Search

Purpose: Describe associations between changes in employment during the COVID-19 pandemic and financial toxicity among adolescent and young adult (AYA) cancer patients and survivors. Methods: Eligible individuals were diagnosed between 15-39 years of age, currently age ≥18, and recruited through the Huntsman-Intermountain Adolescent and Young Adult Cancer Care Program. We sent the survey to N=709. Survey questions included demographics, employment, and the 11-item COmprehensive Score for financial Toxicity (COST) which captures financial toxicity in the last four weeks. COST is scored from 0 to 44 with lower scores indicating greater financial toxicity. Scores were dichotomized as high (0-21) or low (22-44). Changes in employment since March 2020 were categorized as no change, increase in hours, and decrease in hours/lost job. We calculated descriptive statistics and fit a multivariable logistic regression to examine the association between employment change and financial toxicity controlling for current age, gender, and treatment status. Results: Of 280 respondents (39.5% participation), 198 (70.7%) were employed prior to the pandemic and were thus included in analyses. Employed individuals were a mean of 29.4 years of age (range 18-58), 64.3% were female, and 50.5% had received cancer treatment since March 2020. Nearly a third (31.3%) had lost their job or reported reduced hours; 50.3% reported high financial toxicity. Among those previously employed, participants who lost their job or had their hours reduced had nearly six times the odds of high financial toxicity than those who reported no change in hours (Odds Ratio [OR]=5.8, 95% Confidence Interval [CI]: 2.6-12.9). In the same model, the odds of reporting high financial toxicity was over twice as high among females than males (OR=2.3, 95% CI: 1.2-4.5). Treatment status and age were not significant. Conclusions: Employment changes during the COVID-19 pandemic resulted in increased financial toxicity among a population already susceptible to high financial hardship. Societal gender inequity appears to be mirrored in participants’ financial toxicity during the pandemic. Employment interventions for patients and survivors of AYA cancers who have experienced job loss or reduction in work hours during the pandemic are needed and may particularly benefit females. Citation Format: Austin Waters, Heydon Kaddas, Karely Mann, Perla L. Vaca Lopez, Echo L. Warner, Joemy Ramsay, Judy Ou, Nicole Ray, Tomoko Tsukamoto, Douglas B. Fair, Joseph M. Letourneau, Mark A. Lewis, David A. Gill, Lauri Linder, Anne C. Kirchhoff. Adolescent and young adult cancer patient and survivor employment changes during COVID-19 are associated with financial toxicity [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2021 Feb 3-5. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(6_Suppl):Abstract nr S10-03.

Background: Air pollution is a carcinogen and causes pulmonary and cardiac complications. We examined the association of fine particulate matter pollution (PM2.5) and mortality from cancer and all causes among pediatric, adolescent, and young adult (AYA) patients with cancer in Utah, a state with considerable variation in PM2.5. Methods: We followed 2,444 pediatric (diagnosed ages 0–14) and 13,459 AYA (diagnosed ages 15–39) patients diagnosed in 1986–2015 from diagnosis to 5 and 10 years postdiagnosis, death, or emigration. We measured average monthly PM2.5 by ZIP code during follow-up. Separate pediatric and AYA multivariable Cox models estimated the association of PM2.5 and mortality. Among AYAs, we examined effect modification of PM2.5 and mortality by stage while controlling for cancer type. Results: Increases in PM2.5 per 5 μg/m3 were associated with cancer mortality in pediatric lymphomas and central nervous system (CNS) tumors at both time points, and all cause mortality in lymphoid leukemias [HR5-year = 1.32 (1.02–1.71)]. Among AYAs, PM2.5 per 5 μg/m3 was associated with cancer mortality in CNS tumors and carcinomas at both time points, and all cause mortality for all AYA cancer types [HR5-year = 1.06 (1.01–1.13)]. PM2.5 ≥12 μg/m3 was associated with cancer mortality among breast [HR5-year = 1.50 (1.29–1.74); HR10-year = 1.30 (1.13–1.50)] and colorectal cancers [HR5-year = 1.74 (1.29–2.35); HR10-year = 1.67 (1.20–2.31)] at both time points. Effect modification by stage was significant, with local tumors at highest risk. Conclusions: PM2.5 was associated with mortality in pediatric and AYA patients with specific cancers. Impact: Limiting PM2.5 exposure may be important for young cancer patients with certain cancers. See all articles in this CEBP Focus section, “Environmental Carcinogenesis: Pathways to Prevention.”

