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Objective: We aim to determine the effect of region of residence (urban vs. rural) on the odds of receiving standard of care treatment for locally advanced BCa in Louisiana and its impact on survival outcomes. Methods: Using the Louisiana Tumor Registry, we identified American Joint Committee on Cancer (AJCC) stage II or III, BCa diagnoses in Louisiana residents between 2010 and 2020. Treatment received was classified as standard or non‐standard of care according to American Urological Association (AUA) guidelines and location of residence was determined using Rural Urban Commuting Area‐Tract‐level 2010 (RUCA). Multivariable logistic regression analyses and multivariate cox proportional hazard analyses were performed. Results: Of 983 eligible patients, 85.6% (841/983) lived in urban areas. Overall, only 37.5% received standard‐of‐care (SOC) for the definitive management of locally advanced bladder cancer. Individuals living in rural areas (OR 0.53, 95% CI: 0.31–0.91, p = 0.02) were less likely to receive standard of care treatment. Both rural residence and receipt of non‐standard of care therapy were associated with an increased risk of bladder cancer‐specific (adj HR 1.53, 95% CI: 1.09–2.14, p = 0.01 and adj HR: 1.85, 95% CI: 1.43–2.39, <0.0001) and overall mortality (adj HR: 1.28, 95% CI: 1.01–1.61, p = 0.04 and adj HR: 1.73 95% CI: 1.44–2.07, p < 0.0001). Conclusions: Most patients with locally advanced bladder cancer in Louisiana do not receive SOC therapy. Individuals living in rural locations are more likely to receive non‐standard of care therapy than individuals in urban areas. Nonstandard of care treatment and rural residence are both associated with worse survival outcomes for Louisiana residents with locally advanced bladder cancer. [ABSTRACT FROM AUTHOR]

Simple Summary: Hepatocellular carcinoma has a clear male predominance, but gender-specific differences remain incompletely understood. Our findings look specifically at the Louisiana population, which has some of the highest rates of hepatitis, alcoholic liver disease, and metabolic syndrome—thus providing important data to better evaluate HCC trends. Our findings help illustrate specific gender differences in this disease, which remains one of the leading causes of cancer-related deaths worldwide. Hepatocellular carcinoma (HCC) is a male-dominated disease. Currently, gender differences remain incompletely defined. Data from the state tumor registry were used to investigate differences in demographics, comorbidities, treatment patterns, and cancer-specific survival (HSS) among HCC patients according to gender. Additional analyses were performed to evaluate racial differences among women with HCC. 2627 patients with HCC were included; 498 (19%) were women. Women were mostly white (58%) or African American (39%)—only 3.8% were of another or unknown race. Women were older (65.1 vs. 61.3 years), more obese (33.7% vs. 24.2%), and diagnosed at an earlier stage (31.7% vs. 28.4%) than men. Women had a lower incidence of liver associated comorbidities (36.1% vs. 43%), and more often underwent liver-directed surgery (LDS; 27.5% vs. 22%). When controlling for LDS, no survival differences were observed between genders. African American women had similar HSS rates compared to white women (HR 1.14 (0.91,1.41), p = 0.239) despite having different residential and treatment geographical distributions. African American race and age >65 were predictive for worse HSS in men, but not in women. Overall, women with HCC undergo more treatment options—likely because of the earlier stage of the cancer and/or less severe underlying liver disease. However, when controlling for similar stages and treatments, HCC treatment outcomes were similar between men and women. African American race did not appear to influence outcomes among women with HCC as it did in men. [ABSTRACT FROM AUTHOR]

