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Background Heavier body mass index (BMI) is the most established predictor of earlier age at puberty. However, it is unknown whether the timing of the childhood switch to heavier BMI (age at BMI rebound) also matters for puberty. Methods In the LEGACY Girls Study (n = 1040), a longitudinal cohort enriched with girls with a family history of breast cancer, we collected paediatric growth chart data from 852 girls and assessed pubertal development every 6 months. Using constrained splines, we interpolated individual growth curves and then predicted BMI at ages 2, 4, 6, 8 and 9 years for 591 girls. We defined age at BMI rebound as the age at the lowest BMI between ages 2 and 8 years and assessed its association with onset of thelarche, pubarche and menarche using Weibull survival models. Results The median age at BMI rebound was 5.3 years (interquartile range: 3.6–6.7 years). A 1-year increase in age at BMI rebound was associated with delayed thelarche (HR = 0.90; 95% CI = 0.83–0.97) and menarche (HR = 0.86; 95% CI = 0.79–0.94). The magnitude of these associations remained after adjusting for weight between birth and 2 years, was stronger after adjusting for BMI at age 9, and was stronger in a subset of girls with clinically assessed breast development. Conclusions Earlier BMI rebound is associated with earlier pubertal timing. Our observation that BMI rebound may be a driver of pubertal timing in girls with and without a family history of breast cancer provides insight into how growth and pubertal timing are associated with breast cancer risk.

Race and ethnicity are associated with risk of venous thromboembolism in population-based studies. Blacks/African Americans have a higher incidence, whereas Asians/Pacific Islanders and Hispanics have a lower incidence of venous thromboembolism compared with non-Hispanic Whites. The impact of race/ethnicity on the incidence of cancer-associated thrombosis (CAT), a common complication in patients with malignancy, has not been well defined. Using the California Cancer Registry linked to the California Patient Discharge Dataset and Emergency Department Utilization database, we studied a large, diverse cohort of patients (n = 942 109) from 2005 to 2017 with the 13 most common, first primary malignancies to determine the association between race/ethnicity and incidence of incident and recurrent CAT. Multivariable Cox proportional hazards regression models were performed to determine the effect of race/ethnicity on the risk of overall CAT, specific CAT by location, and recurrent CAT. Blacks/African Americans had a higher incidence of CAT for all tumor types except myeloma, whereas Asians/Pacific Islanders had a consistently lower incidence of CAT compared with non-Hispanic Whites, after adjusting for potential confounders. The main driver for the racial/ethnic differences was incidence of pulmonary embolism. We speculate the association of race/ethnicity with incidence of CAT may be partially because of underlying thrombotic predisposition that varies by ancestry, but we also must consider the impact of social determinants of health on our results.

e23539 Background: Synovial sarcoma (SS) is a rare, high-grade soft tissue tumor and often requires multidisciplinary care with different treatment modalities. However, information on treatment patterns, especially in patients with localized disease and impact on survival is currently lacking. Methods: Adolescents and young adults (AYA, 15-39 years) and older adults (“adults,” ≥40 years) diagnosed with localized SS from 2000-2018 were identified in the California Cancer Registry. Treatment for SS consists of surgery and may also include chemotherapy and/or radiation. Multivariable logistic regression was used to identify clinical (e.g., tumor size) and sociodemographic factors (e.g., neighborhood socioeconomic status [SES]) associated with receipt of chemotherapy and/or radiation (versus none). Cox proportional hazards regression identified factors associated with overall survival (OS). Results are reported as odds ratios (OR) and hazard ratios (HR), respectively, with corresponding 95% confidence interval (CI). Results: There were 346 AYAs and 272 adults diagnosed with localized SS. Surgical resection occurred in 95% of patients. AYAs with tumors > 5 cm (vs. ≤5) were more likely to be given chemotherapy (OR 4.83, CI 2.66-8.79) as were adults with tumors > 10 cm (OR 5.21, CI 2.28-11.92). Adults ≥65 (vs. 60-65 years) were significantly less likely to receive chemotherapy (OR 0.11, CI 0.03-0.43). Adults living in high SES neighborhoods were more likely to receive chemotherapy (vs. low SES: OR 3.20, CI 1.40-7.31) or chemotherapy and radiation (OR 3.03, CI 1.24-7.41). In contrast, adults with public/no insurance were less likely to receive chemotherapy (OR 0.44, CI 0.20-0.95) or chemotherapy and radiation (OR 0.32, CI 0.13-0.79) than those with private insurance. There were no associations with age, insurance or SES and therapy given in the AYA patients. In AYAs, living in a low SES neighborhood (HR 2.28, 1.09-4.77) and tumor size > 5 cm (HR 2.01, CI 1.02-3.95) was associated with poor OS. In adults, older age (> 65: HR 3.34, CI 1.88-5.94), tumor size > 5 cm (HR 3.14, CI 1.92-5.15) and no surgical resection (HR 4.31, CI 1.54-12.06) was associated with worse OS. Treatment with chemotherapy and/or radiation was not associated with OS in either age group. Conclusions: In AYAs and adults with localized SS, tumor size impacted the likelihood of receiving treatment and influenced survival. Importantly, non-clinical factors, such as insurance and SES, also influenced the likelihood of receiving treatment among adults though they did not impact survival. Even in a population of patients with localized disease, living in a low SES neighborhood was associated with worse survival among AYAs. This underscores the impact of non-clinical factors in this population, and further research is needed to elucidate how these factors lead to disparities in care and to identify interventions to improve survival outcomes for these patients.