Background: Subsequent malignant neoplasms (SMN) are a leading cause of premature mortality among adolescent and young adult (AYA) cancer survivors, who have unique health needs. Human Papillomavirus-related second cancers (HPV-SMN) are generally preventable through screenings and vaccination. We identified disparities in HPV-SMN among AYA survivors by demographics and first cancer therapy, and examined temporal trends in incidence of HPV-SMN. Methods: We identified diagnoses of any HPV-SMN, oropharyngeal-SMN, and cervical-SMN among AYA survivors in the SEER 9 1976-2015 registries starting two months after the first cancer. Standardized incidence ratios (SIR) compared risk between AYA survivors and general population. We used Fine and Gray competing risk models to estimate hazard ratios (HR) of therapy on risk for HPV-SMN while controlling for cancer site and demographic confounders. Age-period-cohort (APC) models identified temporal trends in HPV-SMN incidence. Results: Of 374,408 survivors diagnosed with a first primary cancer ages 15-44, a total of 1,369 had an HPV-SMN occurring on average five years after the first cancer. Compared to the general population, AYA survivors had increased risks of 70% for any HPV-SMN (95%CI=1.61-1.79) and 117% for oropharyngeal-SMN (95%CI=2.00-2.35). Cervical-SMN risk was generally lower in survivors (SIR=0.85, 95%=CI 0.76-0.95). Hispanic AYA survivors had a significant increase in cervical-SMN relative to the general population (SIR=1.46, 95%CI=1.01-2.06). AYAs who were uninsured or on Medicaid at diagnosis had significant increases in HPV-SMN risk relative to the general populations (Uninsured SIR=5.23, 95%CI=2.26-10.31; Medicaid SIR=5.95, 95%CI=4.07-8.40). AYAs first diagnosed with Kaposi sarcoma, leukemia, Hodgkin, and Non-Hodgkin lymphoma had increased risk for HPV-SMN relative to the general population. Among survivors with HPV-related first primary cancers, radiation was associated with increased risk for HPV-SMN (HR=1.35, 95%CI-1.03-1.77). Among survivors whose first primary cancer was not HPV-related, chemotherapy was associated with increased risk for HPV-SMN (HR=1.20, 95%CI=1.00-1.44) but the general effect of treatment was not significant (p=0.16). In APC models, incidence of oropharyngeal-SMN significantly declined over time. Conclusion and Impact: While the overall risk is low, AYA survivors are at higher risk for HPV-SMNs than the general population, largely driven by oropharyngeal-SMN. Hispanic survivors are the only group at higher risk for cervical-SMN than the general population suggesting a need to improve their cervical cancer screening. Uninsured/Medicaid AYA survivors also face higher HPV-SMN risks. Improving access to screening and HPV vaccination is needed to reduce the burden of HPV-SMN in AYA survivors. Citation Format: Judy Y. Ou, Natalie Bennion, Kellee Parker, Douglas Fair, Heidi A. Hanson, Deanna Kepka, Echo L. Warner, Joemy M. Ramsay, Heydon K. Kaddas, Anne C. Kirchhoff. Risk factors, trends, and disparities in HPV-associated subsequent malignant neoplasms among adolescent and young adult cancer survivors. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 5763.

We examined whether financial burdens occurring during the COVID-19 pandemic impacted healthcare utilization among survivors of adolescent and young adult cancers.We surveyed survivors enrolled in a patient navigation program to obtain self-reports of delayed/skipped cancer care or other care, changes to medication obtainment, and changes to medication use since the COVID-19 pandemic began. Reported financial burdens were defined as financial toxicity in the past 4 weeks (COmprehensive Score for financial Toxicity [COST] ≤ median 21) and material hardships (range = 4-11) since March 2020. Adjusted logistic regression models calculated associations and effect modification by gender.Survivors (n = 341) were mostly female (61.3%) and non-Hispanic White (83.3%). Nearly 20% delayed/skipped cancer care, 35.2% delayed/skipped other care, 19.1% changed medication obtainment, and 12.6% changed medication use. Greater material hardships were associated with delayed/skipped cancer care (odds ratio (OR) = 3.13, 95% CI = 1.44-6.81) and other care (OR = 2.17, 95% CI = 1.18-3.98), and changed medication obtainment (OR = 2.72, 95% CI = 1.43-5.18) or use (OR = 4.49, 95% CI = 2.05-9.80). Financial toxicity was associated with delayed/skipped other care (OR = 2.53, 95% CI = 1.31-4.89) and changed medication obtainment (OR = 1.96, 95% CI = 1.01-3.83) and medication use (OR = 3.73, 95% CI = 1.59-8.73). The association of material hardships and any changes in healthcare utilization was greater among female compared to male survivors.Financial burdens experienced during the pandemic impeded survivors' ability to utilize necessary healthcare, with worse impacts among female survivors.Delayed or skipped healthcare may lead to an increased cancer mortality or severity of therapy-related conditions. Providing resources that enable survivors experiencing financial burdens to continue critical cancer and preventive care during the COVID-19 pandemic is a priority.

Currently, there are no publicly-available estimates of indoor radon concentration at scales smaller than the county. Radon-hazard potential soil maps that reflect underlying geologic factors can be created at small geographic scale and linked to residential and census data. We determined the association between residential radon tests and high radon-hazard potential soil at the residential and block group levels using a large Utah-based dataset. We also identified characteristics of block groups with limited tests in the dataset.We geocoded a dataset of residential radon tests obtained from 2001 to 2017 by a statewide educational program. We linked each location to maps of radon-hazard potential soil, the Environmental Protection Agency's (EPA) county radon zones. We also calculated the number of tests conducted in each block group and linked block groups to demographic data from the 2020 United States census. Log-linear and logistic models identified the association between residential home test results and 1) radon-hazard potential soil of each residence, 2) percent of residences on high radon-hazard potential soils in block groups, and 3) EPA's radon zones. We compared demographic characteristics among block groups with ≥5 or5 residential tests in our dataset.Approximately 42% of homes in the dataset tested ≥4 pCi/L. We found significant positive associations for residential radon test results with 1) residential location on high radon-hazard potential soil and 2) block groups with0% of residences on high radon-hazard potential soil. EPA radon zones were not associated with residential test results. Block groups with5 tests had higher than the statewide median percentage of Hispanic residents (OR = 2.46, 95% CI = 1.89-3.21) and were located in rural counties.Radon-hazard potential soil has a significant association with residential home radon tests. More efforts are needed to improve radon testing in block groups that are rural and have greater percentages of racial minorities.

The study objective was to identify sociodemographic and coronavirus disease 2019 (COVID-19) factors that are associated with COVID-19 vaccine hesitancy among adolescent and young adult (AYA) cancer survivors. Eligible participants were 18 years or older and were diagnosed with cancer as an AYA (ages 15-39 years) and received services through an AYA cancer program. A total of 342 participants completed a cross-sectional survey. Our primary outcome—COVID-19 vaccine hesitancy—was surveyed as a 5-point Likert scale and operationalized as a binary outcome (agree vs hesitant). A large proportion of participants reported COVID-19 vaccine hesitancy (37.1%). In the multivariable regression, female survivors (odds ratio = 1.81, 95% confidence interval = 1.10 to 2.98) and survivors with a high school education or less (odds ratio = 3.15, 95% confidence interval = 1.41 to 7.04) reported higher odds of vaccine hesitancy compared with their male or college graduate or higher counterparts. COVID-19 vaccine hesitancy persists among AYA survivors despite their recommended priority vaccination status and higher chances of severe COVID-19 outcomes.