Background: Breast‐conserving surgery plus radiation (BCT) yields equivalent or better survival than mastectomy for early‐stage breast cancer (ESBC) women. However, nationwide mastectomy trends increased in recent decades, attracting studies on underlying causes. Prior research identified that long distance to the radiation treatment facility (RTF) was associated with mastectomy. Still, it is unclear whether such association applies to young and old ESBC women comparably. We sought to delineate such impacts by age. Methods: Women diagnosed with stages 0–II breast cancer in 2013–2017 receiving either BCT or mastectomy were identified from the Louisiana Tumor Registry. We assessed the association of surgery (mastectomy vs. BCT) with the distance to the nearest or nearest accessible RTFs using multivariable logistic regression adjusting the socio‐demographic and tumor characteristics. The nearest accessible RTF was determined based on patients' health insurance. For Medicaid, uninsured, and unknown insurance patients, the nearest accessible RTF is the nearest RTF owned by the government. The interaction effect of age and distance was evaluated as well. Results: Of 11,604 patients, 46.7% received mastectomy. Compared with distance ≤5 miles to the nearest RTF, those with distance ≥40 miles or 15–40 miles had higher odds of mastectomy (adjusted (adj) OR = 1.39, 95% CI = 1.07–1.82; adj OR = 1.17, 95% CI = 1.02–1.34). To the nearest accessible RTF, the adj ORs were 1.25 (95% CI = 1.03–1.51) and 1.19 (95% CI = 1.04–1.35), respectively. Age‐stratified analysis showed the significant association (p < 0.05) only presented among women aged ≥65, but not those aged <65 years. Conclusion: Distance to the nearest or nearest accessible RTF influences the surgery choice, especially among women in Louisiana ≥65 years with ESBC. Further understanding of factors leading to the decision for mastectomy in this age group is needed. [ABSTRACT FROM AUTHOR]

Background: Louisiana is one of the few Southern states that enacted the Medicaid expansion of the Patient Protection and Affordable Care Act (ACA). To the authors' knowledge, the issue of how this has affected the breast cancer landscape in Louisiana is unknown. The authors have postulated that ACA expansion had a positive impact for Louisiana women diagnosed with breast cancer. Methods: Data from the Louisiana Tumor Registry regarding 14,640 women aged 20 to 64 years who resided in Louisiana and were diagnosed with American Joint Committee on Cancer stage 0 to stage IV breast cancer between 2012 and 2018 were analyzed. The study period was divided into 2 groups: 1) before ACA expansion (January 1, 2012–May 31, 2016); and 2) after ACA expansion (June 1, 2016–December 31, 2018). The chi‐square test and multivariable logistic regression models were used to assess the impact of ACA expansion. A P value <.05 was considered statistically significant. Results: After ACA expansion, the rate of uninsured patients decreased from 5.4% to 3.0% (P <.0001), and the rate of Medicaid recipients increased from 11.6% to 17.7% (P <.0001). The diagnosis of stage I breast cancer increased from 36.8% to 44.7% (P <.0001), whereas the diagnosis of stage III breast cancer decreased from 10.7% to 8.5% (P <.0001). The receipt of radiotherapy after breast‐conserving surgery increased from 81.2% to 84.0% (P =.0035), and the receipt of radiotherapy within 90 days increased from 57.2% to 61.7% (P =.0012). After adjustment for sociodemographic and clinical variables, the models demonstrated that ACA expansion decreased the uninsured rate by 48% (odds ratio [OR], 0.52; 95% CI, 0.43‐0.63), increased the diagnosis of early‐stage disease (stage0 to stage II) by 27% (OR, 1.27; 95% CI, 1.15‐1.41), increased receipt of radiotherapy after breast‐conserving surgery by 19% (OR, 1.19; 95% CI, 1.03‐1.37), and reduced the delay of receipt of radiotherapy by 16% (OR, 0.84; 95% CI, 0.74‐0.95). Conclusions: ACA expansion in Louisiana reduced the uninsured rate, increased the diagnosis of early‐stage disease, and increased access to treatment. Medicaid expansion under the Patient Protection and Affordable Care Act (ACA) in Louisiana was found to result in a decrease in the uninsured rate, an increase in the amount of early‐stage disease detected at diagnosis, and increasing access to treatment. These results provide guidance for other nonexpansion states as they deliberate the advantages and disadvantages of ACA expansion for their own state. [ABSTRACT FROM AUTHOR]