Adolescents and young adults (AYAs) ages 15 to 39 years with cancer continue to experience disparate survival outcomes compared with their younger and older counterparts. This may be caused in part by differential access to specialized cancer centers (SCCs), because treatment at SCCs has been associated with improved overall survival. The authors examined social and clinical factors associated with AYA use of SCCs (defined as Children's Oncology Group-designated or National Cancer Institute-designated centers).A retrospective, population-based analysis was performed on all hospital admissions of AYA oncology patients in California during 1991 through 2014 (n = 127,250) using the Office of Statewide Health Planning and Development database. Multivariable logistic regression analyses examined the contribution of social and clinical factors on always receiving care from an SCC (vs sometimes or never). Results are presented as adjusted odds ratios (ORs) and 95% confidence intervals (CIs).Over the past 20 years, the percentage of patients always receiving inpatient care at an SCC increased over time (from 27% in 1991 to 43% in 2014). In multivariable regression analyses, AYA patients were less likely to always receive care from an SCC if they had public insurance (OR, 0.64; 95% CI, 0.62-0.66), were uninsured (OR, 0.51; 95% CI, 0.46-0.56), were Hispanic (OR, 0.88; 95% CI, 0.85-0.91), lived 5 miles from an SCC, or had a diagnosis other than leukemia and central nervous system tumors.Receiving care at an SCC was influenced by insurance, race/ethnicity, geography, and tumor type. Identifying the barriers associated with decreased SCC use is an important first step toward improving outcomes in AYA oncology patients. Cancer 2017;123:2516-23. © 2017 American Cancer Society.

Studies have demonstrated superior outcomes for adolescent and young adult (AYA) patients with acute lymphoblastic leukemia (ALL) who are treated using pediatric versus adult therapeutic regimens. To the best of our knowledge, whether adult oncologists in the United States have adopted this approach to ALL in AYA patients is currently unknown. The objective of the current study was to provide a population-based description of ALL treatment patterns in AYA individuals over the past decade.Data regarding AYA patients aged 15 to 39 years and diagnosed with ALL between 2004 and 2014 while living in the Greater Bay Area were obtained from the Greater Bay Area Cancer Registry (GBACR). Treating facilities were designated as pediatric or adult centers; induction treatment regimens were abstracted from registry text data fields.Of 304 patients diagnosed in the GBACR catchment region, complete treatment data were available for 229 (75%). The location of care was identified for 296 patients (97%) treated at 31 unique centers. Approximately 70% of AYA patients received induction therapy at an adult treatment center. All AYA patients who were treated at pediatric centers received pediatric ALL regimens. Among AYA patients treated by adult oncologists with complete treatment data, none received a pediatric regimen before 2008. Between 2008 and 2012, while the US Adult Intergroup C10403 pediatric-inspired ALL protocol was open to accrual, 31% of AYA patients treated by adult oncologists received pediatric regimens. This rate fell to 21% from 2013 through 2014. Adult facilities treating ≥ 2 AYA patients with ALL per year captured in the GBACR were more likely to administer pediatric regimens than lower volume centers (P = .03).As of 2014, only a minority of AYA patients with ALL received pediatric ALL regimens at adult cancer centers. Cancer 2017;122-130. © 2016 American Cancer Society.