Background Emerging research suggests that survivors of childhood and adolescent cancers are at risk for morbidity and mortality associated with air pollutants. However, caregiver perceptions of the effects of air pollution are unknown. Thus, to address this gap we described caregivers’ perceptions of air pollution’s impact on general population health and specifically on childhood cancer survivors, and caregivers’ air pollution information-seeking and exposure reduction behaviors. Methods Participants were Utah residents, ≥18 years, and caregiver of a childhood cancer survivor who had completed treatment. Semi-structured interviews were conducted with caregivers to describe their perspectives on air quality, how air pollution impacts health (general population and survivor health), and their information seeking and exposure reduction behaviors. Interviews were recorded, transcribed, and analyzed through two rounds of structured coding. Results Caregivers (N = 13) were non-Hispanic white and primarily females (92.3%) between 30 and 49 years old (46.2%). Most families lived within the Wasatch Front (69.2%), the main metropolitan of Utah. Two categories emerged pertaining to caregiver’s perceptions of air pollution: 1) Limited awareness about the health effects of air pollution, and 2) Unsuccessful information seeking and minimal exposure reduction behaviors. All caregivers held negative perceptions of air pollution in Utah, but most were unaware of how pollution affects health. While some families limited air pollution exposure by avoiding outdoor activity or physically leaving the region, few practiced survivor-specific exposure reduction. Nearly half of caregivers worried about potential effects of air pollution on survivor health and wanted more information. Conclusions Despite negative perceptions of air pollution, caregivers were divided on whether air pollution could impact survivor health. Few caregivers engaged in exposure reduction for their cancer survivor. As air pollution levels increase in the U.S., continued research on this topic is essential to managing cancer survivor respiratory and cardiovascular health.

BACKGROUND Children and adolescents and young adults (AYAs) with cancer often experience severe respiratory morbidity and mortality from the therapies used to treat their cancers. Few studies have examined respiratory outcomes among this population using emergency department (ED) visits as an objective measure of respiratory health. METHODS ED visits for respiratory conditions were identified for children and AYAs diagnosed with cancer, 0-25 years of age, from 1997 through 2012 (2535 cases) and compared with a birthdate-matched and sex-matched cohort without cancer drawn from the general population (7605 controls). Negative binomial regression with robust standard errors was used to estimate incidence rates, rate ratios (RRs), and 95% confidence intervals for primary respiratory ED visits, combined and by diagnosis (asthma, respiratory disease, and respiratory infection) from 1997 through 2015. Analyses were performed for new cases (0 to

Background Acute Lymphoblastic Leukemia (ALL) has a high survival rate, but cancer-related late effects in the early post-treatment years need documentation. Hospitalizations are an indicator of the burden of late effects. We identify rates and risk factors for hospitalization from five to ten years after diagnosis for childhood and adolescent ALL survivors compared to siblings and a matched population sample. Methods 176 ALL survivors were diagnosed at ≤22 years between 1998 and 2008 and treated at an Intermountain Healthcare facility. The Utah Population Database identified siblings, an age- and sex-matched sample of the Utah population, and statewide inpatient hospital discharges. Sex- and birth year-adjusted Poisson models with Generalized Estimating Equations and robust standard errors calculated rates and rate ratios. Cox proportional hazards models identified demographic and clinical risk factors for hospitalizations among survivors. Results Hospitalization rates for survivors (Rate:3.76, 95% CI = 2.22–6.36) were higher than siblings (Rate:2.69, 95% CI = 1.01–7.18) and the population sample (Rate:1.87, 95% CI = 1.13–3.09). Compared to siblings and population comparisons, rate ratios (RR) were significantly higher for survivors diagnosed between age 6 and 22 years (RR:2.87, 95% CI = 1.03–7.97 vs siblings; RR:2.66, 95% CI = 1.17–6.04 vs population comparisons). Rate ratios for diagnosis between 2004 and 2008 were significantly higher compared to the population sample (RR:4.29, 95% CI = 1.49, 12.32), but not siblings (RR:2.73, 95% CI = 0.54, 13.68). Survivors originally diagnosed with high-risk ALL did not have a significantly higher risk than siblings or population comparators. However, high-risk ALL survivors (Hazard ratio [HR]:3.36, 95% CI = 1.33–8.45) and survivors diagnosed from 2004 to 2008 (HR:9.48, 95% CI = 1.93–46.59) had the highest risk compared to their survivor counterparts. Conclusions Five to ten years after diagnosis is a sensitive time period for hospitalizations in the ALL population. Survivors of childhood ALL require better long-term surveillance.

Previous studies of the environment and cancer have focused on etiology, showing that extrinsic factors in the environment contribute to 70% to 90% of cancers. Cancer patients and survivors often continue to live in the same neighborhoods they resided in before their cancer diagnosis. Thus, patients and survivors are exposed to the same environmental contexts that likely contributed to their original cancer, but little is known about the health effects of continued exposure to carcinogens after a cancer diagnosis. This commentary provides a summary of studies of the association between PM2.5 and cancer mortality among patients and PM2.5 and posttreatment morbidity among cancer survivors, and proposes new directions and opportunities for future research on such topics. See all articles in this CEBP Focus section, “Environmental Carcinogenesis: Pathways to Prevention.”