Objectives: To determine cohorts of women diagnosed with cervical and endometrial cancers in Louisiana, meeting national NCORP clinical trial eligibility criteria based on cancer histology and stage. Then, to determine if there is a disparate rate of disqualification among these cohorts for potential trial participation based on comorbid conditions according to age, race, and socioeconomic markers. Methods: The baseline population for this study was all women with either endometrial or cervical malignancies from the Louisiana Tumor Registry (LTR) between January-December 2019. Based on the eligibility criteria of cooperative group clinical trials open at NCORP sites in Louisiana, a cohort of 'potentially eligible' trial patients was defined based on cancer stage and histology. This cohort was then further filtered according to registry reported, potentially excluding comorbid conditions (renal and/or hepatic disease, Charlson comorbidity index >6, HIV/AIDs and secondary malignancy) to define those who were 'eligible and included' versus those who were 'eligible but excluded.' Summary and comparative statistical analyses were used to determine differences between these groups based on demographic and socioeconomic factors. Results: From the baseline population, 152 (68%) patients were defined as potentially eligible for cervix clinical trials. Comparing women who did and did not meet inclusion criteria, women who were excluded were older (p=0.008) and of lower socioeconomic status (n =8, 38%) (p=0.038). Among those with endometrial cancer, 326 (55%) patients were potentially eligible for endometrial cancer trials. Patients eligible and included were more likely to be younger (p=0.028), of the White race (86%) than Black race (55%) (p=0.002) and privately insured (43%) than publicly insured (54%) (p=0.001). Those eligible and included were more likely to be alive at the time of reporting than those eligible but excluded. Conclusions: Age, race, underinsurance, and lower SES are associated with the exclusion of eligible patients from endometrial and cervical cancer trial enrollment. Critical efforts to address barriers to enrollment into clinical cancer trials, especially for underrepre-sented groups, are required in order to reconsider and tailor eligibility criteria to be more equitable and inclusive. [ABSTRACT FROM AUTHOR]

Objectives: We examined electronic health records (EHRs) to assess the impact of systems change on tobacco use screening, treatment, and quit rates among low-income primary care patients in Louisiana., Methods: We examined EHR data on 79,777 patients with more than 1.2 million adult primary care encounters from January 1, 2009, through January 31, 2012, for evidence of systems change. We adapted a definition of "systems change" to evaluate a tobacco screening and treatment protocol used by medical staff during primary care visits at 7 sites in a public hospital system., Results: Six of 7 sites met the definition of systems change, with routine screening rates for tobacco use higher than 50%. Within the first year, a 99.7% screening rate was reached. Sites had a 9.5% relative decrease in prevalence over the study period. Patients were 1.03 times more likely to sustain quit with each additional intervention (95% confidence interval = 1.02, 1.04)., Conclusions: EHRs can be used to demonstrate that routine clinical interventions with low-income primary care patients result in reductions in tobacco use and sustained quits.

Introduction: Health informatics systems are a proven tool for tobacco control interventions. To address the needs of low-income groups, the Tobacco Control Initiative was established in partnership with the Louisiana State University Health Care Services Division to provide cost-effective tobacco use cessation services through the health informatics system in the state public hospital system., Methods: In this study we used a Web-based, result-reporting application to monitor and assess the effect of the 2009 federal cigarette tax increase. We assessed readiness to quit tobacco use before and after a cigarette tax increase among low-income tobacco users who were outpatients in a public hospital system., Results: Overall, there was an increase in readiness to quit, from 22% during the first week of February to 33% during the first week of April, when the tax went into effect. Smokers who were female, 31 or older, African American, and assessed at a clinic visit in April were more likely to report readiness to quit than were men, those aged 30 or younger, those who were white, and those who were assessed at a clinic visit in February., Conclusion: A health informatics system that efficiently tracks trends in readiness to quit can be used in combination with other strategies and thus optimize efforts to control tobacco use. Our data suggest that a cigarette tax increase affects smokers' readiness to quit and provides an opportunity to intervene at the most beneficial time.