Introduction Osteonecrosis of the femoral head (ONFH) is characterized by insidious onset of hip joint pain, limited range of motion and disability in sickle cell disease (SCD) patients. Prevalence of ONFH, rates of hip replacement surgery and post-operative course have not been previously described in population-based cohort studies. We retrospectively reviewed a large SCD patient cohort from California's Office of Statewide Planning and Development (OSHPD) Patient Discharge Database (PDD), and report the risk factors and clinical outcomes for SCD patients with ONFH. Methods Patients were ascertained from the PDD from 1991 to 2013, through an iterative search algorithm using ICD-9 codes. In addition to descriptive statistics and univariate comparisons with the chi-square test, we used multivariable Cox proportional hazards models (with age as the time scale), to analyze factors associated with ONFH diagnosis, including sex, SCD severity and antecedent acute chest syndrome (ACS; data available from 2003-2013). Patients with more severe SCD were defined as those who averaged 3 of more hospitalizations per year. Antecedent ACS was considered as a time-dependent covariate to first ONFH diagnosis after 2003. We estimated the cumulative incidence of ONFH, accounting for the competing risk of death, by SCD severity and antecedent ACS diagnoses, with differences assessed by the Gray's test for equality. We also determined rates of all re-admissions to the PDD and emergency department within 30-90 days after hip replacement surgery, including re-admissions for venous thromboembolism (VTE) and painful vasoocclusive crises (VOC). All data were analyzed using SAS 9.4 software, and results presented as hazard ratios (HR) and 95% confidence intervals (CI). Results Of the 6,237 SCD patients identified, 1,356 (22%) were diagnosed with ONFH (Table 1). Three hundred and eight of the SCD patients with ONFH underwent hip arthroplasty. The median ages of ONFH diagnosis and hip replacement surgery were 27 and 36 years, respectively. In Cox regression analyses over the entire study period, both males (HR 1.13, CI 1.01 - 1.27) and SCD severity (HR 2.75, CI 2.44 - 3.11) were associated with ONFH. In Cox regression analyses from 2003-2013, SCD severity (HR 2.89, CI 2.48 - 3.36) and antecedent ACS (HR 1.56, CI 1.31 - 1.84) were independently associated with ONFH diagnosis. The cumulative incidence curves corroborate the association between SCD severity, antecedent ACS, and ONFH (Figures 1 and 2; p Conclusions The overall prevalence of ONFH in this SCD cohort was 22%, and approximately 23% of the ONFH patients underwent hip arthroplasty (5% of the entire SCD cohort). Thus, ONFH is a common complication of SCD, which often requires surgical intervention. ONFH was independently associated with SCD severity and ACS, as has been previously suggested (Kato, Gladwin et al. 2007). Readmission within 30-60 days after hip surgery was common in this SCD cohort, and often due to painful VOC. Of the 144 readmissions within 90 days of discharge from hip replacement surgery, only 2 (~1%) were due to VTE, which is lower than reported in non-sickle cell patients undergoing hip replacement surgery. Our large, populations-based cohort study provides insight into the frequency and risk factors of ONFH in SCD patients, and also reveals that post-operative readmissions are common. References Kato, G. J., M. T. Gladwin and M. H. Steinberg (2007). "Deconstructing sickle cell disease: reappraisal of the role of hemolysis in the development of clinical subphenotypes." Blood Rev 21(1): 37-47. Cumulative incidence of ONFH among SCD patients in the Patient Discharge Database, 1991-2013 (n=6,237) Cumulative incidence of ONFH among SCD patients in the Patient Discharge Database, 1991-2013 (n=6,237) Figure 1 Cumulative incidence of ONFH among SCD patients entering the Patient Discharge Database after 10/1/2003 (n=1,538) Figure 1. Cumulative incidence of ONFH among SCD patients entering the Patient Discharge Database after 10/1/2003 (n=1,538) Figure 2 Figure 2. Disclosures Adesina: bluebird bio: Honoraria.