Purpose Incompleteness of treatment data is a recognized limitation of cancer registry data. An all-payer claims database (APCD) is a tool that states use to capture health care information across systems and payer. We linked the Utah Cancer Registry (UCR) records to Utah’s statewide APCD and evaluated how this linkage led to improvements in the capture of cancer treatment information. Methods We linked cancers diagnosed and reported to the UCR with Utah APCD claims for the calendar years 2013 and 2014 using LinkPlus Software. For patients with breast or colorectal cancers, manual abstraction was completed to provide a gold-standard comparison for the treatment data obtained from the claims. Results Among 10,759 reportable cancer occurrences linked to the APCD, the claims identified additional patients with cancer who received therapies that had been unknown to the registry, increasing the proportion treated with chemotherapy from 23.7% to 27.6%, hormone therapy from 14.1% to 18.8%, immunotherapy from 4.3% to 13.2%, and radiation therapy from 24.9% to 27.5%. The APCD increased the sensitivity of treatment variables compared with the abstraction gold standard. Notably, sensitivity of hormonal therapy for breast cancer increased from 78.6% to 95.2% when augmented with APCD claims data. However, the APCD alone did not achieve as high specificity for treatment data as did the data collected through traditional registry methods. Conclusions This is the first study, to our knowledge, showing that linking cancer registry data with a statewide claims database that covers multiple insurance companies improves cancer treatment data collection. Linking of cancer registry and APCD data can improve comprehensiveness of cancer registry treatment data.

Background: Adolescents and young adults (AYA, age 15–39 years) with cancer may be at elevated risk for late morbidity following their cancer treatment, but few studies have quantified the excess burden of severe disease in this population. Using population-based data from Utah, we examined the risk of inpatient hospitalizations among AYA cancer survivors compared with their siblings and the general population. Methods: Survivors of AYA cancer who were ≥2 years from diagnosis and diagnosed from 1994 to 2015 (N = 6,330), their siblings (N = 12,924), and an age- and sex-matched comparison cohort (N = 18,171) were identified using the Utah Population Database (UPDB). Hospitalizations from 1996 to 2017 were identified from statewide discharge records in the UPDB. We estimated multivariable-adjusted hazard ratios (HR) for first hospitalization and rate ratios (RR) for total hospitalizations for survivors relative to the matched comparison cohort and siblings. Results: Overall, the risk of a first hospitalization was higher among AYA cancer survivors than the matched population-based cohort [HR = 1.93; 95% confidence interval (CI), 1.81–2.06]. Risk was most elevated for survivors of leukemia (HR = 4.76), central nervous system tumors (HR = 3.45), colorectal cancers (HR = 2.83), non-Hodgkin lymphoma (HR = 2.76), and breast cancer (HR = 2.37). The rate of total hospitalizations was also increased among survivors relative to the comparison cohort (RR = 2.05; 95% CI, 1.95–2.14). Patterns were generally similar in analyses comparing survivors to their siblings. Conclusions: AYA cancer survivors have a higher burden of inpatient hospitalization than their siblings and the general population. Impact: Results indicate the importance of long-term, risk-based follow-up care to prevent and treat severe morbidities after cancer treatment.

Background: Radon and smoking synergistically increase risk of lung cancer, particularly for small cell and squamous cell carcinoma; however, associations by sex and race/ethnicity have not been reported. Methods: We used data from the Behavioral Risk Factor Surveillance System (BRFSS), Environmental Protection Agency (EPA), and SEER21, excluding Alaska, to investigate the associations between county-level radon and smoking prevalence with lung cancer incidence by histotype, sex, and race/ethnicity (2006-2016). We only examined Non-Hispanic (NH) White and NH Black race/ethnicities due to the small proportion of cases from other groups. We used tertiles of sex-specific smoking prevalence estimates (1996-2000) from the BRFSS and EPA-defined radon zones of low, moderate, and high, to categorize 729 counties by both radon levels and smoking prevalence by sex. We fit generalized linear models using modified Poisson regression with Huber-White robust standard errors to compute rate ratios (RRs) and 95% confidence intervals (CIs) associating radon exposure, stratified by smoking tertile with histotype-specific lung cancer incidence. Results: The smoking prevalence captured by each tertile was considerably lower for women (Low=9.0-22.4%, Moderate>22.4-25.3, High>25.3-36.6) than men (Low=14.4-27.3, Moderate>27.3-31.6, High>31.6-40.3). Among women, we observed the most pronounced associations between high radon and lung cancer risk compared to low radon within the highest female smoking tertile. These associations were evident among NH Black women, particularly for small cell carcinoma (RR=1.34, 95% CI: 1.05-1.71) and squamous cell carcinoma (RR=1.41, CI: 1.14-1.74), but were smaller and non-significant among NH White women. For men, the associations with radon were observed even in counties with low male smoking prevalence. For example, in counties in the lowest tertile of male smokers, associations of high radon with squamous cell and small cell lung cancer were observed among NH Black men (RR=1.27, 95% CI: 1.11-1.44, and RR=1.37, 95% CI:1.15-1.63, respectively) and NH White men (RR=1.18, 95% CI: 1.11-1.26, and RR=1.20, 95% CI: 1.11-1.29, respectively). When we considered that the percent of current smokers in the lowest smoking tertile for men overlaps the highest tertile for women, we observed radon-associated small cell and squamous cell lung cancer risk for NH Black men and women at comparable absolute smoking prevalence, and a similar but attenuated pattern in NH White men and women. Discussion: While our analysis is limited by the ecological nature of the radon and smoking data, this research suggests that previously reported associations between radon and smoking exposure and histotype-specific lung cancer risk may differ by race and sex. Further research is needed to understand the impact of combined radon and smoking exposure on lung cancer risk in other racial and ethnic groups. Citation Format: Rachel McCarty, Lindsay Collin, Laurie Grieshober, Judy Ou, Carol Sweeney, Mollie E. Barnard, Jennifer A. Doherty. County-level radon and smoking exposure and lung cancer risk by histotype, sex, and race/ethnicity [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 795.

