 22.6, respectively; P < 0.0001]. Declines began in the 1980s, but risk fell sharply in 1996 and was stable thereafter. Risk of cervical cancer did not change (n = 64; SIR, 4.2 and 5.3, respectively; P = 0.33). Among non-AIDS malignancies, lung cancer was most common, but risk declined between 1990-1995 and 1996-2002 (n = 344; SIR, 3.3 and 2.6, respectively; P = 0.02). Risk of Hodgkin lymphoma increased substantially over the 1990-2002 period (n = 149; SIR, 8.1 and 13.6, respectively; P = 0.003). CONCLUSIONS Dramatic declines in KS and NHL were temporally related to improving therapies, especially introduction of HAART, but those with AIDS remain at marked risk. Among non-AIDS-related cancers, a recent increase in Hodgkin lymphoma was observed.

By linking HIV/AIDS and cancer surveillance data in 12 US regions, breast and reproductive cancer risks with AIDS were compared to those in the general population. Trends in standardized incidence ratios (SIRs) were assessed by CD4 count, AIDS-relative time, and calendar time. Standardized incidence ratios were indirectly adjusted for cancer risk factors using data from AIDS cohort participants and the general population. With AIDS, 313 women developed breast cancer (SIR 0.69, 95% confidence interval (CI) 0.62-0.77), 42 developed ovary cancer (SIR 1.05, 95% CI, 0.75-1.42), and 31 developed uterine corpus cancer (SIR 0.57, 95% CI, 0.39-0.81). Uterine cancer risk was reduced significantly after age 50 (SIR 0.33). Breast cancer risk was reduced significantly both before (SIR 0.71) and after (SIR 0.66) age 50, and was lower for local or regional (SIR 0.54) than distant (SIR 0.89) disease. Breast cancer risk varied little by CD4 count (Ptrend=0.47) or AIDS-relative time (Ptrend=0.14) or after adjustment for established cancer risk factors. However, it increased significantly between 1980 and 2002 (Ptrend=0.003), approaching the risk of the general population. We conclude that the cancer deficit reflected direct or indirect effects of HIV/AIDS and that anti-HIV therapy reduced these effects.

Purpose A population-based investigation was conducted to examine the prevalence of health behaviors (smoking, alcohol use, physical activity, and cancer screening) of cancer survivors by age, time since diagnosis, and cancer site. Understanding health behaviors of survivors is imperative, as many survivors are living longer and are at risk for cancer recurrence, second cancers, and complications from treatment. Methods Using the National Health Interview Survey, this study examined the prevalence of smoking and alcohol use as well as whether cancer survivors (n = 7,384) are meeting current recommendations for physical activity and cancer screening compared with noncancer controls (n = 121,347). Results Cancer survivors are similar to controls with respect to smoking status and alcohol consumption after adjusting for group differences. However, younger survivors (18 to 40 years) are at greater risk for continued smoking than controls. Survivors are 9% more likely to meet physical activity recommendations compared with controls. χ2 tests indicate no significant differences in smoking, alcohol consumption, and physical activity by time since diagnosis, but differences by cancer site exist. Female cancer survivors are 34% and 36% more likely to meet mammogram and Papanicolaou smear screening recommendations, respectively, compared with controls. Similar screening patterns were found for prostate-specific antigen screening in men. Conclusion This study provides benchmark approximations of the prevalence of risky health behaviors of survivors by time since diagnosis and cancer site. As part of the collective effort to reduce late effects of cancer treatment, oncologists may be in the best position to offer initial guidance for promoting healthy lifestyle behaviors among cancer survivors.

Purpose: Prostate cancer death rates are higher in blacks than whites. Using the Surveillance, Epidemiology and End Results (SEER)-Medicare linked database, we evaluated whether racial disparities exist in the receipt of initial prostate cancer treatment. Methods: We analyzed data on prostate cancer cases diagnosed in 2004-2009 and linked with Medicare claims data from 2003-2010. We focused on cases with SEER race coded as white or black; and enrolled in both Medicare Parts A and B continuously during 12 months before diagnosis to 24 months after diagnosis, death, or December 2010, whichever was earliest. We defined prostate cancer recurrence risk categories using tumor stage, prostate specific antigen (PSA), and Gleason scores. We identified initial prostate cancer treatment using: radical prostatectomy, radiation therapy, or androgen deprivation therapy within 1 month before to 6 months after diagnosis; or evidence of active surveillance based on prostate biopsies or PSA tests from 1 to 18 months after diagnosis. We used multivariate logistic regression to determine adjusted odds ratios (OR) and 95% confidence intervals (CI). The outcome variable was receipt of initial treatment. Explanatory variables were: race; prostate cancer disease recurrence risk category; asymptomatic or symptomatic at time of first diagnosis; life expectancy from the man's age at diagnosis; comorbidity; census tract poverty; and census region. Results: Our final study cohort included 70,254 white men and 8,653 black men with prostate cancer. After adjustment for multiple variables, men were less likely to receive initial treatment if: expected survival < 5 years (OR, 0.36; 95% CI, 0.33–0.40; ref.= > 10 years); black race (OR, 0.54; 95% CI, 0.50–0.57; ref. = white); or symptomatic at time of diagnosis (OR, 0.77, 95% CI, 0.74–0.81; ref.=asymptomatic). Men were more likely to receive initial treatment if: high recurrence risk (OR, 2.75; 95% CI, 2.55–2.96; ref.= low); resided in Northeast (OR, 1.30; 95% CI 1.24–1.38; ref.= West); comorbidity score > 2 (OR, 1.24; 95% CI, 1.17–1.31; ref. = 0); or lived in a census tract with 19%). Conclusion: Low expected survival and black race were relatively important reasons that older men did not receive initial treatment for prostate cancer. Citation Format: Thomas B. Richards, Serban Negoita, Timothy S. McNeel, Jun Li, Chunyu Li. Racial disparities in receipt of initial prostate cancer treatment, SEER Medicare, 2004-2009. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr C55. doi:10.1158/1538-7755.DISP13-C55

6521 Background: Researchers are increasingly using diagnosis codes from administrative claims for cancer patients to identify metastatic disease at initial diagnosis or recurrence. However, the validity of metastasis codes on claims has not been established. We used the linked SEER -Medicare data to assess the completeness and validity of metastasis codes from Medicare claims for three common U.S. cancers. Methods: The study included 80,052 breast, lung, and colorectal cancer patients diagnosed with localized, regional, or distant disease in the SEER data between January 1, 2005 and December 31, 2007. From Medicare claims, patients were classified as having regional or distant disease at diagnosis if they had one hospital claim or two physician claims with metastasis codes within 3 months of diagnosis. Patients without claims with metastases codes were classified as having local disease. Using SEER data as the gold standard, we calculated sensitivity, specificity, positive and negative predictive values of metastasis codes on Medicare claims. We conducted multivariate logistic regression analysis to evaluate patient factors associated with stage misclassification for each cancer site. Results: For patients with distant disease per SEER data, the sensitivity and PPV of the claims to identify distant disease was: breast (50.6%, 67.3%), colorectal (72.2%, 68.8%) and lung cancer (42.1%, 88.6%). None of the measures for stage simultaneously exceeded 80% for sensitivity, specificity, and PPV for any of the cancer sites. In adjusted analysis, older, lower-income, and African American patients were more likely to have stage at diagnosis misclassified from Medicare claims. Conclusions: Use of diagnosis codes alone in Medicare claims will misclassify stage at diagnosis for cancer patients, particularly for patients with metastatic disease. Our findings also suggest that using diagnosis codes for metastasis to define recurrence in Medicare claims will be limited.