Purpose: To describe adolescent and young adult (AYA) cancer patients’ and survivors’ experiences with telehealth during the COVID-19 pandemic. Methods: Eligible participants were identified through the Huntsman Intermountain Adolescent and Young Adult Cancer Care Program, which provides age-specific programming and patient navigation to AYA cancer patients and survivors in Utah and surrounding Mountain West states. Participants were emailed an online survey if they were currently age 18 or older and had been diagnosed with cancer between the ages of 15-39 years. We applied descriptive statistics to summarize demographics, comfortability with technology, access to reliable internet connection, and perceived quality of care while using telehealth. Results: AYAs (N=280) were an average of 29.4 years old at survey (range 18-58); 65.2% were female and 82.4% non-Hispanic white. Over half (54.2%) had received cancer treatment since March 2020. All participants reported owning a computer, tablet, and/or smart phone they could use for telehealth appointments. The majority (93.5%) reported almost always or always having a reliable internet connection. AYAs felt most comfortable having a telehealth appointment in their own home (96.4%); only 12.5% felt comfortable using telehealth at work. Since March 2020, (N=183) 65.4% had a health care visit moved to a telehealth platform due to COVID-19. Of those who recently moved to telehealth, 60.1% had an oncology visit, 33.9% had a primary care visit, and 31.1% had a mental health visit. Additionally over one-third (35.2%) reported the quality of their medical care had decreased since moving to telehealth. This was most commonly due to 1) troubles with audio, video, or connecting through telehealth platforms; 2) telehealth visits feeling impersonal; and 3) feeling that providers more easily dismissed or did not fully address their symptoms. Conclusions: Although AYAs are digital natives, over one-third of AYAs feel the quality of their medical care has decreased since moving to telehealth for COVID-19. Further research should explore medical provider training in using telehealth systems and encourage telehealth practices that help AYAs feel more supported and understood. Citation Format: Karely Mann, Austin R. Waters, Perla L. Vaca Lopez, Echo L. Warner, Judy Ou, Heydon Kaddas, Joemy Ramsay, Nicole Ray, Tomoko Tsukamoto, Douglas B. Fair, Joseph M. Letourneau, Mark A. Lewis, David Gill, Lauri Linder, Anne C. Kirchhoff. Telehealth experiences of adolescent and young adult cancer patients and survivors during the COVID-19 pandemic [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2021 Feb 3-5. Philadelphia (PA): AACR; Clin Cancer Res 2021;27(6_Suppl):Abstract nr S06-04.

Purpose The results of a study evaluating all patients treated with adjunctive low-dose ketamine for analgesia over a three-year period are presented. Methods A retrospective single-center analysis evaluated all adult patients who received adjunctive low-dose i.v. ketamine infusions from September 2010 to September 2013. Patients were excluded if they received concomitant oral ketamine, if ketamine was used to treat seizures, or if the patients received ketamine boluses without infusion. The primary endpoint was to identify the patient populations receiving low-dose intravenous ketamine. Secondary endpoints included an assessment of clinical variables and adverse events. Demographic information, level of care, clinical variables, adverse events, and patient outcomes were recorded. Results A total of 460 patients were evaluated. Of these, 396 were included in this analysis. Ketamine was administered to 69.9% of the patients in association with a surgical procedure, as opposed to 30.1% who received ketamine for medical management of pain. The percentage of patients receiving intensive care unit level care was 24%. Before initiation of ketamine, patient-reported pain scores averaged 7.1 ± 2.63 S.D.; during the ketamine infusion, patient-reported pain scores averaged 6.42 ± 2.01 S.D.; ( p < 0.001). In the safety analysis, hypertension occurred in 21.4% of patients, hypotension occurred in 15.1% of patients, and respiratory depression occurred in 6.3% of patients. Conclusion A retrospective review found that patients receiving continuous ketamine infusions in addition to opioid therapy saw a reduction in pain scores and experienced cardiovascular adverse effects in greater than 20% of cases.

Radon (&sup2, &sup2, Rn), a radioactive gas, is the second leading cause of lung cancer deaths in the U.S. Classroom radon concentrations in public schools in our target area had never been measured or had not been measured in many years. We had university students, primarily enrolled in environmental health courses, measure radon concentrations in 2289 classrooms in 66 of Utah&rsquo, s public schools and identify school characteristics associated with classroom radon concentrations. The geometric mean (GM) classroom radon concentration was 31.39 (95% confidence interval (CI): 27.16, 36.28) Bq/m3 (GM: 0.85, 95% CI: 0.72, 0.98 pCi/L). Thirty-seven (2%) classrooms in 13 (20%) schools had radon concentrations at or above the U.S. Environmental Protection Agency&rsquo, s (EPA) recommended action level of 148 Bq/m3 (4.0 pCi/L). Number of classrooms had a u-shaped association with classroom radon concentrations. The year the heating, ventilation, and air conditioning (HVAC) system was installed was inversely associated with having classroom radon concentrations at or above the EPA&rsquo, s recommended action level. Number of classrooms and number of students had u-shaped associations with having classroom radon concentrations at or above the EPA&rsquo, s recommended action level. Classroom radon concentrations decreased when schools&rsquo, HVAC systems were on. Replacing HVAC systems and turning/keeping them on may be effective radon mitigation strategies to prevent radon-associated lung cancer, especially for small and large schools.

Background: Fine particulate matter air pollution (PM2.5) is associated with mortality in the adult population and in adults diagnosed with lung and breast cancer. The effect of PM2.5 on mortality in pediatric, adolescent, and young adults (AYA) diagnosed with cancer is unknown. We examine the association between PM2.5 and mortality among pediatric and AYAs diagnosed with cancer in Utah, a state with severe PM2.5 pollution. Methods: We identified 2,631 pediatric cancer patients aged 0 to 14 years and 14,575 AYA cancer patients aged 15 to 39 years diagnosed from 1986 to 2016. Patients were followed from first diagnosis date to five or ten years post-diagnosis, death, or emigration out of Utah as indicated by Utah Population Database records. We estimated average PM2.5 at each subject’s ZIP code at diagnosis from the first diagnosis date to the five- and ten-year follow-up dates, death, or emigration. We estimated the effect of five- and ten-year PM2.5 exposure on mortality at five and ten years post-diagnosis. Cox models controlled for parental education, sex, diagnosis year, and cancer stage/severity. Pediatric and AYA cancers were run in separate models. Pediatric cancers were stratified by International Classification of Childhood Cancer categories and AYA cancers were stratified by the WHO Classification for AYA cancers. Models were run for all-cause mortality and cancer-mortality, with noncancer deaths included as competing risks. Results: We found 571 (20%) deaths among pediatric patients and 3,064 (19.6%) deaths among AYA patients. Most deaths occurred within five years of diagnosis for both groups (83% and 67%, respectively). Cancer was the predominant cause of death among pediatric (94%) and AYA patients (92%). Pediatric patients were exposed to mean PM2.5 of 9.13 μg/m3 and AYA patients were exposed to a mean PM2.5 of 8.31 μg/m3. During five years of follow-up, we found significant associations between PM2.5 and all-cause and cancer mortality for pediatric central nervous system (CNS) patients (all-cause: 1.07 [95%CI: 1.01-1.13], cancer: 1.10 [1.04-1.17]). Among AYAs, we found that five-year PM2.5 exposure was associated with all-cause mortality and cancer-mortality among CNS (all-cause: 1.07 [1.03-1.12], cancer: 1.09 [1.04-1.14]) and carcinoma patients (all-cause: 1.03 [1.01-1.06], cancer: 1.04 [1.02-1.07]). During ten years of follow-up, PM2.5 had a significant association with all-cause and cancer-mortality among pediatric leukemia (all-cause: 1.09 [1.03-1.15], cancer: 1.09 [1.03-1.16]) and CNS patients (all-cause: 1.10 [1.05-1.15], cancer: 1.12 [1.06-1.17]). Among AYAs, ten-year PM2.5 was associated with all-cause and cancer-mortality among CNS (all-cause: 1.05 [1.02-1.09], cancer: 1.06 [1.03-1.10]), melanoma (all-cause: 1.07 [1.02-1.12], cancer: 1.08 [1.02-1.14]), and carcinoma patients (all-cause: 1.06 [1.04-1.08], cancer: 1.07 [1.05-1.09]). Conclusion: PM2.5 is associated with mortality among pediatric and AYA cancer patients. This abstract is also being presented as Poster A35. Citation Format: Judy Y. Ou, Heidi A. Hanson, Joemy M. Ramsay, Heydon Kaddas, C. Arden Pope, Claire L. Leiser, James A. VanDerslice, Anne C. Kirchhoff. Fine particulate matter and mortality among pediatric, adolescent, and young adults with cancer [abstract]. In: Proceedings of the AACR Special Conference on Environmental Carcinogenesis: Potential Pathway to Cancer Prevention; 2019 Jun 22-24; Charlotte, NC. Philadelphia (PA): AACR; Can Prev Res 2020;13(7 Suppl): Abstract nr PR05.

In the United States, Latinos are more likely to be uninsured and diagnosed with later stage cancer than non-Hispanic whites. Promotoras (lay health educators) help improve cancer knowledge and facilitate access to cancer screenings. We tested a promotora led workplace-based intervention to improve knowledge of and adherence to breast, cervical, and colorectal cancer screening among Latino employees in service or manual labor jobs. Latinos 18 and older from Salt Lake County, Utah were enrolled from January 2015 to February 2016. N = 265 completed pre- and post-intervention surveys that measured knowledge of and adherence to breast, cervical, and colorectal cancer screenings. Demographic, economic, and cancer factors of participants who completed the intervention were compared to those who were incomplete. Changes in knowledge and adherence were calculated using McNemar’s tests. Logistic regression compared outcomes by select demographic, economic and cancer factors. More participants were older, spoke Non-English languages, were single/widow(er)s, worked part-time, and had an immediate family member with cancer compared to those who did not complete the study (all p

Hispanics have the lowest colorectal cancer (CRC) screening rates of all racial/ethnic groups and comprise the largest proportion of low-income manual laborers in the nation. We partnered with businesses to implement a community health worker (CHW)-led intervention among Hispanic workers in service-related and manual labor occupations, which often pay low wages and do not provide health insurance. CHWs measured knowledge, screening adherence and perceptions of CRC risk before and after educational interventions via interview. CHWs provided fecal immunochemical tests (FITs) to participants aged ≥50 years. Chi-square tests and logistic regression identified pre-intervention predictors of CRC knowledge of all participants and adherence among eligible participants. Adherence among participants increased from 40% (n = 307) pre-intervention to 66% post-intervention. Knowledge about CRC was associated with age ≥50 years (OR = 8.90 [95% CI = 2.61–30.35]; ref = 18–30) and perceived personal risk for CRC (Likely, OR = 3.06 [95% CI = 1.40–6.67]; ref = Not likely). Insurance status was associated with screening adherence pre-intervention (OR = 3.00 [95% CI 1.10–8.12]; ref = No insurance). Improvement in adherence post-intervention was associated with income between $25 000 and ≥$55 000 (OR = 8.49 [95% CI 1.49–48.32]; ref = $5000–

Children and adolescents and young adults (AYAs) with cancer often experience severe respiratory morbidity and mortality from the therapies used to treat their cancers. Few studies have examined respiratory outcomes among this population using emergency department (ED) visits as an objective measure of respiratory health.ED visits for respiratory conditions were identified for children and AYAs diagnosed with cancer, 0-25 years of age, from 1997 through 2012 (2535 cases) and compared with a birthdate-matched and sex-matched cohort without cancer drawn from the general population (7605 controls). Negative binomial regression with robust standard errors was used to estimate incidence rates, rate ratios (RRs), and 95% confidence intervals for primary respiratory ED visits, combined and by diagnosis (asthma, respiratory disease, and respiratory infection) from 1997 through 2015. Analyses were performed for new cases (0 to5 years from diagnosis) and survivors (5-18 years from diagnosis).Subjects were followed for an average of 8 years (range, 0-18 years). Relative to the comparison cohort, cancer cases had higher incidence rates for all types of respiratory ED visits over both follow-up times. New cases had significantly higher RRs for any respiratory condition (RR, 4.14), respiratory disease (RR, 4.62), and respiratory infection (RR, 4.74). Among survivors, the RRs for any respiratory condition (RR, 2.00) and respiratory infection (RR, 2.10) were significantly elevated, although the magnitude tended to decline in survivorship. Demographic and clinical risk factors found to be associated with respiratory ED visits included Hispanic/other race/ethnicity, male sex, exposure to chemotherapy, diagnosis at a younger age, and a diagnosis of leukemia.The results of the current study demonstrated that children and AYAs with cancer face an increased burden of respiratory complications compared with a comparison cohort without cancer from diagnosis through survivorship.

Background Survival estimates for soft tissue sarcomas (STS) and malignant bone tumors (BT) diagnosed in pediatric, adolescent, and young adult patients are not easily available. We present survival estimates based on a patient having survived a defined period of time (conditional survival). Conditional survival estimates for the short-term were calculated for patients from diagnosis to the first five years after diagnosis and for patients surviving in the long-term (up to 20 years after diagnosis). Methods We identified 703 patients who were diagnosed with a STS or BT at age ≤25 years from January 1, 1986 to December 31, 2012 at a large pediatric oncology center in Salt Lake City, Utah, United States. We obtained cancer type, age at diagnosis, primary site, and demographic data from medical records, and vital status through the National Death Index. Cancer stage was available for a subset of the cohort through the Utah Cancer Registry. Cox proportional hazards models, adjusted for age and sex, calculated survival estimates for all analyses. Results Short-term survival improves over time for both sarcomas. Short-term survival for STS from diagnosis (Year 0) did not differ by sex, but short-term survival starting from 1-year post diagnosis was significantly worse for male patients (Survival probability 1-year post-diagnosis [SP1]:77% [95% CI:71-83]) than female patients (SP1:86% [81–92]). Survival for patients who were diagnosed at age ≤10 years (Survival probability at diagnosis [SP0]:85% [79–91]) compared to diagnosis at ages 16–25 years (SP0:67% [59–75]) was significantly better at all time-points from diagnosis to 5-years post-diagnosis. Survival for axial sites (SP0:69% [63–75]) compared to extremities (SP0:84% [79–90]) was significantly worse from diagnosis to 1-year post-diagnosis. Survival for axial BT (SP0: 64% [54–74] was significantly worse than BT in the extremities (SP0:73% [68–79]) from diagnosis to 3-years post diagnosis. Relapsed patients of both sarcoma types had significantly worse short-term survival than non-relapsed patients. Long-term survival for STS in this cohort is 65% at diagnosis, and improves to 86% 5-years post-diagnosis. BT survival improves from 51% at diagnosis to 78% at 5-years post-diagnosis. Conclusion Conditional survival for short- and long-term STS and BT improve as time from diagnosis increases. Short-term survival was significantly affected by patients' sex, age at diagnosis, cancer site, and relapse status.

Some chemotherapies that treat childhood cancers have pulmonary-toxic properties that increase risk for adverse respiratory-health outcomes. PM2.5 causes similar outcomes but its effect among pulmonary compromised cancer survivors is unknown. This case-crossover study identified the PM2.5-associated odds for primary-respiratory hospitalizations and emergency department visits among childhood cancer survivors in Utah. We compared risk among chemotherapy-treated survivors to a cancer-free sample. We calculated 3-day-average PM2.5 by ZIP code and county for event and control days. Conditional logistic regression estimated odds ratios. Models were stratified by cause of admission (infection, respiratory disease, asthma), previous chemotherapy, National Ambient Air Quality Standard (NAAQS), and other variables. Results are presented per 10 &micro, g/m3 of PM2.5. 90% of events occurred at 3-day PM2.5 averages &lt, 35.4 &micro, g/m3, the NAAQS 24-h standard. For survivors, PM2.5 was associated with respiratory hospitalizations (OR = 1.84, 95% CI = 1.13&ndash, 3.00) and hospitalizations from respiratory infection (OR = 2.09, 95% CI = 1.06&ndash, 4.14). Among chemotherapy-treated survivors, the PM2.5-associated odds of respiratory hospitalization (OR = 2.03, 95% CI = 1.14&ndash, 3.61) were significantly higher than the cancer-free sample (OR = 0.84, 95% CI = 0.57&ndash, 1.25). This is the first study to report significant associations between PM2.5 and respiratory healthcare encounters in childhood cancer survivors. Chemotherapy-treated survivors displayed the highest odds of hospitalization due to PM2.5 exposure and their risk is significantly higher than a cancer-free sample.

Cancer survivorship clinics manage cancer-related health complications and are available primarily in urban areas. We examine how demographic, clinical, and geographic-based characteristics are associated with attendance at the only pediatric survivorship clinic in a largely rural, multistate region. One thousand eight hundred sixteen cancer survivors were diagnosed at age ≤ 25 from 1986 to 2005 while living in the region. Cox models incorporating death as a competing risk and generalized estimating equations calculated hazards ratios (HR) for characteristics measured at the clinic’s opening. Subjects were followed from the clinic opening their first visit, death, emigration from the catchment area, or December 31, 2014. Five percent of survivors visited the clinic. Attendance is positively associated with a leukemia or lymphoma diagnosis (HR = 3.32, 95% confidence interval [CI] = 1.72–6.78 vs CNS tumors), previous relapse (HR = 1.78, 95% CI = 1.00–3.19), and residing >100 mi from the clinic (HR = 2.05, 95% CI 1.03–4.10). Survivors aged ≥ 31 years at clinic opening (HR = 0.19, 95% CI = 0.07–0.54) are less likely to attend than younger survivors. Residence between 16 and 100 mi had an inverse association with attendance, although not significant. Survivorship clinics are not widely attended by survivors in this catchment region. Efforts should be made to recruit survivors aged ≥ 31 and diagnosed with CNS tumors. Distance has a complex association with attendance, which could be attributed to the limited availability of preventative services in regions > 100 mi from the clinic. Survivors living in this catchment region may not be receiving care necessary to prevent severe late effects.

Background: Hispanics report the lowest CRC screening rate of any ethnic group in the United States. Hispanics comprise 14% of Utah's population and are growing rapidly. Most of the Hispanics in Utah are foreign-born immigrants who work low-wage jobs that do not offer health benefits, making them a high-risk population for low CRC screening rates. We partnered with companies in Salt Lake County with a large Hispanic employee population to implement an educational intervention to improve knowledge of and adherence to cancer screenings. We identify demographic predictors of CRC knowledge and adherence pre-intervention, and of improvements in adherence post-intervention. Methods: Current and previous employees of service/manual labor companies (e.g., professional cleaning, restaurants, construction) were recruited by local businesses and community organizations. Promotoras held educational sessions at the local businesses. Pre- and post-interviews measured CRC screening knowledge, adherence, demographics, and perceptions of CRC risk. Interviews were conducted in person or on the phone within 10 months of the intervention. Participants aged ≥50 were given FOBT/FIT tests. Chi-square tests examined differences in knowledge among participants and adherence preintervention. Multivariable logistic regression models identified predictors of knowledge, awareness, and adherence preintervention, and identified characteristics associated with improvements in adherence post-intervention. Results: We recruited 307 Hispanic employees. 95% of our population were Hispanic immigrants, 88% speak Spanish, 64% make $25,000 or less a year, and 70% do not have health insurance. 40% of adults aged ≥50 were adherent to CRC screening guidelines before the intervention; after the intervention, 66% of eligible adults were adherent, with the majority of the improvement in FOBT/FIT tests. We found significant differences in initial knowledge of CRC among participants aged 18 to 49 years (51%) vs age ≥50 years (85%, p Conclusions: Knowledge of CRC screenings among Hispanics is related to older age, education, and insurance. Providing FOBT/FIT yielded significant improvements in adherence. Ensuring that Hispanics have access to health insurance and affordable CRC screenings is a critical factor in improving CRC screenings in this vulnerable population. Citation Format: Judy Y. Ou, Anne C. Kirchhoff, Echo L. Warner, Laura Martel, Deanna Kepka. Colorectal cancer knowledge and adherence among Hispanic workers [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr B15.

Background: Cancer late effects clinics are important to manage health complications experienced by cancer survivors, but little is known about potential barriers to attendance in rural states where many patients live far away from cancer centers. We identify demographic, clinical and residency factors associated with clinic attendance at the only pediatric cancer late effects clinic in Utah. Methods: Medical records identified survivors diagnosed with cancer at age ≤25 years from 1986-2011 who currently reside in Utah. We linked records to the late effects clinic patient registry, available from 2010 to present. Participants were geocoded using their most recent residential zip code according to medical and driver's license records. The Euclidean distance between the clinic and the centroid of each zip code were calculated. Participants were classified into median income brackets based on the same zip code information. Log-linear models identified associations between attendance and the demographic and clinical factors. Generalized estimating equations were used in analyses for zip-code level residential distance and income with attendance. Results: Of 1,935 survivors, only 10% had ≥1 clinic visit. Attendance is associated with leukemia/lymphoma diagnosis (odds ratio [OR]=1.65; 95% confidence interval [CI]=1.14-2.39 vs. other solid tumors) and current age between 19-30 years (OR=3.01; 95% CI=1.33-6.79 vs. ≥30 years). Hispanic ethnicity was not associated with late effects clinic attendance (OR=0.94; 95% CI =0.47-1.87 vs Non-Hispanic). Living in a zip code with a residential distance of less than 20 miles (OR=1.37, 95% CI=0.73-2.58 vs. ≥60 miles), and living in zip codes with median income between $60,000 and $70,000 (OR=1.45, 95% CI=0.67-3.11 vs. >$50,000/year) showed positive, non-significant associations with attendance. Conclusions: Late effects clinics are not widely attended by childhood and adolescent cancer survivors in Utah. Current age and previous cancer diagnosis are associated with attendance. Area of residence and income show possible associations with clinic attendance, although more investigation is needed to examine how these access-related factors influence attendance. Outreach efforts may be needed to connect cancer survivors with late effects clinics. Further investigation is needed to identify potential economic and geographic barriers to care. Citation Format: Judy Y. Ou, Rochelle R. Smits-Seemann, Jennifer A. Wright, Anne C. Kirchhoff. Pediatric Cancer Late Effects Clinic Patients in Utah: Potential Barriers to Care. [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 B19.